Court sides with doctors on reporting teen sex

In a decision hailed by the medical community for protecting adolescent patients' confidentiality, the U.S. District Court for the District of Kansas ruled in April that health care professionals are not required to report all underage sexual activity as child abuse.

The federal court decision stops Kansas Attorney General Phill Kline from enforcing what physicians say was an overly broad interpretation of a 1982 law that requires health professionals to report to the state suspicions "that a child has been injured as a result of ... sexual abuse."

The ruling "protects health care professionals from being prosecuted for providing good care," said Bonnie Scott Jones, a staff attorney for the Center for Reproductive Rights, which filed the lawsuit in October 2003 on behalf of Aid for Women, a Kansas City-based medical clinic that provides a range of gynecological care, including abortions and contraception.

In his 2003 opinion, Kline concluded that doctors, nurses, teachers and counselors had to report sex, both consensual and nonconsensual, between minors younger than 16. He said teenagers seeking medical attention for a sexually transmitted disease, pregnancy or birth control could also trigger mandatory reporting.

Failing to report could result in a misdemeanor criminal charge against a physician or other health professional.

But the court said the statute gives doctors the discretion to determine whether a child has been injured.

"A plain language interpretation of the reporting statute acknowledges the importance of the health care professional's ability to obtain and maintain a young patient's confidence in order to treat the patient appropriately," Judge J. Thomas Marten wrote.

Kline's office did not return calls for comment.

However, Kline said in a statement that the ruling affirms that "the state has a substantial interest in protecting its children."

In court, Kline had argued that it was the state's duty to protect children and prosecute sexual abuse. He said any sexual intercourse involving a minor was "inherently harmful."

He has not indicated whether he will appeal the ruling.

Organized medicine's involvement

Doctors say they support laws aimed at protecting their young patients from sexual abuse. But until the federal court decision, they feared that Kline's strict application of the law would do more harm than good by discouraging minors from seeking medical care if they knew their sexual conduct would be reported.

"We are very encouraged by this ruling, and [the mandatory reporting issue] goes far beyond what it may appear as a legal case. It is a public health issue in terms of access to care," said John C. Nelson, MD, MPH, the American Medical Association's immediate past president.

More than a dozen medical and social groups filed a friend-of-the-court brief in the case, including the AMA, the American Academy of Family Physicians and the American Medical Women's Assn.

In their brief, doctors, nurses and other health care professionals expressed concern that the attorney general's interpretation would "create a conflict" between acting in the best interests of their patients and obeying the state's reporting requirement.

"Physicians take the responsibility of reporting very seriously and first want to protect the child, and second want to meet their obligations under the law," said Jerry Slaughter, executive director of the Kansas Medical Society, which also joined in the brief. The KMS supports a 1992 interpretation of the reporting law by then-Attorney General Robert T. Stephan. He concluded that doctors and others could use their professional judgment to determine whether injury had occurred and whether to report.

In addition, a number of medical professionals later joined as plaintiffs on the Aid for Women lawsuit on behalf of their minor patients.

Jones said this case sets a precedent. While the courts have previously addressed adults' privacy rights, the Kansas ruling is the "first time a federal court has very clearly recognized and protected adolescents' rights to confidentiality," she said.

Doctor-patient relationship upheld

Kline appealed the initial injunction placed on the opinion by District Court Judge Marten. The 10th U.S. Circuit Court of Appeals in January, however, reversed the trial court's decision and sent the case back for further consideration. But again, Marten blocked enforcement of Kline's interpretation, finding that it would impose a "zero tolerance" rule on a broad range of sexual activity among minors.

Marten reaffirmed the original intent of the statute by recognizing the patient's expectation of privacy when the doctor has no reason to suspect injury as a result of sexual activity.

"Automatic reporting of illegal sexual activity involving a minor will change the nature of the relationship between the health care provider and the minor patient to a certain degree," the ruling stated.

The court also agreed with doctors that with mandatory reporting "there will be a significant decrease in minors seeking care and treatment related to sexual activity."

In upholding the original intent of the statute, the court has helped to protect the health of adolescent patients, doctors say.

However, they expect the ruling to be appealed and are prepared to fight.

"If the attorney general continues to act as he has, he may push it all the way to the [U.S.] Supreme Court," Dr. Nelson said. "If that's the case, you can anticipate that [physicians] are going to mount a real offensive."