by Renee McGuinness, Vermont Family Alliance Policy Analyst
A proposed state law allowing child vaccination without parental consent violates federal law, a Washington, D.C. law firm has notified a Vermont Senate committee. The firm also informed the senators it will challenge any such law passed by the State of Vermont, and that it has successfully challenged similar laws elsewhere.
The law firm Siri-Glimstad wrote a May 10, 2023 letter to Senators Virginia Lyons, Chair (D), David Weeks, Vice Chair (R), Terry Willliams (R), Ruth Hardy (D), and Martine Larocque Gulick (D) of the Senate Committee on Health and Welfare, putting them on notice that S.151, Section 7 providing minor consent to preventative STI services violates a federal law that requires healthcare providers to provide vaccine information statements to the legal representatives of children and to any individual to whom the provider intends to administer a vaccine. The letter notifies Committee members that the firm has been directed to challenge S.151 if it becomes law and has prevailed in a similar case in Washington, D.C. Health Choice Vermont, which shared the letter in a recent newsletter, is the premier independent watchdog on legislation regarding vaccination choice in Vermont.
Despite the notice from Siri-Glimstad, Committee Chair Virginia Lyons accepted testimony from Dr. Erica Gibson, board certified pediatrician and adolescent medicine specialist, and Division Head of Adolescent Medicine at UVMMC Children’s Hospital. Dr. Gibson testified before the Senate Committee on Health and Welfare February 6, 10 AM on S.151 Section 7: her testimony begins @1:50 and ends @ 17:30 .
Doctor Gibson expressed support for S151, Section 7, not only as a pediatrician with an active practice, but also as an official representative of UVM Health Network, a Member of the Executive Board of the Vermont Chapter of the American Academy of Pediatrics, and as a member of the Vermont Medical Society.
Vermont 18 V.S.A. § 4226 (a)(1) has allowed minors aged 12+ to consent to testing and treatment for STI’s since 1971. Dr. Gibson believes that it is time to legally expand minor consent to STI and HIV prevention. She stated there is a decline in adolescent vaccine coverage because adolescents are less likely to attend yearly well-child visits and receive recommended vaccines, and currently physicians in Vermont cannot provide STI and HIV preventative services to minors 12+ without parental consent.
Dr. Gibson spoke briefly on the efficacy of the HPV vaccine and PrEP pills or shots for HIV.
In addition to her letter of support, in which Dr. Gibson claims, “we know there is a significant cohort of young people under 18 years of age that state they would not seek care for STI’s if they were not guaranteed that services would be kept confidential from parents or guardians.” Dr. Gibson cites two studies in a five page power-point: the first, Ford C, et al. JAMA 1997;278:1029–34, “Influence of Physician Confidentiality Assurances on Adolescents’ Willingness to Disclose Information and Seek Future Health Care,” is a survey of adolescents’ willingness to disclose sensitive health care information and willingness to seek care based upon their perceived sense of confidentiality. It is not a study with data that proves minors who perceive partial or full confidentiality actually receive health care.
The second study, Thrall J, et al. Arch Pediatr Adolesc Med. 2000;154:885–892, “Confidentiality and adolescents’ use of Providers for Health Information and for Pelvic Examinations,” is also a survey in which the conclusions are based upon the probability that adolescents would seek care based upon perceived confidentiality.
There is no confidentiality statement in S.151, Section 7, however there is a sentence in both 18 V.S.A. § 4226 (a)(1) and S.151, Section 7, “Consent under this section shall not be subject to disaffirmance due to minority of the individual consenting,” which binds the consenting minor with full responsibility for the consequences of their consent.
Dr. Gibson’s letter also states, “Young people have a variety of reasons for wanting to keep their sexual lives private but some young people might also be at risk of great psychological or physical harm should their sexual activity and any related medical problems be revealed to a parent or guardian without their consent.” Stop It Now statistics state the average age for a minor to enter the sex trade is 12 – 14, and that, “in as many as 93 percent of child sexual cases, the child knows the person that commits the abuse; 60% of children who are sexually abused do not disclose; and that most [sexual abusers] are acquaintances but as many as 47% are family or extended family.”
After reading her letter of support for S.151, Section 7, Senator David Weeks, Vice Chairman of the Committee, asked Dr. Gibson (@8:33) for a quantitative figure on the number of adolescents that would not seek medical care if their parents participated in the process. Dr. Gibson stated there is a variety of data and studies, and offered to get back to the Committee with specific information if they wanted it.
Senator Terry Williams asked Dr. Gibson (@9:33) for data on minors accessing STI treatments without parent consent that is specific to Vermont. When Dr. Gibson said there is no data, Senator Williams further questioned why there is no data for a law that has been in place since 1971. Dr. Gibson suggested the Vermont Department of Health might gather such data but did not offer to investigate further.
Committee Chair Lyons asked Dr. Gibson (@11:05) to talk about how pediatric practice works with kids at different age levels. Dr. Gibson stated it is “really common” for parents to continue to bring their 11–13-year-old in for pediatric visits, “but also for the provider to offer some time alone with the young person so they can begin to establish a relationship with that young patient and inform them of their rights to confidential care and provide them with opportunities to speak with them privately if they wish to do so. And this is done because we know it’s really important for young people to have adults they can count on for advice and support; and in some particular situations, and regarding sensitive topics, sometimes a young person is not always comfortable speaking with a parent or guardian, so to be able to be available to that young person as a resource as their primary care clinician or specialty clinician is really important, and this is something we go over with parents and guardians also as a part of our pediatric practice.”
Not only does Section 7 of S.151 violate a federal law, but also both the U.S. and Vermont State Constitutions. The existing statute, 18 V.S.A. § 4226 (a)(1) minor 12+ consent to STI treatments, does not appear to violate federal law but violates both the U.S. and Vermont Constitutions.
According to an August 2022 JAMA study published in the National Library of Medicine, all fifty states and D.C. have minor consent laws for STI and HIV testing and treatment, with varying age restrictions, clinician discretion, and confidentiality protections. Thirty-three states have minor consent to preventative services for STI’s, 17 of which also have confidentiality protection; and thirty-five states have minor consent to HIV prevention, with 18 of those states providing confidentiality.
In a January 31 (@15:20) Committee meeting, Senators Lyons and Gulick opted for retaining Section 7, while Senators Weeks and Willliams expressed interest in removing it. Senator Williams also expressed interest in repealing the existing statute for minor consent to STI testing and treatments. Senator Hardy was not present.
Vermont Family Alliance (VFA) submitted written testimony along with a request to testify before the Committee on January 29. VFA testimony has not been uploaded to the Committee page for public viewing as of February 10. No date and time has yet been set for VFA to appear before the Committee. S.151 is scheduled for review on Wednesday, February 14th at 11:00 am with legislative counsel.
The author is a Monkton resident. The Vermont Family Alliance opposes S.151.