Reply to: Gayl M. Manthei Health and Public Assistance Tel.: (919) 716-6855 Fax.: (919) 716-6758
May 9, 2001
Koy E. Dawkins Attorney at Law
P.O. Drawer 399 Monroe, N.C. 28111
Re: Advisory Opinion: School Nurses Referral of Students to Health Department;
G.S. 90-21.5, G.S. 115C-81(e1)8, G.S. 90-21.12
Dear Mr. Dawkins:
You asked a variety of questions about the school health nurse who operates a clinic at the Union County schools pursuant to a contract between the Union County Health Department and the Board of Education:
1. Does state law permit school nurses to refer minors to the Health Department for medical assistance in the matters covered in G.S. 90-21.5 without parental consent?
Yes, state law permits a school nurse to refer minors to the Health Department for medical assistance in the matters covered by G.S. 90-21.5 without parental consent. Under G.S. 90-21.5, a minor may give effective consent for medical health services for the prevention, diagnosis and treatment of: (i) venereal disease and other diseases reportable under G.S. 130A-135; (ii) pregnancy;
(iii) abuse of controlled substances or alcohol; and (iv) emotional disturbance. Obtaining a referral to a practitioner who can provide services is the first step in obtaining services. Thus, the minor who can consent for medical treatment for those conditions can consent to referral to a practitioner.
2. Can the Board of Education legally prohibit school nurses from referring students to the Health Department, under any and all circumstances, without parental consent?
Yes, the Board of Education has the authority to define and limit the scope of clinical services provided at the school. There are, however, tort liability issues which the Board of Koy E. Dawkins Page 2 May 9, 2001
Education should consider when attempting to impose qualifications upon an otherwise comprehensiveclinicalprogram. Furthermore, the Health Department may be unwilling to enter into a relationship whereby it contractually agrees to provide students with incomplete information about the student’s health options, particularly in the absence of exceptions for emergencies and for situations where the information is otherwise medically indicated.
3. Assuming the answer to 2 is “yes”, what is the legal liability of the Board of Education if a minor student seeks assistance or referral, without parental consent, and assistance or referral is denied, resulting in an injury to the minor student or others. For example, an emotionally disturbed or suicidal student having been denied assistance, suffers serious harm to himself or herself or causes harm to others?
Although G.S. 90-21.5 authorizes a physician to accept the consent of a minor for certain services, it does not give a minor the right to treatment from any particular practitioner in any particular setting. Thus, it would not be a violation of G.S. 90-21.5 to prohibit referrals to the Health Department. Nonetheless, once a practitioner undertakes to treat a patient, (s)he must do so in accordance with the standard of care of the community. G.S. 90-21.12. The difficulty arises, therefore, once the nurse undertakes to provide services to the minor and becomes aware of the minor’s need for additional services, yet, pursuant to Board of Education policy, cannot refer the minor to a practitioner who can provide those services. The standard of care of the community may require action.
- Can health department nurses give information to minors pursuant to G.S. 90-21.5 regarding the subject matters covered therein without parental consent?
- Yes, each health department has a medical director who establishes standard operating procedures for the health department nurses. The health department nurses operate under the charge of a physician and therefore G.S. 90-21.5, which authorizes a physician to accept the consent of a minor, is fully applicable to the health department nurses.
- Does G.S. 115C-81(e1)(8) limit the information school nurses may provide on the subjects addressed by G.S. 90-21.5?
No, G.S. 115C-81(e1)(8) regulates curriculum. It applies to school nurses who are providing classroom instruction within a comprehensive sex education program, but does not regulate matters which a school nurse may discuss with a student in the context of providing individual medical assistance to a student.
6. Can the Board of Education prohibit referrals or information only as to: (i) contraception Koy E. Dawkins Page 3 May 9, 2001
and/or (ii) abortion services without limiting referrals on other health matters?
Yes, the Board of Education has the authority to define and limit the scope of clinical services provided at the school. Again, however, as in questions number 2 and 3 above, there are tort liability issues for both the Board of Education and the Health Department to consider.
Ann Reed Senior Deputy Attorney General
Gayl M. Manthei Special Deputy Attorney General