A doctor's duty

A law designed to keep kids safe may have unintended consequences.

A new state house proposal would push doctors to ask more questions when it’s clear that a preteen has been sexually active. It’s an effort to detect child predators in Pennsylvania. Doctors are already required to report underage sex, but it’s a responsibility that worries some physicians. From WHYY’s Health and Science Desk, Taunya English asked doctors how they’re balancing their duty toward their patients and the law.

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Transcript:

In the past when a very young patient revealed she was sexually active, those conversations were generally confidential. Dr. Nadja Peter says two years ago a new law called Act 179 changed the rules.

Peter: So anytime, now, that a kid under the age of 13 reports to us that they’re having sex – and it doesn’t matter what the age of the partner is, or any other aspect of it, we need to report it to Childline.

Childline is Pennsylvania’s child abuse hotline. Peter is an adolescent health specialist at the Children’s Hospital of Philadelphia. She says her obligation to obey the law sometimes conflicts with doctor-patient confidentiality.

Peter: I tell them upfront that if you are having sex, I’m going to need to report it to Childline, um, and, yes, your parents will find out.

Peter thinks that news makes her young patients less likely to open up about their sexual behavior. And that’s information Peter says she needs to provide good care.

Pediatrician Cindy Christian directs the Child Protection Program at Children’s Hospital. She says Act 179 has created some unintended consequences. But she says the legislature created the law to identify more children at risk. And that, she says, is a worthy purpose.

Christian: The state doesn’t want predators out there sexually abusing and preying on young adolescents who are not cognitively mature enough to know that they are being taken advantage of and that this is a crime.

If a 12-year-old reveals a one-time sexual experiment with a same-age partner, a doctor must report it. If a child tells her doctor she’s having sex and fears violence from a partner because she shared that secret, the doctor is still required to break confidentiality and call Childline.

That worries Dr. Peter. In the past, she had more time to gain a patient’s trust and weigh the details of a child’s home life before deciding to make a report.

I don’t think any of us in our office think that it’s a good thing for 12-year-olds to be having sex. So anytime a kid comes in, who is let’s say under the age of 15, maybe, we definitely scrutinize that visit that more closely.

Dr. Christian says at Children’s Hospital, doctors follow the law, even when that requirement feels like it’s not in the immediate, best interest of the patient. She says it’s a tough situation for doctors and adolescents.

Christian: If you were a 13-year-old and you go to a doctor and you find out that your boyfriend or you, or your partner is going to be reported to police, would you come back for health care?

Dr. Peter says it’s hard to judge the impact of the law but she says some patients have missed follow-up appointments after her office filed a report.

She knows child welfare workers do contact her patients’ families, but she’s not sure her calls to Childline lead to more help.

Peter: We haven’t heard anything saying: Oh, after we got that call, they got a mental health worker to come in, a counselor to come into our house once a week, or once every other week to work with me, or something like that. Which would be great, I’d be psyched about that.

Calls to Pennsylvania’s child abuse hotline have increased since Act 179 became law. But the Department of Welfare says it’s not clear if that increase has come from doctors, teachers or counselors, who are all required to pass along the information when a very young adolescent is having sex.