North Dakota Senate votes down bill on parents' access to minor's medical exam rooms

BISMARCK — The North Dakota Senate struck down a bill on Thursday regarding parent or guardian access to the medical examination room of minors after an extensive and emotional floor debate.

House Bill 1450 would have clarified that a parent or guardian had “full and complete access” to the examination room of a minor in their care, and would have required health care facilities to post this information prominently for parents and guardians to see.

The bill would also have required that a health care provider give written notice to the parent or guardian of a minor before they ask the minor any questions. The notice would have informed parents and guardians of their right, and the minor’s right, to opt out of questions; whether the minor’s answers to questions will be shared with other people or recorded in any capacity; and a list of the topics of the questions that may be asked.

HB1450’s primary sponsor, Rep. SuAnn Olson, R-Baldwin, said a parent or guardian’s right to be in a medical examination room with their child already exists, but the bill sought to clarify it and ensured that health care providers informed parents and guardians of the right.

The measure garnered extensive opposition testimony in the Senate Human Services Committee from medical professionals, including representatives from Central Dakota Forensic Nurse Examiners, Rolette County Public Health, the North Dakota Hospital Association and the North Dakota Medical Association.

They said they were concerned the bill would “reinforce the power dynamics that perpetuate abuses,” and potentially conflict with North Dakota laws that allow minors to consent to their own health care in limited circumstances, such as instances of sexual assault, or when consent is implied due to a life-threatening situation that requires emergency examination and treatment.

According to the National Association of Adult Survivors of Child Abuse, 1 in 4 girls and 1 in 6 boys are sexually abused by the age of 18 and of those, over 60% will be abused by a family member.

“How can a child be honest if the person sitting next to them may be the biggest part of the problem?” The bill’s carrier Sen. Judy Lee, R-West Fargo, said. “Passing this bill will cripple the ability of health care providers to do what is right for their child and adolescent patients.”

The discussion on the Senate floor, which took over an hour, brought multiple senators to tears and prompted some to allude to their own experiences with abuse at home that they said would have prevented them from answering questions from medical professionals honestly had a parent or guardian been in the medical examination room.

“I stood on the doorstep in one of my early campaigns, I heard a child crying loudly in the house. Then I heard a male voice shout, ‘You quit crying or I’ll give you something to cry about,’” Sen. Dick Dever, R-Bismarck, said on the floor of the Senate.

“I knocked on the door. Immediately I heard only silence. I knocked again, there was no answer. Those sounds were familiar from my own childhood. I don’t know whether I am heaven-bound because my mother shared the love of Christ with my three brothers and me or because my father beat the hell out of us. Both were true … If I had been questioned in this kind of circumstance (in a medical examination room), my responses would have been different with my father in the room than without him.”

The bill does specify that it does not apply to legally emancipated minors or in instances of suspected physical or sexual abuse when a provider has documented the concern and notified the appropriate authorities. However, Sen. Kristin Roers, R-Fargo, said this is not specific enough and leaves a grey area for medical professionals to have to navigate.

“I am a mandated reporter as a nurse,” Roers said. “When do we consider something a suspected case of abuse? Is it when I saw a bruise, or once I’ve had a chance to find out that it wasn’t from falling off the jungle gym, but because their dad hit them? When? Where’s the line? This doesn’t define that. How can I ask the questions and actually get at the root of that?”

“I was one of those girls who was abused,” she continued. “Not by my parents, really, and I never told my parents until I was an adult. And I just wonder, would I be in a different situation if someone had asked me the right questions? I never would have answered them correctly if my parents were in the room. But would I have, if I had been there alone?”

Sen. Janne Myrdal, R-Edinburg, said she respected those who shared their stories in the chamber but, “sometimes a sad story makes for bad law.”

She said there were stories on both sides of the issue and shared a story she said was from a constituent about their 12-year-old daughter being “pushed” by a nurse practitioner to get on the birth control pill during a sports physical. She said the nurse practitioner had attempted to speak with her constituent’s daughter privately but the constituent refused to let them, and when the nurse practitioner continued to push on the topic of birth control, the constituent took their daughter and left the medical examination.

“The reason these bills are before us today is because of vaccinations,” Myrdal said. “Should a child be vaccinated without a parent’s permission? I certainly don’t think so. And also the transgender issue — I mean let’s be honest here, that’s why this bill is before us — where we read stories of teachers or … health providers taking a child and agreeing to help them (transition) and not tell their parents.”

Other senators who spoke in support of the bill said parents were responsible for the protection of their children and brought up stories about children being asked questions that they felt were inappropriate by medical professionals during examinations and about physicians abusing children under the guise of medical examinations.

Sen. Kent Weston, R-Sarles, read from a handout of stories that he said happened to North Dakota legislators.

“’My 13-year-old son went for a sports physical. The doctor asked him if he was sexually active and offered him condoms. What does that have to do with playing basketball?’” Weston said. “This was a personal friend of mine that, while she was 17, (she said) ‘While I was lying on the exam table, my doctor gave me — a teenager at the time — advice as what best placement for my hips during sex (was).’”

Weston said 99% of doctors were “fantastic” and that he was not bashing doctors, but that in all professions there were good and bad people. He said that the fundamental right belongs to the parents.

“We need to give parental rights and then get after the bad actors,” Weston said. “That’s how we deal with this.”

Multiple senators said the bill had them conflicted about which way to vote. An amendment was offered on the floor that some said would have moved the bill “in the right direction” but it was voted down in a narrow 26-21 vote.

The bill previously passed the House with a 72-15 vote but came out of the Senate Human Services Committee without a recommendation. The Senate voted the bill down in a 29-18 vote.