By Rachel Crumpler and Grace Vitaglione

Patient-doctor dynamics in an exam room could soon change for minors.

Republican lawmakers in the state House of Representatives have introduced a bill seeking to limit confidentiality between minors and their health providers — and to grant parents greater access to their children’s medical records and decision-making.

Lead bill sponsor Rep. Jennifer Balkcom (R-Hendersonville) introduced House Bill 519 at the House Rules Committee on May 5, where it passed. Supporters say the bill, also known as the Parents’ Medical Bill of Rights, will help parents make informed decisions about their children’s health care and restore parental authority.

Over two dozen Republican lawmakers are co-sponsoring the bill, including three co-chairs of the House Health Committee: Reps. Larry Potts (R-Lexington), Donny Lambeth (R-Winston-Salem) and Donna White (R-Clayton).

Under the current state law, minors can independently consent to some medical care — for diagnosis and treatment of sexually transmitted diseases, pregnancy, substance use and mental health.

The bill would roll back the law to only allow minors to consent for treatment related to pregnancy, excluding abortion. Parental consent would be required for any other medical care or treatment, except in some limited scenarios outlined in the bill, such as in an emergency or if a medical provider believes a child could be experiencing parental abuse or neglect.

One exception would allow minors age 16 or older to access treatment for venereal disease without parental consent if the disease can be treated with a prescription duration of 10 days or less.

Becky Lew-Hobbs, a mother of three and chair of the Wake County chapter of Moms for Liberty, spoke in support of the bill at a House Judiciary meeting on April 29. She voiced her frustration with the current law, explaining that when she took her 14-year-old son to the emergency room for hurting himself, she was asked to leave the room so the doctor could ask him questions about his mental health and family alone. 

“We as parents were treated as the enemy,” Lew-Hobbs said. “The doctor excluded us, preventing us from being part of the solution all because current North Carolina statute is used to exclude parents from their medical care.”

Bianca Allison, a pediatric primary care provider in the Triangle, said that confidentiality is the “cornerstone” of adolescent health care — it fosters open communication. And she added that confidentiality is not completely counter to parental rights — the goal isn’t to shut parents out. Instead, Allison said medical providers are often actively encouraging teens to involve their parents and help them work through why they may be hesitant to talk with them about their concerns. 

Sometimes a health care provider is a more comfortable starting point to discuss sensitive topics, she said.

“Even as we provide that care confidentially to an adolescent, often we are having at the same time a conversation asking them, ‘Who is a trusted adult in your life who can help you navigate this situation? Can we help you have a conversation with your parents either here in the room or can I help give you a way to navigate that conversation outside of the exam room?’” Allison explained.

Change from decades-old law

When heard in committee, several doctors, including the president of the North Carolina Pediatric Society, quickly voiced opposition. They based their concerns on how the changes could worsen health outcomes for young people. They said teens would likely skip going to a provider in the first place if sensitive information, such as their sexual activity, will automatically be disclosed to a parent.

Erica Pettigrew, a family physician in the Triangle, explained to lawmakers that the conversations and questions she fields from teens won’t happen — or won’t be honest — if parents are in the exam room or have access to all communication. That will push teens to seek out information from unreliable sources such as TikTok instead, she said.

The state Department of Health and Human Services has also expressed opposition to this bill.

“The Parents’ Medical Bill of Rights would result in fewer children and youth seeking needed health care services, including mental health, substance use, services to treat sexually transmitted diseases and pregnancy prevention,” a DHHS spokesperson said in a statement to NC Health News.

Young people in North Carolina have had the ability to consent to these services since 1977.

The American Academy of Pediatrics, the professional association of U.S. pediatricians, stated in an April 2024 position statement that confidentiality is an “essential component of high-quality health care for adolescents.” Other medical organizations support this stance. 

However, state laws on consent and privacy for adolescents vary widely, according to a May 2022 analysis published in the Journal of the American Academy of Pediatrics. The analysis found that many do not reflect pediatric professionals’ standards of care.

A Planned Parenthood South Atlantic spokesperson said in a statement that, “This bill would mark a departure from historical and national trends around informed, medical consent for young people.”

Doctors, advocates push back

Allison worries about the risk of harm to youth in unsupportive environments if their parents were to have full access to medical records. Even though the number has dropped over the years, there are still tragedies within families. Of the 99 child homicides that took place in North Carolina in 2022, 31 of them were at the hands of a parent or caregiver, according to the N.C. Office of the Chief Medical Examiner.

“Removing confidentiality protections doesn’t necessarily, by default, foster open communication between parents and children,” Allison said. “Parents should still be attempting to build the skills and creating an environment where open conversations can happen, regardless of whether or not these confidential protections are in place.”

Erica, a mother of three in Moore County, including a transgender daughter, said she’s worried about the impact of taking away a trusted space for children to go.

“I’m a mom, so of course I want my children to be upfront and honest with me, and I try to facilitate an environment where they can talk to me about anything,” said Erica, who asked to only use her first name for privacy and safety concerns. “But some parents aren’t like that, and some kids aren’t like that, and they need to have an outlet to share. Otherwise it’s going to cause issues — physically and mentally.”

Allison emphasized that she and other medical providers don’t take lightly the responsibility that they might be the first to hear about sensitive topics during otherwise routine screenings with teenagers. Often those discussions are around sexual orientation, gender identity and sexual health.

“There’s a lot of benefits to confidential care in terms of open communication with physicians and the ability for a physician to potentially be seen as another trusted adult in this young person’s life, their ability to ask questions in an environment that is nonjudgmental, that doesn’t have the same implications of them potentially asking these things of their parents,” Allison said.

‘Undermine care’

Allison said this bill is part of the larger trend of state lawmakers seeking to dictate medical practice, particularly around controversial treatments. 

In the last legislative session, lawmakers passed increased abortion restrictions over the objections of many doctors and several medical associations. The General Assembly also banned gender-affirming care for minors in North Carolina — except for those who had already started care before the law change.

“I just think that medical decisions should really be driven by best practices and the needs of individual patients — not politics and political ideology. As a provider, I just want my patients to know that they are seen, respected and safe,” Allison said. “Legislation like this can really threaten the sense of safety and undermine care for really everyone that we take care of — even if individuals aren’t necessarily coming in for more sensitive care and treatment right now.

“If and when it becomes relevant to them, they may fear.”