Emotions ran high but never boiled over at a standing-room-only public meeting about starting a school-based health center at Enterprise Elementary School. A panel from Winding Waters Medical Clinic, led by Dr. Elizabeth Powers, hosted the question-and-answer session at Cloverleaf Hall on Sept. 3.
Powers started the meeting with a brief Power Point presentation of the priorities of the center, which focused on providing health and dental care to school children who had little or no access to such care. She said the motivation for implementing the program arose from a survey conducted by the Community Area Council that identified specific needs for youth health care, particularly for the poor.
Powers’ presentation showed that 38.6 percent of the county lives at or below 200 percent of the federal poverty level, none of these people were served by a health center. The survey cited lack of transportation, poverty, lack of providers and lack of health education as reasons for inadequate access to health and dental care.
The presentation cited statistics that show utilization of school health centers results in better student grades, reduction of missed work by parents, fewer athletic injuries and an increase in healthy behaviors.
Powers said parental input on policies and procedures of the center was central to its operation. She added that parents of students could sign an “opt-out” form if they didn’t wish their children to utilize the center.
While acknowledging parental rights, Powers added that legally, any child over the age of 15 can consent to health care at health clinics without parental knowledge, while children over 14 can consent to mental health care and any child can get reproductive health care or counseling, again without parental knowledge. The health center, however, would not treat children whose parents signed an opt-out slip.
“We feel very strongly about parents being involved with their children every step of the way and with every visit,” Powers said.
Much of the audience debate centered around parental rights and the notion that the center would provide birth control services or abortion referrals without parental knowledge or permission. Powers said the health center would not distribute birth control of any kind as it was readily available at the county’s health department.
While Powers said a yearly state grant and a sliding fee scale would help the health center provide treatment for the poor or under-insured, the center would bill more financially stable parents’ insurance for services rendered to their children. When pressed, Powers said that a minor accessing services could legally call their parents’ insurance company to keep treatment information from reaching them. That information brought a few gasps from the audience.
Powers added that even if a parent hadn’t signed an opt-out slip, she would do her utmost to convince the patient to involve the parents, and had been quite successful doing so in the past.
In answer to an expressed concern about statistics that would be released on children who accessed care, Powers said those would include only the age, diagnosis and sex of the patient, with no individual identification provided. She said it was virtually identical to patient information released from patient treatment at the hospital.
When asked if health center policies might change with shifts in personnel, Powers urged parents and community members to form a steering committee to keep policies and procedures enforced in such an event.
Powers explained to a questioner that treatment protocols for minors at the school-based clinic would be virtually identical to those followed at the other clinics in town. This prompted another audience member to ask Powers why another clinic was needed when two were already within walking distance of the school. “We think the clinics here and the hospital do a wonderful job. Why change what’s working?” that person asked.
Enterprise school counselor Julie Garland replied the clinic was needed on site for children who did not have access to health or dental care for one reason or another. “After being here for five years, I’ve seen it happen with multiple children. My heart is with those children who don’t get care unless it’s at school,” Garland said. She added that many children who need health care are too young to walk to the clinic alone.
Powers added that another difference was that the opt-out prevented affected children from accessing school clinic resources until the age of 18, while standard clinics offered no such option.
A number of people suggested hiring a school nurse as an alternative, and Enterprise School Superintendent Brad Royse replied the school budget had no room for a nurse, and the clinic did not place a financial burden on the school.
He also cited other reasons. “I didn’t approve of this to usurp anyone’s authority. It was to provide needy kids and families with access to care. We see kids every day with no one to turn to that our hearts are crying for,” Royse said.
He also cautioned parents worried about losing parental authority. “I can tell you from personal experience that you don’t have the rights you think you do. Your angst is going toward them (the Winding Waters panel) and it needs to go toward your legislators,” he said.
Royse also said that while the school board had initially approved of the health center, the topic was still up for discussion at future school board meetings.
The meeting ended 40 minutes over its one-hour schedule with parents and the Winding Waters panel agreeing to another meeting to answer further questions.
Shannon Vernam said she hadn’t been given notice about the meeting and only heard about it through social media. She added the meeting hadn’t allayed her concerns.
“I’m still extremely concerned regarding parents being taken out of the medical care of their children. I don’t think they (Winding Waters) have an opt-out program. I know they’re saying they do, but I don’t know how strong it is, and I’m very concerned about that. I don’t think we need the (health center) at our school,” she said.
Powers was more upbeat about the night’s exchange. “I’m glad that people came because it’s important to ask questions and talk. I think having some clarity on the issue, on what (the school-based health center) is and what it’s not is important, and I hope we got some of that across tonight,” Powers said.