S 6 Session 112 (1997-1998)
S 0006 General Bill, By M.T. Rose
A BILL TO AMEND TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING
CHAPTER 54 SO AS TO CREATE THE SOUTH CAROLINA DRUG IMPAIRED INFANTS ACT, TO
AMEND SECTION 20-7-290, RELATING TO THE RENDERING OF HEALTH SERVICES TO MINORS
WITHOUT PARENTAL CONSENT, TO PROVIDE THAT A PHYSICIAN PROVIDING CARE FOR A
NEWBORN CHILD MAY ORDER TESTING FOR ALCOHOL AND OTHER DRUGS WITHOUT THE
CONSENT OF PARENTS UNDER CERTAIN CIRCUMSTANCES, TO AMEND SECTION 20-7-510,
RELATING TO THE REQUIREMENT THAT CERTAIN PERSONS REPORT INSTANCES OF CHILD
ABUSE OR NEGLECT, SO AS TO ADD SUBSECTION (D) TO PROVIDE THE CIRCUMSTANCES
UNDER WHICH PERSONS ARE REQUIRED TO REPORT POSITIVE RESULTS OF DRUG OR ALCOHOL
TESTING PERFORMED ON A NEWBORN, TO AMEND SECTION 44-7-260, RELATING TO
HOSPITALS, ETC. AND REQUIREMENTS FOR LICENSURE, SO AS TO PROVIDE, AMONG OTHER
THINGS, THAT NO FACILITY OR SERVICE THAT PROVIDES DIAGNOSTIC TREATMENT OR
REHABILITATIVE SERVICES RELATED TO ALCOHOL OR OTHER DRUGS MAY REFUSE TO
PROVIDE THESE SERVICES TO A WOMAN SOLELY BECAUSE THE WOMAN IS PREGNANT, TO
AMEND SECTION 44-49-40, RELATING TO POWERS AND DUTIES OF THE DEPARTMENT OF
HEALTH AND ENVIRONMENTAL CONTROL CONCERNING NARCOTICS AND CONTROLLED
SUBSTANCES, SO AS TO COORDINATE SERVICES OF THE DEPARTMENT RELATING TO
PRENATAL SUBSTANCE ABUSE, TO AMEND SECTION 44-53-140, RELATING TO THE ALCOHOL
AND DRUG ABUSE COMMITMENT, SO AS TO PROVIDE THAT EVIDENCE OBTAINED IN THE
ADMINISTERING OF HEALTH CARE MAY NOT BE USED AGAINST THE PERSON SEEKING
TREATMENT IN ANY PROCEEDING EXCEPT PROCEEDINGS INITIATED BY THE DEPARTMENT OF
SOCIAL SERVICES, AND TO AMEND SECTIONS 59-32-20 AND 59-32-30, RELATING TO
EDUCATION, SO AS TO PROVIDE FOR THE DEVELOPMENT AND INCLUSION OF APPROPRIATE
DRUG EDUCATION CURRICULA CONCERNING THE EFFECTS OF ALCOHOL AND DRUG ABUSE.
01/14/97 Senate Introduced and read first time SJ-87
01/14/97 Senate Referred to Committee on Medical Affairs SJ-87
03/12/97 Senate Committee report: Favorable Medical Affairs SJ-14
03/13/97 Senate Read second time SJ-22
03/18/97 Senate Read third time and sent to House SJ-9
03/19/97 House Introduced and read first time HJ-27
03/19/97 House Referred to Committee on Judiciary HJ-28
Indicates Matter Stricken
Indicates New Matter
COMMITTEE REPORT
March 12, 1997
S. 6
Introduced by Senator Rose
S. Printed 3/12/97--S.
Read the first time January 14, 1997.
THE COMMITTEE ON MEDICAL AFFAIRS
To whom was referred a Bill (S. 6), to amend Title 44, Code of
Laws of South Carolina, 1976, by adding Chapter 54, so as to create
the "South Carolina Drug Impaired Infants Act", etc., respectfully
REPORT:
That they have duly and carefully considered the same, and
recommend that the same do pass:
DAVID L. THOMAS, for Committee.
A BILL
TO AMEND TITLE 44, CODE OF LAWS OF SOUTH
CAROLINA, 1976, BY ADDING CHAPTER 54, SO AS TO
CREATE THE "SOUTH CAROLINA DRUG IMPAIRED
INFANTS ACT"; TO AMEND SECTION 20-7-290, RELATING
TO THE RENDERING OF HEALTH SERVICES TO MINORS
WITHOUT PARENTAL CONSENT, SO AS TO PROVIDE THAT
A PHYSICIAN PROVIDING CARE FOR A NEWBORN CHILD
MAY ORDER TESTING FOR ALCOHOL AND OTHER DRUGS
WITHOUT THE CONSENT OF PARENTS UNDER CERTAIN
CIRCUMSTANCES; TO AMEND SECTION 20-7-510,
RELATING TO THE REQUIREMENT THAT CERTAIN
PERSONS REPORT INSTANCES OF CHILD ABUSE OR
NEGLECT, SO AS TO ADD SUBSECTION (D) TO PROVIDE
THE CIRCUMSTANCES UNDER WHICH PERSONS ARE
REQUIRED TO REPORT POSITIVE RESULTS OF DRUG OR
ALCOHOL TESTING PERFORMED ON A NEWBORN; TO
AMEND SECTION 44-7-260, RELATING TO HOSPITALS, ETC.
AND REQUIREMENTS FOR LICENSURE, SO AS TO PROVIDE,
AMONG OTHER THINGS, THAT NO FACILITY OR SERVICE
THAT PROVIDES DIAGNOSTIC TREATMENT OR
REHABILITATIVE SERVICES RELATED TO ALCOHOL OR
OTHER DRUGS MAY REFUSE TO PROVIDE THESE SERVICES
TO A WOMAN SOLELY BECAUSE THE WOMAN IS
PREGNANT; TO AMEND SECTION 44-49-40, RELATING TO
POWERS AND DUTIES OF THE DEPARTMENT OF HEALTH
AND ENVIRONMENTAL CONTROL CONCERNING
NARCOTICS AND CONTROLLED SUBSTANCES, SO AS TO
COORDINATE SERVICES OF THE DEPARTMENT RELATING
TO PRENATAL SUBSTANCE ABUSE; TO AMEND SECTION
44-53-140, RELATING TO THE ALCOHOL AND DRUG ABUSE
COMMITMENT, SO AS TO PROVIDE THAT EVIDENCE
OBTAINED IN THE ADMINISTERING OF HEALTH CARE
MAY NOT BE USED AGAINST THE PERSON SEEKING
TREATMENT IN ANY PROCEEDING EXCEPT PROCEEDINGS
INITIATED BY THE DEPARTMENT OF SOCIAL SERVICES;
AND TO AMEND SECTIONS 59-32-20 AND 59-32-30,
RELATING TO EDUCATION, SO AS TO PROVIDE FOR THE
DEVELOPMENT AND INCLUSION OF APPROPRIATE DRUG
EDUCATION CURRICULA CONCERNING THE EFFECTS OF
ALCOHOL AND DRUG ABUSE.
Whereas, according to the "1991 South Carolina Prevalence
Study of Drug Use Among Women Giving Birth", over fifteen
thousand infants, representing approximately twenty-five percent of
the births in this State, are born each year in this State to women who
used alcohol, illegal drugs, or nonprescribed drugs during the latter
stages of pregnancy; and
Whereas, the problem of alcohol and drug use among women giving
birth is not limited to any one group of women or one area of the
State and the percentage of women using alcohol and drugs varies by
type of drug, geographic location, and characteristics of the women;
and
Whereas, the use of alcohol and other drugs during pregnancy can
have serious consequences on the health of the baby, on the woman,
and on society in general; and
Whereas, prenatal exposure to alcohol and other drugs is associated
with mental retardation, low birth weight, learning disabilities, drug
withdrawal symptoms, cleft palate, and other facial abnormalities
among infants; and
Whereas, alcohol and other drug use also is associated with increased
risk of premature delivery, increased risk of premature separation of
the placenta, and increased risk of miscarriage; and
Whereas, women who use alcohol and other drugs during pregnancy
are more likely to have other poor health behaviors, such as smoking
cigarettes, poor nutrition, inadequate prenatal care, starting prenatal
care later and having no prenatal care at all, and are at a higher risk
for hepatitis and sexually transmitted diseases; and
Whereas, the costs of these health problems to society are enormous
and result from the increased need for neonatal intensive care due to
premature and low weight births, social services, including the foster
care system, and special education services; and
Whereas, the excess medical cost of caring for drug-exposed infants
can easily exceed fifty thousand dollars an infant in the first year of
life and the lifetime economic cost associated with each of the
children severely affected by drugs before birth can exceed one
million dollars. Now, therefore,
Be it enacted by the General Assembly of the State of South
Carolina:
SECTION 1. This act may be cited as the "South Carolina
Drug Impaired Infants Act".
SECTION 2. It is the policy of this State that:
(1) Prevention of harm to the fetus is the primary objective of this
State and its subdivisions in formulating programs and policies to
address the use of alcohol or other drugs during pregnancy.
(2) Programs and policies to address the use of alcohol or other
drugs during pregnancy should concentrate on measures that improve
the individual's ability to act responsibly. Punitive or coercive
measures should be used only as a last resort.
(3) Prenatal harm can be caused by exposure to various drugs,
including alcohol, and is often a result of multiple exposures as well
as other influences, such as poor maternal health, malnutrition, and
lack of prenatal care. The most effective way to prevent this harm is
to improve the overall well-being and the self-esteem of women.
Efforts to prevent prenatal harm should utilize innovative strategies
aimed at the broad range of factors contributing to harm associated
with prenatal substance abuse. New models of service delivery
should be developed to increase the utilization of available services,
using outreach and community-based services as means for
identifying and serving the target population.
(4) The use of alcohol and other drugs by women places them at
risk for the development of numerous physical and psychological
problems. Women whose physical or psychological health is
compromised have diminished capacity to care for themselves and
their families as well as to participate meaningfully in the community
in which they live. Alcohol and other drug abuse isolates women
from the institutions of society which support the building and
maintenance of self-respect and healthy relationships. Progress and
policies of the State and its subdivisions should seek to promote
health-enhancing behaviors in women and to develop treatment
programs which improve the capacity of women to function fully
within their communities.
(5) Prevention, treatment, rehabilitation, and support services for
alcohol and other drug abuse, which reflect the unique needs of
pregnant women, should be accessible and available to these women.
Public and private funds and resources should be identified to
implement model intervention programs. Providers of alcohol or
drug treatment services must not discriminate against pregnant
women or women of childbearing age in providing these services.
Pregnant women should be given priority access to treatment services
for alcohol or drug dependency.
(6) Adequate prenatal care, through the public and private sectors,
should be available and accessible for every pregnant woman. In
order to avoid deterring pregnant substance abusers from obtaining
prenatal care at the earliest possible time, the privacy of the
physician-patient relationship should be protected.
(7) All men and women of childbearing age should be educated
about the physical, emotional, and medical effects of alcohol and
other drug use during pregnancy. Appropriate educational materials
and programs should be developed for use in schools. Educational
efforts should emphasize prevention.
(8) All agencies with functions related to use of alcohol or other
drugs by pregnant women, including health, social services,
corrections, and law enforcement agencies, shall develop plans and
interagency policies for coordination of services and resources.
These plans and policies should provide for a continuum of services
to prevent harm caused by prenatal exposure to alcohol or other
drugs. They should include innovative strategies that take into
consideration social conditions likely to affect the success of
prevention or treatment initiatives, including housing, child care,
transportation, and job training specific to women's needs.
(9) Health, social services, and educational agencies shall develop
plans and interagency policies for coordination of services and
resources to meet the special needs of children who have been
harmed by prenatal exposure to alcohol and other drugs.
(10) Statutes, including statutes defining the authority of state or
local agencies or providers of services, must be broadly construed to
accomplish the policies set forth in this act.
(11) The policies provided for in this act shall be implemented
through the cooperative efforts of state, county, and municipal
legislative, judicial, and executive branches, as well as other public
and private resources. Where resources are limited, services must be
targeted to have the greatest impact on preventing harm associated
with prenatal exposure to alcohol or other drugs.
SECTION 3. Title 44 of the 1976 Code is amended by adding:
"CHAPTER 54
Assessment and Intervention in the
Perinatal Effects of Alcohol
Controlled Substances, and Cigarettes
Section 44-54-10. A physician licensed in South Carolina who
provides obstetrical or gynecological care to a patient who is
pregnant shall counsel the patient on the perinatal effects of smoking
cigarettes, the use of alcohol, and the use of a controlled substance as
defined in Section 44-53-110, as well as other risk factors appearing
to be present in the patient's life. A physician may fulfill this
obligation by causing a nurse, social worker, or other allied health
professional to provide the required counseling. A statement
evidencing that this counseling has been provided and signed by the
patient or by the person giving this counseling must be maintained as
part of that patient's medical records.
Section 44-54-20. The South Carolina Department of Health and
Environmental Control, in cooperation with the South Carolina
Commission on Alcohol and Drug Abuse, shall develop and provide
educational programs and materials to physicians who provide
obstetrical or gynecological care, to other health care providers who
provide services for pregnant women, to hospitals, and to other
appropriate persons and entities. This information must include, but
is not limited to:
(1) the effects of cigarettes, alcohol, and controlled substances on
pregnancy and fetal outcome;
(2) how other aspects of a woman's life, such as poor nutrition and
domestic violence, interact with substance abuse to affect fetal
outcome;
(3) what services are available for addicted or substance-abusing
women and their families;
(4) the harm done to fetuses from drug use by the mother; and
(5) the law relating to drug use during pregnancy, including the
provisions of this chapter.
Section 44-54-30. The South Carolina Commission on Alcohol
and Drug Abuse shall establish and maintain a toll-free information
line to provide information on resources for substance abuse and to
assist with referral for substance-abusing pregnant women.
Section 44-54-40. A pregnant woman referred for substance abuse
treatment must receive first priority for use of available treatment.
All records and reports regarding the pregnant woman are
confidential. The South Carolina Commission on Alcohol and Drug
Abuse shall ensure that family-oriented substance abuse treatment is
available, as appropriations allow. Substance abuse treatment
facilities that receive public funds may not refuse to treat a woman
solely because she is pregnant.
Section 44-54-50. (A) A physician or health care provider, upon
identification of a woman with a high risk pregnancy due to the abuse
of alcohol or a controlled substance or whose newborn child
reasonably appears to have been exposed to alcohol or controlled
substances in utero, shall inform the woman of the availability of
services offered by substance abuse programs and the option of
referral to the South Carolina Commission on Alcohol and Drug
Abuse Office of Women's Services.
(B) Upon consent by a woman identified in accordance with
subsection (A) the physician or health care provider shall within
seventy-two hours of making the identification make a referral to the
South Carolina Commission on Alcohol and Drug Abuse Office of
Women's Services. The commission's toll-free information line and
any other reasonable means may be used for this purpose.
(C) Any individual providing a government service to a woman
identified in accordance with subsection (A) may refer the woman,
with the woman's consent, to the South Carolina Commission on
Alcohol and Drug Abuse Office of Women's Services. The
commission's toll-free information line and any other reasonable
means may be used for this purpose.
(D) The South Carolina Commission on Alcohol and Drug Abuse
Office of Women's Services promptly must refer each woman
referred in accordance with subsections (B) or (C) to a substance
abuse program licensed by the Department of Health and
Environmental Control and chosen by the woman, or if the woman
does not choose a substance abuse program licensed by the
Department of Health and Environmental Control, to the county drug
and alcohol abuse authority in the county in which the woman
resides. This substance abuse program or county drug and alcohol
abuse authority must provide assessment and interdisciplinary
treatment to each woman for whom a referral is made in accordance
with subsections (B) or (C), and must report to a physician or other
health care provider treating the woman the failure of the woman to
comply with any reasonable plan of assessment or treatment
prescribed by the substance abuse program or the county drug and
alcohol abuse authority.
(E) Nothing in this section shall preclude a physician or other
mandated reporter from reporting abuse or neglect of a child as
required pursuant to Section 20-7-510. Nothing in this section shall
preclude or interfere with voluntary admission to a drug treatment
facility or emergency drug treatment pursuant to Chapter 52 of Title
44.
(F) A physician, health care provider, or other individual
providing a government service who in good faith substantially
complies with this section is immune from any civil liability that
otherwise might result by reason of this compliance.
(G) Referral and associated documentation resulting from
compliance with this section is confidential and may not be used in
any criminal prosecution.
(H) The consent required by subsections (B) and (C) is considered
a waiver of confidentiality solely for the purpose of making the report
pursuant to subsections (B) and (C)."
SECTION 4. Section 20-7-290 of the 1976 Code is amended to
read:
"Section 20-7-290. (A) Health services of any kind
may be rendered to minors a minor of any age
without the consent of a parent or legal guardian when, in the
judgment of a person authorized by law to render a particular health
service, such the services are deemed
considered necessary unless such involves the
services involve an operation which shall may
be performed only if such it is essential to the health
or life of such child the minor in the opinion of the
performing physician and a consultant physician if one is available.
(B) A physician providing care for a newborn child may order
testing for alcohol and other drugs without the consent of a parent or
legal guardian if the testing is medically necessary to protect the
health of the newborn child in the opinion of the performing
physician. Consent from the mother should be sought before testing,
if practicable.
(C) Information obtained from the drug or alcohol testing
performed on a newborn must not be disclosed in a manner that
would identify the child or parents to anyone other than the child's
parents or guardian, except:
(1) to make a report pursuant to Section 20-7-510 and to
cooperate with an investigation pursuant to such report;
(2) to obtain treatment or other services or benefits for the child
or the child's family;
(3) as may be permitted by Section 44-53-140 pursuant to
Chapter 52 of Title 44; or
(4) upon consent of a custodial parent or legal guardian.
Any person who discloses such information except as authorized in
this section is guilty of a misdemeanor and, upon conviction, must be
fined not more than five hundred dollars or imprisoned not more than
one year, or both."
SECTION 5. Section 20-7-510 of the 1976 Code is amended by
adding:
"(D) A person is not required to report based on positive
results of drug or alcohol testing performed on a newborn unless the
test results combine with one or more other factors, such as the
infant's home or family situation or condition, to give the reporter
reason to believe that a child's physical or mental health or welfare
may be affected adversely by abuse or neglect while in the care of a
parent, legal guardian, or custodian."
SECTION 6. Section 44-7-260 of the 1976 Code is amended by
adding:
"(F) No facility or service that provides diagnostic,
treatment, or rehabilitative services related to the abuse of alcohol or
other drugs may refuse to provide these services to a woman solely
because the woman is pregnant. Pregnant women must be given
priority access to these services. Diagnostic, treatment, or
rehabilitative services must be provided in accordance with accepted
professional standards applicable to the treatment of abuse of alcohol
or other drugs in pregnant women. All treatment providers must
ensure that family-oriented substance abuse treatment is available, as
resources may allow."
SECTION 7. Section 44-49-40(C) of the 1976 Code is amended
by adding:
"(11) Coordinate these matters relating to prenatal substance
abuse:
(a) study of issues related to prenatal substance abuse;
(b) development of prevention and treatment strategies;
(c) education of policymakers and other relevant professionals;
(d) identification of grants and other private funding sources
and the coordination of efforts to obtain these funds; and
(e) provision of interagency communications and actions
relating to the use of alcohol and other drugs during
pregnancy."
SECTION 8. Section 44-53-140 of the 1976 Code is amended to
read:
"Section 44-53-140. (A) Whenever
When a holder of the privilege shall seek
seeks counseling, treatment, or therapy for any
a drug problem from a confidant, no statement made by
such the holder and no observation or conclusion
derived from such the confidant shall be
is admissible against such the holder in any
proceeding. The results of any an examination to
determine the existence of illegal or prohibited drugs in a holder's
body shall are not be admissible in any
proceeding against such the holder. The privilege
belongs to the holder and if he the holder waives the
right to claim the privilege the communication between the holder of
the privilege and the confidant shall be is admissible
in evidence in any proceeding. There is no privilege if the services
of a confidant are sought to enable the holder of the privilege to
commit or plan to commit a crime or a tort.
(B) When a person seeks prenatal care from a licensed health
care provider, no statement made by the person and no observation
or conclusion of the health care provider is admissible against the
person in any proceeding. The results of an examination to determine
the existence of alcohol or other drugs in the person's body or in the
body of the newborn child of the person are not admissible in any
proceeding against the person. However, the provider may release
that information necessary to bring about the commitment of the
person for alcohol or drug treatment pursuant to Section 44-52-110,
where the release is consistent with professional standards of care.
The provider also may release information necessary to judicial
proceedings that are initiated by the Department of Social Services
following a report under Section 20-7-510. The privilege belongs to
the person and may be waived by the person."
SECTION 9. Section 59-32-20 of the 1976 Code is amended by
adding a new paragraph at the end of the section to read:
"All school districts shall develop and include in their drug
and alcohol education programs in grades one through twelve, age-
appropriate drug education curricula concerning the physiological
effects and problems before and after birth caused by the use of
cigarettes, alcohol, and controlled substances."
SECTION 10. Section 59-32-30(A) of the 1976 Code is amended
by adding at the end:
"(7) Where appropriate to the students' age group, a
program of instruction in reproductive health education or substance
use or abuse must include instruction concerning the effects of the
use and abuse of cigarettes, alcohol, and controlled substances on
persons of reproductive age, pregnant women, and fetuses."
SECTION 11. The South Carolina Commission on Alcohol and
Drug Abuse shall ensure that a staff position is designated to carry
out the functions required by Section 44-49-40(c)(11) of the 1976
Code as added by Section 8 of this act.
SECTION 12. This act takes effect upon approval by the Governor.
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