S 155 Session 110 (1993-1994)
S 0155 General Bill, By M.T. Rose
A Bill to amend the Code of Laws of South Carolina, 1976, by adding Section
44-53-60 so as to provide for the reporting of prenatal exposure to controlled
substances.
01/12/93 Senate Introduced and read first time SJ-67
01/12/93 Senate Referred to Committee on Medical Affairs SJ-67
01/26/93 Senate Recalled from Committee on Medical Affairs SJ-5
01/26/93 Senate Committed to Committee on Judiciary SJ-5
04/13/93 Senate Committee report: Favorable with amendment
Judiciary SJ-14
04/15/93 Senate Amended SJ-17
04/15/93 Senate Read second time SJ-25
04/15/93 Senate Ordered to third reading with notice of
amendments SJ-25
04/20/93 Senate Read third time and sent to House SJ-27
04/21/93 House Introduced and read first time HJ-18
04/21/93 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-18
03/03/94 House Committee report: Majority favorable with amend.,
minority unfavorable Medical, Military, Public
and Municipal Affairs HJ-5
03/03/94 House Committed to Committee on Ways and Means HJ-5
04/21/94 House Committee report: Favorable with amendment Ways
and Means HJ-12
05/11/94 House Objection by Rep. Breeland, Whipper, Neal, Scott,
& Inabinett HJ-78
06/02/94 House Objection withdrawn by Rep. Breeland HJ-31
06/02/94 House Objection by Rep. Wofford HJ-31
Indicates Matter Stricken
Indicates New Matter
COMMITTEE REPORT
April 21, 1994
S. 155
Introduced by SENATOR Rose
S. Printed 4/21/94--H.
Read the first time April 21, 1993.
THE COMMITTEE ON WAYS AND MEANS
To whom was referred a Bill (S. 155), to amend the Code of Laws
of South Carolina, 1976, by
adding Section 44-53-60 so as to provide for the reporting of prenatal
exposure to controlled substances, etc., respectfully
REPORT:
That they have duly and carefully considered the same, and
recommend that the same do pass with amendment:
Amend the bill, as and if amended, by striking all after the enacting
words and inserting:
/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) 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.
(2) 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.
(3) 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.
(4) Prevention, education, counseling, 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.
(5) 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 must be protected.
(6) 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.
(7) 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.
(8) 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.
SECTION 3. Title 44 of the 1976 Code is amended by adding:
"CHAPTER 54
Assessment and Intervention in the
Prenatal 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 prenatal 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 Department of Alcohol and Other Drug
Abuse Services 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 4. 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 5. 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 6. 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 7. Chapter 13, Title 61 of the 1976 Code is amended
by adding:
"Section 61-13-890. (A) Every person engaged in the
business of selling at retail beer, wine, or liquor may post in every
location for which the person has obtained a license or permit a sign
with the following words printed thereon:
`A HEALTHY BABY BEGINS WITH YOU:
PREGNANCY AND ALCOHOL DO NOT MIX
Drinking beer, wine, or liquor while you are
pregnant or nursing can be
harmful to your baby.
FOR MORE INFORMATION, CALL
'
(B) The sign required by this section must be no smaller than six
inches high by twelve inches wide, with print no smaller than one-half
inch bold print in clear, readable letters. The number for the South
Carolina Commission on Alcohol and Drug Abuse's toll free
information line may be handwritten on the line following `CALL'.
The Alcoholic Beverage Control Commission shall prescribe by
regulation the location of the sign in a conspicuous place on the
seller's premises."
SECTION 8. The Department of Alcohol and Other Drug Abuse
Services 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 4 of this act.
SECTION 9. This act takes effect upon approval by the
Governor./
Renumber sections to conform.
Amend title to conform.
WILLIAM D. BOAN, for Committee.
A BILL
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976,
BY ADDING SECTION 44-53-60 SO AS TO PROVIDE FOR THE
REPORTING OF PRENATAL EXPOSURE TO CONTROLLED
SUBSTANCES.
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, as last amended
by Act 501 of 1990, is further 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 counselling, 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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