S 890 Session 110 (1993-1994)
S 0890 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 provide for the assessment and intervention in the
perinatal effects of alcohol, controlled substances, and cigarettes; to amend
Section 20-7-290 of the 1976 Code, so as to provide for drug and alcohol
testing and reporting by a physician providing care for a newborn child; to
amend Section 20-7-510 of the 1976 Code, relating to positive testing of
newborns for alcohol and drug abuse, so as to not require a report of positive
testing for drugs or alcohol, except in cases of abuse and neglect; to amend
Section 44-7-260 of the 1976 Code, so as to provide for priority access to
alcohol and drug abuse services for pregnant women; to amend Section
44-49-40(C) of the 1976 Code, relating to powers and duties of the Alcohol and
Drug Abuse Commission; to amend Section 44-53-140 of the 1976 Code, relating
to the observation or conclusion of prenatal care, so as to not permit
evidence in any proceeding; to amend Section 59-32-20 of the 1976 Code, so as
to provide for school districts to develop education programs concerning the
problems on the usage of cigarettes, alcohol, and controlled substances, to
amend Section 59-32-30(A) of the 1976 Code, so as to provide reproductive
health education instruction concerning the effects of cigarettes, alcohol,
and controlled substances for persons of reproductive age; and for the General
Assembly to provide funding.
11/08/93 Senate Prefiled
11/08/93 Senate Referred to Committee on Medical Affairs
01/11/94 Senate Introduced and read first time SJ-30
01/11/94 Senate Referred to Committee on Medical Affairs SJ-30
A BILL
TO AMEND TITLE 44, CODE OF LAWS OF SOUTH CAROLINA,
1976, BY ADDING CHAPTER 54, SO AS TO PROVIDE FOR THE
ASSESSMENT AND INTERVENTION IN THE PERINATAL
EFFECTS OF ALCOHOL, CONTROLLED SUBSTANCES, AND
CIGARETTES; TO AMEND SECTION 20-7-290 OF THE 1976
CODE, SO AS TO PROVIDE FOR DRUG AND ALCOHOL TESTING
AND REPORTING BY A PHYSICIAN PROVIDING CARE FOR A
NEWBORN CHILD; TO AMEND SECTION 20-7-510 OF THE 1976
CODE, RELATING TO POSITIVE TESTING OF NEWBORNS FOR
ALCOHOL AND DRUG ABUSE, SO AS TO NOT REQUIRE A
REPORT OF POSITIVE TESTING FOR DRUGS OR ALCOHOL,
EXCEPT IN CASES OF ABUSE AND NEGLECT; TO AMEND
SECTION 44-7-260 OF THE 1976 CODE, SO AS TO PROVIDE FOR
PRIORITY ACCESS TO ALCOHOL AND DRUG ABUSE SERVICES FOR PREGNANT WOMEN; TO AMEND SECTION
44-49-40(C) OF THE 1976 CODE, RELATING TO POWERS AND
DUTIES OF THE ALCOHOL AND DRUG ABUSE COMMISSION;
TO AMEND SECTION 44-53-140 OF THE 1976 CODE, RELATING
TO THE OBSERVATION OR CONCLUSION OF PRENATAL CARE,
SO AS TO NOT PERMIT EVIDENCE IN ANY PROCEEDING; TO
AMEND SECTION 59-32-20 OF THE 1976 CODE, SO AS TO
PROVIDE FOR SCHOOL DISTRICTS TO DEVELOP EDUCATION
PROGRAMS CONCERNING THE PROBLEMS ON THE USAGE OF
CIGARETTES, ALCOHOL, AND CONTROLLED SUBSTANCES;
TO AMEND SECTION 59-32-30(A) OF THE 1976 CODE, SO AS TO
PROVIDE REPRODUCTIVE HEALTH EDUCATION
INSTRUCTION CONCERNING THE EFFECTS OF CIGARETTES,
ALCOHOL, AND CONTROLLED SUBSTANCES FOR PERSONS OF
REPRODUCTIVE AGE; AND FOR THE GENERAL ASSEMBLY TO
PROVIDE FUNDING.
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 must 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. 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 must promptly 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 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:
"(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:
"(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. The General Assembly shall provide an appropriate
amount of state funds for these programs and services, should grants and
other funding sources not be sufficient.
SECTION 13. This act takes effect upon approval by the Governor.
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