In This Issue:
- Report: Mom Shocked When School Pulled Son’s Teeth
- By the Numbers: Children and Dental Health
- Go Deeper: HIPAA
Report: Mom Shocked When School Pulled Son’s Teeth
According to a January 20 news report from Baltimore CBS affiliate WJZ, mother Shanda Fleming was shocked and outraged when her son Michael came home from school missing three teeth. A dental program visiting his school had removed the teeth and sent him home with no medicine – without notifying his mother. Even worse, he came home late and on foot, because the procedure caused him to miss the bus.
“He walked home alone after having three teeth extracted from his mouth. He could have fell out or anything,” Fleming told WJZ.
Such school dental programs apparently have become commonplace in Maryland since a child died from an infected tooth in 2007. But protecting children doesn’t involve cutting parents out of key health decisions.
Fleming recalls signing a permission form regarding the dental clinic, but insists she thought it was just for a routine cleaning. “They just said they was gonna clean my teeth,” Michael insists.
To be balanced and fair, it is possible, depending on what the form said, that Fleming’s rights were not violated when the teeth were pulled. We do not have access to the form to know what it said, and we must acknowledge the possibility that she signed consent for the extractions.
But even that would not excuse the school from letting him walk home alone afterwards. A single phone call to a concerned parent seems a small price to pay to protect a third-grade boy in that situation.
“I just don’t understand how a school or a company can take it in their hands to do something like this to a child,” Fleming said.
While the proposed Parental Rights Amendment cannot instantly cure in detail every parental rights violation, its passage will communicate and demand a deeper respect for parents by educators and clinicians alike. The PRA’s provision that “[t]he liberty of parents to direct the upbringing, education, and care of their child is a fundamental right” would inform schools like this one in Baltimore when they are deciding how they will work with parents in these events.
And it will give parents solid legal ground to stand on in court if they have to defend against their rights being taken away.
If the school in this case had spoken with the mom, she could have told them about the appointment Michael already had set with his own dentist for January 23. Perhaps then his teeth could have been pulled in a safer environment, by a dentist aware of the boy’s full medical and dental history.
And certainly the boy would have had a safe ride home.
By the Numbers: Children and Dental Health
In part because February is National Dental Health Month, and in part because the story above deals with an unfortunate dental experience, we offer a few statistics on children and their dental health that may be helpful for parents.
|50.4M||Students in public schools as of the fall of 2016, according to the National Center for Education Statistics. There are about 56M students total nationwide.|
|42%||Percentage of children aged 5-17 with a cavity, according to the Center for Disease Control (CDC).|
|17.0%||Percentage of children aged 2-17 who did not see a dentist in 2014, the latest year for which stats are available, per the CDC. That’s roughly 9.5M students.|
|$61.14||Average cost of a pediatric dental visit and general cleaning according to Dentalinsurance.org.|
|66||Deaths between 2000 and 2008 from tooth abscesses and related infection, according to a 2013 study in the Journal of Endodontics. Filling cavities early can prevent these infections.|
Going Deeper: HIPAA
HIPPA – the Health Information Portability and Accountability Act of 1996 – is a federal law designed to protect the privacy of patients. It instructs doctors, dentists, and insurance companies in how to respect and protect your medical or dental records.
Unfortunately, HIPAA is intentionally vague to work effectively with related state laws. Even more unfortunate, insurance companies and professional associations have stepped up to try to fill in some of the details in ways that will best serve themselves, and not necessarily the patient or parents.
In the Baltimore case featured above, for instance, the school cited HIPAA when it declined to answer questions for WJZ, as though HIPAA were designed to protect the school. HIPAA is often misused by child welfare service organizations the same way: “We can’t comment on that case because it would violate HIPAA,” even if the family are the ones asking them to comment.
HIPAA is designed to protect the privacy of the patient and family, not to hide the workings of a public agency.
State laws vary on when a child can make his own medical decisions. It is not uncommon for state laws to allow children as young as 12-14 to make their own decisions in areas of sexuality, drug and alcohol use, and mental health (particularly depression) in an attempt to encourage young people to seek the medical help they need, even if they’re afraid of what their parents might say or do.
HIPAA is designed to allow for these state laws. So it protects the privacy of a minor against the parents in the event that state law permits this and that the doctor believes such privacy to be necessary for the health of the minor. Your 15-year-old’s flu shot records? They wouldn’t be kept from you under HIPAA.
But insurance companies want efficiency, and to that end “one size fits all” works best. That’s why so many doctors’ offices won’t let you access your minor’s records online, and won’t share them with you at all without your child’s consent.It’s simpler for them to hide the whole record from you than to hide only those parts where a minor may have a legal right to individual privacy from mom and dad.
For the insurance company, the greater risk is that a minor may sue for privacy violations than that a parent may sue to see an inappropriately hidden record. If the parent wins, the records are handed over. If the minor wins, the doctor could shell out millions in “damages.”
No state law that we are aware of protects a privacy right of a minor against his or her parents regarding dental care. That means HIPAA keeps your dentist from sharing your child’s information with anyone else – a nosey reporter or teacher, for instance – but it does not keep them from sharing that record with you.
If your doctor or dentist doesn’t understand this, though, try to go easy on them. They didn’t dream this up on their own to shut you out. They’re probably just doing what their malpractice insurance company has told them they have to do. HIPAA can be vague, and doctors are left in a tight spot.
As parents come to better understand HIPAA, and share this information in a helpful way with their doctor or dentist, perhaps we can find common sense ways for these professionals to keep those parents in the loop.
And the proposed Parental Rights Amendment may give health professionals the incentive they need to apply HIPAA as it was intended, and not as best suits the insurance companies.
Director of Communications & Research