Abortion referral puts spotlight on school-based health centers

County health officials say they will try to spell out more clearly the range of services available to minors after an incident in which a pregnant Ballard High student got an abortion, apparently without her mother's knowledge, some time after visiting a school-based health-care center.

The consent form parents and guardians sign for children to use the county-administered health centers states, "Youth may independently access reproductive-health care at any age," but it does not explicitly cite abortion.

"Not every individual is aware of what is included in 'reproductive-health care,' " acknowledged T.J. Cosgrove of Public Health — Seattle & King County, which runs the centers for the school district. "We're going to work constructively with our partners and experts in adolescent health to strategize the best ways to communicate that."

The incident, first reported earlier this week by KOMO-TV, involved a 15-year-old girl referred by the health center to a medical facility, where the abortion was performed.

The referral was done in accordance with state law, which gives minors the right to receive reproductive services, including abortion, without consent from parents, guardians or the baby's father.

"From a legal/procedural standpoint, it's a nonissue," said Seattle School District spokeswoman Teresa Wippel.

KOMO reported the girl's mother was upset about not having been told of the situation, but that she had signed a consent form at some point allowing her daughter to use the health center.

Public Health — Seattle & King County operates 14 school-based health centers in Seattle — 10 at high schools, four at middle schools — and two sites in the Kent and Tukwila school districts.

Organizations such as Group Health Cooperative and Seattle Children's hospital are contracted to run the clinics. Ballard High's is operated by Swedish Medical Center.

Though procedure was followed, the incident generated outrage in some corners.

"What that school did was unconscionable," read one posting on the Fox News Channel Web site.

Cosgrove said reproductive services, including termination of pregnancy, could have originated in any health-care setting, whether a pediatrician's office or community clinic.

"It's not unique to school-based health-care centers," he said.

Washington is one of seven states that give minors the right to act alone in deciding whether to have an abortion. The other states are Oregon, Hawaii, Connecticut, New Hampshire, New York and Vermont. Parental involvement is also not required in Washington, D.C.

Thirty-six states do require some form of parental involvement — notification and/or consent — though most make exceptions in cases of medical emergencies, abuse, neglect or incest.

Seven more passed parental-involvement laws but courts have enjoined them from enforcing those laws.

At King County's school-based health centers, once a pregnancy is confirmed, center staffers discuss options with the girl.

Abortions are not provided at the health centers; rather, a girl who wants one is referred elsewhere, and clinic staff may help make the appointment.

"But that is no different than how it would be handled in any health-care setting," Cosgrove said.

He said health-center staffers also remind students of the importance of health care and inclusion of a supportive network — family members, for instance.

Payment is handled either through a girl's private health plan or through income-based public-health options available to individuals.

Follow-up care and counseling are part of routine care offered by health-care providers.

Cosgrove was dismayed by the furor this week over the issue, noting that reproductive care is just a small part of what the county offers to minors.

Reproductive services are part of the county's strategy to prevent unplanned pregnancies and keep kids in school. Pregnancy is the No. 1 reason girls drop out of school, Cosgrove said.

Seattle Times news researcher Gene Balk contributed to this report.

Marc Ramirez: 206-464-8102 or mramirez@seattletimes.com