— North Carolina could be on the verge of implementing the nation's strictest law on medical care for teenagers.

House Bill 693 would require notarized written approval from a parent before a doctor or other provider could diagnose, treat or even counsel anyone under 18 for mental health or substance abuse. Parental approval would also be required for contraception, pregnancy care and testing for sexually transmitted diseases.

North Carolina would be the only state in the nation to require parental consent for STD testing.

Sponsor Rep. Chris Whitmire, R-Transylvania, says the bill "strengthens parental rights in their determination of what's appropriate in terms of their child's medical needs."

Whitmire said that, if a minor needs mental health, substance abuse, STD or contraceptive care, "it reflects a risky behavior that goes down a primrose path that yields these outcomes. It's very behavioral related."

"We make (teens) wait till they're 18 to buy cigarettes, 21 to buy alcohol," Whitmire told the committee. "With the particular items that are very serious, that threaten their health, they certainly need a parental figure."

Doctors spoke out against the proposal. Groups opposed include the North Carolina Pediatric Society, the North Carolina Medical Society, the North Carolina Academy of Family Practice, the North Carolina Child and Adolescent Psychiatry Association, school nurses and public health directors.

Dr. John Rusher, speaking for the pediatricians, said the proposal would discourage teens from seeking medical or psychological help that could save their lives.

"You're going to eliminate a certain subsection of patients with either substance abuse or who have been subject to child abuse, physical abuse or even emotional disturbance that are not going to be able to come seek care because they can't do it in confidence,” he warned the committee.

"I have had numerous instances where teenagers have come to me in confidence to discuss concerns they have about fears of pregnancy, sexually transmitted infection, HIV," said community physician Dr. Neva Bartholomew. "I’ve been able to counsel them because I’m able to assure them that they have my confidentiality.

"If they think that we are going to tell their parents about everything they come to talk to us about, they are not going to tell us what is going on, and they are not going to come in," she said.

But Tami Fitzgerald with the N.C. Values Coalition called the bill "a commonsense bill that puts control back in the hands of the parents, where it belongs."

"There is something insanely wrong about physicians' associations coming into this building and asserting that their judgment should be substituted for the judgment of a child’s parents," Fitzgerald told the committee.

Jere Royall with the North Carolina Family Policy Council also spoke in support: "Sexually transmitted diseases, abuse of controlled substances or alcohol, mental illness or pregnancy are critical, sensitive and necessary areas for parents to be aware of and involved in."

Rep. Marilyn Avila, R-Wake, said allowing teens to receive confidential medical care or advice is "an insidious sort of thing."

"We're undermining our families by creating this 'Don't tell mom and dad, just come tell me,'" she said. "If you look at the direction our children have taken in the last 20 or 30 years, maybe we've created some of the problems."

But Rep. Beverly Earle, D-Mecklenburg, called that outlook unrealistic.

"There's a whole world of other young people out there that don't have that relationship with their parents. Many of the parents are not there. Some of these kids are being abused. There's this word of different issues out there," Earle said.

Rob Thompson with Covenant with North Carolina Children agreed minors who are physically, emotionally or sexually abused by their parents or guardians would be especially vulnerable.

“None of these youth should be required to go back to their parents and ask them to consent for them to get medical care for those instances,” he told the committee.

The bill would also extend to pharmacists, who would be unable to dispense any medication used to treat any of the subject conditions without the presence or notarized permission of the parent.

However, because federal law requires strict confidentiality in the provision of medical care and bans age discrimination against minors, providers who get Title X or Medicaid funds would not be subject to the parental consent requirement. That would include most community health centers, county health departments and Planned Parenthood.

House Bill 693 also adds a new restriction on abortion. It would require written, notarized parental permission for a minor seeking an abortion, even if the parent is present with the teen. Critics say the purpose is to shame the parent by having to reveal the abortion to a notary – a third person who has no duty to protect medical privacy. Whitmire didn't explain why notarization would be required if a parent is present.

The measure passed the committee largely on party lines, 14-8. Its next destination is the House floor, where it could be heard Wednesday.