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be it conversations with patients, signing letters of endorsement, or simply providing campaign literature in a physician's office. While neither the law nor ethical considerations prohibit physicians from exercising such rights, physicians should always be mindful that patient care is their essential mission and it should not be affected by their patients' decisions to support or not support particular political positions, parties, or candidates.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: March 2013 PREGNANT MINORS' RIGHTS For years, society has wrestled with the problems associated with teenage pregnancy. With the exception of the pregnant minor, however, no person is more involved with the issues surrounding this societal problem than the physician who treats the pregnant minor. Not only must the physician serve as both doctor and counselor to a young woman forced to make very mature decisions, but the physician must also take into account the myriad of laws concerning the rights of the pregnant minor and her parents.In the past, Florida law required a minor wishing to terminate a pregnancy to obtain the consent of at least one parent. Both federal and state courts, however, found that such a requirement violated a women's "constitutional right to privacy", and therefore, ruled the offending statute, Section 390.001(4)(a), Florida Statutes unconstitutional. Poe v. Gerstein, 517 F.2d 787 (5th Cir. 1975), aff’d 428 U.S. 901; Scheinberg v. Smith, 482 F. Supp. 529 (D.Ct. 1979); In Re T.W., 551 So. 2d 1186 (Fla. 1989). Current law not only eliminates the need for parental consent, but Section 743.065(1), Florida Statutes, explicitly states, "an unwed pregnant minor may consent to the performance of medical or surgical care or services relating to her pregnancy by a hospital or clinic or by a physician licensed under Chapter 458 or 459, and such consent is valid and binding as if she had achieved her majority."By combining this statute with the court's decision to overturn former Section 390.001(4)(a), Florida Statutes, the state has affirmed a pregnant minor's right to make her own medical decisions regarding her pregnancy, including the option of terminating the pregnancy, without the consent of the minor's parents.In 1999, the Legislature attempted to scale back a minor's right to terminate her pregnancy by passing the "Parental Notice of Abortion Act." The Act required a physician who refers or plans to terminate the pregnancy of a minor to give 48 hours actual notice prior to the procedure to one parent of the minor or her legal guardian. The constitutionality of the Act was challenged immediately, and in North Florida Women’s Health v. State, 866 So.2d 612 (Fla. 2003), the Florida Supreme Court declared the Act unconstitutional. The Court, relying on In Re T.W., 551 So. 2d 1186 (Fla. 1989), held that the Act violated the right to privacy under Florida’s Privacy Amendment.In 2004, however, the voters in Florida approved the “Parental Notification of a Minor’s Termination of Pregnancy” Amendment to Article X, Section 22 of the Florida Constitution. The amendment provides that the Florida Legislature is authorized to require, by general law, for notification to a parent or guardian of a minor before the termination of the minor’s pregnancy. The 2005 Legislature proceeded to enact Section 390.01114, Florida Statutes, to implement the amendment. The statute requires that the physician performing or inducing a termination of a pregnancy of a minor must provide notice, either directly in person or by telephone, to a parent or guardian of the minor at least 48 hours before the performance of the termination of pregnancy.The notice must be documented in the minor’s medical records. The statute allows the referring physician to provide the required notice. In that event, the physician performing the termination of pregnancy must receive a written statement from the referring physician certifying that the notice has been given. If the notice is provided by telephone, the physician must actually speak with the parent or guardian and must record in the minor’s medical record the name of the parent or guardian, the telephone number dialed, and the date and time of the telephone call. Notice to the parents or guardian is not required if:• In the physician’s good-faith judgment, a medical emergency exists and there is not enough time to provide the required notice;• Notice is waived by the person who is entitled to notice;• Notice is waived by the minor who is or has been married or has had the disability of nonage removed;• Notice is waived by the parent because the patient has a minor child dependent on her.The statute provides that failure to comply with the notice requirement constitutes grounds for disciplinary action. The statute also provides a procedure whereby the minor may petition a court to waive the notice requirements.While it is clear that current Florida law allows a pregnant minor to consent to all medical treatment with regard to her pregnancy, including the potential termination of the pregnancy, the Florida law on whether parents are entitled to medical records concerning such care is less certain. Although Section 456.057, Florida Statutes, allows a legal representative, such as a parent of a minor, to obtain medical records, it must be remembered that Florida courts have found that a pregnant minor has a constitutional right to privacy. In Re T.W., 551 So. 2d 1186 (Fla. 1989). In that case, the Florida Supreme Court held that the right of privacy under Florida’s Privacy Amendment extends to "every natural person." The Court found that minors are natural persons in the eyes of the law and "constitutional rights do not mature and come into being magically only when one attains the state-defined age of majority. Minors, as well as adults, possess constitutional rights." This holding, combined with North Florida Women’s Health and existing Florida law which allows a pregnant minor to consent to such medical services without the permission of parents, implies that the medical records concerning a pregnant minor should not be disclosed to the minor's parents, except with the consent of the minor.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: August 2016 PRESCRIBING STANDARDS VIA TELEMEDICINE Physicians should be aware of the laws relating to prescribing for patients that they do not see in person, otherwise known as telemedicine. Telemedicine is defined as the practice of medicine by a licensed Florida physician or physician assistant where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications. Telemedicine shall not include the provision of health care services only through an audio only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service. Rule 64B8-9.0141, F.A.C., issued by the Florida Board of Medicine, further delineates the standards for telemedicine practice:• The standard of care shall remain the same regardless of whether a Florida licensed physician or P.A. provides health care services in person or by telemedicine.Providers of telemedicine are responsible for the quality of the equipment and technology employed and are responsible for their safe use. Telemedicine equipment and
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