The medical director and chief nurse practitioner of Gloucester High School's health center have abruptly resigned over an advisory-board dispute — one centering on the Addison Gilbert Hospital representative's stand against supporting a potential school-based contraception program amid a soaring GHS pregnancy rate.
Dr. Brian Orr, the medical director of the school clinic, and Kim Daly, the primary nurse practitioner, submitted their resignations Friday and have notified AGH officials that their move follows a lack of hospital support for recommending a comprehensive contraception effort as part of the school-based clinic.
"This is one of the most outrageous things I have ever been a part of in my career," said Orr, who has worked in teen clinics for 18 years.
The news that 10 Gloucester High students were pregnant became public in March, and that number — as reported to the clinic staff — is now 17. Teen pregnancy, long on the decline across the country, is on the upswing nationally for the first time in 15 years, national statistics show. The situation in Gloucester — which normally deals with about four pregnancies per school year, officials have said — has reached what Orr calls epidemic proporations.
Orr noted that, of the 17 pregnant teens, 14 were diagnosed at the clinic and only three were diagnosed at Cape Ann Pediatricians. "This shows that they were using the clinic preferentially when they needed to turn to a health care provider," said Orr.
The advisory committee for the GHS student health clinic had been preparing to bring a proposal to the School Committee, and that proposal included a plan to provide confidential contraception. But Orr said that direction began to change after January when Cindy Donaldson — executive director of Addison Gilbert — became the new representative on the student health center advisory board.
"We had a program we wanted to go to the School Committee with, and Cindy started balking on it because she said the hospital has liability here," said Orr, who noted that about 25 percent of the 50 school-based health clinics around the state provide confidential contraception. In a school-based health clinic, parents must enroll their child and provide their health insurance information. Gloucester High's clinic has close to 95 percent student enrollment.
"We, as an advisory committee, started reacting to the pregnancy crisis. It was time to go to the School Committee about initiating a comprehensive contraception program, including condoms and contraceptives," said Orr. "Then the hospital changes their representation to our board."
The advisory panel includes representation from the school, Cape Ann Pediatricians, the city's department of public health and Addison Gilbert Hospital, which is under the umbrella of Northeast Health Systems.
Orr said that, at a meeting with Donaldson last week, he and Jack Vondras — the city's health director — pleaded with Donaldson for the hospital to change its stand regarding a contraception program at the school. Vondras could not be reached for comment.
Both Orr and Daly said in interviews on Friday they had no confidence that the hospital would support the advisory board's proposal to begin a confidential contraception program at the school clinic. They also feared that the hospital would try to undermine them at a school board meeting by watering down the need for such a move. The teen clinic at the high school is funded through a state public health grant, which is administered by the hospital.
Donaldson, in responding to the resignations, said Northeast Health Systems is committed to the clinic, which she vowed would not close, even though it may have to recruit another medical director.
"I'm surprised to hear of the resignations," she said. "In the past month we've increased the regularity of the subcommittee working on the teenage pregnancy. At the end of the meeting on Wednesday, we came to what we thought was a good resolution," she said.
Donaldson said she believed it was critical to get School Committee approval before the advisory committee moves ahead with a plan.
"When the issue came up of confidential contraception around February, we said 'yikes,'" Donaldson said. "We as a hospital have three concerns: What is our liability should a teen suffer adverse effects from birth control? What will be the community reaction? And what does the community want?"
She said that, if clear community support for confidential contraception should arise, then the matter could be brought before the Northeast board for consideration.
Gloucester Superintenent of Schools Christopher Farmer, who became aware of the resignations Friday, said he was dismayed by the news. He commended both Dr. Orr and Daly for their outstanding service to young people and families in the community.
He said the school district has been working with the Student Health Center Advisory Board to develop a draft plan to respond to the problem of the steep increase in adolescent pregnancies.
"The issue of the possibility of the health center prescribing contraceptives in appropriate circumstances is one strand of a discussion which also emphasizes health education, the early identification of girls at-risk, the role of parents, building adolescents' capacity to be resilient, an understanding of the consequences of making poor choices, and the skills needed to make healthy choices," said Farmer.
"I understand that the hospital administration has taken the position that the issue of the prescription of contraceptives in appropriate circumstances cannot be on the agenda for discussion," he added. "I also understand that that position flies in the face of the views and experience of the medical profession. The liability issue which has been raised by the hospital does not appear to be a cause for concern elsewhere."
Although the issue of contraception is sure to generate strong views within the Gloucester community, Farmer noted, the consequences of teen pregnancy are far reaching for all involved — the girl, the child and the father.
"We need the opportunity for considered discussion about how we might best respond to the current difficulties without establishing 'no-go' areas from the start," he said. "I do not expect the high school health center to close or close for long. If the hospital's position is non-negotiable, we will seek to open up an alternative route for the state funding to the health center, which provides an exceptional service and is very highly regarded at the state level."
The escalating spike in teen pregnancy among students began raising serious concerns on the advisory committee when Daly informed the committee late last year that she had already confirmed 10 pregnancies and continued to perform dozens of pregnancy tests, some for the same students returning multiple times.
Daly, who has done about 150 pregnancy tests since September, noted that pregnancy is the No. 1 reason for teen-age girls dropping out of high school, according to data from the Centers for Disease Control. Daly, who has been part of the school clinic for the past three years, said the usual number of pregnancies per year was four or five on average.
"It's very frustrating to see these girls coming in and returning for pregnancy tests," said Daly, who said she was advised by the hospital to send them to HealthQuarters in Beverly. "I'm not saying birth control is the answer. It's not. It's far more comprehensive. It's part of a greater pregnancy solution and that's what we are trying to do. But we've been shut down before we got started. We were told regardless of the School Committee decision, the hospital won't support it. We were blindsided at the meeting."
Adolescents already can obtain confidential contraception at family planning clinics without a parent's knowledge. The problem for local teens is that it is located at HealthQuarters in Beverly, a location difficult to reach, especially if the student does not drive or have access to transportation.
Donaldson, however, said she hopes to maintain a working relationship with Dr. Orr and Daly.
"We are always open to people coming back and working with us," she said. "I hope there is a resolution. We would never close any doors to good employees."
Gail McCarthy can be reached at email@example.com