Senate Human Services committee advances bill letting health providers use discretion before reporting prenatal substance exposure

The Senate Human Services Committee voted 6-0 to give Senate Bill 22-32 a favorable recommendation, advancing legislation that would change North Dakota law so health care providers are not automatically required to report any alcohol or controlled-substance use during pregnancy to child protective services.

Sponsor Senator Scott Meyer, R-18 of Grand Forks, told the committee the bill "combines both controlled substance and alcohol use" in statute and creates a waiver allowing a provider to forgo reporting if the pregnant woman "receives and complies with medical care during the pregnancy." Meyer said the measure also replaces mandatory language in statute — "shall report" — with permissive language — "may report" — to preserve clinician discretion.

Supporters including the North Dakota Medical Association and three physicians told the committee that current law deters people from seeking prenatal care. "Addiction and substance abuse is a health condition in the same way that hypertension, heart disease, cancer, and diabetes are health conditions. It's not a moral failing," said Dr. Anna Tobias, an obstetrician-gynecologist and maternal-fetal medicine physician who serves as North Dakota section chair of the American College of Obstetricians and Gynecologists. Tobias said she has seen pregnant patients stop returning to care after being reported and linked that avoidance to worse neonatal outcomes.

Dr. Daniel Thurl, a pediatrician who oversees a substance-exposed newborn program at Sanford Health Bismarck, described testing and mandatory reporting as a deterrent to care. "Drug testing is highly flawed," he said, and the bill's change from "shall" to "may" would let clinicians resolve potential false positives and exercise clinical judgment before filing a CPS report. Thurl and other witnesses noted that North Dakota is one of three states that currently requires compulsory testing of newborns for substance exposure.

Rhonda Allery, director of the Mountain Lakes Human Service Zone, told the committee child welfare receives many reports from medical providers and that some reports "don't make sense." Allery said she could supply counts of reports to the committee on request and expressed concern that overly broad reporting requirements create barriers to care and harm the provider-patient relationship.

Committee discussion focused on where the line would be drawn for reporting and how clinicians would document attempts to engage patients in treatment. Senator Hogan, who moved the bill, said the central problem is the mandate itself — not the ability to report when there is a safety concern — because the requirement discourages treatment-seeking.

The committee recorded a 6-0 roll call in favor of advancing SB 22-32. The motion to pass was made by Senator Hogan and seconded by Senator Van Osteen; Senators Lee, Weston, Rohrs, Hogan, Van Osteen and Clemens voted yes. A committee member volunteered to carry the bill to the floor.

Votes at a glance

- SB 22-32 (reporting requirements for prenatal exposure to alcohol and controlled substances): Motion to pass recommended by committee; vote 6-0 in committee (Lee, Weston, Rohrs, Hogan, Van Osteen, Clemens — yes). Sponsor: Senator Scott Meyer.

- SB 22-49 (step therapy; study/report): Committee adopted an amendment and recorded a due-pass recommendation as amended; vote 6-0 in committee (committee roll call recorded). Sponsor and further legislative status not specified in committee record excerpt.

- SB 23-88 (over-the-counter availability of ivermectin): Committee recorded a "do not pass" recommendation after testimony in opposition from veterinary and medical groups; motion carried on roll call (committee recorded vote in favor of do-not-pass). Sponsor: Senator Van Osteen (requested the bill be killed after review with Board of Pharmacy).

- SB 21-71 / 21-72 (inmate/behavioral health custody/72-hour hold amendment): Committee recorded a due-pass as amended; vote 6-0 in committee (committee roll call recorded). Exact bill identifiers and sponsor details are in the committee file.

Why it matters

Supporters said the bill aims to preserve the physician-patient relationship and improve maternal and neonatal outcomes by removing a statutory disincentive for pregnant people to seek prenatal care. Opponents of mandatory reporting in testimony described cases where reporting led patients to avoid care or resulted from potentially false-positive newborn screens.

What the bill changes (as discussed in committee)

- Combines alcohol misuse and controlled-substance use into a single statutory reporting category. - Replaces mandatory reporting language ("shall report") with permissive language ("may report"). - Creates a waiver allowing providers to withhold a report when a pregnant patient is actively engaged in and complying with medical care. - Preserves clinician authority to report when there are clinical concerns about safety, unexplained neonatal symptoms, or discharge planning.

Documentation and next steps

Committee members asked how clinicians should document interventions and safety plans if they decide not to file a report; witnesses said documentation of efforts to engage patients and coordinate care would be part of clinical practice and could be shared where safety concerns exist. The committee advanced the bill; the committee record shows it will move to the full Senate with a committee sponsor responsible for carrying the measure.

Sources: Hearing testimony from sponsor Senator Scott Meyer; testimony from Courtney Coble, executive director of the North Dakota Medical Association; Dr. Anna Tobias, obstetrician-gynecologist and maternal-fetal medicine physician; Dr. Daniel Thurl, pediatrician; Dr. Erica Houghland, obstetrician-gynecologist; Rhonda Allery, director, Mountain Lakes Human Service Zone; and the Senate Human Services Committee roll-call record included in the hearing transcript.