School based health centers at Lincoln County high schools will be open when school starts next month, but they will not be allowed to dispense prescription birth control.

In July, the Lincoln County School District Board of Directors voted to terminate the district’s contract with Lincoln County Health and Human Services to run the health centers. This was done to address what Superintendent Tom Rinearson described as “mechanical issues” relating to communication between the two agencies and policies on how parents’ complaints were handled.

A team comprised of district and LCHHS employees spent the past month working on the contract to address those issues and to make sure it complied with numerous legislative rules that have been enacted since the health centers started in Lincoln County in the 1980s.

However, when the new contract was presented to the board on Tuesday evening, it contained three options inserted by Rinearson for the board members to decide on regarding the dispensing of prescription birth control:

• Retain the changes made last year that allow the dispensing of prescription birth control, including Plan B and condoms at the SBHCs;

• No dispensing of prescription birth control, but dispensing of condoms allowed, with a review of the policy no later than Dec. 1, 2009;

• No school site dispensing of any type of birth control, with a review of the policy by Dec. 1, 2009.

The school health centers have always been able to prescribe birth control, but students had to fill the prescription at an off-site facility.

After a yearlong process of public meetings and workshops, the board voted last November by a 4-1 margin to allow the SBHCs to dispense contraceptives to students as young 14 without parental consent as part of a comprehensive teen reproductive health plan.

Rinearson said he put in the three options two-weeks ago when he realized that only three of the five board positions would be able to vote on approving a new contract. Under parliamentary rules, all three would have to vote to approve the contract in order to have the SBHCs open when school begins.

“We needed to have some option they could all agree on so we can get the health centers open when school starts,” Rinearson said.

Board director Amy Coulter has resigned her seat, and a replacement isn’t expected to be chosen until late September. Newly seated board chair Jana Cowan has been hired as a physician assistant at the Toledo SBHC and could not vote because of financial conflict of interest.

Cowan voiced her displeasure that the birth control issue was again up for a vote.

“In terminating the contract, it was never our intention to undo the labor of the full board,” she said. “For me, it’s an ethical issue. I would hate to think there was someone with a personal agenda who was trying to overturn a board decision.”

The vote to approve the contract came down to essentially a game of chicken over whether any one of the three voting board members would oppose the contract with an option they didn’t favor at the risk of keeping the health centers, which provide numerous other services to students, closed.

Board member Jean Turner and Brenda Brown were opposed by Ron Beck - the sole vote against dispensing prescription birth control in November - on passing Brown’s motion to approve the contract with birth control dispensing done at the SBHCs.

Beck immediately made a motion to approve it with only the dispensing of condoms, amended by Turner to include all “barrier methods,” which Turner and Brown supported.

Turner did express some concern that students are given only about 45-minutes of counseling before receiving a birth control prescription.

There appeared to be some confusion on the part of board members over who could make another motion to approve the contract and how many chances they had to pass it Tuesday night. Cowan, Turner, Beck and Brown were still quizzing the superintendent about the vote procedure as they left the meeting.

Beck said he was opposed to dispensing birth control at school, particularly Plan B, because of the risk that students would sell or share the medicine. If procedures such as having a student take the Plan B pill in front of an adult are established, Beck said he would vote in favor of lifting the restriction, and in the meantime, condoms and other barrier methods would help prevent sexually transmitted diseases among teens with perhaps a slight increase in the risk of pregnancy.

During the discussions before the vote, Beck said the three objectives of reducing teen pregnancy and STDs and increasing communication between students and parents had not been met, calling the dispensing of birth control on school grounds a “train wreck.”

When the board reviews the SBHC birth control policy later this fall, Cowan will be able to vote because she will not stand to gain financially if prescriptions are issued at the centers.

As part of the new contract, the school board will receive quarterly quality assurance reports about the health centers.