BALTIMORE — A mother learned her 16-year-old daughter received a birth control implant at school after the teen started complaining about headaches and a pain in her arm.
Nicole Lambert sent her daughter to get checked out by a pediatrician. The doctor notified her that the three-year contraceptive, Nexplanon, had been improperly implanted in her daughter's arm and it needed to be removed.
According to paperwork on Merck's website, the maker of Nexplanon, the implant should go on the inside of the upper arm. Photos show Lambert's daughter had the implant near the back of arm. Her doctor advised taking the implant out to avoid possible complications, including blood clots.
"I instantly started crying because just to hear that your child, anything could happen to your child and you didn't even know what's going on, it's a scary feeling," Lambert said.
The tiny tube was removed a few days later.
"I actually went to the school. I was furious. I was mad, so I went to the school and the nurse told me, 'I don't have to talk to you about absolutely nothing.' I'm like that is my child, I take care of this child, you can talk to me about my child, and they put me out of the school," said Lambert.
Birth control dispensed in city schools
The state law permitting minors to receive contraceptive services confidentially dates back nearly 50 years. And several of Baltimore City's 17 School-Based Health Centers (SBHC) provide reproductive health care services.
Of the five SBHCs operated by the Baltimore City Health Department, there were 164 users of birth control during the 2017-2018 school year. The different kinds of birth control include oral contraceptive pills, Plan B, Depo-Provera, NuvaRing, and Nexplanon. 
WMAR-2 News requested the data above for the eight SBHCs operated by the Baltimore Medical System. The Baltimore City Law Department and Baltimore Medical System did not provide the requested information.
WMAR-2 News Mallory Sofastaii also reached out to the school system for more information on the nurse's training, qualifications, birth control policies in schools, and comment on the incident, but was told to direct her questions to the Baltimore City Health Department, which oversees the Digital Harbor school-based health center.
The health department said the law department advised them not to respond to our questions because of a pending case against the city.
Merck responded to several questions sent by WMAR-2 News. The Nexplanon manufacturer strongly recommends health care professionals participate in a training session to become familiar with insertion and removal of Nexplanon. Training is required to purchase the product.
And while clinical studies haven't been done on women under the age of 18, a Merck spokesperson said safety and efficacy are expected to be the same.
Mom seeking answers
Lambert's not opposed to preventing teen pregnancies. Statistics show there's been a 69% decrease in the last 10 years in Baltimore City. However, she's not comfortable with unfamiliar nurses in schools doing invasive procedures. She hired an attorney to investigate.
"Ms. Lambert wasn't given the choice to pick the medical provider where her daughter would feel comfortable going and receiving these services, who she knew did a comprehensive medical exam, who she knew knew her medical history," said David Ledyard, the attorney representing Lambert.
In addition to Lambert's questions regarding the health professional's experience, she also wants to know why her permission was sought for other things, yet this was never brought up.
"They call me for Tylenol, but they don't call me about birth control," said Lambert. "You gave my daughter this insertion so she might be suffering from that, but do they even look at that?"
Lambert's relieved the implant was removed, but worries about other students and their parents still in the dark.
"Other kids out here could be going through the same thing and their parents don't know about it. And I just think these kids, if they have it incorrectly or whatever it is, they should be checked because anything could happen to these kids," said Lambert.
UPDATE:
The union representing registered nurses and nurse practitioners within Baltimore City Health Department issued a response to this report. On Tuesday morning, Wendy Smith RN BSN, president of AFSCME 67 Local 558, sent the below statement:
"Our union has chosen not to comment on this case directly due to pending litigation, but we do stand behind our members, and I hope the student receives the care she needs. The WMAR report shows the uniqueness of having clinics within Baltimore City Public Schools. Quality healthcare begins with quality staffing, utilizing evidence-based practices, and most importantly, continuing education for all of our healthcare practitioners. We as a union have made this a cornerstone of our fight. Presently, there is a critical shortage of Registered Nurses and Nurse Practitioners within Baltimore City Public Schools. We're asking that the public support our efforts in demanding that all schools have safe staffing, and this must include a licensed individual in every school building immediately."
A number of schools right now only have a health aide or a certified nursing assistant.
WMAR-2 News reached out to the health department for their response to the union's statement. A spokesperson wrote: "Given the sensitive nature of this matter, we have no comment at this time."
WMAR-2 News Mallory Sofastaii contacted several other school systems in the area to ask about their birth control policies. Their responses are below.
Anne Arundel County:
Does not provide birth control in schools.
Baltimore County:
School-based wellness centers do not offer birth control.
Harford County:
The Harford County school-based health centers are primarily in 4, title I, elementary schools in Harford County. Birth control is not offered at those schools.
Howard County:
Birth control is not being dispensed at the three traditional school-based health centers. The other health centers are all telehealth.
To learn more about Maryland School-Based Health Centers, click here.
