Case: 1:14-cv-00129-TSB Doc #: 19 Filed: 02/28/14 Page: 1 of 6 PAGEID #: 603

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION BRITTANI HENRY, et al., Plaintiffs, vs. : : : : : : : : : :

Case No. 1:14-cv-129 Judge: Timothy S. Black

THEODORE E. WYMYSLO, M.D., et al.,

Defendants.

STIPULATIONS

1.

The parties hereby stipulate to the facts set forth below describing in part the

current practice with respect to the issuance of birth certificates in Ohio. These stipulations are not intended to and do not provide a comprehensive depiction of the body of statutes and practices that relate to the issuance of birth certificates in Ohio under all circumstances. The parties note that the law speaks for itself. Additionally, while the stipulations are accurate, these stipulations do not constitute agreement by either party as to the relevance or legal import of any of any of the statements herein to the issues raised in this litigation. When a child is born in a hospital or other birth facility, the facility initiates the process of issuing a birth certificate by obtaining information about the child and the birth parents. In addition, the facility may abstract medical data from its records either electronically or through a written worksheet of its own design. 2. A suggested worksheet is provided to the hospital or other birth facility by the

Ohio Department of Health (ODH) to be completed by the mother of the child, the father of

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the child or other person providing information. A copy of the suggested worksheet is attached as A-1. The hospital or birth facility may utilize the suggested worksheet or a worksheet of its own creation for obtaining the requisite information. 3. The suggested worksheet states in part: The information you provide below will

be used to create your childs birth certificate as well as other public health purposes. The birth certificate is a document that will be used for important purposes including proving your childs age, citizenship and parentage. The birth certificate will be used by your child throughout his/her life. 4. Question number 18 of the suggested worksheet asks the mother to answer:

Were you married at the time you conceived this child, at the time of birth, or within the last 300 days prior to the birth of your child? 5. The hospital or birth facility where the child is born fills out a separate worksheet

or electronically collects information on the health of the birth mother and the infant that is used by health and medical researchers but does not appear on the birth certificate. 6. The hospital or birth facility then enters the information gathered into the

Integrated Perinatal Health Information System (IPHIS), a database maintained by ODH which collects pregnancy and newborn data. Two flow sheets (pages 4 and 5 of IPHIS) describing the typical sequence of steps leading to a birth certificate are attached as A-2 and A -3. 7. If the record is complete, IPHIS generates a printed birth certificate which lists the

name of the child, the date and place of birth, the sex, the mothers name and birthplace, and the fathers name and birthplace. A state file number is also assigned. A sample record is attached as A-4.

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8.

The printed birth certificate generated by IPHIS is signed by a physician in

attendance at the birth. 9. O.R.C. 3705.09 (A) states: A birth certificate for each live birth in this section

shall be filed in the registration district in which it occurs within ten days after such birth and shall be registered if it has been completed and filed in accordance with this section. 10. The local registrar verifies that the birth certificate is complete. If it is complete,

the registrar signs the birth certificate and the original is filed with ODH, Office of Vital Statistics. completed. 11. If a married woman in an opposite-sex marriage refuses to provide her husbands If not, the birth certificate is rejected and returned to the birth facility to be

name as the father of her child, the birth certificate is signed and forwarded to the local registrar where it is placed in a hold status until the parent either completes the fathers information or provides court documentation to exclude the husband from being listed on the certificate. A certificate in a hold status is not filed or registered; no legal copy can be issued. 12. For purposes of Ohios statutory scheme regarding vital statistics, relevant

definitions for which are set forth in O.R.C. 3705.01, a birth certificate is filed when present[ed] for registration by the office of vital statistics. O.R.C. 3705.01 (P).

[A]cceptance by the office of vital statistics and the incorporation of [the birth certificate] into its official records constitutes registration of the birth certificate. O.R.C. 3705.01 (Q). [A] birth certificate that has been registered with the office of vital statistics is a birth record as defined in O.R.C. 3705.01 (R). 13. As one part of Ohios statutory scheme governing parentage, O.R.C. 3111.03

sets forth specified circumstances under which [a] man is presumed to be the natural father of a

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child, including when [t]he man and the childs mother are or have been married to each other, and the child is born during the marriage or is born within three hundred days after the marriage is terminated by death, annulment, divorce, or dissolution or after the man and the childs mother separate pursuant to a separation agreement. O.R.C. 3111.03 (A) (1). 14. As one part of Ohios statutory scheme governing parentage, O.R.C. 3111.95

(A) states: If a married woman is the subject of a non-spousal artificial insemination and if her husband consented to the artificial insemination, the husband shall be treated in law and regarded as the natural father of a child conceived as a result of the artificial insemination, and a child so conceived shall be treated in law and regarded as the natural child of the husband. 15. As one part of Ohios statutory scheme governing adoption, O.R.C. 3107.19

provides that if a child adopted in Ohio was born in Ohio, the Ohio probate court of the county where the adoption takes place shall forward specified information to the Department of Health, including a copy of the adopted persons certificate of adoption, within thirty days after an adoption decree becomes final. 16. When the adoption of a child whose birth occurred in this state is decreed by a

court in another state and when the department of health has received, from the court that decreed the adoption, an official communication containing information similar to that contained in the certificate of adoption for adoptions decreed in this state, the procedures for issuance of a new or foreign birth record after adoption set forth in R.C. 3705.12 (A) apply just as if the adoption had taken place in this state. R.C. 3705.12(B). 17. As part of Ohios statutory scheme governing vital statistics, O.R.C. 3705.12 (A)

(1) states: Upon receipt of the items sent by a probate court pursuant to section 3107.19 of the Revised Code concerning the adoption of a child born in this state whose adoption was decreed

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on or after January 1, 1964, the department of health shall issue, unless otherwise requested by the adoptive parents, a new birth record using the childs adopted name and the names of and data concerning the adoptive parents. 18. O.R.C. 3705.12 (A) (1) further states: The new birth record shall have the

same overall appearance as the record that would have been issued under section 3705.09 of the Revised Code if the adopted child had been born to the adoptive parents. O.R.C. 3705.12 (A) (2) states: Upon the issuance of the new birth record, the original birth record shall cease to be a public record. The index references to the original birth record, including references that were not a public record under this section as it existed prior to the effective date of this amendment, are a public record under section 149.43 of the Revised Code. The department shall place the original birth record and the items sent by the probate court pursuant to section 3107.19 of the Revised Code in an adoption file and seal the file. The contents of the adoption file shall not be open to inspection, be copied, or be available for copying, except [as specified in O.R.C. 3705.12 (A)(2)(a)-(g)]. O.R.C. 3705.12 (A) (3) mandates that the probate court shall

retain permanently in the file of the adoption proceedings information that is necessary to enable the court to identify both the childs original birth record and the childs new birth record. AGREED:

Lisa T. Meeks #0062074 Newman & Meeks Co., LPA 215 E. Ninth Street, Suite 650 Cincinnati, OH 45202 Phone: 513.639.7000 Fax: 513.639.7011 lisameeks@newman-meeks.com Ellen Essig 105 East Fourth Street Suite 400

/s/ Alphonse A. Gerhardstein Alphonse A. Gerhardstein # 0032053 Trial Attorney for Plaintiffs Jennifer L. Branch #0038893 Jacklyn Gonzales Martin #0090242 Gerhardstein & Branch Co. LPA 432 Walnut Street, Suite 400 Cincinnati, Ohio 45202 Phone: 513.621.9100 Fax: 513. 345-5543 5

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Cincinnati, OH 45202 Phone: 513.698.9345 Fax: 513.345.2588 ee@kgnlaw.com Attorneys for Plaintiffs

agerhardstein@gbfirm.com jbranch@gbfirm.com jgmartin@gbfirm.com Attorneys for Plaintiffs Susan L. Sommer M. Currey Cook Lambda Legal Defense & Education Fund, Inc. 120 Wall Street, 19th Floor New York, New York 10005 Phone: 212.809.8585 Fax: 212.809.0055 ssommer@lambdalegal.org ccook@lambdalegal.org Attorneys for Plaintiffs admitted Pro Hac Vice

Paul D. Castillo #0081813 Lambda Legal Defense & Education Fund, Inc. 3500 Oak Lawn Avenue, Suite 500 Dallas, Texas 75219 Phone: 214.219.8585 Fax: 214.219.4455 Pcastillo@lambdalegal.org Attorneys for Plaintiffs /s/ Aaron Herzig /s/ Ryan L. Richardson AARON HERZIG (0079371) RYAN L. RICHARDSON (00090382)* Deputy City Solicitor *Lead and Trial Counsel Room 214, City Hall BRIDGET E. COONTZ (0072919) 801 Plum Street ZACHERY P. KELLER (0086930) Cincinnati, Ohio 45202 Assistant Attorneys General (513) 352-3320 Constitutional Offices Section FAX: (513) 352-1515 30 East Broad Street, 16th Floor aaron.herzig@cincinnati-oh.gov Columbus, Ohio 43215 Tel: (614) 466-2872; Fax: (614) 728-7592 Trial Counsel for Defendant ryan.richardson@ohioattorneygeneral.gov Camille Jones, M.D. bridget.coontz@ohioattorneygeneral.gov zachery.keller@ohioattorneygeneral.gov Counsel for Theodore E. Wymyslo, M.D., Director of the Ohio Department of Health

Case: 1:14-cv-00129-TSB Doc #: 19-1 Filed: 02/28/14 Page: 1 of 6 PAGEID #: 609 For hospital use only:
Mothers Medical Record # Mothers Name Newborns Date of Birth Newborns Medical Record # __________________________ __________________________ __________________________ __________________________

Mothers Worksheet for Childs Birth

The information you provide below will be used to create your childs birth certificate as well as other public health purposes. The birth certificate is a document that will be used for important purposes including proving your childs age, citizenship and parentage. The birth certificate will be used by your child throughout his/her life. It is very important that you provide complete and accurate information to all of the questions. In addition, this information is used by health and medical researchers to study and improve the health of mothers and newborn infants. Items such as education, race, and smoking will be used for studies but will not appear on copies of your childs birth certificate (unless requested by a person listed in the certificate). State of Ohio law provides protection against the unauthorized release of health and medical information, but mandates the release of identifying information from the birth certificate under public record law.

Please print clearly. Newborns Sex Male Female single birth Undetermined multiple birth (twins, triplets, etc.) D (fourth born) Newborns Date of Birth____________________ Was this delivery a: If multiple, this worksheet is for baby: A (first born) B (second born) C (third born)

1. What will be your babys legal name (as it should appear on the birth certificate)? Special accents, excluding numbers, are allowed on your childs name. Please note that other government agencies (such as social security), will not be able to accommodate these special characters when reprinting your childs name.
______________________________ First ______________________________ Middle ______________________________ Last ____________ Suffix

Name not yet chosen 2. What is your current legal name?

______________________________ First ______________________________ Middle ______________________________ Last ____________ Suffix

3. What was your last name prior to your first marriage (maiden name, surname, family name, or your name as it appears on your birth certificate)?
______________________________ Maiden Name/Surname

4. Where do you usually live - that is - where is your household/residence located? United States or Canada Outside of the United States* *If NOT United States or Canada, country: ________________________ [Please go to Question #6] If United States or Canada, please list your state, Province, or U.S. territory: __________________ County (if applicable): __________________________________ City, Town, or Township: __________________________________________ Street address: _______________________________________ Apartment Number: ______________ Zip Code/Postal Code: _____________
(HEA 0137 Rev. 12/13)

Exhibit A-1

Page 1 of 6

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5. Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?

Yes

No

Dont know

6. What is your mailing address? This is the address where your childs Social Security card will be sent if requested.

Same as residence [Go to Question #7]

Complete number and street: _______________________________________________ Apartment Number: __________ P. O. Box.___________ City, Town, or Location: __________________________ State: __________________ Zip Code or Postal Code: ___________
(or U.S. Territory, Canadian Province)

If not in the United States, country __________________________________________ 7. What is the telephone number that someone can contact you at? Primary Phone Number: _________ _________ _____________ Area Code Phone Number work phone number Secondary Phone Number: _________ _________ _____________ cell phone number Area Code Phone Number relative I have no phone number where I can be contacted. 8. What is your date of birth? (Example: 03 - 2 4 - 1977 for March 24, 1977)
Month Day Unknown Year

9. In what State, U.S. territory, or foreign country were you born? Please specify one of the following: If born in the United States or US Territory (i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Northern or the Marianas), please list the state or U.S. Territory: _______________________ or , If born outside of the United States, please list the foreign country _____________________ Unknown

(HEA 0137 Rev. 12/13)

Page 2 of 6

Case: 1:14-cv-00129-TSB Doc #: 19-1 Filed: 02/28/14 Page: 3 of 6 PAGEID #: 611 10. What is the highest level of schooling that you will have completed at the time of delivery? 1.8th grade or less th 2. No 12th diploma, grade 9 3. 4. 5. (e.g. Associate AA, AS) s degree 6. e.g. Bachelor BA, AB, BS) s degree ( High 7. school graduate or e.g. GED Master MA, MS, completed MEng, s degree MEd, ( MSW, MBA) Some college 8. credit, but no Doctorate degree ( Professional degree (e.g. MD, DDS) e.g. PhD, EdD) or 9. Unknown

11. Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the No box. If Spanish/Hispanic/Latina, check the appropriate box or boxes. No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (e.g. Spaniard, Salvadoran, Dominican, Colombian) (specify)_____________________ Unknown 12. What is your race? (Please check one or more races to indicate what you consider yourself to be.) White Black or African American American Indian or Alaska Native (name of enrolled or principal tribe) _________________________________ Asian Indian (e.g. Cambodian, Vietnamese, Laotian) Chinese Filipino Japanese Korean Vietnamese Other Asian (specify) ________________________ Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander (specify) ________________________ Other (specify) _________________________________ Unknown 13. Did you receive WIC (Women, Infants & Children) food for yourself because you were pregnant with this child? No Yes Unknown

14. What is your height? ________feet _______ inches Unknown

15. What was your pre-pregnancy weight, that is, your weight before you became pregnant with this child?
(HEA 0137 Rev. 12/13) Page 3 of 6

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__________ lbs

Unknown

16. How many cigarettes OR packs of cigarettes did you smoke on a typical day during each of the following time periods? If you NEVER smoked, enter zero (0) for # of cigarettes for each time period. Three months before pregnancy First three months of pregnancy Second three months of pregnancy Third trimester of pregnancy # of cigarettes # of packs OR OR OR OR

17. How many alcoholic beverages did you consume on a typical day during each of the following time periods? If you NEVER drank, enter zero (0) for # of drinks for each time period. # of drinks Three months before pregnancy First three months of pregnancy Second three months of pregnancy Third trimester of pregnancy 18. Were you married at the time you conceived this child, at the time of birth, or within the last 300 days prior to the birth of your child? 1. Yes [Please go to Question #19] 2. Yes, but I can provide legal documentation (court order, separation agreement, journal entry, divorce decree) stating my husband is not to be listed as the father of my child. [Please go to Question #18B] This documentation is subject to approval by the Ohio Department of Health, Office of Vital Statistics. 3. Yes, but I refuse to provide my husbands name as the father of my child*[Please go to Question #25]
*Please note that under state of Ohio law, by refusing to complete your husbands information, your childs birth certificate will not be registered as a legal document and your childs birth information will not be electronically transmitted for a Social Security number to be issued.

4. No [Please go to Question #18B] 18B Has a paternity acknowledgment been completed? (That is, have you and the father signed an Affidavit of Paternity form in which the father accepted legal responsibility for the child?) Yes [Please go to Question #19] No [Please go to Question #25] If you were not married, or if an Affidavit of Paternity form has not been completed, information about the father cannot be included on the birth certificate. 19. What is the current legal name of your childs father that is his name as it appears on his birth certificate?
______________________________ First ______________________________ Middle ______________________________ Last ____________ Suffix

20. What is the fathers date of birth? (Example: 03 - 2 4 - 1977 for March 24, 1977) Unknown
Month Day Year

21. In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
(HEA 0137 Rev. 12/13) Page 4 of 6

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If born in the United States or US Territory (i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Northern or the Marianas), please list the state or U.S. Territory: _______________________ or , If born outside of the United States, please list the foreign country _____________________ Unknown 22. What is the highest level of schooling that the father will have completed at the time of delivery? 1. 2. 3. 4.
th

grade 8 or less th diploma, No 12th grade 9

5. e.g. Associate AA, AS) s degree ( 6. e.g. Bachelor BA, AB, BS) s degree ( High 7. school graduate Master degree or (e.g. GED sMA, MS, completed MEng, MEd, MSW, MBA) Some college 8. credit, but e.g. no Doctorate PhD, degree EdD) or ( Professional degree (e.g. MD, DDS) 9. Unknown

23. Is the father Spanish/Hispanic/Latino? If not Spanish/Hispanic/Latino, check the No box. If Spanish/Hispanic/Latino, check the appropriate box or boxes. No, not Spanish/Hispanic/Latino Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (e.g. Spaniard, Salvadoran, Dominican, Colombian) (specify)_____________________ Unknown 24. What is the fathers race? Please check one or more races to indicate what he considers himself to be. White Black or African American American Indian or Alaska Native (name of enrolled or principal tribe) _________________________________ Asian Indian (e.g. Cambodian, Vietnamese, Laotian) Chinese Filipino Japanese Korean Vietnamese Other Asian (specify) ________________________ Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander (specify) ________________________ Other (specify) _________________________________ Unknown 25. Furnishing parent(s) Social Security Number(s) (SSNs) is required by Federal Law, 42 USC 405(c)(section 205(c) of the Social Security Act). The number(s) will be made available to the (State Social Services
(HEA 0137 Rev. 12/13) Page 5 of 6

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Agency) to assist with child support enforcement activities and to the Internal Revenue Service for the purpose of determining Earned Income Tax Credit compliance. The SSN is also collected as authorized by Ohio law to be use for public health purposes. 25a. What is your Social Security Number? IF you do not have a Social Security Number, please mark None. None 25b. What is the fathers Social Security Number? If you are not married AND an Acknowledgement of Paternity has not been completed, please leave this item blank. If the father does not have a Social Security Number, please mark None. None 26a. Do you want a Social Security Number issued for your child? Yes [Please sign request below] No [Go to Question #27] 26b. I request that the Social Security Administration assign a Social Security number to the child named on this form and authorize the State to provide the Social Security Administration with the information from this form which is needed to assign a number. I understand that if I was married at any time during the 300 days prior to the birth or my child; and I refuse to list my husband as the father; and do not have legal documentation (court order, separation agreement, journal entry, divorce decree) stating that my husband is not to be listed as the father of my child, my childs birth information will not be electronically transmitted to receive a Social Security number. Signature of mother ________________________________________Date _________ 27. What is the name and relationship of the person providing information for this worksheet? Mother of the child Father of the child Other, please specify ______________________________________ 28. What is your primary language that is what language do you feel the most comfortable speaking? - English - Spanish - Somali Other, please specify ______________________________________

Please return your completed birth certificate worksheet to: XXXXXXXXXXXXXXXXXXXXXXXXXX

(HEA 0137 Rev. 12/13)

Page 6 of 6

Ohio Department of Health Vital Statistics Birth Facility IPHIS Easy-Step Handbook

IPHIS Work Process Flow:

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Proprietary and confidential information for the Ohio Department of Health, Office of Vital Statistics

Revised: 09/11/07

Page 4 of 33

Exhibit A-2

Ohio Department of Health Vital Statistics Birth Facility IPHIS Easy-Step Handbook

IPHIS Work Process Flow Facility Detail:

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Proprietary and confidential information for the Ohio Department of Health, Office of Vital Statistics

Revised: 09/11/07

Page 5 of 33

Exhibit A-3

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