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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF OHIO

WESTERN DIVISION

BRITTANI HENRY, et al.,

Plaintiffs,

vs.

THEODORE E.

WYMYSLO, M.D., et al.,

Defendants.

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Case No. 1:14-cv-129

Judge: Timothy S. Black

STIPULATIONS

1. The parties hereby stipulate to the facts set forth below describing in part thecurrent 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 theOhio 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 willbe 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 worksheetor 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 theIntegrated 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 thename 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 inattendance at the birth.

9. O.R.C. 3705.09 (A) states: A birth certificate for each live birth in this sectionshall 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. If not, the birth certificate is rejected and returned to the birth facility to be

completed.

11. If a married woman in an opposite-sex marriage refuses to provide her husbandsname 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, relevantdefinitions 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. 3111.03sets 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. 3107.19provides 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 acourt 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 thesame 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 650Cincinnati, OH 45202

Phone: 513.639.7000

Fax: [email protected]

Ellen Essig105 East Fourth Street

Suite 400

/s/ Alphonse A. Gerhardstein

Alphonse A. Gerhardstein # 0032053

Trial Attorney for Plaintiffs

Jennifer L. Branch #0038893

Jacklyn Gonzales Martin #0090242Gerhardstein & Branch Co. LPA

432 Walnut Street, Suite 400

Cincinnati, Ohio 45202Phone: 513.621.9100

Fax: 513. 345-5543


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Cincinnati, OH 45202

Phone: 513.698.9345Fax: 513.345.2588

[email protected]

Attorneys for Plaintiffs

[email protected]

[email protected]@gbfirm.com

Attorneys for Plaintiffs

Susan L. SommerM. Currey Cook

Lambda Legal Defense & Education Fund,Inc.

120 Wall Street, 19th

Floor

New York, New York 10005Phone: 212.809.8585

Fax: 212.809.0055

[email protected]

[email protected] for Plaintiffs admitted Pro Hac Vice

Paul D. Castillo #0081813Lambda Legal Defense & Education Fund,

Inc.

3500 Oak Lawn Avenue, Suite 500Dallas, Texas 75219

Phone: 214.219.8585

Fax: 214.219.4455

[email protected] for Plaintiffs

/s/ Ryan L. Richardson

RYAN L. RICHARDSON (00090382)**Lead and Trial Counsel

BRIDGET E. COONTZ (0072919)ZACHERY P. KELLER (0086930)

Assistant Attorneys General

Constitutional Offices Section30 East Broad Street, 16th Floor

Columbus, Ohio 43215

Tel: (614) 466-2872; Fax: (614) [email protected]

[email protected]

[email protected] for Theodore E. Wymyslo, M.D.,

Director of the Ohio Department of

Health

/s/ Aaron Herzig

AARON HERZIG (0079371)Deputy City Solicitor

Room 214, City Hall

801 Plum StreetCincinnati, Ohio 45202(513) 352-3320

FAX: (513) [email protected]

Trial Counsel for Defendant

Camille Jones, M.D.

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

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(HEA 0137 Rev. 12/13) Page 2

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 ifrequested.

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 Numberwork 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 Year

Unknown

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 orUS Territory (i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Northern or thMarianas), please list the state or U.S. Territory: _______________________

or,

If born outside of the United States, please list the foreign country _____________________

Unknown

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10.What is the highest level of schooling that you will have completed at the time of delivery?

1.8thgrade or less 5. Associates degree(e.g. AA, AS)2. No diploma, 9th 12thgrade 6. Bachelors degree (e.g. BA, AB, BS)3. High school graduate or GED completed7. Masters degree (e.g. MA, MS, MEng, MEd, MSW, MBA)4. Some college credit, but no degree8. Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DD

9.Unknown

11.Are you Spanish/Hispanic/Latina? If not Spanish/Hispanic/Latina, check the No box. IfSpanish/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?


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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 followingtime periods? If you NEVER smoked, enter zero (0) for # of cigarettes for each time period.

# of cigarettes # of packsThree months before pregnancy ORFirst three months of pregnancy ORSecond three months of pregnancy OR

Third trimester of pregnancy OR

17. How many alcoholic beverages did you consume on a typical day during each of the following timeperiods? If you NEVER drank, enter zero (0) for # of drinks for each time period.

# of drinksThree months before pregnancy

First three months of pregnancy

Second three months of pregnancyThird 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 prioto 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 wilbe 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]

18BHas a paternity acknowledgment been completed? (That is, have you and the father signed an Affidavit of Paternity formwhich 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 n

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 certifica

______________________________ ______________________________ ______________________________ ___________First Middle Last Suffix

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

UnknownMonth Day Year

21. In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:


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If born in the United States orUS Territory (i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Northern or thMarianas), 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. 8thgrade or less 5. Associates degree (e.g. AA, AS)2. No diploma, 9th 12thgrade 6. Bachelors degree (e.g. BA, AB, BS)3. High school graduate or GED completed7. Mastersdegree (e.g. MA, MS, MEng, MEd, MSW, MBA)4. Some college credit, but no degree8. Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DD

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.

WhiteBlack 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 HawaiianGuamanian 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)(sectio

205(c) of the Social Security Act). The number(s) will be made available to the (State Social Services


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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

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 SecurNumber, 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 fromthis 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 refuslist 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 childsbirth 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 childOther, please specify ______________________________________

28. What is your primary language that is what language do you feel the most comfortable speaking?

- English - Spanish - SomaliOther, please specify ______________________________________

Please return your completed birth certificate worksheet to:XXXXXXXXXXXXXXXXXXXXXXXXXX


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