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Consent for Treatment of an Adolescent: Unaccompanied Adolescents

March 4, 2019

Not all adolescent consent issues involve sensitive treatment scenarios. As adolescent patients become drivers, they are more likely to present for treatment without a parent. Although a patient may seem mature enough to consent for general treatment, a parent’s consent is still required. Consider the following case.

The following case study and the additional two “consent for treatment” cases linked below indicate the different kinds of adolescent consent issues that arise in various practice environments.

Case File

A dermatologist called Risk Management after a 17-year-old patient arrived without a parent for a six-month acne follow-up. The patient’s mother was contacted, and she consented to the treatment over the telephone. Since her child was able to drive himself to appointments, and she felt he was competent to consent to his own acne treatment, she asked if her son could continue acne treatment without her involvement. The dermatologist wanted to know how to accommodate her request and whether it was appropriate to get her consent over the telephone.

Discussion

When an unaccompanied adolescent patient presents for non-urgent treatment, consent by a parent is necessary. However, because the parent and patient had an established relationship with the dermatologist, telephone consent from the parent for this simple follow-up appointment was sufficient. If during the appointment the dermatologist decided treatment was necessary that required informed consent (i.e., the mother needed to consider risks, benefits and alternatives to determine whether she wanted her son to undergo the treatment), she would need to call the mother back to obtain a full informed consent. As for the patient returning regularly without a parent, the dermatologist could obtain consent from the mother for the series of follow-ups, if that series of appointments was not expected to involve new risks, benefits, and alternatives. However, if any of the future appointments involved treatment that fell outside of the anticipated follow-up services (e.g., excision of a mole), the dermatologist would have to obtain separate consent to treat and, if necessary, informed consent.

Medical Liability Risk Management Recommendations

Prior to obtaining consent for the treatment of an unaccompanied minor over the telephone or when obtaining consent for a series of treatments, it is important to establish a relationship with the patient and their parent(s). Parents should be told up front whether and under which circumstances their unaccompanied adolescent child will be treated. This can be accomplished by developing a written policy statement or handout that is provided to all parents whose children are approaching adolescence. For the treatment of unaccompanied minors, consider including the following issues:

Telephone Consent

  • Verify the authenticity of the parent/guardian giving consent.
  • If possible, have the call witnessed by a second responsible person.
  • Document in the minor’s medical record who consented, who obtained the consent, and who witnessed it.
  • Document that the consent was obtained by telephone.

Consent for a Series of Treatments

  • Clarify with the parents what services may and may not be performed without explicit consent.
  • Do not provide treatment outside of the scope of the agreed upon series without obtaining additional consent from the parent.
    • Err on the side of caution.

Although some parents may expect it, only accommodate parents’ requests to treat unaccompanied adolescents to your level of comfort and capabilities. Policies and procedures should be created and consistently adhered to throughout the practice to avoid confusion.

This content from Claims Rx

Filed under: Patient Privacy, Confidentiality & HIPAA, Pediatrics & Family Practice, Physician, Case Study

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