As a parent of a teenager, I welcomed the day my child was old enough to do things independently. This has included freeing me up from routine orthodontist trips (just a bike ride away), and even a quick visit to the pediatrician for minor issues. The providers that see my child have never questioned his solo visits, and I know I am not alone in allowing my child these limited freedoms.
Earlier this week, I received a call from a client who was asked to provide services to a teenager attending a local boarding school. The parent wanted the child to be seen and indicated that he would be available by telephone, but that the child would come on hisown by train. Neither the parent nor the minor had an issue with the solo visit, but the provider wondered whether this was acceptable and what type of precautions needed to be taken.
In thinking about my client’s dilemma from a legal standpoint, I was concerned about the responsibility he, as a provider, took in seeing a minor patient without an adult present:
• Is documentation of parental consent needed to see the patient or has the patient or guardian given adequate consent by calling the doctor’s office to make the appointment?
• What happens if the patient runs into a problem traveling to the physician’s office or even while at the office?
• What if the initial exam reveals something that is an issue or requires additional testing? Is there consent to follow up/order additional testing during the patient visit?
• What risk does the provider have in not following through with that which he feels is medically necessary without the parent present?
With all of these questions, the best advice is to simply be conservative about the procedures that are followed in your office regarding unaccompanied minors. Consider the following:
1. Question whether the minor patient needs to be seen without an adult present. Can the visit be delayed or rescheduled so that an adult can be present?
2. Have the parent/guardian sign a consent form that allows the provider to see the patient. The only time this is likely not needed is when immediate or emergency intervention is required. However, in routine situations it should always be obtained. Make sure the consent specifies exactly what it covers. Additional procedures/testing may or may not require the parent provide additional consent, depending on the consent form being used.
3. Although in this blog I am largely referring to routine medical/dental services, be aware of those types of items and services that may require you to NOT contact a parent, depending on your state (HIV testing, abortion, etc.).
4. Make sure the consent you obtain is from the correct parent — it must be the parent legally authorized to provide consent, which is not always the one paying the fees.
5. Make sure all parental contact information is up to date in your file. If you do see a minor patient without her parent, you should be able to contact the parents as needed and all efforts should be well documented.
Although the age of majority varies from jurisdiction to jurisdiction, as well as the law concerning when a minor is deemed emancipated, it is always a good idea to know what your state requires so that you can ensure your full compliance.
While meeting the needs of your patients and their parents is always desirable from a customer service standpoint, providers should be focused on protecting their practice from possible liability. With a proper policy on the treatment of unaccompanied minors, and the availability of appropriate forms for patients, there is no reason that a certain amount of independence cannot be offered to minor patients.
Ericka L. Adler has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.