620: Adolescent Rights

Must the physician inform parents or a legal guardian prior to giving care and treatment for HIV/AIDs to a minor?

A minor may be examined and treated without parental consent only if the physician determines that notification to the parents or guardian of the minor will result in denial of such treatment or that the minor will not seek or pursue treatment as a result of notification

A public health official may inform or warn partners of an individual that they may have been exposed to HIV under the following conditions:

1) The public health official reasonably believes there is a significant risk of transmission to the partner 2) The official has counseled the protected individual regarding the need to notify the partner and the officer reasonably believes the protected individual will not inform the partner 3) The official has informed the protected individual of such officers intent to make such disclosure and may also warn or inform partner at the request of a protected individual

For the purposes of inpatient mental health treatment, what age is considered a minor or child?

Any person less than 16 years of age

Is informed consent from guardian required prior to routine or non-emergent examination of a minor?

CT law does not require informed consent for these situation although minors in CT do not have the legal capacity to provide informed consent for procedures that ordinarily require informed consent.

Who is liable for the cost of "unconsented" drug or alcohol (EtOH) treatment of a minor?

Under CT statutes, the minor is liable

Statutory Rape

defined by statute in CT and consists of various separate criminal offenses classified under " sexual assault" category: Sexual Assault in the 1st, 2nd and 4th degree

At what age is a minor considered an "adult voluntary patient"?

16 years of age or older

How does a healthcare facility/clinic know that a minor is emancipated?

Minor should present their emancipation order, duly signed by a judge of the superior or probate court. The order is simply a piece of paper from the appropriate court, signed by a judge that verifies the emancipation order.

What are the responsibilities of the health care provider upon communicating HIV/AIDS test results to minors?

The provider must work toward the goal of involving the minors guardians in the decision to seek and in the ongoing provision of medical treatment and the provider must counsel the minor about the need to notify partners and if necessary provide assistance in notifying partners at the time of communicating the test results

Does CT state law coincide with Federal law (PHSA) regarding drug and EtOH treatment of a minor?

YESSSS

Does the minors consent need to be in writing?

Yes

Parental Conset

the consent of a parent or legal guardian

Can a grandparent, aunt/uncle or other kinship caretaker provide informed consent?

A kinship caretaker does not possess legal status to provide informed consent for the minor in their charge unless there is an order from a court of appropriate jurisdiction (i.e. Probate court). Informed consent must come from legally responsible caretaker (parent/legal guardian, DCF).

Can a minor be hospitalized for inpatient mental health treatment without parental consent?

A minor 14 or 15 years of age may be admitted to a hospital for the diagnosis and treatment of a mental health disorder if the minor provides written consent. Parents or closest relative must be notified within 5 days of admission.

How does a minor become emancipated?

A minor 16 or 17 can petition the Juvenile or Probate court for an emancipation order. A court may emancipate a minor if: the minor has been married, the minor actively serves in the US armed forces, the minor willingly lives away from home with or without parental consent and manages his own finances or the court determines for good cause that emancipation is in the best interest of the minor

Under what circumstances is a minor considered emancipated under common law?

A minor is considered emancipated if the youth enters a living arrangement that is inconsistent with his being a subordinate situation in the the parents immediate family.

What are medical consequences if a minor is emancipated?

A minor may consent to medical, dental or psychiatric care without parent consent, knowledge or liability

Where one parent has legal custody of a child is the non-custodial parent entitled to obtain the child's medical records from a provider?

A non-custodial parent retains the statutory right to obtain his child's medical records absent an order from the superior court. A non-custodial parent whose parental rights were terminated by the Superior Court would not be entitled to obtain these records.

What recourse can a patient take against a psychiatrist or psychologist for violating privilege?

A patient may petition the superior court for appropriate relief including a temporary and permanent injunction and/or damages

Must the physician warn or inform the partner of a minor who tests positive for HIV/AIDS?

A physician may warn or inform a known partner if both the partner and the "protected individual" (the minor who tests positive) under the physicians care and the physician reasonably believes there is a significant risk of transmission to the partner the physician has counseled the protected individual and he reasonably believes he will not inform the partner then the physician informs the protected individual that he intends to inform the partner

What is the liability for conducting a drug or EtOH screening without the minor's permission?

CT law is silent with respect to this however drug tests obtained in the course of drug treatment are protect by Federal/State law and must be kept confidential unless exceptions apply; Providers should be aware that it could be infringement of patient's rights and constitute battery

Must a hospital/provider obtain informed consent from guardian before performing medical or surgical procedure/treatment?

Common law states that parental consent is necessary for medical or surgical treatment that requires informed consent (except in cases with explicit statutory exception such as with Abortion, HIV/AIDS, STD testing/treatment, treatment of drug/EtOH abuse, hospitalization for mental disorder, 6 IOP visits or if minor is emancipated). The only other exception to this rule is during an emergency when it is impractical to obtain parental consent or any delay would unduly endanger the patients life. In this situations, parental consent is implied by law. AMA code of ethics states that a competent minor can consent to medical care without parental consent. This creates tension in the law and is an unresolved issue under CT Law. The general rule is that anyone under the age of majority (18 in CT) does not possess legal capacity to consent .

When must a physician abide by PHSA vs state law?

Federal law only applies to providers or facilities that are "federally assisted"

HIPAA

Health Insurance Portability and Accountability Act

What is a patient's rights to emergency contraception if she is a victim of sexual assault?

Hospital emergency departments must provide access to emergency contraception on site when requested by a victim of sexual assault. This law generated significant controversy with Catholic hospitals but have agreed.

What must be reported to DCF by the mandated reporter?

If in the ordinary course of employment there is reasonable cause to suspect or believe that a child has been abused or neglected or is at imminent risk of serious harm are required to report the abuse/neglect/risk of imminent harm to DCF or law enforcement officials

At what age is it required to report sexual activity of a minor?

Mandated reporters must notify DCF or police if a child under the age of 13 is involved in sexual intercourse or activities. Thus, the use of birth control by someone under the age of 13 would mandate a report. However, confidential care and treatment of a minor in a protected area (i.e. birth control) protects minor from report to parents/guardians.

Can a minor apply for their own health insurance coverage in their own name?

Minors whether emancipated or not may apply for and receive medical insurance from the state under the HUSKY A plan (medicaid) if they are under nineteen years of age. Minors whose income exceeds the eligibility requirement for HUSKY A coverage (over 185% of the federal poverty rate) must be emancipated in order to qualify for coverage under the HUSKY B program

Can a physician tell the parents after treatment has started?

No

Does a minor need permission from guardian to obtain pregnancy test?

No as it is considered a routine medical procedure that does not require informed consent or notification of test

Does a minor have a right to obtain a medical record?

No specific statute but generally implied yes but not an absolute right if provider feels it would be detrimental the provider may with hold and the patient can petition the superior court for an order

Does a minor need parental consent to undergo a physical exam including a pap smear?

No, CT law does not require parental notification for minors who wish to undergo an examination (including gynecological) or to obtain a pap smear

Can a parent be told his child is receiving drug/EtOH treatment?

No, a parent cannot be told without the minors consent

Must parental consent be obtained for minor to receive birth control?

No, parental consent or notification are not required to obtain contraceptives

Must a healthcare provider obtain a parental consent to examine or treat a minor for a STD?

No, the consultation, examination and treatment of a minor is confidential and must not be divulged to the minor's parents or guardians including sending of a bill to anyone other than minor who will be liable for the costs. The provider is required to report any disease on the health commissioners list of reportable disease to the DPH within 12 hours after recognition of the disease and to the town health director

Does it matter if the minor victim lied about his age?

No, the statute does not provide a defense to an actor who claims deception by a minor into having consensual sexual intercourse

Is a 16 or 17 year old who signs out of DCF care emancipated?

No. Absent a valid emancipation order a 16/17 year old who leaves DCF custody is not an emancipated minor under state law

Must a minor obtain parental consent for the disbursement of emergency contraception (i.e. the morning after pill)?

No. Parental consent is not required for the disbursement of emergency contraception. However, a minor requires a prescription to obtain emergency contraception from a pharmacy. Once the minor turns eighteen, the contraception may be obtained OTC without a prescription.

Must minors seek parental consent to receive HIV/AIDS test?

Nope

Must a physician obtain the informed consent of a parent prior to terminating the pregnancy of a minor?

Parental consent is not required prior to performance of an abortion on a minor (person less than 16 years of age)

"Voluntary Patient"

Patient under 16 with parental consent or minor over 16 without parental consent

Protected Confidential Areas

Reproductive freedom and confidentiality (reproductive rights, birth control)

What if the minor discloses that he was raped?

Sexual assault is defined by being forced to engage in sexual relations against his/her will. IF the minor discloses that he was sexually assaulted or a sexual relationship was the result a parent's neglect this was a reportable offense to DCF under the mandated reporting laws governing child abuse

If the minor is liable for costs and doesn't pay what happens?

The consequences of unpaid costs remain the responsibility of the minor. An uninformed parent is not liable for treatment costs incurred.

Who receives the lab report after testing?

The lab results must be sent directly to the person who orders the test

Must a guardian be notified if a UTOX is done (i.e. part of physical exam or follow-up for illness)?

The law is silent on this in CT. Physicians carry with them an ethical duty to promote the autonomy of minor patients and thus, should treat the confidentiality of a minor as they would any adult. However, according to the AMA guidelines confidentiality for immature minors may be ethically breached when necessary to enable the parent to make an informed decision about treatment or to avoid serious harm to minor patient

How many mental health sessions can minor receive before parental notification?

The minor can receive six sessions after which time the provider must notify the parent and secure parental consent unless the provider determines the notification would be detrimental to the minors well being. After every six sessions, a re-eval must take place.

How old does a person have to be to obtain birth control?

There is no minimum age any person of any age can obtain birth control in CT without parental consent. However, the duty to report sexual activity to child welfare authorities for minors less than 13 years of age

Would a minor who enrolls in a smoking cessation program be entitled to confidentiality?

This is an open topic certainly a minor is probably entitled to confidentiality in this instance and certainly a provider has an ethical obligation to grant a minor's confidentiality request for treatment

May a minor give consent for participation in a smoking cessation program?

This type of treatment is not defined as confidentially protected under CT law however given the confidentiality under EtoH/SA treatment privacy and confidentiality could be covered under nicotine as an addictive substance

A psychiatrist can disclose privileged communications if:

To another MH facility to which the patient is admitted if the psychiatrist determines that the disclosure is needed to accomplish the objectives of dx or tx; when there is substantial risk of imminent physical injury by the patient to himself or others; in a dispute over fees or claims for service provided to a patient; in the course of an examination made in connection with the application for the appointment of a conservator by the probate court for good cause shown; in civil proceeding in which the patient introduce a mental condition as an element of the claim or defense; to a member of the immediate family or legal representative of the victim of a homicide committed by the patient

May the parents of a minor be billed for consultation, examination and treatment of a minor with HIV/AIDS?

Treatment and billing for services is confidential and cannot be divulged to a minors parents/guardian. If the minor consents the bill may be sent to parents otherwise a minor is personally liable for all costs resulting from treatment

May a minor parent provide informed consent for her child for a procedure or treatment?

Very gray area of the law. Absent a court order or 96 hour hold (placed by DCF or the hospital) the minor parent should be afforded all legal rights and responsibilities of parenthood upon delivery of her child

May a legal guardian consent to medical or surgical treatment?

Yes

May a minor make a decision to carry the pregnancy to term?

Yes

Can a minor sign himself out of a psychiatric hospital?

Yes if she is fourteen or older and does not present harm to self or others in the community

Are there any circumstances under which DCF would be notified?

Yes if the child is 12 years of age or under

Can the hospital provide emergency treatment without parental consent?

Yes if the condition is considered "extremely critical nature" or "to prevent serious harm."

Can a minor give consent for alcohol (EtOH) or drug treatment or rehab?

Yes, a minor does not parental consent for treatment of drug or alcohol dependency

May a minor receive routine gynecological care for pregnancy without parental consent?

Yes, no parental consent is needed for routine examinations. In addition, a minor may receive confidential treatment for delivery and postpartum care.

Neglect:

a child who has been abandoned, a child not properly cared for physically, educationally, emotionally or morally; a child who is permitted to live under conditions or circumstances or associations injurious to his well being

Sexually Transmitted Disease

a venereal disease; any of several contagious diseases such as syphillis, gonorrhea, chylamidia, chancroid, genital warts that is contracted through sexual intercourse

A reportable offense of statutory rape includes:

all instances of consensual sexual activity involving minor 12 or younger must be reported to DCF or police; when a minor older than 12 and younger than 16 engages in consensual activity with a parter 21 or older the act must be reported; NOT if they are more than three years older but under 21

Sexual Assault in the Second Degree

an actor engages in sexual intercourse with another person and the other person is 13 years of age or older but under sixteen years of age and the actor is more than three years older than such person

Privileged Communication

any confidential oral or written communication and record relating to the diagnosis and treatment of a person between such person and treatment provider or between of member of such persons family and treatment provider

Minor

anyone under 18 years of age unless otherwise noted

Mandated Reporter

defined as a health care professional/provider who in his professional capacity has reasonable cause to suspect or believe that a child has been abused/neglected or is at imminent risk of serious harm shall report such abuse/neglect to DCF or police

Consent

in the context of privileged communications as "written consent" by the patient or his authorized representative

Emancipated Minor

is one who is 16 or 17 years of age and has been declared "emancipated" by the court because 1.) the minor is married 2.) the minor actively serves in the US armed forces 3.) the minor willingly lives away from home and manages his own finances without parental consent 4.) court determines "for good cause" that emancipation is in the "best interest" of the minor

Living Will

legal document that states a person's wishes regarding any aspect of health care including with holding or withdrawal of life-support systems. It is a subcategory of "advanced directives" which are written instructions such as a living will or durable power of attorney which are recognized under CT law to express a persons wishes as to health care if the person is unable to communicate treatment decisions.

Informed Consent

medical doctrine whereby medical providers inform patients of the risks and benefits of alternative approaches to treatment and the risks and possible consequences resulting from those approaches. After such an explanation, the provider obtains a signed consent from the patient who acknowledges receipt of the information and an understanding of the risks and benefits of the procedure or treatment. "every human being of adult years and sound mind has a right to determine what shall be done with his own body"

How long does a mandated reporter have to make a report to DCF after discovering abuse/neglect?

no later than 12 hours after discovering the abuse/neglect. within 48 hours of making an oral report, the mandated reporter must submit a written report to DCF

Abuse:

non-accidental physical injury; injury that conflicts with a reported injury; a condition which is the result of maltreatment such as malnutrition, sexual molestation or exploitation deprivation of necessities, emotional maltreatment or cruel punishment

Public Health Services Act (PHSA): Minor Drug/EtOH Treatment Disclosure

restricts access to drug treatment records without the patients consent even a minor patient although the law allows for disclosure to a parent when there is a serious threat to the incompetent minors life or physical well-being and it is determined that this threat can be diminished by disclosure to the parents exempting physicians from federal requirement of obtaining written consent .

A psychiatrist, psychologist, MSW or LMFT can provide mental health treatment without parental consent or notification if:

the consent requirement would cause the minor to reject treatment the treatment is clinically indicated the failure to receive the treatment would be seriously detrimental to the minor's well-being the minor knowingly and voluntarily sought such treatment the provider deems the minor mature enough to participate in treatment productively

Drug Abuse

the use of psychoactive substance for other than medicinal purposes which impairs the physical, mental, emotional or social well being of the user

A psychologist can disclose privileged communications if:

they are made for the purposes of court ordered psychological examination, in a civil proceeding, the psychological condition is an element of the claim or defense; the psychologist determines there is a risk of imminent personal injury to the person or other persons or risk of imminent injury to the property of others or the communication of child abuse, elder abuse or abuse of an individual who is disabled or incompetent is known or in good faith suspected

Sexual Assault in the Fourth Degree

when a person 1.) intentionally subjects a person under 13 years old and more than two years younger to sexual contact or 2.) intentionally subjects a person who is older than 13 years old but younger than 15 years old to sexual contact and the person is more than three years older Previously, the law only required that the person subjected to sexual contact be less than 15 years old regardless of the age difference

Sexual Assault in the First Degree

when a person engages in sexual intercourse with another person and the person is under thirteen years of age and the actor is more than two years older than the person