Wednesday, December 14, 2011

Author Beware: The Law-- HIPAA (Part 2/3)

Situations involving minors can be an easy way to increase conflict in your manuscript. Here is an easy area to use.

Minors presenting to the ED for evaluation of a pregnancy or STD related complaint.

Here's a set-up. Mother brings her 14 y/o daughter in to "get checked for pregnancy". Okay, great. Already we have inherent conflict. After all, if the daughter was in agreement about allowing her mother to know this information, they could have done a home pregnancy test and matter solved.

At times, parents will bring their children to the ER thinking that, because they've signed them in as a patient and they're the parent, we'll have to do as they ask and they'll learn the information that way.

This isn't the case. Will we do the pregnancy test? Maybe. The patient has to be willing. Will we relay the pregnancy test results to the parent? If the 14 y/o patient says "no" then we will not.

Most states have laws surrounding minors that issues related to pregnancy or STD's is protected information and can only be released to the patient. Depending on the state, the cut-off is 13 or 14 years. This is different from us giving information about a follow-up culture for strep throat.

I've had parents call back for test results. I had a step-mother call for pregnancy test results on a patient. Nope, can't give you the information.

Another area is that minor patients can sign themselves into the ER without parental consent for these matters as well. Generally, for all other conditions, we have to make attempts to get the parent on the phone for verbal consent witnessed by two individuals.

What do we do?

As healthcare providers, we really do try and facilitate open dialogue between the parent and child. We'll sit with the 14 y/o daughter privately and go over why it would be best for her to share this information, regardless of the results, with an adult.

Can you think of other healthcare situations involving minors that could be high areas of conflict?


  1. Drug testing can be an issue as well. Frequently a parent will bring their teen into the doctor and say, "I want him/her drug tested." Can be a thorny issue if the adolescent refuses.

  2. I can imagine there'd be problems if there was some treatment for the child's condition that was risky or experimental or in some way controversial, and the child (a teenager, say, who is old enough to understand) and their parents disagree about having it.
    An example might be an organ transplant: it's not particularly controversial these days, but some people just don't like it, and the child will have to take anti-rejection medication, with the side-effects of that, for life.

  3. crubin and Carrie,

    You're right. Both of those situation have a lot of inherent conflict.

    In the instance of drug testing-- if there is not a concern the teen has ingested something harmful, we are likely not going to get a urine specimen under force. I think the medical team could have a concern for being charged with battery under that circumstance. We will try to do a lot of talking with the family to try and have the teen do it voluntarily. Our concern as well is what will the family do with the information-- even if the test is negative-- just the family coming with that concern means there are issues to address.