Consent for Treatment of an Adolescent: When Divorced Parents Disagree

Complicated family dynamics are often on full display in family practice and pediatric offices. Situations involving divorced or separated parents who disagree about their child’s treatment are a typical reason that insured physicians contact the NORCAL Risk Management department for advice. Sometimes the issue is about access to medical records. And, on occasion, a clinical problem is not at the forefront, but the parents are involving their children’s physicians in the family’s difficulties.

For example, insureds have described the following situations:

• A parent wanted the office to consult her for anything related to a visit that the other parent made an appointment for, including notification of the appointment and what happened at the visit.
• The parents of a patient were legally separated and in the process of a divorce; they shared legal custody. The child lived with his mother. The mother missed an appointment for the child’s immunization. The father wanted the physician to write a letter about the missed appointment, which would presumably be used in custody proceedings.
• A patient whose parents were divorced was brought to appointments by her mother. The patient’s father called the office to request a copy of his daughter’s medical record. The patient’s mother had told the office not to talk to the father.

Discussion

Taking a calm, methodical approach can help practices work through these challenges. Key to this is understanding who has the legal authority to consent to the minor patient’s treatment. Divorced parents may have joint legal custody, which generally means that both parents share the right to authorize medical treatment of the minor patient. In this arrangement, consent of either parent might be satisfactory; however, a court order could exist that gives the consent authority to only one parent, or it may specify who can consent to certain treatments for the child.

Medical practices also need to understand that just because a minor patient does not live with one parent, the non-custodial parent may still be able to access the child’s medical records. All these considerations depend on state law, so make sure you maintain an awareness of the applicable laws in approaching care of minor patients. Obtaining documentation of authority to consent is the starting point and will guide the practice’s response to parental requests.

Medical Liability Risk Management Recommendations

• Establish a process for obtaining information about any potential custody or supervision concerns for minor patients.
  • Such information/documentation can guide the practice in determining to what extent each parent must be involved in the decision-making process, who may access information guiding the minor, and what the practice requires for supportive documentation.
• If there is any legal document establishing a specific medical decision maker for a patient or prohibiting a parent or other person from obtaining information about a patient, file a copy of the document in the patient’s chart.
• Make notations or flags to alert physicians and staff about the situation and alert scheduling, billing, and other appropriate staff to this circumstance.