Texas Adolescents and Consent

1
Texas Adolescents and Consent

• Angela Hobbs-Lopez, D.O.
• Adolescent Health Coordinator

2
Acknowledgement

• Celia Neavel, M.D.Director of Adolescent
  HealthAt Peoples Community Clinic

3
Disclaimer

• I am not a lawyer
• For specific concerns or questions regarding the
  law or consent, it is recommended that you seek
  advise from
• legal counsel
• licensing board
• local ISD
• Texas Education Agency

4
Definition of a Minor

• A person under 18 years of age who has never been
  married and never been declared an adult by a
  court.

5
Who may consent to the medical treatment of
minors?

• Parents have the duty to support the minor,
  including providing the minor with clothing,
  food, shelter, medical and dental care, and
  education.
• Parents have the right to consent to the minors
  marriage, enlistment in the armed forces, medical
  and dental care, and psychiatric, psychological,
  and surgical treatment.
• Non-parent sole managing conservator has
  essentially same rights and duties as parent sole
  managing conservator.

Texas Family Code 151.001
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Divorced Parents

• Either parent can give consent for any emergency
  health care, including surgical procedures.
• The parent appointed as sole managing conservator
  may give consent for the minors nonemergency
  surgical procedure.
• Rights of possessory conservator(s) are specified
  by the court, usually allowing them the right to
  consent for medical/dental care not involving a
  surgical procedure, except in an emergency.

7
Divorced Parents

• In the case of divorced parents or for children
  in foster care, a court order may limit or
  specify who is authorized to provide medical
  consent, and for what.
• Providers with concerns can request to review
  this portion of the divorce decree.

8
Who may consent for emergencies?

• Either parent
• A health care provider does not need parents or
  guardians consent for emergencies to preserve
  life and limb.
• Appropriate personnel should at least attempt to
  contact the parent/conservator while emergency
  progresses.

9
Who else may consent to medical treatment of
minor?

• The following persons may consent to medical,
  dental, psychological, and surgical treatment of
  a minor when the person who has the right to
  consent (parent or legal guardian) cannot be
  contacted and that person has not given actual
  notice to the contrary
• Grandparent
• Adult sibling
• Adult aunt or uncle
• Educational institution in which minor is
  enrolled that has written authorization to
  consent from person having the right to consent
• Adult who has actual care, control, and
  possession of minor and has written consent from
  person having right to consent
• Court having jurisdiction
• An adult under court jurisdiction
• Peace officer who has lawfully taken custody of
  minor
• Texas Youth Commission (when minor committed to
  it)

Texas Family Code 32.001
10
Who else may consent to medical treatment of
minor?

• This does not apply to consent for immunizations.

Texas Family Code 32.001
11
Who may consent to immunization of a minor?

• Parent
• Guardian
• Person authorized under the law of another state
  or a court order to consent

Texas Family Code 32.101
12
Who may consent to immunization of a minor?

• If the parent, legal guardian, or court-appointed
  person are not available and authority to consent
  is not denied, the following may
• Grandparent
• Adult sibling
• Adult aunt or uncle
• Stepparent
• Educational institution in which minor is
  enrolled that has written authorization to
  consent from person having the right to consent
• Adult who has actual care, control, and
  possession of minor and has written consent from
  person having right to consent
• Court having jurisdiction
• An adult under court jurisdiction
• An adult having actual care, control, and
  possession of minor as the minors primary
  caregiver
• Texas Youth Commission (when minor committed to
  it)

Texas Family Code 32.101
13
Who may consent to immunization of a minor?

• A person may not consent for the minor if they
  have actual knowledge that a parent, managing
  conservator, guardian, or other person who under
  the law of another state or court order may
  consent for the minor
• Has expressly refused to give consent for
  immunization
• Has been told not to consent for the minor
• Has withdrawn a prior written authorization for
  the person to consent

Texas Family Code 32.101
14
Requirements of non-parents to provide consent
for immunization

• Provide health care provider with sufficient and
  accurate health history
• Other information about minor, if necessary
• Sufficient and accurate history about the minors
  family in order to determine risks and benefits
• Provide informed consent and form

Texas Family Code 32.101 32.102
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Limited Liability for Immunization

• A health care provider is not liable for an
  adverse reaction to an immunization or for
  injuries to the minor resulting from factual
  errors in the health history or information given
  by the person consenting to the health care
  provider, except from the persons own acts of
  negligence.

Texas Family Code 32.103
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Limited Liability for Immunization

• A person consenting to immunization of a minor, a
  health care provider, nurse, or any medical
  facility is not liable for damages arising from
  an immunization administered to a minor
  authorized except for injuries resulting from the
  persons or facilitys own acts of negligence.

Texas Family Code 32.103
17
Consent Form

• Consent to medical treatment or immunization must
  be
• In writing
• Signed by the person giving consent
• Given to the doctor, hospital, or medical
  facility that administers the treatment
• Must include
• Name of child
• Name of one or both parents, if known, and name
  of any managing conservator or guardian
• Name of person giving consent and persons
  relationship to minor
• Statement of nature of medical treatment to be
  given
• Date treatment is to begin

Texas Family Code 32.002
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When can a minor give consent for own medical
treatment?

• Is on active duty with armed services.
• Is 16 years of age or older and resides separate
  and apart from their parents, managing
  conservator, or guardian (with or without their
  consent) and managing their own financial
  affairs, regardless of the source of income.
• Is consenting to diagnosis or treatment of an
  infectious, contagious, or communicable disease
  that is reportable, including STIs.

Texas Family Code 32.003
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When can a minor give consent for medical
treatment?

• Is unmarried and pregnant and consents to
  treatment related to pregnancy, other than
  abortion.
• Is consenting to examination or treatment for
  chemical addiction, dependency, or any other
  condition directly related to chemical use.
• Is unmarried, is the parent of a child, and has
  actual custody of their child and consents for
  them.
• Is consenting for counseling for suicide
  prevention, chemical addiction or dependency, or
  for sexual, physical, or emotional abuse.

Texas Family Code 32.003 and 32.004
20
Consent for Family Planning

• Parental consent is not required in any state for
  minors to purchase nonprescription contraceptives
  or to receive information about family planning.
• No state explicitly prohibits minors from
  receiving contraceptive prescriptions.

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Consent for Family Planning

• Texas prohibits the use of state funds to provide
  contraception without parents consent.
• Federal law also explicitly states that minors on
  Medicaid and Title X must be provided family
  planning services on request.
• Minors may consent if legally emancipated or 16
  and living on own.
• This does not include abortion.

22
Consent for Family Planning

• Rider 13
• Parental consent for contraceptives required if
  funding source
• Title V
• Title XX and not Title X
• Parental consent for contraceptives not required
  if funding source
• Medicaid
• Title X (or X and XX)

23
Liability

• Those persons under jurisdiction who consent to
  the medical treatment of a minor are immune from
  liability for damages resulting from examination
  or treatment, except to the extent of a persons
  own acts of negligence.
• A physician, dentist, psychologist, hospital, or
  medical facility at which the minor is treated is
  immune from damages, except to the extent of
  persons own acts of negligence.

Texas Family Code 32.001
24
Liability

• A physician, dentist, psychologist, hospital, or
  medical facility may rely on the written
  statement of the minor containing the grounds on
  which the minor has capacity to consent to the
  minors medical treatment.

25
Confidentiality

• A provider is legally permitted, but not legally
  required, to provide confidential care to a
  minor.
• A physician, dentist, or psychologist may, with
  or without the consent of a minor who is a
  patient, advise the parents, managing
  conservator, or guardian of the minor of the
  treatment given to or needed by the minor.

26
Confidentiality

• If it is the practice of the provider to inform
  the parent or guardian about care given to a
  minor, it is considered ethical to inform the
  minor of this practice prior to taking a history.
• The minor may choose to go to a different
  provider who will provide confidential services.

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Limitations of Confidentiality

• Abuse or neglect
• Suicidal/homicidal ideation
• Reportable disease
• Your best judgment

Texas Family Code 32.005
28
Abuse/Neglect Reporting

• Abuse is mental, emotional, physical, or sexual
  injury to a minor or failure to prevent such
  injury.
• Neglect of a minor includes
• (1) failure to provide a minor with food,
  clothing, shelter and/or medical care and/or
• (2) leaving a minor in a situation where the
  minor is at risk of harm.

Texas Family Code 261.001
29
Abuse/Neglect Reporting

• Providers may evaluate for this without parental
  or minor consent
• Exceptions
• Minor is 16 years of age or older and refuses
  consent
• For whom consent is prohibited by a court order

30
Abuse/Neglect Reporting

• An unmarried minor under 17 cannot consent to
  sexual activity
• Must be reported unless affirmative defense of
  prosecution determined including
• Minor is not less than 14
• Any partners not more than 3 years older
• Partners are not of the same sex
• Force is not involved
• Partners have no history of being a sex offender
• Professionals must report within 48 hours

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Abuse/Neglect Reporting

• Any case of sexual activity of minor less than 14
• May report to law enforcement
• Generally report to CPS by
• Phone [phone]
• Fax [phone]
• Internet https//reportabuse.ws
• Login professional
• PW report1
• State-funded organizations at biggest risk for
  not reportingcan lose all state funding

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Resources

• THSteps Online Provider Training
• Overview
• Adolescent Health Screening
• Case Management
• Cultural Competence
• Dental Health Care for Primary Care Providers
• Dental Screening by Dental Professionals
• Developmental Screening
• Hearing and Vision Screening
• Immunization
• Introduction to Medical Home
• Mental Health Screening
• Newborn Hearing Screening
• Newborn Screening
• Nutrition
• Pharmacy
• Weight Management
• Accredited for CNE by the American Nurses
  Credentialing Center
• http//www.dshs.state.tx.us/thsteps/default.shtmOv
  erview

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Resources

• Texas Family Code (chapters 32, 151, 261)
• http//tlo2.tlc.state.tx.us/statutes/fa.toc.htm
• Legal and Ethical Issues Facing Adolescent Health
  Care Professionals
• http//www.mssm.edu/msjournal/71/71_3_pages_181_18
  5.pdf

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Resources

• DSHS Child Abuse Screening, Documenting, and
  Reporting Policy For Contractors/Providers
  Revised effective September 1, 2005
• http//www.dshs.state.tx.us/childabusereporting/gs
  c_pol.shtm
• Texas Department of Family and Protective
  Services Report Abuse or Neglect
• http//www.dfps.state.tx.us/Contact_Us/report_abus
  e.asp