Consent for Minors
                                ==================
      
ž Should not wait for parental consent to treat minors in ED
 - morally and ethically improper
 - civil liabilty risk
 - COBRA/EMTALA violation resulting in Letter of Termination
   [ACEP Patient Transfers: How to comply with the law, 2E. Appendix 3,
   Summary of EMTALA Violations, #39.]
   
ž Refusal of Care by Minors in NM
  <Refusal.txt>
  
ž Minors & Consent Protection for Good Faith Reliance: A physician may rely in 
good faith upon a minor's representations that she is able to give consent. 
Documentation: Whenever an adult's consent is unnecessary to treat a minor, the 
physician secure a document signed by the minor setting forth the facts which 
would allow the minor to consent to treatment. The physician should also 
document those facts in the medical record. 

Additionally, all minors can consent to certain alth services, including: 
• Sexual and reproductive health services (except abortion*) 
Substance abuse treatment . Mental health treatment (14 or older) 
*Minors can obtain an abortion without parental consent if they obtain a court 
order or go out of state. Questions? Contact CHOICE Hotline (1-800-84-TEENS) 

Confidentiality 
Where a minor has the right to consent under PA law, the minor is entitled to 
absolute confidentiality, unless the law explicitly provides an exception. 
Exceptions are relevant in sexual assault cases. 
General Rule = Confidentiality (even from >arents) 
Exception = Mandated Reporting Situations 
Confidentiality includes getting the minor's ^^^ permission before disclosing 
any of the minor's health information. 


Certain minors may consent to ALL health care services. 
Ail minors may consent to SOME services: pregnancy testing and treatment, HIV 
and other STDs, emergency contraception, rape crisis counseling, substance 
abuse, mental health services (if 14 years or older). 

Minors May Consent to Urgent Care 
Federal Law Obligations: Emergency Medical Treatment and Active Labor Act 
(EMTALA) mandates a medical screening examination (MSE) for every patient 
seeking treatment in an ED of any hospital that receives federal funding, 
regardless of consent or reimbursement issues. Hospitals must treat emergency 
medical patients until stable. 
State Law Obligations: According to PA law, care must state Law Obligations: 
According to PA law, care must minor's life or health," which includes potential 
psychological harm. 

U.S. Department of Justice recommends that sexual assault patients be treated as 
emergency sexual assault patients be treated as emergenc p3i!^?«Jents, even if 
they do 

PA law requires providers to report when a PA law requires providers to report 
when a victims of sexual violence and minors. victims of sexual violence and 
minors. included. 
There is an exception for adult victims of domestic and intimate partner 
violence. 
Note: patients are under no obligation to speak with the police or file 
complaint. 

Crime Victims Act 
Requires that law enforcement provide a crime victim (or, if appropriate, a 
member of the victim's direct family) with information about the crime victim's 
right to compensation within 48 hours of the reporting of a crime. 
¦ Requirement could compromise patient Requirement could compromise patient 
contacting the patient's parent or guardian. 
Act 179 
. Every health care provider has an independent obligation to report offenses 
covered by Act 179 
and other types of child abuse. Rape against a minor (person under the age of 
18) is covered by Act 179 and must be reported immediately to ChildLine. 
Requirement could compromise patient _^ cntirii|M|,Fintiality, since the 
ChildLine may contact the patient's parent or guardian or take other actions. 

PA law w does not specify whether or not the PA law does not specify whether or 
not the collection of forens iic evidence is a medical treatment. 

Collecting Forensic Evidence 

Forensic evidence cannot be collected without consent. 
A sexual assault exam should not be performed against the minor's will - A 
parent cannot demand that a "rape kit" be performed without the minor's consent. 
Interview patient separately from parent to ensure that consent is voluntary. 
When a person has the capacity to consent to a health service, that person also 
has the right to refuse to consent to a health service. This includes minors. 

• You must immediately call ChildLine 1-800-932-0313 because under Act 179 
sexual assault of a person under 18 is child abuse. 
• You must within 48 hours make a written report to the CPS unit in the county 
where the suspected abuse occurred. ¦ You must report the crime to police. 

Case 11: Emergency Contraception 
m, ««** ^^' «••'¦«* unE«nscl.n.s in ^%..^^y^ u emergency department, an apparent 
victim of sexual assault 
Her parents consent to forensic examination and treatment 
They don't want LR to receive emergency contraception due to their religious 
beliefs. 
Subsequently, LR regains consciousness. 
After discussing emergency contraception After discussing emergency coi 
ntraception with LR, she requests it