ACEP Update - Minors in the ED

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This is a needed update to the 1993 ACEP statement on the Evaluation and Treatment of Minors in the ED.

Why does this matter?
If a minor shows up in your ED, what do you do?  Should you treat without yet having parental consent?  What treatment is allowed?  What is not?  This is core knowledge for the Emergency Physician.

We have a minor problem
This is an update of the 1993 ACEP policy statement on this issue.  Key points on minors in the ED are:

  • Always provide emergency treatment to protect "life or health" and perform a medical screening exam regardless of available consent.
  • A minor may consent for certain conditions even if not emancipated. 
    • Some states provide exceptions for sexual and reproductive care. The Guttmacher Institute keeps track of this state by state.
    • Others have adopted various forms of the "mature minor doctrine." Commonly set at age 12 as long as clinician feels patient is of appropriate maturity to understand medical concepts. 
  • HIPAA generally allows the parent to have access to the records of his or her minor child.  Minors are generally given confidentiality when:

    • "A minor has consented for the care and the consent of the parent is not required by state or other applicable law;

    • A minor obtains care at the direction of a court;

    • A parent agrees that a health care provider and minor may have a confidential relationship."

  • HIPAA, allows latitude to the licensed clinician, stating if, “state and other law is silent concerning parental access to the minor’s protected health information, a covered entity has discretion to provide or deny a parent access to the minor’s health information."

  • EHR patient portals to review information could compromise adolescent confidentiality, as parents often have access until age 18.

  • Regarding refusal of care: Determination of the ability to consent also confers the right to refuse care. However, in circumstances in which minors do not have the ability to independently provide consent, refusal of care by the patient is significantly more complicated. Involve social work and ethics.

  • Parental authority to refuse care may be overridden in extreme circumstances in which life or limb of the child is imminently threatened by the parental refusal.  This process involves law enforcement and child protective services and should only be used in extreme circumstances.

Source
Evaluation and Treatment of Minors.  Ann Emerg Med. 2018 Feb;71(2):225-232. doi: 10.1016/j.annemergmed.2017.06.039. Epub 2017 Aug 11.

Peer reviewed by Thomas Davis, MD.

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