Documenting Who Can Consent for Your Patients
Documenting consent to medical care for minors is a special case of the general problem of documenting proxy consent: the person who may consent to the care is not the person receiving the care. The physician must first document the relationship between the person giving consent and the patient and then document the risks and alternative treatments that the consenting person was informed of. If the patient is a mature minor, the physician should also discuss the treatment with the minor and document this discussion.
One common problem is that pediatric patients are often brought to the office by someone other than the parent or legal guardian. In a busy pediatrics practice, it is easy to lose track of who has the legal right to consent to medical care for a child. As the divorce rate increases, more children have multiple parents with varying rights to consent to medical care. Ideally, the first time children are brought to the office, they should be accompanied by the parent or guardian who has full authority to consent to care. At that time, the physician should obtain written consent to care, including written authorization for any other persons who will be bringing the child in for care. This authorization should list who may consent to the child’s care and whether there are any restrictions on what kind of care they may authorize. Although it sometimes cannot be avoided, the physician should check with the parents or guardian before accepting this proxy consent for surgical procedures or extensive nonemergency care. If there is disagreement between divorced parents over a child’s medical care, it is important to find out which parent has the legal right to consent to the child’s care. This can usually be determined by a call to the clerk of the court that has jurisdiction over the divorce. Child welfare services can also help in determining this information.
If there are disputes between the parents about the treatment or about who has the authority to consent, these disputes should be documented. It is important to document the rationale for deciding to accept the consent for treatment. The medical necessity of the treatment should be stressed. All contacts with child protective services should be documented. If the child is hospitalized, this information should be copied into the hospital medical record. Physicians who render necessary care to children are seldom sued for failure of consent. Proper documentation is important to reduce the chance that the physician will be sued as an ancillary party in child custody battles.