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 People�s 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 minor�s 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.

6. 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 minor�s 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 parent�s or guardian�s 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)

10. Who else may consent to medical treatment of minor? This does not apply to consent for immunizations.

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

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 minor�s primary caregiver Texas Youth Commission (when minor committed to it)

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

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 minor�s family in order to determine risks and benefits Provide informed consent and form

15. 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 person�s own acts of negligence.

16. 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 person�s or facility�s own acts of negligence.

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 person�s relationship to minor Statement of nature of medical treatment to be given Date treatment is to begin

18. 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 parent�s, 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.

19. 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.

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.

21. Consent for Family Planning Texas prohibits the use of state funds to provide contraception without parent�s 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 person�s 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 person�s own acts of negligence.

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 minor�s 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.

27. Limitations of Confidentiality Abuse or neglect Suicidal/homicidal ideation Reportable disease Your best judgment

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.

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

31. Abuse/Neglect Reporting Any case of sexual activity of minor less than 14 May report to law enforcement Generally report to CPS by: Phone: 1-800-252-5400 Fax: 1-800-647-7410 Internet: https://reportabuse.ws Login: professional PW: report1 State-funded organizations at biggest risk for not reporting�can lose all state funding

32. 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.shtmOverview

33. 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_185.pdf

34. Resources DSHS Child Abuse Screening, Documenting, and Reporting Policy For Contractors/Providers Revised effective September 1, 2005 http://www.dshs.state.tx.us/childabusereporting/gsc_pol.shtm Texas Department of Family and Protective Services: Report Abuse or Neglect http://www.dfps.state.tx.us/Contact_Us/report_abuse.asp