Minor sign offs

[ffmedic2112]

I was wondering what your departments do to handle minor sigh offs for medical care. In Ohio, any person under 18 is considered a minor unless emmansipated(sp?) or married. I have heard of other crews in my depatment have signed off a minor with just a phone conversation from a parent or guardian. I recently had a minor in a minor MVA and I allowed her uncle to sign for her. Just wondering if your departments have any SOG's or protocols to define who and how a minor can be signed off.

[MedicDVG]

The law, at least in Wisconsin, is that minors are unable to give or retract consent for medical care. There is no emancipated minor statute in WI. That having been said it is possible to get consent from a responsible party. Now, a responsible party needs to be a parent or a gaurdian and consent or refusal can be achieved over the telephone.

The only way that you could legally have the uncle accept the responsibility of refusal of care for his niece is if he was her primary caregiver and was her legal gaurdian.

This gets confusing as well when it comes to step parents. Technically I can not grant/refuse consent for them without prior written authorization from their bilogical mother or father. Technically I can't even get information from the ER if they are there being treated and my wife isn't there... Gotta love HIPPA...

Anyway... How do you handle minor refusals, the short answer is that minors can't refuse. They are to be treated uner the doctrine of implied consent (from the parent). If they are still refusing treatment/transport, then law enforcement has to get involved as they are considered de facto gaurdians in an emergency.

Hope that helps.

[Weruj1]

I am in Ohio and also ............when we get a minor patient that is ijured and doesnt want to go we will try and contact the parent or gaurdian. If no one is available then they go. If another family member wants to come get them that is a call to med control.

[ullrichk]

In a medical liability class taught by a local attorney who also runs an area ambulance service, a responsible adult other than a parent can make medical decisions for a minor under the theory of "in loco parentis" - and don't quote me on the spelling.

A teacher, for example, could request transport and treatment for an injured child on a field trip because they are a responsible party, and there is some expectation that the parents placed them in charge of their child.

For what it's worth, we try to establish telephone contact with parents as well.

[stormk]

hello you seem to no alot about emancipation of minors in wisconsin i allready know that there is no law but am woundering if i may still patiton the court for my emancipation from my parents i will be seventeen soon and wish to declaire my independence form my parents shortly after my birthday and help/info whould me greatfully apreciated , storm

[mcfd45]

hello you seem to no alot about emancipation of minors in wisconsin i allready know that there is no law but am woundering if i may still patiton the court for my emancipation from my parents i will be seventeen soon and wish to declaire my independence form my parents shortly after my birthday and help/info whould me greatfully apreciated , storm
Why don't you just stay with your parents. Finish high school and then college, it looks like you need it.
J

[Weruj1]

let him/her leave while they still know it all .............

[firespec35]

We deal with a lot of kids at events. You wouldn't believe how many parents just dump their kids at a concert then go hit the casino or other places. We actually have an area on our PCR for a telephone contact with parents and them signing off via phone. We get a lic # or SSN for verification of who they are. Granted we don't have immediate access to the info but if I need to I can get a LEO to look it up in LEIN for me. And that is just for the BS dehydrations, I scraped my knee, etc..., if we feel they need to go then we go off of implied consent, send em and call the parents to say where they are going.

[RoryEl]

I've never hear of a phone conversation being defendable. To whom is the minor being released? Himself? Can you identify the person you actually spoke to, if needed? The list goes on. Unless you can find a specific clause in your governing statute I'd avoid this phone conversation practice

[EMT007]

Yeah in Los Angeles County, we have an emmancipated minor statute, but they must be legally emancipated by the courts or be pregnant (and making decisions related to their pregnancy). To AMA a minor, they must be signed out by a biological parent or legal guardian (with legal paperwork as proof).
AMA-ing over the phone is absolutely forbidden.

However, we of course can still exam/treat/release a minor on scene if it is very minor and we don't feel they require transport, and that doesn't require a guardian to be present.

[TurkII]

I've never hear of a phone conversation being defendable. To whom is the minor being released? Himself? Can you identify the person you actually spoke to, if needed? The list goes on. Unless you can find a specific clause in your governing statute I'd avoid this phone conversation practice

Phone conversations are a legal way to obtain a parent's permission to treat or release a patient and they have held up in courts in the past. In the case of a refusal, a lot of departments will have the EMT or Medic speak with the parent via telephone and obtain permission to treat/release and then have the parent speak with another individual such as a police officer. The refusal is then again repeated to the second individual who then signs as the witness.

This practice is usually used in the case of a minor incident..... a 16 year old in a minor car accident that cuts her finger on broken glass requiring nothing more than a bandaid. It is a mute point with any serious or semi-serious incident as these patients can be treated and transported under implied conscent.

Another poster brought up the practice of using another individual "in loco parentis." These individuals can only be used when they have on file signed permission from the parents or guardians to act on their behalf. Schools, summer camps, etc all obtain these signatures before kids are allowed anywhere near their property.

[RoryEl]

I'm well aware of the practice of having two people hear a phone consent or refusal but I've never heard that it is a valid practice from anyone with competence in that area. Now on the flip side how are you going to prove with whom you spoke in the event this becomes an issue? Do you have polices outlining this procedure? I've seen it used but I know we do not have a policy on phone consents or refusals. If you know of any case law that is on point share it. i'd love to peruse the holding of the court

[TurkII]

Now on the flip side how are you going to prove with whom you spoke in the event this becomes an issue?

Any reasonable EMT or Medic could make the assumption that when they speak with someone that identifies themselves as the parent of the minor in question, they are in fact who they say they are. Attorneys could play what if games all day in court. "Well, Mr. Medic - I understand you placed direct pressure on the laceration your patient had on his ***, but did it occur to you the possibility of an anal probe performed by aliens and the possibility of internal bleeding?"

If I ask a sixteen year old girl for the phone number of her parents, call that number, and confirm with that person that they do in fact have a sixteen year old daughter then that's good enough for me.

Again, this issue arrises only for minor problems. Nobody would win a court case for a minor problem that clearly does not require a MD's evaluation.

[RoryEl]

Chill out! You can do whatever you want, but when your dealing with an issue that has direct legal complications you should expect a legalistic reply. This is the exact reason we do not give out any information over the phone; you do not know with whom your talking. Anyone can say anything over the phone and you can't prove anything other than two of you heard it. Therefore consent or refusal requires the party to actually be present. It's just another of those difficult gray areas that causes so much consternation.

For those who choose to us phone consents/refusals - its your livelihood, knock yourself out

[medic27205]

We are allowed to obtain verbal consent over the phone from minors.. per our departments attorney. We obtain a name and phone number from the minor. We call our 911 center and they transfer the call to the requested number (there by it is recorded). We ask for the specific person that the minor stated was a legal guardian. We explain in detail what happened, what injuries if any we found on the patient and then obtain the verbal refusal. A copy of the 911 call is electronically attached to the call and their by the the ambulance call report when it is electronically filed as well. If we are unable to obtain consent from a guardian, then we transport. We use this same system for AMA refusals on scene, we let the medical control doctor talk directly to the patient and then the medical control doctor can tell us what he thinks about the patients competency to refuse care and transport. Has worked well for us and has held up in court the only time it was challenged.

[RoryEl]

We are allowed to obtain verbal consent over the phone from minors.. per our departments attorney. We obtain a name and phone number from the minor. We call our 911 center and they transfer the call to the requested number (there by it is recorded). We ask for the specific person that the minor stated was a legal guardian. We explain in detail what happened, what injuries if any we found on the patient and then obtain the verbal refusal. A copy of the 911 call is electronically attached to the call and their by the the ambulance call report when it is electronically filed as well. If we are unable to obtain consent from a guardian, then we transport. We use this same system for AMA refusals on scene, we let the medical control doctor talk directly to the patient and then the medical control doctor can tell us what he thinks about the patients competency to refuse care and transport. Has worked well for us and has held up in court the only time it was challenged.


I like your system and will mention it at the next EMS oversight meeting

[firespec35]

I deal with this all the time at concerts. Most of my patients are unaccompanied minors. We call a parent and speak to them and get a drivers license number or SSN. No numbers then come get them or they get transported. Granted there is no way to verify the DL# belongs to the parent but I'm pretty good at ferreting out the BSers. Our owner's lawyers say that we are protected due to the good faith effort to identify them.

[doughesson]

During EMT school last year,I was told if they were unconcious,it fell under implied consent.
If they were concious and alert times 3,they needed to be emancipated before a minor could sign their own refusal agreement.
I was told emancipated is defined in Tennessee as"married,pregnant,or serving in the military."
If someone with more experience can define it better in Tennessee,please chime it.