This policy guide was updated from the 07/01/14 version to remove emergency medical consent and HIV testing from this policy as the information exist in their own separate policies. The name of the policy was changed to reflect the current information. Also, a new section regarding parent's/guardian's rights was added.

POLICY

Medical Consent

Consent for medical, dental, remedial, or psychiatric treatment requires that the person giving consent (including the youth if they are eligible to give consent) must be informed of the nature of the treatment, the reason for the treatment, and possible outcomes and side effects of the treatment by the health care provider. In cases where the youth is giving consent, it is the responsibility of the health care provider to establish that the youth is capable of giving informed consentInformed consent requires the asking of a question and the receiving of an affirmative answer. However, informed consent involves a greater discussion and more information. For example, to obtain informed consent, a doctor must fully discuss a patient's options and how a procedure will affect them. If a patient is considering a surgery, a doctor will explain the surgical procedure, possible complications and other possible courses of action.. If the health care provider determines that the youth is not able to provide informed consent, the youth’s consent cannot be used. A child’s attorney does not have legal authority to give consent for medical procedures.

Parent/Legal Guardian Consent

In most cases, a child’s parent or legal guardian has legal authority to consent to medical and psychiatric treatment for a child, unless the child can consent for themselves. However, parents cannot provide consent if:

Parental rights have been terminated

The court has limited the parent’s ability to consent

The child is under legal guardianship

A parent whose parental rights have not been terminated by the Juvenile Court cannot consent to medical treatment in the following situations:

Abortion over the objection of the pregnant youth.

Private Psychiatric Hospitalizations

Psychiatric Medication (under certain circumstances).

Psychosurgery

A legal guardian, appointed by the Juvenile Court or Probate Court cannot consent to the same medical and dental procedures as a parent in the following circumstances:

If the letters of guardianship limit this right in any way

Surgery, anesthesia or other invasive procedures are recommended

If the youth is fourteen (14) or older, the legal guardian may consent to surgery. But, the youth must also consent unless the legal guardian determines in good faith, based on medical advice, that the case is an emergency in which the youth faces loss of life or serious bodily injury if the surgery is not performed.

Sterilization

Experimental drugs

In cases where parents or legal guardians cannot, or will not give consent, DCFS can authorize medical treatment of a child with a court order.

Licensed Foster Parent Consent

If the child is placed with a licensed foster parent, the licensed foster parent can consent to routine medical and dental care.

Relative Caregiver/NREFM Consent

RelativeFor the purpose of placement and foster care payments: An adult who is related to the child by blood, adoption or affinity within the fifth degree of kinship, including stepparents, stepsiblings, and all relatives whose status is preceded by the words, "great," "great-great" or "grand" or the spouse of any of these persons even if the marriage was terminated by death or dissolution. caregiver or nonrelative extended family member who sign the Agency Caregiver Placement Agreement, can also consent to routine medical and dental treatment.

Court Authorization

The court can authorize medical treatment for a dependent child when:

The medical procedure is recommended by the child’s physician or dentist; and

The parent objects or is not available to consent; and

The procedure is not one to which the child or CSW has the statutory authority per WIC 369(a).

Child/Youth Consent

Per California minor consent laws, any youth may consent to their own treatment without parental consent, or DCFS approval in the case of dependent youth, in the following circumstances:

A child/youth, of any age, who has been a victim of a sexual assault, can consent to diagnosis, treatment, collection of medical evidence and care related to the sexual assault.

The medical practitioner must attempt to contact the child’s parent or legal guardian, unless it is believed that the parent or legal guardian is the perpetrator.

A youth, of any age, can consent to termination of her pregnancy without a court order or parental consent or notice.

A youth, of any age, may consent to medical, hospital, or surgical care related to prevention or treatment of pregnancy, except sterilization.

Treatment includes contraception, pregnancy testing and prenatal care

If surgery is required, DCFS should be informed for coordination of care. The specifics need not be shared if it's related to abortion and treatment of STDs

A youth must sign an authorization to release information of records related to services that the minor consented to, or could have consented to.

A youth is twelve (12) or older, meets the criteria for Mental Health and/or Developmental Assessment and Services, can consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services.

A youth is twelve (12) or older and came into contact with a Reportable Communicable Disease, can consent to medical, hospital, and surgical care related to the diagnosis or treatment of any infectious, contagious, communicable, or sexually transmitted disease.

A youth is twelve (12) or older, who is alleged to have been raped, can consent to diagnosis, treatment, and medical evidence collection related to the alleged rape.

A youth twelve (12) or older can consent to HIV testing. They are also permitted to disclose results, prohibit disclosure of the testing, and provide written authorization for disclosure.

A youth is twelve (12) or older, seeking treatment of a drug or alcohol-related problem can consent to the medical care and counseling relating the diagnosis and treatment of that problem.

The youth cannot consent to narcotic replacement therapy, such as methadone maintenance.

A youth is fifteen (15) or older, living apart from their parents/legal guardian and managing their own financial affairs, can consent to medical or dental care.

A youth seventeen (17) or older can consent to donating their blood.

Youth Over 18 and Nonminor Dependents Consent

Youth, eighteen (18) and older who are dependents of the court, including Nonminor Dependents can consent to their own medical care without court authorization, unless there is a court order that does not allow them to do so (e.g. conservatorship). If the youth refuses medical treatment and that places them in serious harm, or at risk of death, County Counsel must be contacted to discuss next steps, as a court order may be required.

Parent’s/Guardian’s Rights to be Notified and Present for Medical Examinations

Parents/guardians have a right to be given notice of medical exams and procedures their children are scheduled to undergo, as well as the right to be with their children while they are receiving medical exams and procedures, or to be in a waiting room or other nearby area if there is a valid reason for excluding them while all or a part of the medical procedure is being conducted. Therefore officials (CSWs, law enforcement, etc.) cannot exclude parents from the room where their child is receiving medical attention unless there is either parental consent, a valid reason for exclusion, or an emergency requiring immediate medical attention.

A valid reason to exclude a parent from the room where their child is receiving medical attention may include circumstances where authorities have reasonable cause to believe that the parent is abusive or will interfere in the examination in a significant way, or where the non-abusive parent is so emotionally distraught that they would disrupt the examination.

If there is a valid reason to exclude family members from the examination room, a parent’s right to be present in the examination room may be limited to being near the examination (e.g. in the waiting room or another nearby area).

Parents must be notified in all instances when their child is to receive medical attention, including instances where parental consent is not obtained. Efforts to notify the parents of the medical examination or procedure should be documented.

If a CSW determines that he/she needs to exclude a parent/guardian from the medical examination, even if that medical examination was ordered by the court, the CSW should consult with his/her SCSW for guidance. The SCSW will consult with the Warrant Liaison or County Counsel as needed. Any decision to exclude a parent/guardian from the examination must be documented by the CSW in the case contact notebook.

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PROCEDURE

Consent for Routine Medical Care

CSW Responsibilities

In Pre-Disposition cases, when the child is in temporary custody:

Ensure the parent/guardian has signed the DCFS 179, 179-MH, and 179-PHI and that the original 179 has been given to the caregiver. The forms are also available on the Mobile Client Portal for electronic signatures.

If unable to get the parent’s signature on the DCFS 179, complete and sign the DCFS 4158, give the original to the caregiver, and place a copy in the child’s case file.

If unable to get the licensed caregiver’s signature, complete the DCFS 4158 and give a copy to the caregiver to show that the child is placed with them. If the parent signed the DCFS 179, give a copy to the caregiver.

Place a copy of the 179 and the originals of the 179-MH and 179-PHI in the case file.

In Post-Disposition cases, when the child is suitably placed:

If the parent refuses to sign the DCFS 179 or the parents cannot be located, after giving notice to the parents, request the court grant DCFS the ability to authorize medical, surgical, dental, or other remedial care for the dependent child by licensed practitioners.

Once court authorization is obtained, provide the caregiver with the signed DCFS 4158.

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Notifying Parents/Guardians of Medical Exams

CSW Responsibilities

Remind the caregiver to notify the CSW as soon as medical appointments are made.

Reasonable efforts must be made to notify parents/guardians of all medical exams via phone, text or email as soon as the CSW becomes aware of the date, time and place.

Document the notification in the contact notebook and court reports under the medical section.

Court Authorized Medical Treatment

ER/Case-Carrying CSW Responsibilities

Completely fill out all fields on the DCFS 4225, Report of Children’s Social Worker with Recommendation of Authorization for Medical Care.

Attach the completed DCFS 4158-2 (including the CSW contact information section in the lower left corner) from the physician or dentist describing the treatment recommended for the child’s problem.

Use the DCFS 4225 to document the reason why the child’s parents and or legal guardian cannot consent to medical treatment.

Complete the following fields in the Authorization for Medical Care section of the DCFS 4225:

Name and phone number of hospital, clinic, or physician

Name of child

Court number

Print your name, sign, and date the DCFS 4225.

Transmit the completed DCFS 4225, 4158-2, Physician’s Questionnaire, and any supporting documentation to the Court Liaison via the Walk On process (note: no Ex-Parte Application and Order is required).

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APPROVALS

None

HELPFUL LINKS

Attachments

Reportable Communicable Diseases

Forms

LA Kids

DCFS 179, Parental Consent and Authorization for Medical Care

DCFS 179-MH, Parental Consent for Child’s Mental Health/Developmental Assessment and Participation in Mental Health/Developmental ServicesServices provided by the Regional Centers, which include diagnostic evaluation, coordination or resources such as education, health, welfare, rehabilitation and recreation for persons with developmental disabilities. Additional services include program planning, admission to and discharge from state hospitals, court-ordered evaluations and consultation to other agencies.

DCFS 179-PHI, Authorization for Disclosure of Child’s Protected Health Information (includes a Revocation of Authorization)

DCFS 450, Parent’s/Guardian’s Consent for HIV Test

DCFS 451, Child’s Consent for HIV Test

DCFS 1688-1 , DCFS Worker’s Report to the Juvenile Court of Death, Injury, or Illness

DCFS 4158, Authorization for General Medical Care for a Child Placed by an Order of the Juvenile Court

DCFS 4158-A, Authorization for Emergency Medical Care for a Child Pursuant to WIC 369

DCFS 4158-2, Physician’s Questionnaire

DCFS 4158-2, Physician’s Questionnaire (type-fillable template)

DCFS 4225, Report of Children’s Social Worker with Recommendation of Authorization for Medical Care

DCFS 4225, Report of Children’s Social Worker with Recommendation of Authorization for Medical Care (type-fillable template)

DCFS 4334, Court Medical Consent-Medical Emergency Worksheet

DCFS 5402, Notice to Child’s Attorney Re: Child’s Case Status

Referenced Policy Guides

0600-501.15, Consent for Emergency Medical Care

0070-548.20, Taking Children into Temporary CustodyThe removal of a child from the home of a parent or legal guardian and placement or facilitation of placement of the child in the home of a non-offending parent, relative, foster caregiver; group home or institutional setting.Temporary custody also includes: placing hospital holds on children; situations in which the CSW interrupts an established Family Law Court custody or visitation orders when the CSW believes that if the order is carried out, the child would be placed in immediate risk of abuse, neglect or exploitation and the child is allowed to remain in the home of the non-offending parent; situations in which DCFS requests that law enforcement remove a child from the home of his or her parent/legal guardian and the CSW places the child with a relative or unrelated caregiver; and situations in which the child is living with a relative or an unrelated caregiver and all of the following conditions exist: child’s parent is asking for the child to be returned home, CSW believes that the return of the child to his or her parent would place the child at risk of abuse, neglect or exploitation, CSW does not allow the child to be returned to his or her parent; and, the child remains in the home of the relative or is placed in out-of-home care.

0600-501.09, Consent for Mental Health Treatment

0600-502.20, HIV/AIDS Testing and Disclosure of HIV/AIDS Information

0600-507.10, Youth Development Reproductive Health

0600-514.10, Psychotropic MedicationMedications used as tools for producing certain chemical and physiological effects in the central nervous system. They are usually classified according to the types of disorders they are primarily used to treat.: Authorization, Review, and Monitoring for DCFS Supervised Child

0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children

Statutes

California Supreme Court Decisions, American Academy of Pediatrics vs. Lungren 1997 – States that girls as young as twelve (12) can obtain abortions without their parent’s knowledge or consent.

Family Code (FC) Section 6550(a) – States that a relative caregiver who meets the criteria in the caregiver’s authorization affidavit can consent to medical and dental treatment, with some exceptions.

FC Section 6922(a) – States that a minor can consent to their medical or dental care if they are fifteen (15) or older, living apart from their parents/legal guardian, and managing their own financial affairs.

FC Section 6925(a) – States that a minor can consent to medical care related to prevention or treatment of a pregnancy. This section does not authorize a minor to be sterilized without consent of their parent or legal guardian.

FC Section 6926(a) – States that a minor, twelve (12) or older can consent to medical care related to the diagnosis or treatment of a disease if the disease or condition is one that is required by law or regulation to be reported to the local health officer or is a related sexually transmitted disease, as determined by the State Director of Health Services.

FC Section 6927 – States that a minor, twelve (12) or older who is alleged to have been raped can consent to medical care related to the diagnosis or treatment of the condition and the collection of medical evidence with regard to the alleged rape.

FC Section 6928(b) – States that a minor, alleged to have been sexually assaulted can consent to medical care related to the diagnosis or treatment of the condition and the collection of medical evidence with regard to the alleged sexual assault.

FC Section 6929 – States that a minor, twelve (12) or older can consent to medical care and counseling relating to the diagnosis and treatment of a drug or alcohol related problem.

Health and Safety Code Section 1530.6 – States that persons licensed to provide residential foster care to a child placed with them by order of juvenile court or voluntarily placed with them by persons, who have legal custody of the child, can give consent for ordinary medical and dental treatment for the child.

Welfare and Institutions Code (WIC) Section 362(a) – States that when a child is adjudged a dependent child of the court, per Section 300, the court may make any and all reasonable orders for the care, supervision, custody, conduct, maintenance, and support of the child, including medical treatment.

WIC Section 369(a) and 369(b) – States that whenever a person is taken into temporary custody and is need of medical, surgical, dental, or other remedial care, the social worker may authorize this care upon the recommendation of the physician, surgeon, or dentist. The social worker must notify the parent/legal guardian/person standing in loco parentis of the care needed before the care is provided to the child. If they object, the care can only be given with a court order.

WIC Section 369(c) – States that when a dependent child of the juvenile court is placed by order of the court within the care and custody under the supervision of a social worker in the county in which the child resides, and it appears that there is no parent/legal guardian/person capable or willing to authorize treatment for the child, the court can, after providing notice to the parent/legal guardian/person standing in loco parentis, order that the social worker can authorize medical, surgical, dental, or other remedial care, as needed.

WIC Section 369(d) – States in part that when a child requires immediate emergency medical, surgical, dental, or other remedial care, in an emergency situation, the care can be provided by a licensed physician, surgeon, or dentist, without a court order, and upon authorization of the social worker.

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