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Intake > Responsibilities > Requests for Emergency Medical Consent

Consent for Emergency Medical Care

0600-501.15 | Revision Date: 02/25/16

Overview

This policy guide provides staff with guidelines on authorizing emergency medical, surgical, dental, or other remedial care, which if not immediately diagnosed and treated, would lead to serious disability and/or death.

TABLE OF CONTENTS

Policy

Emergency Medical Consent (EMC)

For HIV Related Care

When Emergency Medical Consent (EMC) Cannot Be Authorized

Parental Consent for Emergency Medical Consent (EMC)

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

Procedure

Requests for Emergency Medical Consent (EMC)

CPH CSW Responsibilities

No Allegations of Abuse/Neglect

Allegations of Abuse/Neglect

Consent for Emergency Medical Care

CSW Responsibilities

SCSW Responsibilities

SCSW/ARA/RA Responsibilities

Approvals

Helpful Links

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version to clarify when DCFS can authorize an emergency medical procedure and the title and policy number (CPH: Requests for Emergency Medical Consent, 0050-503.75) were changed to reflect this. Also, a new section regarding parent's/guardian's rights was added.

POLICY

Emergency Medical Consent (EMC)

An emergency situation means a child “requires immediate treatment for the alleviation of severe pain or an immediate diagnosis and treatment of an unforeseeable medical, surgical, dental, or other remedial condition or contagious disease which is not immediately diagnosed and treated, would lead to serious disability or death,” per WIC 369(d).

 

Emergency medical, surgical, dental or remedial care may be provided to a child by a licensed physician without a court order and upon the authorization of a social worker when:

 

The social worker must make reasonable efforts to obtain the consent of, or to notify the parent, guardian, or person standing in place of a parent prior to authorizing emergency medical care.  A CSW must check with the physician and determine how much time there is to contact the parent (e.g. an in-person contact, telephone call, voicemail).  If time is limited due to the urgency, the CSW may give authorization for the emergency medical procedure after making one attempt to contact the parent(s).

 

Should the parent(s) not have legal authority to provide medical consent the CSW must make a reasonable effort to contact a person that can give medical consent, such as one of the following individuals:

 

As long as the child meets the criteria, an EMC must be processed in an expedited manner in consultation with SCSW.  The following staff can receive an initial request for an EMC and deny or approve without court approval:

For HIV Related Care

If the attending physician and surgeon determine that immediate HIV treatment is necessary to render appropriate care to a HIV positive infant 0-12 months old, it is considered emergency medical care, thereby authorizing the CSW to consent to treatment without a court order provided all the requirements for emergency medical care are met. 

When Emergency Medical Consent (EMC) Cannot Be Authorized

CPH staff can never give medical consent for the following:

 

  1. Administration of psychotropic medications or psychiatric hospitalizations, even if the physician defines the situation as an emergency

 

  1. For treatment that has been performed or may potentially be performed later

 

  1. For youth in probation placements.

 

  1. Psychosurgery, which refers to the treatment of psychiatric disorders by surgical removal or interruption of certain areas or pathways in the brain

 

  1. Convulsive therapy (i.e., electrically or chemically induced therapeutic seizure). 
  1. It is an emergency situation and convulsive treatment is deemed a lifesaving treatment.
  1. The need for and appropriateness of the treatment are unanimously certified to by a review board of three board-eligible/board-certified child psychiatrists appointed by the local mental health director. 
  1. It is performed in full compliance with regulations promulgated by the Director of Mental Health.
  1. It is thoroughly documented and reported immediately to the Director of Mental Health.

 

  1. If the situation is not an emergency.

Parental Consent for Emergency Medical Care (EMC)

A parent may not provide consent for EMC if any of the following apply:

 

Parental consent for EMC is not necessary in the following situations:

  1. The youth, in the opinion of the treating professional, is mature enough to participate intelligently in mental health services.
  1. The youth either may present a serious danger of physical or mental harm to himself/herself or others without mental health treatment or counseling or is an alleged victim of incest/child abuse.

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

Requests for Emergency Medical Consent (EMC) Made to the CPH

CPH CSW Responsibilities

Use the following tables and instructions (1-11) provided below to make a request for emergency medical consent (EMC). The numbers in the tables correlate with the numbers in the instruction list.

No Allegations of Abuse/Neglect

 

Parental Consent Given

Parental Consent Unavailable

Parental Consent Refused

Non-court Dependent

3, 8

3, 4, 8

1**, 5, 6, 7, 8

Court Dependent (during or after business hours)

2, 8

2, 5, 6, 9, 10, 11

1**, 5, 6, 9, 10

 

Allegations of Abuse/Neglect

 

Parental Consent Given

Parental Consent Unavailable

Parental Consent Refused

Non-court Dependent

1, 8

1, 4, 8

1**, 5, 6, 7

Court Dependent (during or after business hours)

1, 8

1, 5, 6, 7, 9, 10, 11

1**, 5, 6, 7, 9, 10

 

* *If the parents refuse to consent due to religious practices, CPH staff must inquire whether the hospital staff has consulted with representatives of the parent's religion (e.g., Jehovah Witness Liaison) and the result of the consultation.

** If the refusal to obtain or consent to medical treatment amounts to medical neglect, create an allegation of general neglect.

 

Instructions (1-11):

 

  1. Create a referral if there is no open referral being investigated

 

  1. Create an Info to CSW form

 

  1. Create a Consultation form

 

  1. Refer caller to Business and Professions Code Section 2397

 

  1. Complete the DCFS 4334, Court Medical Consent-Medical Emergency Worksheet

 

  1. Fax the DCFS 4158-2, Physician Questionnaire, to the caller

 

  1. If it is highly likely that the ER CSW will place a Hospital Hold, create the referral as an expedited referral and consult with the Warrant Desk to determine whether the parent’s refusal to obtain or consent to medical treatment amounts to medical neglect. Do not place a hospital hold and do not authorize EMC unless and until the child is in temporary custody.

 

  1. Do not give medical consent

 

  1. Make a reasonable effort to obtain the consent of, or to notify the parent or guardian prior to giving medical consent

 

  1. Review the DCFS 4158-2 to ensure that the physician or surgeon marked “yes” for question number

 

  1. Forward the following forms to the Case-Carrying CSW:

Back to Procedure  

Consent for Emergency Medical Care

CSW Responsibilities

When the CPH or Court Liaison consents to a medical emergency procedure/surgery, the Case-Carrying CSW will notify the Court and the child’s attorney and forward the DCFS 4158-A, 4158-2, and 4334 forms to the Case-Carrying CSW.

 

The following procedures apply to the CSW who is completing the emergency medical consent:

 

  1. Complete the DCFS 4334, Court Medical Consent-Medical Emergency Worksheet.

 

  1. Fax the DCFS 4158-2, Physician Questionnaire to the hospital and request that the Physician complete the form.

 

  1. Make reasonable efforts to obtain the consent, or to notify the parent or legal guardian regarding the emergency medical procedure prior to giving medical consent.
  1. Document the efforts made to obtain consent and notify the parent or legal guardian in the Contact Notebook.
  2. Document any decision to exclude a parent or legal guardian from being present for the medical procedure.

 

  1. Once the DCFS 4158-2 is received from the hospital, verify that the physician or surgeon marked “yes” for question number 3, indicating that the medical treatment is in fact an emergency situation.

 

  1. Review the DCFS 4158-2 with the SCSW and obtain approval to give consent to the emergency medical request.

 

  1. If medical consent is granted, fax the 4158-A, Authorization for After-Hours Emergency Medical Care for a Child Pursuant to WIC 369(d) to the hospital to give consent for the emergency medical procedure.

 

  1. If medical consent is granted, complete the DCFS 5402, Notice to Child’s Attorney Re: Child’s Case Status to notify them of the emergency medical procedure.

 

  1. If medical consent is granted, complete the DCFS 1688-1This graphic links to a form tutorial video., DCFS Worker’s Report to the Juvenile Court of Death, Injury or Illness, to inform the Court of the emergency medical procedure.
  1. Obtain the signature of the SCSW, ARA, and RA

 

  1. If medical consent is granted, fax the following completed and signed forms to Juvenile Court Services at (323) 881-3780. Retain the original forms in the case file.

SCSW Responsibilities

  1. Review the DCFS 4158-2 with the CSW and give consent for emergency medical care if the DCFS 4158-2 indicates:

SCSW/ARA/RA Responsibilities

  1. When medical consent is granted, review and sign the completed DCFS 1688-1, and return it to the CSW for submission to the court.

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APPROVALS

SCSW Approval

ARA Approval

RA Approval

HELPFUL LINKS

Forms

CWS/CMS

Info to CSW/Consultation Call form

LA Kids

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

DCFS 4158-A, Authorization for After-Hours Emergency Medical Care for a Child

DCFS 4158-2, Physician Questionnaire

DCFS 4334, Court Medical Consent-Medical Emergency Worksheet

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

Referenced Policy Guides

0300-303.06, Hospital Holds

0600-501.10, Consent for Routine Medical Care

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

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

for DCFS Supervised Children

Statutes

Business and Professional Code (BPC) Section 2397 – States, in part, that a licensed medical professional will not be “liable for civil damages for injury or death caused in an emergency situation occurring in the licensee’s office or in a hospital on account of a failure to inform a patient of the possible consequences of a medical procedure.”

 

Family Code (FC) Section 6922 – Details, in part, when a minor may consent for medical and/or dental care without parental consent. Also states, in part, that a licensed professional may advise a minor’s parent/guardian of treatment given/needed on both the basis of the information provided by the minor and the whereabouts of the parent/guardian.

 

FC 6925 – States, in part, that a minor may consent to medical care related to the prevention or treatment of pregnancy. It does not authorize a minor to be sterilized without the consent of the minor's parent or guardian.

 

FC 69256(a) – States, in part, that a minor may who may have come into contact with an infectious, contagious, or communicable disease may consent to medical care related to the diagnosis or treatment of the disease, if it is one that is required by law … to be reported to the local health officer, or is a related sexually transmitted disease...

 

FC 6927 – States, in part, that a minor who is 12 years of age or older and who is alleged to have been raped may 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 6928(b) – States, in part, that a minor who is alleged to have been sexually assaulted may consent to medical care related to the diagnosis and treatment of the condition, and the collection of medical evidence with regard to the alleged sexual assault.

 

FC 6929 – States, in part, that a minor who is 12 years of age or older may consent to medical care and counseling relating to the diagnosis and treatment of a drug or alcohol related problem. 

 

Health and Safety Code 1607.5 – Details, in part, when and how a minor may and may not donate blood.

 

Health and Safety Code 121020 (d) – States in part that HIV treatment for a HIV positive infant 0-12 months of age is considered emergency medical care.

 

Juvenile Court Rule 7.4 (c) – States, in part, a social worker or probation officer, after making reasonable efforts to obtain parental consent, has the authority to grant "emergency medical treatment" for any minor who "requires immediate treatment for the alleviation of severe pain or an immediate diagnosis and treatment of an unforeseeable medical, surgical or dental, or other remedial condition or contagious disease which, if not immediately diagnosed and treated, would lead to serious disability or death."

 

WIC Section 366.27(a) – States that the court may authorize the relative of a child to provide the same legal consent for the minor’s medical, surgical, and dental care as the custodial parent of the minor if the placement of the child in a planned permanent living arrangement with a relative is ordered.

 

WIC Section 369 – States, in part, that a social worker may authorize the performance of medical, surgical, dental, or other remedial care for a child who is taken into temporary custody, in need of care, and who has obtained the recommendation of a licensed medical professional. Also states, in part, that the court, upon both written recommendation of a licensed medical professional and due notice to the parent/guardian, may authorize the performance of the necessary medical, surgical, dental, or other remedial care for that person. This includes a dependent child placed, by court order, under the custody and/or supervision of a social worker and for whom no parent/guardian is willing to authorize necessary medical treatment for the child.

 

WIC 369(d) – Provides a definition of an emergency medical condition.

 

WIC 5326.6 – Details the circumstances under which psychosurgery may be administered.

 

WIC 5326.8 – States the circumstances under which convalescent therapy may and may not be administered.

 

WIC 5326.95 – States, in part, that the “Director of State Hospitals shall adopt regulations to carry out the provisions of this chapter, including standards defining excessive use of convulsive treatment.”

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