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
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.
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 .
- The child requires immediate emergency medical care in an emergency situation in the opinion of the responsible licensed physician or surgeon or licensed dentist for dental emergencies; and
- The parent is unavailable or refuses to authorize the required treatment; and
- When the child meets any of the following criteria:
- Has already been taken into temporary custody
- Is the subject of a petition filed before the court
- Is a dependent of juvenile court
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, thefor the emergency medical procedure after making one attempt to contact the parent(s).
Should the parent(s) notto 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:
- parent with sole legal custody
- legal guardian
- relative caretaker of a child under a planned permanent living arrangement and who has been court authorized to consent to the child's medical, surgical and dental care
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:
- CPH CSWs, when the request is received at the Hotline during and after business hours, weekends, and holidays
- Exception - When the child does not meet the criteria: CPH CSWs must assess all requests for emergency medical consent for allegations of abuse, neglect and substantial risk. Parental refusal to provide consent for a medical procedure may, in some instances, constitute medical neglect and result in a referral and WIC filing. If the CPH CSW believes the refusal to consent to emergency medical care amounts to medical neglect, the CPH CSW will create an expedited referral.
- Case-carrying CSWs, when the request is received during the business day
- SCSWs or duty workers, when the Case-Carrying CSW is not available to receive a request during the business day
- Juvenile Court Liaisons, when the request is received during the business day
- Non-emergency medical care: Juvenile Court Liaisons will also process the non-emergency medical requests during the business day, which require approval from the Court.
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 for emergency medical care are met.
When Emergency Medical Consent (EMC) Cannot Be Authorized
- Administration of psychotropic medications or psychiatric hospitalizations, even if the physician defines the situation as an emergency
- In such cases, the caller should be directed to contact the Los Angeles County Department of Mental Health.
- For treatment that has been performed or may potentially be performed later
- For youth in probation placements.
- These requests must be referred to Probation’s Intake and Detention Control (323) 226-8506
- Psychosurgery, which refers to the treatment of psychiatric disorders by surgical removal or interruption of certain areas or pathways in the brain
- The use of psychosurgery is banned on all children
- Convulsive therapy (i.e., electrically or chemically induced therapeutic seizure).
- In no case shall convalescent therapy be used on a child under 12 years of age.
- A child, at least 12 but less than 16 years old, may receive convulsive therapy only if he/she or the conservator provide informed consent.
- Children 16 or 17 years of age may be provided convulsive therapy only if they give informed consent or have a conservator who provides consent.
- The use of convalescent treatment on a child must also meet the following criteria:
- It is an emergency situation and convulsive treatment is deemed a lifesaving treatment.
- 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.
- It is performed in full compliance with regulations promulgated by the Director of Mental Health.
- It is thoroughly documented and reported immediately to the Director of Mental Health.
- 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 rights have been terminated
- The court has limited the parent’s ability to consent
- The child is under legal guardianship and/or
- The parent does not have legal custody
Parental consent for EMC is not necessary in the following situations:
- The youth is or was married
- The youth is detained or placed in out-of-home care with an open court case
- The youth’s condition is defined as a medical emergency and the parent(s) are not available
- The youth has a DMV identification card to prove emancipation
- The youth is at least 15 years old, not living at home, and manages his/her own financial affairs
- The youth is seeking care for the treatment of pregnancy preventive treatment, not including sterilization
- The youth is seeking to obtain an abortion
- The youth is under 18 years old and over 12 years old and is seeking care for a contagious reportable disease or condition, a rape, and/or medical care and counseling relating to alcohol or drug abuse.
- Parental consent is necessary for narcotic replacement therapy, such as methadone maintenance
- The youth is seeking diagnosis, treatment and care related to sexual assault.
- The youth is at least 12 years old and is seeking HIV/AIDS testing.
- The youth is at least 12 years of ages and seeking mental health or counseling services.
- Mental health services must be provided by a licensed professional or those under his/her supervision. Mental health services, including psychological testing, may be provided either in a licensed residential shelter or in an outpatient setting if the youth meets both of the following two requirements :
- The youth, in the opinion of the treating professional, is mature enough to participate intelligently in mental health services.
- 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.
- The youth is at least 17 years of age or older and wishes to donate blood.
- For a child 15-16 years old, s/he may consent to blood donation only with the written consent of his/her parents/guardian and the written authorization of a physician.
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.
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
3, 4, 8
1**, 5, 6, 7, 8
Court Dependent (during or after business hours)
2, 5, 6, 9, 10, 11
1**, 5, 6, 9, 10
Allegations of Abuse/Neglect
Parental Consent Given
Parental Consent Unavailable
Parental Consent Refused
1, 4, 8
1**, 5, 6, 7
Court Dependent (during or after business hours)
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 consent or medical treatment amounts to medical neglect, create an allegation of general neglect.
- Create and screen a new referral record if there is no open referral being investigated to determine whether an in-person response is needed and, if so, the appropriate response priority.
- If applicable, create an allegation of general neglect.
- Create an form
- Create a form
- Refer caller to Business and Professions Code Section 2397
- Complete the , Court Medical Consent-Medical Emergency Worksheet
- Fax the , Physician Questionnaire, to the caller
- 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.
- Do not give medical consent
- Make a reasonable effort to obtain the consent of, or to notify the parent or guardian prior to giving medical consent
- Review the DCFS 4158-2 to ensure that the physician or surgeon marked “yes” for question number
- Give medical consent only if the 4158-2 clearly indicates that it’s a medical emergency.
- Fax the DCFS 4158-A, Authorization for After-Hours Emergency Medical Care for a Child.
- Forward the following forms to the Case-Carrying CSW:
- DCFS 4158-A
- DCFS 4158-2
- DCFS 4334
Consent for Emergency Medical Care
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:
- Complete the DCFS 4334, Court Medical Consent-Medical Emergency Worksheet.
- Fax the DCFS 4158-2, Physician Questionnaire to the hospital and request that the Physician complete the form.
- 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.
- Document the efforts made to obtain consent and notify the parent or legal guardian in the Contact Notebook.
- Document any decision to exclude a parent or legal guardian from being present for the medical procedure.
- 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.
- Review the DCFS 4158-2 with the SCSW and obtain approval to give consent to the emergency medical request.
- 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.
- 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.
- If medical consent is granted, complete the DCFS 1688-1, DCFS Worker’s Report to the Juvenile Court of Death, Injury or Illness, to inform the Court of the emergency medical procedure.
- Obtain the signature of the SCSW, ARA, and RA
- 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.
- DCFS 1688-1, DCFS Worker’s Report to the Juvenile Court of Death, Injury or Illness
- DCFS 4158-2, Physician’s Questionnaire
- DCFS 4158-A, Authorization for After Hours Emergency Medical Care for a Child Pursuant to WIC 369(d)
- Review the DCFS 4158-2 with the CSW and give consent for emergency medical care if the DCFS 4158-2 indicates:
- The procedure/surgery is a medical emergency
- The exact risks for the surgery/procedure
- The exact risks and side effects of the anesthesia being used
- When medical consent is granted, review and sign the completed DCFS 1688-1, and return it to the CSW for submission to the court.
- DCFS 164
- DCFS 1688-1
- Consent for emergency medical care
- DCFS 1688-1
- DCFS 1688-1
Info to CSW/Consultation Call form
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 Medication: Authorization, Review and Monitoring for DCFS Supervised Child
0600-505.20, Hospitalization of and Discharge Planning for DCFS-Supervised Children
for DCFS Supervised Children
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 5326.95 – 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.”