When Can You Treat Minors Without Parental Consent?

Q. I treat children and adolescents in my psychiatric practice. Recently, an older adolescent requested treatment but does not want his parents to know. Who may consent to treatment for a minor? Does it make a difference if the adolescent is over 16 years of age?

A. Traditionally, the law has considered minors to be incompetent to give consent to medical treatment. Most states have statutes that govern who may consent to mental health treatment and under what circumstances. Generally, a parent or legal guardian must consent to the treatment of a minor. There are various statutory and judicial exceptions to the rules of who may consent.

Minors of a certain age have been granted the right to consent to specific types of treatment in some states. For example, minors may have the right to consent for themselves to treatment for sexually transmitted diseases or health services for birth control or pregnancy. Several states permit minors to obtain psychiatric treatment and/or substance abuse treatment without parental consent. Even states that permit minors over a certain age to consent to mental health treatment usually do not allow minors to give informed consent for psychotropic medications.

Most states allow emancipated minors or “mature minors” to give consent for mental health treatment. State law establishes the criteria for being considered an emancipated or mature minor.

Do not treat a minor under an exception to the consent law unless you have confirmed that the exception is valid and applies to the particular situation under the laws of your jurisdiction. Documentation in the medical record should support treatment under the exception.

Know your state statutes about who may consent to a minor’s psychiatric treatment or admission to a mental health treatment facility before treating a minor. Written consent for treatment should be obtained from the parent(s) or legal guardian and maintained in the child’s medical record. Consent given by one who does not have the legal authority to give consent is no consent. Individuals who do not have the legal authority to consent to treatment often present children for treatment (grandparents, babysitters, stepparents, siblings, and so on). In a nonemergency situation, the psychiatrist must determine who may legally consent and obtain that person’s written consent before beginning treatment.

In an emergency, treatment may be provided without consent. Some states have passed laws applicable to minors and emergency consent; they vary as to the immediate and probable harm that must be present for treatment to be provided under this exception. The psychiatrist must make a clinical decision about whether treatment is appropriate when a minor is presented for psychiatric treatment under the emergency exception. Physicians should be familiar with the minor consent laws in their states. In any case, the documentation in the medical record should include the clinical rationale for a decision to treat under an emergency exception.

Child-custody situations complicate the issue of who has authority to consent to a child’s psychiatric treatment. Program participants are encouraged to call the Risk Management Consultation Service at (800) 245-3333 for more information about this circumstance and other risk management issues related to treating children and adolescents. Risk management articles about this topic are also available in our Online Risk Management Library in the “For Participants Only” section of www.psychprogram.com.

Q. I am considering reducing my hours and would like to know how part-time discounts are calculated with the Psychiatrists’ Program.

A. The Psychiatrists’ Program offers a premium discount of up to 50 percent for part-time practice. Part-time hours are calculated based on the weekly total hours of all covered professional activities at all covered locations. Should your hours slightly fluctuate from week to week, it is acceptable to average the hours over a longer period, for example, six months. The discount is based on a range, as follows (except in New York, where the part-time discount is 50 percent for 20 hours or fewer):

• 1 to 10 hours weekly: 50 percent

• 11 to 15 hours weekly: 40 percent

• 16 to 20 hours weekly: 30 percent

Weekly hours are determined by calculating not only direct patient care but also other activities your policy covers, such as records management, consultations, peer review and utilization review activities, and hospital rounds. Please note that when seeking coverage for on-call work, the on-call hours are used to calculate total practice time in the context of actual hours worked during the on-call period.

If your hours have changed, contact your underwriter by phone at (800) 245-3333 or by e-mail at [email protected] so that your next premium can be calculated accurately.

This column is provided by PRMS, manager of the Psychiatrists’ Program, for the benefit of members. More information is available by visiting the Program’s Web site at www.psychprogram.com; calling (800) 245-3333, ext. 389; or sending an e-mail to [email protected]. ▪