SEX and the DD population

[SHGR, MSN, RN, CNS]

Hey y'all.

So.... we had a young lady DD patient come to the clinic with her mom, who functions as her guardian, but apparently they never "did the paperwork" for legal guardianship because their arrangement works for them etc. I didn't meet the family, but it turned into a big issue for nursing staff so I'm asking here.

The doc did STI testing and the patient had a positive chlamydia or gonorrhea, then told one of the nurses to call the family and have the patient treated. Because then the mom answered the phone and got very upset at the nurse, whom she had never met, who then realized mid-phone call that this could be some weird HIPAA mixup.

Normally this is a doc that I just adore, but this really left me wondering.

I do have a lot of experience with people with DD in nursing and therapeutic recreation, and also personal experience, and sexual assault and just general "taken advantage of" in all its forms is SO COMMON it makes me want to barf just typing this. (but I also know people in the DD community in loving healthy relationships). Since I didn't meet this young lady I have no idea how capable she might be of making any decisions for herself. The doc said "3rd grade level" but that doesn't tell me too much.

How is this normally handled? I mean, the doc actually met the family, actually did the test, and my thought is that she did the test for a reason, and at that point she should have said, "I am testing for sexually transmitted diseases, and how should we handle the results?" and also do a lot of teaching? And ask if anyone tried to touch her etc? How does HIPAA work in this situation?

[Staragate, ADN, ASN, RN]

I'm speaking as an aide who worked directly with high school DD students.

If she is working at a 3rd grade cognitive level, then she understands things like a 9 year old would. A 9 year old would be able to understand right and wrong, good and bad. I think that if she has been abused, it should be approached at that level. As far as consent goes, she has the right to keep her mom out of the loop, but she probably won't. Just get the okay before you get too detailed. "Would you like your mom here when we talk?" Posed like that, the answer will probably be yes.

Anyway, even though her mind may be at 9 years old, she still has the body and the urges of a woman. It is quite possible, or likely, that she found a boyfriend and it was consentual. If the boyfriend is near her level, then it's not abuse. The STI could have passed between partnerships in her group, or it could have been abuse.

i hope this helps.

[SHGR, MSN, RN, CNS]

That does help, at least partially. At least if the people you are working with actually are under 18, then there are regular laws that apply, but you are definitely right, when people have the body of an adult and a child mind, it gets sooooo tricky.

I have no idea what happened at the visit. It just felt like a "dump" in the sense of a doc having the nurse do something she should have done for the patient's sake- thoroughly explained it all at the visit, then followed up with the call.

[Rob72, ASN, RN]

As far as consent goes, she has the right to keep her mom out of the loop, but she probably won't.

"Sort of...". Legally, until she has been ajudicated incompetent to self-determine within certain parameters, technically, legally, her care should only be discussed with her (the patient).

However. If she is determined clinically to be at the +/- 3rd grade level, then ethically(aka, the State Medical Board's determination),and legally, a care-giver/guardian needs to be included in the conversation. Doc needs to have a serious conversation with mom and/or adult protective services.

IIRC, gonorrhea is still the most common STD. There is also a new ceph. resistant strain just coming to a town near you. My suspicion is that the first rash of deaths r/septicemia will be hookers, johns and the DD community.

[KATRN78]

I have worked in the DD population for about 14 years. This population has sexual urges and act on them just as any other population. The problem is that this population often has poor judgement and less inhibitions.

Only one time did I encounter a woman who was taken advantage of, even then it was not illegal what the man had done with her because she is considered a competent adult (even though she is moderately mentally retarded).

Often I have encountered many promiscuous men and women in this population but for some reason they tend to engage in sex among their peers. This can make day-programs very interesting and not to mention the amount of chaperones needed for camping trips.