HIPPA and Parents of Minors

morte, LPN, LVN · May 27, 2012

I can certainly see providing alone time. But not totally denying parent participation. To me this may well drive the parent to remove the child from any healthcare, the "unintended sequelae of ones actions.".....And it would concern me, what the provider was planning on doing, that I wasn't supposed to see.

While it's not HIPAA, I can see how a California family clinic might get the impression that children 12 and older should have their doctor visits in private. From the link Nurse156 provided:
California Minor
Consent Laws
TIPS….
• A young person is more likely to
disclose sensitive information to a
health care provider if the youth is
provided with confidential services,
and has time alone with the provider
to discuss their issues.
• Remember that even when the chief
complaint is acne or an earache, there
may be underlying issues on the part
of the adolescent (such as the need
for a pregnancy test or contraception),
which will only surface if they are
provided confidential services.

I think that could easily be interpreted as at least strongly recommending children 12 and older see their doctor without their parents being present, since 12 is the age of consent in California for things like reproductive health services, rape, etc.

allnurses Guide · May 27, 2012

I have to admit I was pretty surprised to see the part about acne and an earache. I have two kids that lived in California between age 12 and 17 and received care for various earaches, asthma, sprained ankles, received immunizations, and sports physicals. I never saw a sign , nobody tried to prevent me from walking back to the room with my kids, or even mentioned the issue. I'm sure I wouldn't have quietly accepted it, either - if I was bringing my 12 year old in for an earache.

It does sound like if the asthma situation in the Florida school nurse case had occured in California she would've given the 17 yr old his inhaler.

Esme12, ASN, BSN, RN · May 27, 2012

Health Information Law in the Context of Minors

Thepower to control health information can be thought of as a logical extension of the right to privacy and autonomy in health care decision-making. The basis of these privacy expectations is found in the common law, although a constitutional basis for the right to privacy is now nearly universally acknowledged. Common law, which represents the most explicit legal basis for privacy rights, provides for parental/guardian deference in the case of medical decision-making involving minor children.

Therefore, in treating a minor child, a health care provider must obtain the informed consent of the adult empowered to make health care decisions on the child's behalf. By extension, adults have control over the information that results from health care. Over the decades, however, courts have carved out important legal exceptions.

However, many state legislatures have abrogated statutorily (ie, displaced) common law for certain types of health care or child populations. Together, these judicial or statutory exceptions recognize children as independent of their parents, thus adding to the law's complexity and variability.

Common law and state statutes now recognize 3 distinct types of legal approaches to broadening the power of children to consent to care and to control health information. The first approach builds on 2 legal doctrines, that is, the “mature minor” and the “emancipated minor.” The second approach reflects a doctrine known as parens patriae. The third approach permits exceptions to the parental consent rule for specific types of treatments sought by minors, particularly treatments related to reproductive and behavioral health, especially treatment for substance use.

Health Information Law in the Context of Minors

The law has evolved to include certain condition-specific applications of the emancipated minor or mature minor doctrines, by permitting children to consent to certain types of necessary care that could be deterred as a result of parental notification. Such services include the evaluation, diagnosis, and treatment of drug and/or alcohol abuse; family planning, abortion, and treatment of pregnancy and related services; treatment for sexual assault; and treatment of mental health problems, sexually transmitted diseases (STDs), and HIV/AIDS. The provision of emergency care to minor children without parental consent also is permitted.

Health Information Law in the Context of Minors

The HIPAA Privacy Rule also distinguishes between emancipated and unemancipated minors regarding disclosure to third parties, consistent with the common law tradition. Emancipated minors, like adults, must be given access to their health information and medical records, as well as the ability to obtain copies and to request corrections. For emancipated minors, the rule provides for parental control of information flow.

HIPAA also creates 3 express situations in which a minor's privacy considerations prevail: (1) when the minor has the right to consent to health care and has consented; (2) when the minor may lawfully receive care without parental consent and the minor, another individual, or a court, has consented to the care; or (3) when a parent has agreed to a confidentiality agreement between the health care provider and the minor child, which occurs most often when the treating physician has a professional relationship with the family.

This is a very informative article there is much more content that is free at the links provided. The pediatricians office is out of line. It may be their policy but it is not a HIPAA rule.

vintagemother, BSN, CNA, LVN, RN · May 28, 2012

Thank you all for the additional information. I truly appreciate it, both as a parent (with 2 teens and a 7 year old) and as a future nurse!:redbeathe

RNGriffin · May 28, 2012

HIPAA does protect minors. But, the privacy of healthcare information is not granted solely or independently until the minor is 6,205 days old( weird that we count age by days) 17 years of age. Even then, the only protected information would be sexually transmitted diseases that are not chronic, and positive pregnancy test. Under New York State Laws, I am not certain with other states HIPAA laws outside of (Maryland, New Jersey, CT, MA, CA, and TX) a positive screening for pregnancy is the minor's right to disclose.

nurseprnRN, BSN, RN · May 31, 2012

i have always said that for many people "i can't tell you/do that because of hippa (sic)" is shorthand for, "i slept through that inservice/i'm too lazy to get up and look in the folder on the other side of the desk/i don't feel like it and you can't make me." in this case, when they tell you " 'due to hipaa , parents are not allowed in the exam room with children aged 12-17.'when the mother pressed the issue, she was told there have been recent changes to california hipaa laws" it's probably all of the above.

a child of 12 is a child. the parent/legal guardian is entitled to be present for any examination or conversation with a health care provider. that said, if the provider has any inkling that there may be abuse, there are channels in every state to report those suspicions, and then the proper authorities can follow up.

there is no such thing as a "state hippa (or hipaa) law." hipaa is a federal law. there isn't a dang thing about examining adolescents in it. california apparently has provisions that an adolescent may be seen in private, but anywhere else i'd ask to see it in writing before i acted on it (or let anyone else act on it on anything involving me or my child).

MunoRN, RN · Jun 1, 2012

a child of 12 is a child. the parent/legal guardian is entitled to be present for any examination or conversation with a health care provider. that said, if the provider has any inkling that there may be abuse, there are channels in every state to report those suspicions, and then the proper authorities can follow up.

actually in california the parent/legal guardian is not entitled to be present for any examination or conversation with a health care provider. age 12 is the age of consent for numerous services, including birth control and std treatment, and also allows for examinations and other related services to be confidential, even from the 12 year old's parents.

Esme12, ASN, BSN, RN · Jun 1, 2012

Actually in California the parent/legal guardian is NOT entitled to be present for any examination or conversation with a health care provider. Age 12 is the age of consent for numerous services, including birth control and STD treatment, and also allows for examinations and other related services to be confidential, even from the 12 year old's parents.

The child, in accordance with California law, provides that a child of 12 has the right to have a healthcare examination/conversation with a healthcare provider about STD, birth control etc but only for those specifications that are stated in the law itself. What I posted above talks about CA and 3 other states that have enacted this type of law with very clear specifications....... not that it excludes the parent from the equation. If the child is not seeking these specified treatment then the parent/guardian is not only entitled but required to be present and to give consent. They are still a MINOR unless emancipated by the courts or becoming a parent etc.

HIPAA is a federal mandate and the states may not pass laws in violation of this mandate but they may pass their own specifications/requirements on their own "HIPAA" regulations for their state depicting more stringent protection/processing within that state....like the age of consent of minors. HIPAA is complemented by state laws that, while similar to HIPAA, may offer more generous protections. Your Health Plan And HIPAA ... Making The Law Work For You

Beware of More Stringent State HIPAA Laws

California has the most stringent patient privacy laws in the nation–stronger than new federal laws.Last September, state leaders passed Assembly Bill 211 and Senate Bill 541.

The measures:

Specify penalties for unauthorized access to medical records
Require organizations to report privacy breaches more quickly
Make safeguards, such as password protection, a state requirement
Assign rights to enforce patient privacy violations to a new state office, the California Office of Health Information Integrity.
"California has been on the forefront of patient/medical records privacy laws, and existing California law did not completely address the issue of unauthorized access of patient medical records by employees," says Esther Chang, JD, attorney at McDermott Will & Emery, LLP, in Los Angeles.

Last week, Kaiser was slapped with a six-figure fine for failing to secure electronic patient records from snooping employees.

MattNurse, MSN, RN · Jun 1, 2012

You have a right to receive HIPAA disclosures, in fact you have to sign saying you received their HIPAA pamphlet. Look through it and ask them to point at the part that gives them this right.

However, the parent should not be part of the full physical exam for a 12 year old. This is a very sensitive time and change for a child and it is embarrassing enough to have an adult looking at and touching your genitals, to have a parent present can be too much of a privacy invasion.

vintagemother, BSN, CNA, LVN, RN · Jun 7, 2012

RE: "it is embarrassing enough to have an adult looking at and touching your genitals, to have a parent present can be too much of a privacy invasion."

So, in your mind, because having your private areas touched can be embarrassing and an invasion of privacy, strangers (medical workers) should be allowed to do this with kids without their parents in the room?

I, politely, disagree.

I think it can be very difficult for adults, let along children, to speak up and advocate for themselves, to a person in authority such as a medical pro, while in a compromising (naked) position.

I don't mean to start a debate. It's just that I have a real problem with just that exact issue. I don't want to leave the room and my kids be told to do X, Y or Z. I believe that no-one has the right to invade a person's privacy - not your parents or the doctor or anyone else.

When I paid good cash money to see a specialist, he never would discuss the reasons we were there with me while naked. He knew that being naked on your back with legs open diminishes a person's ability to be an advocate for themselves.

His attitude suited my style.

MattNurse, MSN, RN · Jun 8, 2012

RE: "it is embarrassing enough to have an adult looking at and touching your genitals, to have a parent present can be too much of a privacy invasion."
So, in your mind, because having your private areas touched can be embarrassing and an invasion of privacy, strangers (medical workers) should be allowed to do this with kids without their parents in the room?
I, politely, disagree.
I think it can be very difficult for adults, let along children, to speak up and advocate for themselves, to a person in authority such as a medical pro, while in a compromising (naked) position.
I don't mean to start a debate. It's just that I have a real problem with just that exact issue. I don't want to leave the room and my kids be told to do X, Y or Z. I believe that no-one has the right to invade a person's privacy - not your parents or the doctor or anyone else.
When I paid good cash money to see a specialist, he never would discuss the reasons we were there with me while naked. He knew that being naked on your back with legs open diminishes a person's ability to be an advocate for themselves.
His attitude suited my style.

Yes, not only in my mind, but it is a standard practice to examine an adolecent without a parent present.

A 12 year old boy going through puberty does not (in most cases) want his mother in the room while his genitals are exposed and being touched, boys at that age are very self-conscious. I can imagine a 12 year old female would not want her father in the room while she is undergoing a pelvic examination. Although I think their should be a chaperone in the room during an exam. Nurses are patient advocates and can be the chaperones depending on the office.

Altra, BSN, RN · Jun 9, 2012

The pediatrician and even the pediatric dentist who saw my children when they were still minors strongly encouraged parents of adolescents to remain in the waiting room.

In my state, 13 is the age at which minors do not need parental consent to seek psychiatric services or health care related to birth control, STIs or pregnancy.

I find some posts in this thread disheartening, in the lack of recognition that a patient will most likely provide accurate answers to questions and get the benefit of health care providers' answers to their questions if they are not accompanied by family. Does a 12-year old boy really want his mother to hear his questions about information he has picked up from friends about his developing body, or the developing body of a girl? Without mom present, he may ask those questions, and get accurate answers, without the family dynamics.

There was a recent thread on this same topic with adult patients accompanied by spouses, partners and family members. Some recurring comments included something along the lines of, "don't they think I've ever seen his/her body before?" Again ... very disheartening ... the lack of recognition that they way that intimate partners see each other is very different from a clinical examination.