Confidentiality for children

luvche · Sep 15, 2010

This question on the main page caught my eye. Because i used to deal with this on a daily basis. Certain states have different rules about confidentiality. Here, teens getting reproductive health services for family planning or STD testing/treatment/prevention are considered emancipated minors. Their medical records are confidential. Even from parents.

I worked at a family planning/reproductive health office. We would have mothers call wanting to make appointments for their daughters. They would want them examined to see if they were still virgins. I had many sore parents when I would explain A) an exam can't always tell that and B) even if we would do that exam, the teen would have to sign a release of information to allow us to tell you the result.

I follow the law based on where I am at regarding medical records for minors.

Trauma Columnist · Sep 15, 2010

Look to your state's guidelines. Your ER should have a distinct policy on this subject.

wibobr · Sep 15, 2010

Unfortunately, we do not have a firm policy within the dept. We have experienced multiple run-ins on this issue and in an in-service a couple of years ago we were told that under law, Once a child reaches the age of puberty, they could initiate care for themselves on any sexually related matter,(stds'/pregnancy tests) and enjoy complete confidentiality for the same. As well, they could refuse any care including that which may compromise their life-styles (ie: Drug testing by demand of the parent.)and, that at such age where they understand the implications/ramifications and potential adverse outcome of any care after being so informed of the same, could refuse such care and enjoy complete confidentiality that HIPAA has provided. I realize we are talking about two distinct issues here, but I feel that they are directly related.

We have frequently had issues with parents asking for test results of their children some of which may include std/pregnancy related issues, requests for drug testing and the infamous "virginity" check and specific care that was provided. I personally find it VERY difficult informing parents of their child's rights under both HIPAA and applicable state law as I understand them. I have been called to the carpet multiple times for protecting an adolescents privacy. Yet after researching the subject(after such an incident)find our states statures are often contradictory and just plain difficult to decipher. Guidance anyone?

SlightlyMental_RN · Sep 15, 2010

Really, age of puberty? Do they mean that a menstruating 9 year old (which does happen) is really competent to make sexual decisions? Yowza. I'm pretty liberal in regards to letting teens make their own decisions (and mistakes), but the puberty policy that you're describing sounds horribly irresponsible to me. Why not put an age on it, like 15? That would be more reasonable, in my book. If this is a state law, what state are you in?

Nascar nurse, ASN, RN · Sep 16, 2010

Sorry, off topic a bit...

My highly responsible, honor roll 16 1/2 year old daughter is in trouble at school this week because she didn't turn in the parental permission slip to watch a Star Wars trilogy documentary. Got kicked out of English class for the whole week because she forgot the paper at home. (Had only ONE day to get it returned)

That same girl could go out, get pregnant, have an abortion, etc etc & I'm not even allowed to get information BUT she's in trouble & needed parental permission to watch Star Wars. Jeesh! Just another example of the world gone mad!

Larry77, RN · Sep 16, 2010

Here it's 12 for reproductive, and 14 for psych...or something close to that (I usually ask the social worker for the specifics if I need it)

Can you imagine having your 12 year old daughter pregnant and the doctor couldn't tell you unless she wanted him to? Yikers...

Crazy law!!!

luvche · Sep 17, 2010

Here's my take: because of that "crazy" law, I knew a girl in high school who was able to get out of her house and into a group home for pregnant teens, finish her education and learn a trade and raise her baby. She was in a severely abusive home. Had her dad found out she was pregnant before she could get herself out of there, she would've had the crap beat out of her.

Spare me the any logic of "child protective services could've helped her if he was really that abusive" apparently, they had been called in the past. Each time, he could make her look like a bratty child who was lying. Unfortunately, she did use that protection of the law to get birth control (at least one smart thing to do while finding "love" from guys since she obviously didn't get enough at home).

Her dad found the wrapper in the trash. Unfortunately, it was days of mental abuse, yelling, hitting...etc.

In a perfect world, kids would be able to talk to their parents and be open, and maybe these things can be prevented. Sorry to say, it's not a perfect world...and so this type of law is needed in those cases. Not just ones like the one I stated above.

I have a 13 year old. I hope I have made her comfortable and proved myself to be a parent that she could talk to me about sex and birth control. But if not, I am glad to know that she would have a way to get herself protected or get care in confidence.

wibobr · Sep 23, 2010

Further research has relealed that there are three distinct area in which children can enjoy perfect confidentiality in all but two states. On ANY matter of self incrimination (drug use), sexuality to include birth control and STD care and last but not least Psych care (with significant limitations) As well even if the parent brings the child in and is either asked to leave the room during the objective and subjective exam phase, the law applies, the child must give permission for the information to be disclosed to parental authority. In working with our HIPPA expert here, thus is the rule we must follow. As well, insurers are equally bound to not reveal protected info to the parent if such information wouuld compromise patient confidentiality.