Failure to obtain consent for minor

[bmj518]

What is the name of your state (only U.S. law)? Wisconsin

My ex ("Ann") has some third party visitation time with my children. (We live in Minnesota but this occurred in Wisconsin.) NO other legal or parental rights. Yesterday, she took my 4 year old to the ER because he had a 1 inch cut on his cheek that she decided needed attention. She attempted to call me on my personal cell, which was off. She made no attempts to call my work number (where I was available) or to use any other method to reach me. She left another message 25 minutes later giving me a number I could call to give verbal consent. When I called her back later that evening, I found out that the hospital put stitches in his face.

Had I known about this, I would have
1. Taken him to his clinic. I trust the docs there. (I do not trust the docs in this little rural ER.) There are usually a few options for a cut like this, each with pros and cons.
2. Made a decision based on the information. You know, informed consent

This is where it gets confusing. I was livid that the hospital did anything like this without my consent. (Background - I am a nurse and worked in an ER in the past. A simple cut like that can be stitched/glued/whatever for a good 12 hours. It is urgent, but not emergent. Certainly not threatening to life or limb - which is the requirement to treat a minor without consent.) The hospital clerk told me that Ann signed the HIPPA form as "mother". He told me they always obtain consent and he wasn't there at the time, but could only assume that she told them she was my son's mother. He also told me that Ann had listed her address as my son's address.

So I went out to the hospital today to get more information. The registration clerk was the same one who registered them yesterday. She told me that Ann had "made it clear that you were his mother" and had said over and over that she couldn't consent. She told me that she only had Ann sign one form, which was for billing. This was actually the HIPPA form that, besides billing, authorized the release of my son's records. I'm pretty sure that's not ok and I told her that. I asked why no one called me. The registrar said that she saw Ann try to call me and I wasn't answering. And that's it. I asked who signed for consent and she said that she only had Ann sign that HIPPA form, nothing else. So I guess no consent?

I made a police report yesterday because it looked initially like Ann had committed forgery by pretending to be Mom. But now it looks like the hospital is involved, too. (More background - Ann is a paramedic in the same small town and works with this ER all the time. I am quite sure that they all know her. Based on one comment from the officer I spoke with, I'm sure he knows her, too.)

So...what can I do? The officer said that I should report the HIPPA stuff to the feds and that the failure to obtain consent is probably a civil matter. He agreed that this is messed up. Someone can perform minor surgery on my child without my permission and it's civil???? So what do I do? There is no injury per se, because the cut had already happened I don't know that I would have done anything differently regarding the stitches. Again, I don't know because I wasn't given the chance. I'm sure that the doc did just fine in placing them. I suppose that he will have scarring from the sutures - but again, I may have made the same decision. I don't know. Any advice or opinions would be greatly appreciated.

 

[OHRoadwarrior]

Without researching any WI laws, which I will take a look at, I am thrilled you are not my parent. I could die, while the hospital awaited your approval for treatment, if there was a doubt. As you said, there are options depending on what the doctor felt needed to be done. The doctor made a determination. The is why he/she is a doctor and you are a nurse.

 

[bmj518]

How is the view from way up on that high horse? My son had a frickin 1 inch cut on his cheek. He was not dying. Why have minor consent laws if they don't matter? Why not just let anyone come in off the street and sign as long as the doctor says its ok?

If you blindly follow the advice of every person with Dr. in front of their name, especially those in B-F tiny hospitals, good luck to you. But what do I know, I'm just a nurse.

And, since you know nothing about the situation, this person's demonstrated (like, through her own actions and documented words) behaviors are about to get her visitation revoked. Those behaviors include Munchhausen tendencies, claiming the kids are always hurt or sick. So don't judge. I'm just asking about the law.

 

[LdiJ]

Without researching any WI laws, which I will take a look at, I am thrilled you are not my parent. I could die, while the hospital awaited your approval for treatment, if there was a doubt. As you said, there are options depending on what the doctor felt needed to be done. The doctor made a determination. The is why he/she is a doctor and you are a nurse.

That is one of the more ridiculous statements that I have ever heard you make. This was in no way, shape or form a life or death situation. The OP is a nurse and knows the difference. The OP addressed the particular issue in the first post...that it was urgent but not emergent. The hospital had no right to treat the child without the permission of the parent because it was not a life or death situation, or anything that would cause the child lasting harm if not immediately treated.

OP, in my opinion you are being lied to. If Ann didn't authorize the treatment nothing would have been done. Ann authorized it, even if she did so silently. How did Ann get third party visitation? It needs to be made clear to Ann, by a judge if necessary, that Ann does not have the authority to authorize, even silently, any medical care.

 

[OHRoadwarrior]

Don't argue with me. Argue with the politicians and judges who are apparently much wiser than parents wanting to micro manage their child's medical care in absentia. The bottom line is like it or not, in the emergency room, the law allows the doctor to decide what treatment is needed when a parent is not available.
(The two of you and your emotional control and over-reactions seem almost related)


Delaying treatment, which would unduly extend the the childs pain and have the same end result, is not illegal as a matter of case law. The Federal EMTLA appears to address this and provide the following

When treating a child under the age of 18, in the emergency department, personnel may make efforts to obtain consent for care from a person with “parental responsibility,” such as the child’s mother, father, legal guardian, or local authority responsible for the child. If medical personnel are unable to contact a parental authority, then the medical provider in charge of the child’s care will determine what is in the best interests of the child.

 

[bmj518]

Dude, you're crazy. EMTALA states that anyone receives an assessment and emergency stabilization and treatment - it does not ok the hospital to do whatever the doctor thinks is a good idea. Likewise the non-consent rules. Life, limb, and SEVERE pain management. If you think that the pain from a small lac on the cheek is SEVERE, I would hate to be your caregiver. Besides, a few stitches wouldn't even treat the pain... Do you just hang out here and insult people without even having knowledge of what you speak?

Thank you, LdiJ. Hearing it from someone with no other knowledge of the situation...I keep coming back to it. I just can't see how the doctor would have put her license at risk, even if she does know Ann from work. I'm curious to get the chart on Monday. The police officer that I spoke to said he is planning to investigate forgery charges if she gave consent. I'll still talk to their complaints department. My guess is that they will CYA pretty quickly if she lied to them.

Ugh - this woman is causing many, many problems in my life. She got third party by virtue of being my ex. We lived together when the kids (now 4 and 6) were born. She never took any legal steps regarding them, then walked out when they were 1 and 3. Then made my life hell for a year when I tried to cooperate with her, then motioned for visitation rights. I stipulated at the time because I couldn't prove that her visits were not in their best interests or that they would interfere with my parental relationship (based mostly on the fact that they were so young). Those are the requirements for visitation - best interests AND no interference. The Supreme Court has been very clear that you need both. Now I have LOTS of evidence in both cases. The woman lies like a rug - this is just one of the most blatant instances. I don't think that she has actually signed legal documents before. I'm sure my lawyer will want to amend our materials to include this incident. So, yeah...probably more than you were wondering

 

[ecmst12]

The visitation probably wouldn't have been granted if you hadn't agreed. 3rd party visitation is not easy to get ordered especially by anyone other than a grandparent or step parent (which you weren't married, living together doesn't count). Too late now though.

I think failing to get the cut stitched promptly would have resulted in some nasty scarring on your child's face, though.

 

[OHRoadwarrior]

Soooo, she was a great person when you were looking for a pearl, when you decided she was not a gem, she is a horrible person. Perhaps she rubbed off on the doctor who LEGALLY treated your child as an emergency and based on the inability to contact you, then gave said child a stitch, as their belief regarding sound medical treatment.

Do you always create this much drama in your life?

 

[bmj518]

I had a pretty nasty judge who I now realized railroaded me. At the pre-trial, he declared that it looked like there was some visitation for her and sent us to Early Neutral Evaluation (basically mediation). My lawyer was terrible and allowed that to happen. Then he signed the agreement that came from there without even reading it. (There is one section that was clearly not edited properly before it was sent to him - the entire first half directly contradicts the entire second half). But yeah, she could get it based on having lived with the kids and then on the best interests/no interference stuff. So now that I have indisputable evidence of interference and her behavior not being in the best interests, we are hoping to have the visitation basically modified to zero. The judge is still being terrible and has thrown up roadblock after roadblock. My lawyer is approaching the Chief District Judge this week because my judge has said he will not hear our motion until we go to mediation. Which we did - the mediator quit And you can't really mediate "you're dangerous and should not be around the kids". And we haven't filed any other motions in the past other than the ex parte related to the current situation. It was in the ex parte ruling that he told us he wouldn't allow us to schedule. It is quite clear that the judge does not want to deal with this law and/or our case.

As for the stitches...the thing is, I very well may have made that decision if someone had just contacted me. We're not talking a delay of more than a couple of hours if someone had done what they are supposed to do. Not long enough to scar. Like I said in the OP - you really have a good 12 hours in that situation. Besides, a huge part of my issue is where she took him. I live in, and she lives on the outskirts of, a large metro area with great hospitals. At the ER I worked at, any face stitches were placed by a plastic surgeon. That is why I am upset - if stitches were actually needed, I had the right to decide who would do them. I would have also liked to hear why she decided against glue or steri strips, which would have been much less invasive.

 

[LdiJ]

The visitation probably wouldn't have been granted if you hadn't agreed. 3rd party visitation is not easy to get ordered especially by anyone other than a grandparent or step parent (which you weren't married, living together doesn't count). Too late now though.

I think failing to get the cut stitched promptly would have resulted in some nasty scarring on your child's face, though.

Or, the stiches could result in scarring that would not have existed if butterflies or other methods had been used instead. In this instance the parent didn't get to make an informed decision....when the parent is a medical professional themselves.

 

[bmj518]

Or, the stiches could result in scarring that would not have existed if butterflies or other methods had been used instead. In this instance the parent didn't get to make an informed decision....when the parent is a medical professional themselves.

Thank you. That is my primary issue. I just can't find a specific statute that states the need for consent. I can find informed consent, but this starts with just consent, pure and simple. You cannot perform a medical procedure without consent. Is it considered common law?

 

[LdiJ]

Thank you. That is my primary issue. I just can't find a specific statute that states the need for consent. I can find informed consent, but this starts with just consent, pure and simple. You cannot perform a medical procedure without consent. Is it considered common law?

I am not sure what you are hoping to accomplish at this point. What you want to accomplish has a great deal to do with the overall situation.

If you want to make sure that the hospital does not do this kind of thing in the future, your remedies are very different than if you want to make sure that Ann doesn't overstep her bounds in the future.

 

[bmj518]

Soooo, she was a great person when you were looking for a pearl, when you decided she was not a gem, she is a horrible person. Perhaps she rubbed off on the doctor who LEGALLY treated your child as an emergency and based on the inability to contact you, then gave said child a stitch, as their belief regarding sound medical treatment.

Do you always create this much drama in your life?

Seriously, get a hobby besides harassing people who are looking for advice. Your BS could seriously affect someone who doesn't know that you have no idea what you're talking about.

My ex uses the word "drama" to describe refusing to allow your rights to be trampled on. That's all I need to hear to understand you

 

[bmj518]

I am not sure what you are hoping to accomplish at this point. What you want to accomplish has a great deal to do with the overall situation.

If you want to make sure that the hospital does not do this kind of thing in the future, your remedies are very different than if you want to make sure that Ann doesn't overstep her bounds in the future.

I honestly don't know. Both, I guess - depending on what happened. I would like to see Ann face the consequences of her actions, if there are any. I say that not out of spite, but because she lies so much, then manipulates the situation so that she never gets called on it. Sort of like a sociopath.

As for the hospital, I would like to see them held accountable if they knowingly chose not to contact me. That is a pretty big deal. I don't know what being held accountable means in that case. Like I said before, I have a hard time believing that this was done purposefully, because they know the consequences. When I worked in the hospital, we had "sentinel events" - incidents that were studied in depth to see what happened so it didn't happen again. If this was a case of miscommunication or something along those lines, I would like the see the hospital figure out what happened so it doesn't happen again.

And they do need to teach their registrars about HIPPA paperwork. I am still thinking about reporting that one on the federal complaint portal, because there is no excuse for that. But that is really a separate issue.

I guess that a lot depends on what is in the chart I get on Monday and what the hospital says. If she committed forgery, its in the police hands. If not....I'm not sure.

 

[OHRoadwarrior]

Here is the related Federal statute, outlining the emergency rooms responsibility. As I think you will understand upon reading it, a doctor should not be put into the position of determining whether a 4 year old has the sense not to pull open a temporary medical repair. I do understand why part of you is torqued. Might I politely suggest you are deflecting your ire at your ex on the poor doctor. There are transfer provisions in the statute also. You will want to review it.

http://www.law.cornell.edu/uscode/text/42/1395dd

(b) Necessary stabilizing treatment for emergency medical conditions and labor
(1) In general
If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or

3)
(A) The term “to stabilize” means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta).