Author Question: Consent Issues Peds ER

Carol Asks:

Scenario:

Hero’s daughter is spending the night at the heroine’s house b/c he has to work. They think she has the flu but is appendicitis and is gonna burst [based on a friend’s kid’s experience ;)]. Heroine wakes up to hear her crying in the middle of the night. Goes to check on her and gets her roomie who is a licensed [but not practicing] paramedic. Says we gotta get straight to the hospital but hero isn’t answering phone.

So, they get there, but dad’s nowhere to be found. Heroine knows daughter’s name/birthday but that’s it [not even an address].

1. Will they still try to find a patient in the computer based on the info they have [patient’s name, birthday, town, dad’s name etc]?
Jordyn: How old is the child? A first or second grader should know their address so they would look up her name and birthday and try and match the address. If not, they’ll just create a new chart. It’s possible to merge electronic records at a later time. Do they not even have a phone number to reach him? That would be pretty odd.
2a. How much credence will they give to the medic since it’s not someone they know? He’s gonna rattle off information [HR, BP, temp, etc] and don’t they have some sort of ID card he could use to back up his claim that he knows what he’s talking about?
Jordyn: It’s anecdotal. We’d probably be most interested in the temperature. She’ll get her vital signs taken at the time and it might be curious if they are markedly different than what the paramedic got. But, we won’t ask for his ID. We’ll just want to know what treatment they provided at home and probably the last time she ate or drank (for purposes of surgery that’s important to know.)
2b. Should they call the ER en route?
Jordyn: No, this is cheesy. People do it but it won’t move you up in line, it doesn’t reserve a spot, etc. We’ll say, “Okay, see you when you get here.” Unless they are requesting emergency info—like how to do CPR—it doesn’t make a difference in the care of the patient when they arrive. You’d be surprised how many people call and then never show up.
2c. Is it plausible they’re not too busy at 3am on Sunday morning? And go pretty straight back?
Jordyn: Yes, this is plausible.
3. Will the medical staff allow the heroine/medic back into the ER room etc. before dad gets there?
Jordyn: Yes, if she is the only adult and the daughter is comfortable with her, she’d be allowed back.
4. When dad gets there, will they require any ID for him to prove he’s dad?
Jordyn: Typically, we get ID and insurance card if they have one. Before that—attempts will be made to reach him via phone to get verbal consent to treat. This is a big deal with minors. If it’s not an emergency—medical treatment can wait. If it is an emergency—we can go ahead and treat regardless on consent. 

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When she’s not writing about her imaginary friends, Carol Moncado is hanging out with her husband and four kids in the big yard of her southwest Missouri home, teaching American Government at a community college, reading, or watching Castle and NCIS. She’s a member of ACFW and RWA, founding member and current facilitator for the MozArks ACFW group, and a category coordinator for ACFW’s First Impressions. 

Author Question: Medical Power of Attorney

Stacy Asks:

Is it possible for a father to grant a Medical Power of Attorney to another person for the general health care of their child? In my WIP, I’m dealing with an emotionally abusive father who isn’t particularly concerned with the health and well-being of his minor daughter (the mother is dead.) I wondered if her best friend’s parents might convince him to give them a MPOA (or whatever the abbreviation is) so they could take her to the doc when she is sick, etc.

Later in the story he turns physically abusive and she ends up in the hospital and will need treatment — he’ll be at home passed out from alcohol and won’t be able to grant it, so … would the friend’s parents be able to grant that? Would they even need the MPOA? How would she be treated if there was no responsible adult available?

Oh, and this takes place in 1999, not today.

Jordyn Says:

Interesting question.

Yes, the father can grant medical power of attorney to whomever he wants.

But… if there is not paperwork what happens when the child presents for medical care?

If the child presents with a life threatening situation– we will begin treatment regardless of ability to obtain consent.

If no life threatening situations exist the hospital is required under EMTALA to provide what’s called a Medical Screening Exam (MSE) to determine if the patient is having an emergency or not. If the patient is not having an emergency, the emergency department can opt out of treatment. However, in this case we could do the MSE and then try and contact next of kin for consent. Hospital policies generally dictate who can give consent in cases like this.

However, if there is concern for abuse– we will sign the patient in and get social work involved and follow their direction. We would likely treat this patient under those conditions.