Chief Compliance and Ethics Officers Health Care

1.  Minor Patient question

Posted 05-17-2017 06:10 PM
Hi everyone,

General Questions: If a provider thinks that a parent/personal representative of a minor child is not a positive influence in the child's care, can they ask that parent/personal representative to leave the room during the appointment?

More specific scenario: A personal representative of a 8/9 year old child made a comment to the child and doctor about the child's weight gain and lack of activity. The provider was not happy about the weight/body shaming and asked the personal representative to leave the room. I'm not condoning weight/body shaming but this seems to be more reasonable response would be providing education to the adult rather than having them leave the room. I overheard the provider claim this is his right to do to protect the child, but in my research I've only found guidance about minor consent and such...im interested in everyone's response to this scenario.

Thanks in advance!

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Analicia Burnett CHC
Corporate Compliance/Privacy Officer
Sonoma County, CA

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2.  RE: Minor Patient question

Posted 05-18-2017 09:52 AM
I agree with you Analicia.  The provider took a risk asking the parent/rep to leave the room.  Considering the age of the child, I'm surprised the parent/rep complied.  Education and suggesting resources would go a lot further.

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Diane Pringle MSN, CHC
Compliance/Privacy Officer
Conemaugh Health System
Johnstown, PA
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3.  RE: Minor Patient question

Posted 05-19-2017 02:27 PM
I found this in the HITECH Privacy Rule. I underlined the sections that may be relevant for you.


Personal Representatives. The Privacy Rule requires a covered entity to treat a "personal representative" the same as the individual, with respect to uses and disclosures of the individual's protected health information, as well as the individual's rights under the Rule.84 A personal representative is a person legally authorized to make health care decisions on an individual's behalf or to act for a deceased individual or the estate. The Privacy Rule permits an exception when a  covered entity has a reasonable belief that the personal representative may be abusing or neglecting the individual, or that treating the person as the personal representative could otherwise endanger the individual.

Special Case: Minors. In most cases, parents are the personal representatives for their minor children. Therefore, in most cases, parents can exercise individual rights, such as access to the medical record, on behalf of their minor children. In certain exceptional cases, the parent is not considered the personal representative. In these situations, the Privacy Rule defers to State and other law to determine the rights of parents to access and control the protected health information of their minor children.  If State and other law is silent concerning parental access to the minor's protected  health information, a covered entity has discretion to provide or deny a parent access to the minor's health information, provided the decision is made by a licensed health care professional in the exercise of professional judgment. See additional guidance on  Personal Representatives.



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Cindy Hart LPN, CPA, CPC, CHC
Healthcare Risk Manager
CHAN Healthcare
Horsham, PA & Port Charlotte, FL
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4.  RE: Minor Patient question

Posted 05-18-2017 11:32 AM
In my opinion, the provider should have done as you suggested.  Research has shown that children who are shamed in public may be subject to worse abuse in private.  The parent may blame the child for his/her being banished from the room and take out his/her aggression on the child. By trying to protect the child, the provider may have made the situation worse.

Or, the parent may have been trying to reach out to the provider for help (although in a not so nice way).  The parent may be at a loss as to how to motivate the child (pre-teen, teen?) to get some exercise and to make healthy eating choices. He/she may have expected that a provider talking to the child about a healthy lifestyle would help sway or motivate the child.


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Cindy Hart LPN, CPA, CPC, CHC
Healthcare Risk Manager
CHAN Healthcare
Horsham, PA & Port Charlotte, FL
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5.  RE: Minor Patient question

Posted 05-18-2017 11:39 AM

Thank you for your feedback. I just want to make sure I'm not missing any regulation or guidance about whether the doctor can do this. Its definably above my risk tolerance.

 

 

Analicia Burnett, MS, CHC

Corporate Compliance/Privacy Officer

 

 

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