Privacy Officer's Roundtable

Minors, Tobacco and Substance Use Disorder

  • 1.  Minors, Tobacco and Substance Use Disorder

    Posted 11-11-2019 03:20 PM
    Good afternoon:

    Our state, like many states, allows minors to receive substance use treatment without the parent/guardian's knowledge or consent.  The question that was posed to me was whether tobacco is considered a "substance" thereby triggering the minor's right to receive confidential treatment?  Or do parents/guardians need to be involved?

    Thank you!

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    Sophie Morgan
    Legal/Compliance Officer
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    2020 SCCE Membership


  • 2.  RE: Minors, Tobacco and Substance Use Disorder

    Posted 11-12-2019 05:15 AM
    Edited by Brenda Manning 11-12-2019 05:16 AM
    I think the answer is that it depends on your organization, state law and whether you would like to offer smoking cessation as part of deemed adult or what exactly you mean by substance use disorder in the context of deemed adult services. If you're intending to adhere to the the Part 2 definition, that definition specifically excludes tobacco:

    https://www.law.cornell.edu/cfr/text/42/2.11

    Substance use disorder
    " means a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems such as impaired control, social impairment, risky use, and pharmacological tolerance and withdrawal. For the purposes of the regulations in this part, this definition does not include tobacco or caffeine use.


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    Brenda Manning J.D., C.H.C., C.H.P.C.
    Compliance Director, Privacy
    Carilion Administrative Services Building, Ste. 1201
    213 S. Jefferson Street
    Roanoke, VA 24011
    (540) 224-5757
    Fax: (540) 510-224-5787
    Integrity Help Line Compliance: (844) 732-6232
    bkmanning@carilionclinic.org

    Our Mission: Improve the health of the communities we serve.


    The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.
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    2020 SCCE Membership


  • 3.  RE: Minors, Tobacco and Substance Use Disorder

    Posted 11-13-2019 01:29 PM
    Thanks, Brenda.  The problem that I run into is that state law does not specifically say tobacco/nicotine is a "substance" whenever "substance use" or "substance abuse" is used.  There is no definition, at least as far as I have seen, as to what constitutes a "substance" under our state law, but I would presume it is controlled substances. Also, thank you for the cite to the Part 2 definition.  I think my position will be that tobacco treatment is not a deemed adult service and therefore parents must be involved.  As a side note, we do not offer tobacco treatment.  It would be the discussion of and referral to a program.

    Thanks, again!

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    Sophie Morgan
    Legal/Compliance Officer
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    2020 SCCE Membership


  • 4.  RE: Minors, Tobacco and Substance Use Disorder

    Posted 11-12-2019 08:48 AM
    Edited by Matthew Mayo 11-12-2019 12:17 PM
    I'd like to piggyback on this question.

    Florida allows minors to consent to several categories of treatment (substance abuse, contraception, pregnancy, STD testing, etc).  How do you store these encounters in your EMR?  How do you make sure they are not included in a records request or viewable through the patient portal?

    When we inform the minor that is attempting to use his/her parents' insurance in confidence that he/she will need contact the insurance company to restrict access (we don't control their process) or pay out of pocket, the minor usually goes to the DOH.  My question:  If you perform a test or offer a protected service to a minor how do you keep it separate from the general medical record?  How do you keep it from automatically appearing in the patient portal and alerting the parent?

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    Matthew Mayo
    Grants & Compliance Coordinator/Privacy Officer
    North Florida Medical Centers, Inc.
    Tallahassee,FL
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    2020 SCCE Membership


  • 5.  RE: Minors, Tobacco and Substance Use Disorder

    Posted 11-13-2019 11:32 AM
    MyChart Proxy is typically renewed annually with portal access shut off to parents/guardians when minors become eligible for deemed adult services. The Proxy access is typically done in consultation with the minor's primary care provider. The minor must agree to give permission to their parent/guardian. HIM workflows should include redacting deemed adult services information from ROI's made to parents/guardians.

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    Brenda Manning J.D., C.H.C., C.H.P.C.
    Compliance Director, Privacy
    Carilion Administrative Services Building, Ste. 1201
    213 S. Jefferson Street
    Roanoke, VA 24011
    (540) 224-5757
    Fax: (540) 510-224-5787
    Integrity Help Line Compliance: (844) 732-6232
    bkmanning@carilionclinic.org

    Our Mission: Improve the health of the communities we serve.


    The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.
    ------------------------------

    2020 SCCE Membership


  • 6.  RE: Minors, Tobacco and Substance Use Disorder

    Posted 11-13-2019 12:22 PM
    In Florida, 12 year olds can consent to certain deemed adult services.

    Are you saying that parental portal access is cut off upon reaching that age?  Are you blocking all access because the portal is incapable of filtering out those deemed adult services?  I'm trying to understand why all access would be blocked, since most of or maybe even all of the information is accessible to the parent.

    The parent can request paper/electronic copy of the 12 year olds records, which we would provide with the deemed adult services redacted.

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    Matthew Mayo
    Grants & Compliance Coordinator/Privacy Officer
    North Florida Medical Centers, Inc.
    Tallahassee,FL
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    2020 SCCE Membership