DCBS defines “routine health care” as routine care in an office setting, to treat symptomatic, chronic or acute illnesses and diseases to include:
- Preventive care measures, such as physicals;
- Simple laboratory tests (not to include testing for HIV/AIDS);
- Treatment of communicable diseases;
- Non-invasive radiology procedures;
- Routine suturing of minor lacerations;
- Routine dental care;
- Other medical procedures not listed, but generally governed by implied consent guidelines in the community setting.
DCBS defines “non-routine health care” as any medical or surgical treatment not listed in the definition of routine health care. Non-routine health care requires a parent or legal guardian to consent to care. If the parent or legal guardian is unavailable, DCBS staff consults regional management for assistance in determining appropriate steps for consent. This may involve consultation with the regional attorney regarding the need for judicial intervention.
- The SSW follows procedures outlined in SOP 4.26 Meeting Basic Health Care Needs in addition to the procedures outlined below.
- DCBS does not consent to anything other than routine health care if the child is in the emergency or temporary custody of the Cabinet. The only exception to this is if neither the parent nor the court has provided consent prior to the medical procedure, in which case, the SSW advises the FSOS and the FSOS may sign the consent form. 1
Routine Health Care
- Asks the parent/guardian to sign the DPP-106A Authorization for Health Care upon the child’s entry into out of home care;2
- Places the original signed DPP-106A in the hard copy file and provides a copy to the placement provider, at the time of the child's placement;
- Informs the placement provider that they must maintain a copy of the DPP-106A in the medical passport and also provides a copy to the medical provider when services are needed.
Non-Routine Health Care
If a child is in the emergency or temporary custody of the Cabinet:
- Only a parent or judge may grant approval for anything other than routine health care;
- The SSW documents the judge’s or parent's consent into the child’s case record to include:
- Written authorization from the parent(s) to provide necessary medical services; or
- An order for medical examination or treatment of juvenile completed and signed by the judge.
- The SSW documents in the case record the:
- Nature of the emergency; and
- Efforts to locate the parents and judge to obtain consent.
- The SSW requests the assistance of the court for payment of medical treatment if the child is ineligible for medical assistance.
- The FSOS authorizes treatment in an emergency when the child requires immediate medical attention and the parent or judge cannot be located;
- The caregiver may authorize treatment only in an emergency, when a child needs emergency medical treatment and the SSW or FSOS cannot be located.
If a child is committed to the Cabinet:
The FSOS is permitted to authorize treatment, if the parent(s)/legal guardian is not able to be reached;
The caregiver may authorize treatment only in an emergency, when a child needs immediate medical treatment and the SSW or FSOS cannot be located;
The SSW provides notification the child’s parents when their location is known and parental rights are intact within one (1) working day of any:
Emergency medical treatment;
Serious illness; or
If a child is on extended commitment with the Cabinet:
- The youth is responsible for authorizing medical treatment.
- If the youth is unable to consent, the child’s health care proxy is responsible for authorization.
- If the youth, or their proxy, is unable to authorize medical treatment, the court, SSW or FSOS is permitted to authorize treatment.
If a child is on voluntary commitment to the Cabinet:
- The FSOS consents to treatment when a parent cannot be located in emergency situations;
- The placement provider may authorize treatment only in an emergency, when a child needs medical treatment and the SSW or FSOS cannot be located.
Contingencies and Clarifications
- If the parent or child/youth refuses treatment, the SSW consults with the prescribing health care provider to determine if:
- The treatment or medication is medically necessary;
- If the child may be harmed if he/she does not receive the treatment or medication; or
- If there are less invasive treatments or medications available.
- If the SSW determines that the treatment is necessary to protect the child/youth from harm and having the treatment is in the best interest of the child, the SSW consults with regional management or legal counsel regarding the need for judicial intervention.
- The SSW does not consent to anything other than routine health care if the child is in the emergency or temporary custody of the Cabinet. The only exception to this is if neither the parent nor the court can be contacted prior to the medical procedure.
- Unless termination of parental rights (TPR) has occurred this agency is required to engage and inform birth parent of any and all medical procedures.
- The following health care decisions, do not require consent from a parent/guardian:
- Prenatal care;
- Contraception; and
- Examination, diagnosis and treatment for conditions that, if care was delayed in order to obtain consent, would result in serious threat to the life of the child/youth or serious worsening of the medical condition.
- The burden falls to the medical office to contact DCBS requesting a signed consent.