COMMUNICATION IS CRITICAL
It is usually helpful for a minor to talk to a parent, guardian, or another responsible adult when making health care decisions, and research shows that most young people involve at least one parent or guardian when doing so. Open communication with a parent or guardian should be encouraged both during the initial decision-making process and throughout the course of medical care to help the minor patient better understand the risks, benefits, side effects, and alternatives to a particular medical treatment.
• Encourage minor patients to involve their parent(s) or guardian(s) when appropriate. • Initiate conversations with minors about the issues they can expect to be kept confidential. • Discuss whether and how minors’ parents or guardians will be involved in their health care. • Write a confidentiality statement and share it with your minor patients, and when appropriate, with their parents.
• inform the patient if billing or insurance claims may compromise confidentiality • notify the insurance company that the minor was treated confidentially and that disclosure of the information would be contrary to the patient’s best interests • refer the patient to a site offering confidential services to minors for free or on a sliding-fee scale so that bills are not sent to the minor’s home, where a breach of confidentiality may occur • educate the billing department about minors’ rights to confidentiality and how bills that detail information about services rendered can break confidentiality • consult with legal counsel before releasing medical records to any person other than the minor patient
Please Note: This publication is intended as a guide and does not provide clinical information or legal advice. Be aware that laws related to any or all of the subjects addressed in this pamphlet may have been added, repealed, or amended since publication. Please check with your legal counsel for sitespecific clarification on confidentiality and disclosure issues, including any policies related to the HIPAA privacy rule.
Minors’ Access to Confidential Reproductive Healthcare
Developed by: ACLU of Kansas and Western Missouri Center for Adolescent Health & the Law Physicians for Reproductive Choice and Health Planned Parenthood of Kansas and Mid-Missouri University of Kansas School of Medicine Wichita Sponsored by: Physicians for Reproductive Choice and Health
Unfortunately, open communication may not always be possible for all young people. Some teens come from homes in which emotional abuse, sexual abuse, or physical violence is prevalent. Other teens have parents who do not support them in seeking reproductive health care. For these reasons and others, Kansas law allows health care professionals to keep their minor patients’ medical information confidential in many circumstances. To help protect confidentiality, health care providers may • explain to parents that minors should be seen confidentially and ask parents to agree to such an arrangement • ask the patient for alternative contact information (address and phone number where he or she can be reached) if the patient does not want to be contacted at home • discuss insurance, billing, and alternative forms of payment with the minor
© 2010 PHYSICIANS FOR REPRODUCTIVE CHOICE AND HEALTH
A Minor Informed Consent
A minor is a person under the age of 18.
As a general rule, Kansas law requires a minor who seeks medical care to obtain the consent of a parent or guardian. However, there are important exceptions to this rule that allow minors to give consent for their own care and are described below. When a minor gives consent, it must be voluntary, generally may be verbal or written, and should be noted in the patient’s record.
Minors Who May Consent to Any Medical Treatment
In Kansas a mature minor may authorize medical and surgical services by giving an informed consent, and minors age 16 or older may consent to their own care if a parent is not immediately available.
Minors who are unable to obtain EC from their regular health care providers confidentially may do so at any Title X family planning clinic without parental consent or notification. Although clinicians offer EC up to 120 hours following intercourse, women are urged to take EC as soon as possible to maximize efficacy. Consistent with a recent FDA decision, EC is available “overthe-counter” for individuals age 17 or older, but minors under age 17 must still obtain a prescription from a licensed health care provider. The Emergency Contraception Website (www.not-2-late. com) offers information on how to obtain EC.
guidance on disclosure of a minor’s STD and related care to a parent or guardian, see the section titled “Confidentiality” below.
HIV Testing and Treatment
No provision of Kansas law directly addresses whether minors may consent to HIV testing or treatment. However, HIV is a sexually transmissible virus, so minors should be able to consent for HIV testing and related care.
Any minor who is at least 16 years of age may donate blood voluntarily without consent from a parent or guardian but may not receive compensation for his or her donation without parental permission.
Sexual Abuse and Sexual Assault
Kansas law allows a minor who is an alleged victim of a sex crime to consent to a medical examination to gather evidence of the crime. The hospital or medical facility must give written notice to the parent or guardian that the examination has taken place. Health care professionals are required to comply with the Kansas child abuse reporting laws. Suspected child abuse, including sexual abuse or exploitation, must be reported. For additional information about applicable requirements and procedures under the Kansas child abuse reporting laws and a searchable database of state statutes by topic, please visit http:// www.childwelfare.gov/systemwide/laws_policies/state/. For an overview of Kansas child abuse reporting laws, including those related to sexual abuse, please see http://www.srs.ks.gov/agency/ cfs/Documents/Child%20Abuse%20Reprting%20Guide.pdf.
Fear of disclosure prevents some minors from seeking health care services, but when young people are assured that their health care providers will respect their privacy and keep their medical records confidential, they are more likely to seek out all types of care, including reproductive health care services. Kansas law permits, but does not require, health care providers to inform a parent or guardian if their minor child has been diagnosed with or treated for STD. Such disclosure should only be made when doing so is consistent with the confidentiality policies of the practice setting and with professional ethical guidelines, and when it is in the minor’s best interest.
Pregnancy Testing, Pregnancy-Related Care, Prenatal Care, and Childbirth
Any minor may consent to pregnancy testing and all other hospital, medical, and surgical care related to pregnancy (excluding abortion). For guidance on disclosure of a minor’s pregnancy and related care to a parent or guardian, see the section titled “Confidentiality” below.
REPRODUCTIVE HEALTH CARE
Family Planning and Contraceptives
Kansas does not have a specific statute authorizing minors to consent to family planning services and contraceptives, but Kansas Attorney General opinions have recognized that mature minors may do so and that absolute prohibitions and mandatory parental consent provisions for contraceptives for minors are unconstitutional. So minors in Kansas generally may receive contraceptives without the consent of a parent or guardian. Federally funded Title X family planning clinics must provide confidential services to minors and may not require parental consent for minors to receive the services. For a searchable database of Title X family planning clinics in your area, please visit http://www.opaclearinghouse.org/db_search.asp.
In Kansas, an unmarried, unemancipated minor under age 18 may not obtain an abortion until she has received counseling regarding her alternatives and rights from a counselor and notice has been given to one parent or a legal guardian. A parent or guardian, or a person 21 years of age or older who is not associated with the abortion provider and who has a personal interest in the minor’s well-being, must accompany the minor and be involved in the minor’s decision-making process regarding whether to have an abortion. The law includes a judicial bypass, an emergency exception, and an exception for cases of incest. Kansas residency is not required for a pregnant woman, adult or minor, to have an abortion performed in Kansas, nor is residency required for an unemancipated pregnant minor to seek a waiver of parental notification in Kansas pursuant to the abortion statute.
Exceptions to Confidentiality
There are some circumstances in which confidentiality may not be possible, including • cases of suspected child abuse or neglect • instances in which the minor poses a risk of harm to the self or others • situations in which institutional billing and health insurance claims processes result in the disclosure of confidential information to a minor’s parents In addition to the examples listed above, institutional policies consistent with the HIPAA Privacy Rule may require that confidentiality be overridden in specific circumstances. However, unless one of the above circumstances is present, health care providers should take reasonable care to protect the medical information of their minor patients.
OTHER HEALTH CARE
Health care providers are allowed, in good faith, to provide emergency care without obtaining the prior consent of a parent or guardian to a minor at the scene of an emergency or accident, to a minor who requires such care as a result of engaging in competitive sports, or to a minor during an emergency that occurs in a hospital or elsewhere.
Emergency Contraception (EC)
Kansas law does not specifically require health care professionals to obtain parental consent before a minor receives emergency contraception. As a result, health care professionals can and do provide EC to their minor patients without parental consent.
Sexually Transmitted Diseases (STDs)
Any minor may consent to diagnosis and treatment for sexually transmitted diseases (referred to in the statute as venereal disease), including prophylactic treatment for exposure to an STD. For
Drug and Alcohol Abuse Care
Any minor may consent for examination and treatment for drug or alcohol abuse, misuse, or addiction without notification or consent of a parent.
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