Kids' legal rights in medical care, your obligations

Kids' legal rights in medical care, your obligations and risk minimisation 27 April 2017 Kids' legal rights in medical care, your obligations and risk minimisation Consent, confidentiality and the importance of good record keeping.

Why do health professionals need to understand Child Protection legislation, criminal law, privacy and medical records law? Support structures VFPMS Policies and procedures Legal Services Kids rights consent

* Lets borrow from the Consent its as simple as tea campaign What is consent? Consent voluntary agreement by a patient/parent/guardian to proposed procedure

What you need to look for freely given (voluntary) by the right person informed - specific for the procedure/event, and key points understood Kids rights - consent The person consenting must understand the nature and inherent risks of the procedure/examination in question vs benefits

the alternatives not going ahead/ not going ahead now Kids rights - consent Two extremely challenging aspects of consent in your context Youre dealing with children, who are often very distressed and in the company of distressed support people potentially from a complex family dynamic

The stakes are high What kinds of things need to be understood in the vulnerable children context? Kids rights - consent How do you know what they understand? allow them time to ask questions recognise that consent is not done at a moment in time, be alert to particularly

confronting issues/changing circumstances and reconfirm good communication throughout your encounter with the patient is critical not quite as easy as making a cup of tea Kids rights consent Consent for a child Parent or guardian Consenting party must have parental responsibility

The childs living arrangements are not a determining factor you need to see Court orders to accept that a parents parental responsibility has been limited One parents consent is often sufficient can be challenging Parent must act in the childs best interests Child Protection DHHS (the Secretary) to consent to examinations and treatment for a child in certain circumstances

Kids rights consent mature minors Consent by a minor forensic exam context Gillick competent child A minor is ... capable of giving informed consent when he or she achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed. Gillick v West Norfolk AHA [1986] AC 112 Rules of thumb

under 12, always parent/guardian; 13 be aware of potentially increasing maturity over 14 consider assessment for Gillick competence if the context allows consent from child and Documenting consent risk minimisation A signed consent form is not conclusive of consent - was there adequate discussion?

Evidence this by documenting it with precision - did the person consenting understand the nature and consequences Please note you need to get consent for what youre going to do - follow VFPMS policy and guidelines Kids' rights - Privacy & confidentiality

Ethical basis Respecting a patients privacy and confidentiality is consistent with respect for their autonomy Public policy reasons Trust in medical system; breach of privacy/confidentiality may discourage people to seek help When in doubt, chicken out!

Kids rights - Privacy & confidentiality - disclosure Starting point - obligation to maintain confidentiality and not disclose to anyone except with consent or by operation of law Kids rights - Privacy & confidentiality Consent disclosure

For child and mature minor, recommend same approach as consent to treatment informed and specific Operation of law Subpoenas; warrants Health Services Act, s141

Health Privacy Principles Mandatory reporting will be addressed later in conference; new offences for protecting children Kids rights - privacy and the police No general right in public health, even where relevant to an investigation or suspicion of unlawful behaviour Usually need consent or a warrant; or a subpoena to produce to court

General exception where: the organisation reasonably believes that the use or disclosure is necessary to lessen or prevent-(i) a serious and imminent threat to an individual's life, health, safety or welfare; or (ii) a serious threat to public health, public safety or public welfare-- Health Records Act, Health Privacy Principle 2.2(h) Kids rights privacy and child protection

Child protection officers may seek information ask them to put their request in writing identifying power to obtain the information need consent/legislative power eg section 212 Children Youth and Families Act 2005 child needing therapeutic treatment (s185 investigation) protects the childs rights; protects you note - often health professionals seek the

support of child protection these requests re Kids rights privacy and child protection You may be obliged to give information mandatory reporter (DHHS will consider later) new offences failure to disclose; failure to protect; grooming imminent child safety commissioner

reports Risk minimisation documentation VERY important both clinically and legally: to ensure all information available for future analysis/care to evidence what was done and why particularly important if you need to justify opinion in Court Risk minimisation documentation

Therefore, very important to record all relevant information consider how you do that Very important that documentation is professional and you will be comfortable explaining the language to the patient or a court or others Risk minimisation preparing for disclosure Patient and/or parents can access records

under Freedom of Information Exemptions limited Patient health and safety specifically addressed