Treatment of Minors in the ED

It may surprise you to learn that there are circumstances where an underage minor can sign themselves into the ER for medical treatment without parental consent. In most states, if the patient is 13 y/o and up and requesting treatment over concern for a sexually transmitted disease or concern for pregnancy, they can seek treatment and we cannot call their parents.

This is one area that can be a huge source of conflict in the ED and most doctors and nurses I work with are very uncomfortable with the situation. More sticky would not be the patient who presents alone, but one that does present with a parent. Let's take a situation where a teen girl presents with her parents over complaints of abdominal pain. We do a pregnancy test and guess what... she's got a little bun in the oven. How do we disclose those results?

First off, we ask to speak to the teen alone. We will tell her the results. We tell her that legally we cannot tell her parents though we would like her to tell them and we will help her tell them if she would like.

Let's assume the teen says "no". She doesn't want her parents to know. Then we can't disclose it to them.

Now, parents are very smart and they will likely know what tests were performed. They may ask specifically, "What about the pregnancy test?" What we'll say is, "Mom, I can't legally tell you the results of that test. You need to speak to your daughter about that." A mother's intuition will kick in. After all, what would be the big deal if the test were negative?

Same goes for STD testing. I've had parents call back in a few days for these test results. Again, positive or negative, I can't disclose if the parent knows the test was performed. If the parent doesn't know the test was performed, I can't even disclose they had the test.

Can they get the results through medical records? This is iffy. An astute medical records department will be savvy enough not to disclose but I can see this being a potential gap in the system.

Also, when the insurance bill arrives, the test may be disclosed on that. Or, the parent may call the hospital billing department and ask specifically what test was run. This may be a potential way for them to learn about the test. But again, billing personnel don't have access to lab results.

I want to make clear that all ER professionals I know will make every effort to get the teen to disclose the results to their parent. Other potential areas of conflict. What if the parent is a drug user? An abuser? What should the ER team do then?