So called "Guardian" refusing treatment for a mino

[TRTEmt]

My partner and I had a call last week. It was toned out as a single vehicle accident, too patients. When we arrived on scene, we saw a minivan that had slide off of the road. Air bags had not deployed, and there seemed to be no significant MI. The PT’s climbed up an embankment about 25 ft to the roadway.

My partner, who took the lead, began a rapid trauma assessment palpitating for signs of tenderness. One of the patients did not want treated, he was an adult so no big. But the other patient was a 13yo. When my partner asked if the adult was the parent, the adult said no, I am his uncle. The parents could not be contacted, so the uncle refused treatment for the minor.

After the run I asked my partner, what he would have done if the PT had a significant MI, or showed signs of major trauma. My partner said that he still would have allowed the “Uncle” to sign the release.

This of course caused a S*** storm for me and a lengthy discussion.

In our protocols we allow either a parent or a “Guardian” to refuse treatment of a minor, of course we can always play the “Neglect” card, but that involves LE and can be a lengthy process.

I want to know how you have handled this situation, or what is your department policy on who is considered a “Guardian”.

[akroeze]

A 13 year old could potentially refuse their own care assuming they were competent. Atleast here, there is no age that is set in stone in regards to the age of consent for medical treatment. It's on an individual basis. If the youth can understand the seriousness of their condition and understand the possible outcomes of refusing treatment then they can.

As an example, I signed my own paperwork for my tonsilectomy when I was about 13. My parents didn't sign any of it.

[TRTEmt]

A 13 year old could potentially refuse their own care assuming they were competent. Atleast here, there is no age that is set in stone in regards to the age of consent for medical treatment. It's on an individual basis. If the youth can understand the seriousness of their condition and understand the possible outcomes of refusing treatment then they can.

As an example, I signed my own paperwork for my tonsilectomy when I was about 13. My parents didn't sign any of it.

Here they can only refuse if they are 18 yo, emancipated, parent, member of the military, financially independent and not living at home, or pregnant.

[JCicco345]

That can be a tricky situation. If there is mechanism or signs of injuries, I would definitely treat the patient, you have to do what is best for the patient. As far as the uncle being a "guardian", my understanding would be no, the legal guardian would have to be a parent. In the situation where there is no mechanism or signs of injuries, i would contact a parent by phone to get consent, and have a police officer witness. At minimum if the parents cannot be contact and theres not enough to justify transport, have the uncle sign and someone else witness, preferably a police officer. That's my personal opinions and my understanding of the term guardian.

[MedicRN]

That can be a tricky situation. If there is mechanism or signs of injuries, I would definitely treat the patient, you have to do what is best for the patient. As far as the uncle being a "guardian", my understanding would be no, the legal guardian would have to be a parent. In the situation where there is no mechanism or signs of injuries, i would contact a parent by phone to get consent, and have a police officer witness. At minimum if the parents cannot be contact and theres not enough to justify transport, have the uncle sign and someone else witness, preferably a police officer. That's my personal opinions and my understanding of the term guardian.

If the 'guardian' is someone other than the parent and is refusing for the minor, the 'guardian' signs as well as an LEO witness and everything is thoroughly documented. If we can get ahold of the parents, all the better - signed off as 'parents contacted, refusal by phone.' I have yet to have to use the 'protective custody "clause"' on a severely injured (or potential for) minor. The 'guardian' is usually more then willing to have the minor transported if they are complaining of pain/injury.

Also, here, only 18yoa (emancipated, military, pregnant (but only with regards to the pregnancy and related issues)) and older can 'legally' refuse of their own accord. However, I have 'refused' older minors (usually 16 or 17yoa) if the incident was relatively minor and they understand the gravity of the situation and potentials. As for in the hospitals, parents/guardians must sign all consents for minors.

[Richard B the EMT]

Does the 13 year old have proof of being imancipated? If yes, the youth can sign off on their own RMA (Refused Medical Attention).

If not, any minor aged patient, per my local protocols (my mantra?), I have to contact Medical Control for authorization on my part to accept the "uncle's" RMA on the minor's behalf. If need be, I might need my EMS supervisor, and/or a Law Enforcement intervention

[strippel]

Here they can only refuse if they are 18 yo, emancipated, parent, member of the military, financially independent and not living at home, or pregnant.

We pretty much follow that guideline her in PA.

It pretty interesting, though. Until you ask them to sign a legal document, everyone is related. It didn't take long to realize in the city, everyone is family.

To cover yourself, ask questions that only real family would know. If possible, have the Po show you their ID, or ask about relationships.

[TRTEmt]

[ I have yet to have to use the 'protective custody "clause"' on a severely injured (or potential for) minor. The 'guardian' is usually more then willing to have the minor transported if they are complaining of pain/injury.

I fear the day I meet an adult that refuses treatment of a minor, expecially if my gut instinct is telling me that the PT is critical.

[AnthonyM83]

Here a minor can refuse transport if he understands what's going on AND it's a minor injury. If it's actually, serious and they need to be transported not for precaution sake, but because it's life/death or risk of life/death, then they can't refuse.

[Richard B the EMT]

You just reminded me of a "call" I had a few years ago.

2 boys, one on a bicycle, pulled up to where my ambulance was sitting at roadside (we "stage" for any and all calls on specific street corners for the tour). One of the boys, both looking like pre-teens, had a somewhat deep cut on his arm, allegedly from a fall. We notified dispatch we were treating a "flagdown", got an assignment number, and started treating.

As we finished treating, but prior to starting to write a call report, a car pulled up alongside the ambulance, a woman got out, identified as the mother, yanked the bandaging off the injury site, pronounced it as minor (it probably was), then grabbed the child, put him into the car, and screeched off!

By the way, when the "mother" started in with my partner and me, the other youth convieniently disappeared.

I requested my supervisor for a streetside meetup, and he responded quickly. We asked if a call report should be issued, considering we had no name for the patient, had not transported, but had a report number officially issued to the "assignment". He told us to cover our bets, and generate a call report, with all that transpired mentioned in the comments, with the "final signal" to the call being an RMA (see previous posting of mine), with documentation that no signature was obtained, and why.