The rights of minor patients vary from state to state. Dentists need to be aware of when they can properly defer to an adolescent patient for information instead of requiring the parents to provide it. Dentists also need to be familiar with how to proceed in cases involving children of divorced parents and who has the authority to grant consent, as well as who has financial responsibility for the treatment provided.
As the leader of the dental team, it is your responsibility to make sure that every employee in the practice, clinical and non-clinical, is familiar with state laws regarding the protection of information that an adolescent patient may share, either knowingly or unintentionally. Adolescents may not want to speak about certain medical conditions, such as a pregnancy, drug use, or mental health issues, in front of a parent. These situations are both delicate and difficult.
Oftentimes the best response is to listen to the patient’s concerns, talk to them about the situation in general terms and counsel them to discuss the situation with their parents. Avoid lecturing or judging. Proceed with concern and reassure the patient that you recognize that they’ve trusted you with some very sensitive information. Reiterate the need for them to advise their parents or guardians of the situation to ensure that they receive the appropriate care.
Many states have laws regarding emancipated minors. These are individuals who have not yet reached the age of majority (typically 18 years old) and who have legally been given permission to assume most adult responsibilities before reaching adulthood. Emancipated minors have full responsibility for their own care and are no longer considered to be under the care and control of parents.
State law generally determines who has the right to grant permission to release medical record information on behalf of a patient. That authority is generally granted to:
- The patient, providing he or she is a competent adult or emancipated minor
- A personal representative or the patient, such as a legal guardian or parent if the patient is incompetent or a minor child. When determining who can be considered the patient’s “personal representative,” HIPAA defers to state law.
Dentists and their staffs should always be alert to any signs of abuse and/or neglect and whether state laws require those signs to be reported. It’s important to note that abuse/neglect reporting requirements are sometimes found in laws other than state dental practice acts. Additional guidance on the reporting of abuse or neglect is available in Section 3.E. and Advisory Opinion 3.E.1. of the ADA Principles of Ethics and Code of Professional Conduct.
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