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PED-EM-L  February 2014

PED-EM-L February 2014

Subject:

Re: Questioning a minor

From:

Doc Holiday <[log in to unmask]>

Reply-To:

Doc Holiday <[log in to unmask]>

Date:

Fri, 28 Feb 2014 00:48:42 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (20 lines)

From: Christopher Kelly ([log in to unmask])> ...child is brought in as a patient for an unrelated complaint
--> Thanks for the clarification. This makes your question simpler to answer.
It means that the child is your patient - you have duty of care. Things are thus clearer.
> ...a hospital employee witnesses the child be "verbally abused" by a parent, to the point where she is concerned for the child. It is brought to your attention. What do you do?
--> You clarify in your own mind, from what you now know and understand from this employee, depending on who they are and what they saw, whether you are convinced that the child is safe to discharge under these circumstances. If you share the concern, then the answer is "no". There is a significant risk of harm you could bring to this child by your ACTION of discharge - this IS an action.
So you cannot take this action.
So you admit the child for their own safety.
Before I get to your original question, if you think that further information is required from the child before you can be sure it's safe to discharge, then you cannot discharge without this information.
> Does anyone know about the legalities of questioning a minor (lets say a 9 yr old) about the possibilities of parental abuse without that parent's consent to question them?
--> Every country has different laws. But if you have medical/clinical questions for the child about their history, they need to be asked. It is likely that YOU, as the EP in the ED are not the right person in the right place to ask too much. We tend to leave this to the in-patient situation. Social workers can then also be brought in, as can other experts.
I know of no requirement of parental consent to obtaining a history beyond that which is implied in them bringing the child to you. There is no "contract" which states you may only ask questions related to what the parent thinks the pathology is. But, again, there are likely to be questions here which go beyond the medical/clinical aspects and I would leave those to the experts.
And, if the patient's parents or anyone else attempts to get in the way of you doing your best to prevent harm from potentially coming to this patient, e.g. by trying to remove the child from the ED, then this cannot be allowed to happen.
> I don't tell the parent the nature of the discussion, I just ask them to leave for a few moments.
--> If you are doing this in the interest of your patient - i.e. you think that you are unlikely to get the level of honesty you need to be certain of safety if the parent is present, then you must take the action you need to take to avoid an error, even if this includes such a level of privacy. But you can also take the parent aside and let them know that you will be asking the child this with them outside the room. You can inform them - permission is not required.
> I'm more concerned about the legalities of it. And no, a comprehensive forensic interview was not performed, it was simply a "hey do you feel safe at home? Is anyone hurting you?"
--> You are doing your job! There are obviously ways to do it and ways not to, circumstances/people/locations more and less suitable, etc. But surely it cannot be illegal for you to take a history from your patient in private (with a chaperone) if this is indicated in your professional opinion. 		 	   		   		 	   		  
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

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