1. The minor presents with a single parent.

When parents are divorced, parental powers are divided and the custodial parent and the noncustodial parent may each have parental rights and duties. The emergency physician should be aware of the parental status.

Where the parents are divorced or separated, the relationship of the child to the presenting parent, relative, or friend should be determined. The custodial parent retains the duty to provide the child with medical care and the right to give consent for treatment. Permission need not be obtained from the non-custodial parent.

If the parent without legal custody presents with a minor for medical care, the physician can assume that the accompanying parent with possession of the minor has authority to consent to treatment. Although technically that parent may not retain the right or duty to provide for medical care, practically speaking medical care should be provided as necessary, and the likelihood of resulting liability is remote.

In joint custody arrangements, both divorced parents have an equal responsibility for making decisions that affect the child. Again, the emergency physician may assume that the parent has the authority to consent to treatment. The divorced parent requesting treatment for a child should represent, and the emergency physician should document, that the parent has the legal authority to give consent for the medical treatment requested.

If the child is in need of immediate treatment, or a delay for the purpose of obtaining consent will adversely affect the child, the physician should initiate care. In cases where treatment is elective or the risk of treatment is substantial, and parental status is uncertain, it may be appropriate to request that the parent produce written evidence regarding custody. The emergency physician is not likely to run across this situation very often.

2. The Minor Presents with an Adult Who is Not a Parent.

If an emergency exists, or prompt treatment is necessary, provide evaluation and treatment as necessary, the emergency exception to consent applies. Also, EMTALA requires a medical screening examination. If the minor has an emergency medical condition, EMTALA requires stabilizing treatment. The emergency physician may also provide treatment if the non-parent adult has guardianship or legal custody with the right to provide for the child's medical needs.

3. The Minor resides in a Foster Home

When a child resides in an institutional setting or foster home, the natural parents may or may not have the legal right to consent to medical care for the child. Again, the emergency exception applies for emergent or prompt treatment. Several state statutes provide that the individual or institution with custody may consent to treatment for medical care. If not governed by statute, parents may need to consent for high risk and elective procedures.

4. Minors in Detention Facilities.

Parental consent is unnecessary for the routine medical care of minors in detention facilities. Again, the emergency exception applies. Parental consent should be obtained for high risk or elective procedures.

5. Minors in Boarding Schools, Camps and Related Institutions.

Parents retain the right to provide for the medical care of children in boarding schools, camps and other institutions. Typically, parents must sign a blanket consent form whereby the camp or school officials stand "in loco parentis", in place of the parents, and may consent for routine medical care. This blanket consent does not cover non-emergency high risk or elective procedures.

6. Runaway Minors.

Children who run away from home, but plan to return to the home, are not emancipated and may not consent for their own medical care. Once again, the emergency and other exceptions may be applicable. However, absent an exception to the consent requirements, efforts should be made to contact the parents. In the event the runaway requires routine medical care and will not identify the parents, providing care is usually acceptable, and low risk in terms of the physicians exposure to liability. However, in an elective or high risk situation legal counsel should be consulted before providing treatment.