Custodial Care Issues: Parents of Sexually Active Teens

Treating teenagers can present some of the most challenging confidentiality issues for health care providers. Physicians need to be familiar with the situations where they must honor teenagers’ desire for confidentiality even when it conflicts with parents’ interest in their teenager’s health. This blog post, the third in a series addressing custodial care issues, offers guidance on how to balance these sometimes competing concerns.

The Case

Anne, a seventeen-year-old patient, is visiting her physician’s office with her mother, Sarah, for a routine annual physical. Sarah sits nearby for most of the exam, but at Anne’s request, Sarah steps out of the room during Anne’s pelvic exam. As soon as Sarah leaves the room, Anne tells her physician that she is sexually active and asks for a birth control prescription. The physician writes the prescription and then completes the exam. As the doctor and Anne are walking towards the lobby, Sarah catches up and asks for an update. The physician hesitates for just a second, making Anne look uncomfortable and Sarah look worried.

The Authority

Until a patient turns 18 years old, his or her parents are generally authorized to act on behalf of the minor, including accessing his or her protected health information (PHI) and consenting to treatment. There are, however, exceptions to this rule.

One exception involves situations where the parent agrees to allow the doctor and the patient to have a confidential relationship (45 C.F.R. § 164.502[g][3][C]). Another, more common exception is that a parent is not automatically entitled to obtain his or her minor child’s PHI related to treatment for which parental consent is not required. In other words, where state law authorizes a minor to consent to the treatment, then (in most cases) the minor must also consent before disclosure (45 C.F.R. § 164.502[g][3][A]-[B]).

The Result

As Anne’s parent, Sarah is entitled to nearly all of the results of Anne’s physical. For example, Sarah is entitled to know Anne’s blood pressure, weight, and height. However, Anne does not need to say anything to preserve her right to privacy with respect to her taking birth control. Because Anne consented to the treatment on her own, and her state allows a minor to consent to treatment for the prevention of pregnancy, the physician should not disclose to Sarah that Anne is now taking birth control.

Notwithstanding Anne’s right to privacy, HIPAA does not obligate her provider to lie or mislead Sarah. When physicians find themselves in a similar case with a parent who asks for every detail about their children’s care, it is appropriate for them to inform the parent that they are not at liberty to disclose any further information without the patient’s consent, or to recommend that the parent obtain further information from the patient. 

Tips on Dealing with Disclosure Requests

• If the circumstances are appropriate, encourage the teenager to authorize sharing all of their PHI with their parents.
• Suggest a meeting between the physician, the parent, and the patient to openly discuss the kinds of things that the physician can disclose (e.g., vaccinations) and the things that the physician is obligated to keep private (e.g., treatment for STDs).
• Review files to flag PHI that is exempt from general disclosure rules.
• Reference Curi’s Risk Management Handbooks, which provide state-specific guidance on the treatment of minors, record release issues, and other related issues.

Disclaimer: This post is written in general terms and is not a substitute for legal advice or intended to create an attorney-client relationship.