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Wednesday, April 16, 2014

Health Care Laws That Impeed Health Care Delivery For Your Family

For the past eighteen months my son has been recovering from a traumatic brain injury and throughout the plethora of doctor's visits and CT scans, I have regularly been prevented from obtaining appropriate health care for my son by the health insurer, Community Health Plan of Washington. Apparently Washington State has a law which treats anyone fourteen years or older as an adult when it comes to health care. I find this amazing, when they aren't allowed to drive without drivers training and a licensing test, until age sixteen and can't vote until eighteen, but at fourteen they can legally make adult health care decisions. Upon researching what regulation the health plan gatekeepers were referring I learned there are many laws in Washington concerning age-of-consent and health care emancipation.
A minor is considered emancipated at age fourteen under RCW 70 24 330 and 70 24 0147 for HIV testing, under RCW 9 02 100 for abortion, and for obtainment of birth control services under WAC 388 15 240 and WL 168466. Alarmingly, emancipation is considered to be age thirteen for treatment of chemical dependency  under RCW 70 96A 095, and mental health services under RCW 71 34 030. (1)
Community Health Plan has chosen to interpret the plethora of regulations above as applying to any health care service including; consent for immunization, verification of the required health plan referral to a specialist for brain injury evaluation, and obtainment of counseling services. The result of  this legal morass is my son, who received his head injury while skateboarding without a helmet at age sixteen, has refused his flue shot and refused to go to counseling. I have also been unable to verify medical referral information for his head injury, which is a plan requirement in order to see another specialist at Seattle Children's Hospital.
As an analyst I took a look at what other states have deemed an acceptable age of consent for individually driven health care treatment and here is what I learned. Oregon has age fifteen as the age of consent for medical treatment and Alabama has age fourteen, according to an article published in MedScape- Minor's Rights Versus Parental Rights: Review of Legal Issues in Adolescent  Health Care.(2) Most states still require parental consent to provide health care to a minor, so Washington appears to be an outlier here.
Though I certainly respect someone's right to privacy, the key to emancipation is to be of  sound mind and I don't think we have to do much imagining to question the soundness of a thirteen or fourteen year old's mind. In fact, I recall one of my son's buddies prattling on about emancipation and running away to Florida with his girlfriend's family while in the tenth grade, and eventually coming back with his tail between his legs. Shouldn't we at least have some test to certify soundness of mind? The courts don't consider anyone under the age of eighteen competent to make financial decisions.
Even more confounding, I am constantly reminded of my limitations by my son, who is now seventeen, while I haul him around to doctor's appointments, attempt to assure treatment compliance, and hope he graduates from high school on time. So, I am legally still responsible for my son, in terms of his poor judgement and fiscal needs, but I seem to have no purview over his health care. This situation is even worse for parents whose teens fall under the spell of drug abuse as the addicts are required to consent to drug treatment, which is laughable given the maturity factor at age thirteen or fourteen. And of course the parent is still judged by the success or failure of her children. All I can say is I have laid blood on the tracks in my best effort and ultimately it appears I have no control over this emancipated individual, so I hope the courts will keep that in mind the next time he does something stupid.
This is the healthpolicymaven signing off. Feel free to share this article liberally, especially with your legislative representative. For more information on national health care laws and state by state surveys, read  http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

(1)Washington State Law Survey of Minor's Right to Consent to Treatment.pdf
(2) Ann Maradiegue, C-FNP, MSN, J Midwifery Womens Health. 2003;48(3)

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