Kaleida Health Education Department CONSENTS Kaleida Health Education Department

Purpose of a Consent The purpose of a written consent is to provide visible proof of consent.

Purpose of a Consent If there is only a verbal conversation between the patient and physician in which consent is given, this may be difficult to prove in a court of law

Three Components of an Informed Consent Explanation of the procedure by the physician.

Three Components of an Informed Consent I don’t understand! Understanding by the person giving consent.

Three Components of an Informed Consent A witnessed signature.

Explanation by the Physician Obtaining valid consent is the responsibility of the physician.

Explanation by the Physician The physician explains the procedure or treatment to be performed.

Explanation by the Physician The discussion must include a disclosure of the proposed treatment or surgery risks, benefits, consequences and alternatives, including that of no treatment, and should be accompanied by voluntary, competent and understanding consent on the part of the patient.

Understanding by the Person Giving Consent The consent must be an informed consent.

Understanding by the Person Giving Consent I have questions! The patient (or person deemed to have the responsibility to consent) must have had: the opportunity to discuss the treatment or surgery, and has had time to ask any questions he/she may have about the procedure to be performed with a physician (or dentist, where appropriate).

A Witnessed Signature Physicians, nurses and clerical personnel can witness the signing of a consent

Witness of a Consent If you witness a consent, this means that you watched the patient sign the consent and he/she was not being forced into signing it. You should NEVER sign as a witness unless you have actually watched the person sign the consent. When signing your name as the witness, you must include your job title after your name.

Who Can Sign Their Own Consent Form? Prior to the commencement of a procedure, the Kaleida Health consent form must be signed by one of the following in order of preference:

Who Can Sign Their Own Consent Form? The patient if they are older than 18 years of age A lawfully appointed guardian A New York State Surrogate Decision Making Committee (contact Risk Management) An actively involved parent An actively involved adult child An actively involved spouse A court (Risk Management should be contacted) If the legally appointed person on the above list objects to the proposed treatment of the mentally disabled patient, then an application must be made to the appropriate court. (Contact Risk Management)

Minors and Informed Consent With respect to minors, the general rule is that a health care provider must obtain the informed consent of a parent or guardian before treatment can begin. The law generally assumes that a competent individual will act on the minor’s behalf. Minor is usually defined as a person under 18 years of age.

Emancipated Minor A person less than eighteen years of age and is or has at any time been married, or is the parent of a child

Emancipated Minor States that he or she is self supporting and is living away from his or her parents (based on the reasonable belief of the physician or staff person obtaining patient information).

Emancipated Minor Has been determined to be emancipated by a court.

Emancipated Minor May give effective consent for medical treatment for himself or herself.

Privacy Rights of Minors If a health care provider believes a minor has been subjected to abuse or neglect by the parent or legal guardian, or could be endangered if the parent or legal guardian is treated as the minor’s personal representative, the health care provider may deny a parent or legal guardian to exercise the privacy rights, may deny a parent or legal guardian’s request to inspect or copy the minor’s protected health information, and may refuse to disclose the minor’s protected health information to the parent or legal guardian.

Who Can Sign Consent for a Minor? A minor is defined as a person under 18 years of age.

Minors With respect to minors, the general rule is that a health care provider must obtain the informed consent of a parent or guardian before can treat. The law generally assumes that a competent individual will act on the minor’s behalf.

Unemancipated Minor When a patient is an unemancipated minor, the consent of a parent or guardian is required

Parent or Guardian Note: A Guardian must have written documentation to evidence his/her legal authority to consent. A copy of documentation must be placed in the patient’s medical record. However, if the parent or legal guardian is not reasonably available to sign the consent form, the physician may provide treatment for the unemancipated minor based on the parent or legal guardian’s verbal consent by telephone and agreement to sign the Authorization Form at the first available opportunity. Two individuals on the same telephone line at the same time must hear the verbal consent of the parent or guardian (Policy # LE.10 Treatment of Unemancipated Minor).

Exceptions A consent is NOT REQUIRED for the unemancipated minor when: A medical emergency exists The minor is pregnant Treating sexually transmitted diseases Performance of HIV testing is being conducted Child abuse is suspected Treating alcohol abuse, alcoholism, and/or substance abuse The unemancipated minor is sexually active and the physician determines that the unemancipated minor has the ability to understand and appreciate the nature and consequences of the proposed health care service, treatment or procedure and such minor can make an informed decision, such minor may consent to the provision of health services or treatment for sexually related activities.

Sole and Joint Custody Issues Divorced parents have equal authority to request health information If a court order clearly permits only one parent to make health care decisions for a minor, then only that parent has the right to access protected health information regarding the child. Note: If the case is emergent in nature, the physician may proceed

Sole and Joint Custody Issues If the court order is not clear as to which parent has authority to make health care decisions, both parents may access the minor’s protected health information. If a parent did not sign paternity papers, that parent must petition the court to establish paternity in order to consent.

Sole and Joint Custody Issues If parents with joint custody disagree on the course of treatment, a meeting between the attending physician and the parents should take place.

Adoption Biological parents’ rights are terminated upon adoption. Documentation that is required in the patient’s chart: The court order of adoption must be in the patient’s chart

Pending Adoption County or private agency has custody of minor while adoption is pending. Documentation that is required in the patient’s chart: A signed adoption placement agreement with private agency

Military Power of Attorney Parents in the military obtain power of attorney when leaving their children with a caretaker while they are serving in the military. Call Risk Management to review paperwork. They may decide to contact parents based on the nature of the procedure.

Alternatives to Parental Consent Usually occurs due to the neglect, failure, or absence of a parent. If the guardian is not the parent, the guardian must provide written documentation to evidence legal authority to consent. A copy of the documentation should be placed in the minor’s chart. If the legal guardian or other person who has authority to make health care decisions for the child refuses to sign a consent, contact Risk Management who will contact an attorney. If it is an emergency, you are permitted to treat without a consent. Document in the chart.

Foster Parents Generally do not have authority to consent to health care treatment. In general, the party that has the capacity to make health care decisions is the biological parent(s) (if parental rights have not been terminated) or the custodian (i.e. the county). In some instances, County Social Services Department may issue a letter authorizing a foster parent to consent to medical treatment. Documentation that is required in the patient’s chart: Letter from County Social Services Department authorizing foster parent to consent to medical treatment.

Custodian Refers to a legal relationship that is established by court order, in which one individual, referred to as the Custodian, is given legal authority over, and the corresponding legal responsibility for, the physical care of another individual.

Other than the Parents NOTE: Any person other than the parent(s) must have the required legal Documentation giving consent in the patient’s chart prior to being sent to the surgical holding area.

Who Can Sign Consent For Patients who Lack Capacity to Make Their Own Health Care Decisions? Capacity to make health care decisions means: the ability to understand and appreciate the nature and consequences of health care decisions including the benefits and risks and alternatives to any proposed health care so that an informed decision about the procedure or treatment can be reached.

Health Care Proxy is someone that the patient has identified to act on his/her behalf when medical decisions must be made. Written documentation to evidence his/her legal authority to consent must be placed in the patient’s medical record.

Legal Guardian -has the care, custody and control of the incompetent person. The legal guardian must provide written documentation to evidence his/her legal authority to consent. A copy of the documentation must be placed in the patient’s medical record.

Lack of Capacity If the patient lacks capacity to consent, then consent may be provided by (in order of preference): A lawfully appointed guardian An actively involved spouse An actively involved parent An actively involved adult child A Surrogate Decision Making Committee (Article 80, Mental Hygiene Law). A Court (Risk Management should be contacted)

Written Consent Procedure Obtaining consent is the responsibility of the physician who will perform the surgical operation or the procedure. Necessary blanks that must be filled in prior to the signing of the consent (witnessing). Person Relationship Physician(s) name Name of patient Operation(s)/Procedure(s) Non-technical language for operation/procedure Note: Nursing or clerical personnel may transcribe the name of the operation(s)/procedure(s) and the lay person description onto the authorization form, if the information is supplied by the physician as contained in a written physician order.

Contents of the Form Review the contents of the form with the consenting party. Have consenting party complete all sections of the consent form. Assess the consenting party’s understanding. If the consenting party has any questions, you do not have them sign the consent form. The physician needs to answer these questions before the consent is signed.

The person should sign with his/her legal signature This means that the person signs his/her full name. For Example: John Jones NOT J. Jones Helen Smith Mrs. Joseph Smith

You sign as a witness This means that you watched the person sign the consent and he/she was not being forced into signing it. You should sign with your full name and job title (example RN).

Telephone Consent Obtaining consent over the telephone is acceptable only in accordance with the following: If the person giving the consent is not physically present and is unavailable to provide written consent, the physician’s conversation with the consenting party must be witnessed by 2 members of the Kaleida health staff and must be documented by the physician and witness in the patient’s medical record. The Authorization for Medical and /or Surgical Treatment form must be completed as soon as practical thereafter

Authorization for Medical and/or Surgical Treatment When is this obtained? For all operative procedures and those high-risk treatments designated by the medical staff as requiring consent.

Surgical Operations and/or procedures requiring written informed consent. All surgical operations an/or procedure and/or those involving the administration of general or regional anesthesia or conscious sedation including, but not limited to: Angiography Arthrogram Bronchogram Bronchoscopy Caesarean Section Cardiac Catheterization Elective Cardioversion Electroshock Therapy IABP Insertion Pacemaker Insertion Subdural Block Transesophageal Echocardiogram Vaginal delivery and related procedures

Others Amniocentesis Arterial Line Insertion Biopsy Blood Patch Cardiac Stress Test Chest Tube Insertion Intervascular Contrast Studies CVP Insertion Hemodialysis Induced Pneumothorax Lumbar Puncture Myelogram Nephrostomy Tube Insertion Peg Feeding Tube Peritoneal Dialysis Pheresis Phototherapy Radiotherapy Swan-Ganz Insertion TPA Vaccination and Immunizations Venous Cutdown

Emergency Situation The only time a consent might not be obtained is an emergency situation

Emergency Situation The person must be in immediate need of medical attention. An attempt to secure consent would result in delay of treatment which would increase the risk to the person’s life or health. (The emergency must be clearly documented by the physician in the medical record. Where practical, a second medical opinion indicating the situation is an emergency, should also be documented.)

The Authorization for Medical and/or Surgical Treatment May be completed prior to the person’s admission to the hospital. (For example: By a secretary in the physician’s office during a pre-operative visit.)

The Authorization for Medical and/or Surgical Treatment If written consent is obtained in the physician’s office, it is recommended that the form be signed in duplicate with one copy remaining in the physician’s file and one copy mailed to the site access office.

Language Consents This consent form is also written in Spanish for the Spanish speaking population

How Long is a Consent Good For? Consents will be considered valid during the duration of a single admission except in cases where significant change in the patient’s physical or mental status occurs. Patient‘s who, for whatever reason are readmitted, must sign the appropriate new consent.

How Long is a Consent Good For? There are other types of consent forms used at Kaleida Health. If it is a consent form that is used routinely on your particular nursing unit, you will be instructed how to obtain the consent during your clinical orientation. If you are asked to get a type of consent that you are unfamiliar with, make sure that you have been instructed on the proper procedure prior to obtaining it.

How Long is a Consent Good For? In situations where you have unanswered questions/concerns regarding obtaining consent, you should refer these questions/concerns to administration and/or the risk manager for assistance.