Parent A vs. Parent B vs. Doctor U
Pediatric healthcare and “joint” healthcare provisions in court orders and parenting plans.
You are a pediatric healthcare provider. That means you have been – or will be – dragged into disputes between parents when they cannot agree on the best medical strategy for their children. It is important to keep a clear delineation between your legal and ethical duties as a medical provider to the child, and whatever duties the parents owe to each other by order of the court.
You know that the standard is the “standard of care,” but that is not particularly helpful when determining the legal standing of parents.
When you have minor patients (under the age of 18), you will occasionally be told by a parent that a court order exists that controls the child’s healthcare. Insist on a copy of any legal document impacting the child’s care and put it in the child patient record so it is plainly visible to any treatment providers. Then, follow the direction of the order (more on that below).
However, do not change your treatment plan based on the mere assertions of a parent about the existence of a court order. Do not deviate from your standard of care, communication with parents, or procedures until you have read and interpreted the order (and preferably, consulted with an attorney). It is the responsibility of the parents to provide those documents. No documents – no change in procedure.
How to interpret a court order when you get it.
The best interest of the child is the primary concern of the courts when approving a parenting plan. But the parenting plans are often not clear regarding a child’s healthcare. Most parenting plans in Washington state simply lump healthcare in with other decisions on a simple chart that often looks like this:
That’s it! No further details. When you see a court order like this (with no other mention of healthcare), nothing has changed in the parent’s rights to make decisions about a child’s healthcare as far as you are concerned. That is because you are not a party to this action – you are not the petitioner or the respondent, neither parent A nor parent B. You are a third party.
The what if scenario:
Parent A and B have a parenting plan that only mentions healthcare like illustrated above. What if Parent A makes an appointment for a child, and Parent B calls your office later to cancel it, stating that the court gave them “joint” decision making and therefore you can only take appointments if both parents agree? What do you do?
1. Call an attorney. The answer to the immediate question could be relatively simple, but the fact this is happening indicates there will be future controversy with this family and they will drag you into it.
2. Understand that the parents (not you) have a duty to follow the parenting plan. The parents (not you) have a duty to keep each other informed about the child’s health. The parents (not you) have a duty to get each other’s buy-in for treatment plans and medical strategies. Your job as a third-party medical provider remains the same. Interact openly with whichever parent communicates with you about their child’s healthcare.
3. Courts do have the power to order medical providers to only deal with one parent for healthcare purposes. But a mere “X” in the “Joint” box of the decision’s matrix does not constitute such an order. Without such power, Parent B cannot cancel appointments on behalf of Parent A. In this scenario, Parent B does not have the authority to dictate Parent A’s parenting time. Do not let Parent B use you – the medical provider – as a tool of interference in Parent A’s time.
Therefore, if Parent A makes an appointment for a child, and Parent B calls your office to cancel it, politely decline to do so. Then direct them to address it with Parent A, or the courts. A standard “joint” healthcare provision (like the one above) in a parenting plan does not give either parent power over you as a third party. Until the court specifies otherwise, both parents have a legal right to take their child to medical appointments during their parenting time.
Ways to avoid these issues.
In your initial patient intake agreements, require parents to provide all court orders regarding the healthcare of the child, and store those orders in the medical record at least until the child is of the age of majority.
Create (or contract with) online patient portals that allow both parents to have free access to their child’s medical records and appointments.
Be careful when providing certain treatments to older minors (teenagers). Some procedures may require extra privacy protections even from their own parents – necessitating an alternate way of documenting the medical record so that unauthorized parents do not have access. This is a particularly complex issue. If you treat older minors you should call an attorney to review your privacy plan.
Find a law firm that can boast expert attorneys in both family law and health law. Work with those experts to develop a plan and policies to be prepared. When confused and indignant parents send their lawyers and subpoenas, you want a team on your side.
You want to be able to say, “call my lawyer.”