In family practice, we are frequently placed in delicate situations caring for minors, with regards to parent involvement and patient confidentiality and rights.
It is helpful for parents, caregivers, adolescents, teens, and all health care professionals to have a basic understanding of the legal rights and protections of minors in Oregon.
You might be surprised to learn, for example, that in Oregon, a patient can start a medication for depression or anxiety as young as age 14 without parental consent, get medical care such as a vaccine or physical exam at age 15 without parental consent, and get birth control at any age without parental consent.
Don't shoot the messenger-the author did not make these laws--but healthcare professionals do have to abide by them.
It is especially helpful for those in mental health and who work in academics to be aware of these laws when advising youth and parents of minor's rights.
Some examples of difficult minor's health issues that we've encountered in family practice include the following:
-- a young teen wanting to start antidepressants but the parent refusing
-- an young adolescent wanting birth control but too afraid to tell their parents
--a teen wanting to get the HPV vaccine to protect himself and future partners against HPV-related cancers but his parent refusing
-- a 14 year old being seen for “stomach cramps” who ends up being pregnant but doesn’t want parents to know
--an adolescent positive for chlamydia who wants treatment but doesn’t want caregiver/parent to know
--a 15 yr old assigned male gender at birth who identifies as female and wants to start testosterone-blocking medications and estrogen
--an alcoholic 16 yr old who wants treatment but doesn’t want dad to find out and can’t afford treatment
--a teen whose parent is demanding we start teen on mood stabilizer or parent will stop paying for their rent and education.
Balancing the rights of parents and the rights of minors remains an area of controversy.
There is an acknowledgement on the part of lawmakers that while parental involvement is desirable, many minors will not seek services if they have to inform their parents.
Most youth-serving agencies and medical professionals believe that access to confidential services is essential because many sexually active adolescents or adolescents involved in substance abuse will not seek care if they have to inform a parent or have their parent's consent. Minors' consent laws become extremely important for these situations.
The laws encourage young people to seek the health care services they need and allow them to speak candidly and confidentially with their health care providers.
Medical and dental services (ORS 109.640) Minors who are 15 years or older are able to consent to medical and dental services without parental consent.
This includes hospital care, as well as medical, dental, optometric and surgical diagnostic care. This would include services such as:
• Treatment for illnesses or injuries (colds, sprained ankle);
• Sports or camp physicals;
• Dental visits (check-ups, cleanings, fillings);
• X-ray services;
• Emergency room visits;
• Vision care (except for first time contact lens visit); and
A minor 15 years of age or older may give consent to diagnosis and treatment by a nurse practitioner who is licensed by the Oregon State Board of Nursing under ORS 678.375 and who is acting within the scope of practice for a nurse practitioner, without the consent of a parent or guardian of the minor.
Mental health and chemical dependency (ORS 109.675)
A minor who is 14 years or older may access outpatient mental health, drug or alcohol treatment (excluding methadone) without parental consent.
These services may include:
• Seeking help from a psychiatrist or psychologist;
• Seeking mental health therapy from a doctor or social worker; and
• Seeking help for drug or alcohol use.
Providers are expected to involve parents by the end of the minor’s mental health, drug or alcohol treatment unless:
• The parent refuses involvement;
• Clear clinical indications to the contrary exist and are documented in the treatment record;
• There is identified sexual abuse; or
• The minor has been emancipated and/or separated from the parent for at least 90 days.
109.675 Right to diagnosis or treatment for mental or emotional disorder or chemical dependency without parental consent.
(1) A minor 14 years of age or older may obtain, without parental knowledge or consent, outpatient diagnosis or treatment of a mental or emotional disorder or a chemical dependency, excluding methadone maintenance, by a physician licensed by the Oregon Medical Board, a psychologist licensed by the State Board of Psychologist Examiners, a nurse practitioner registered by the Oregon State Board of Nursing
For mental health and chemical dependency services, the provider may disclose health information to a minor’s parent or guardian per ORS 109.680 if:
• It is clinically appropriate and in the minor’s best interests;
• The minor must be admitted to a detoxification program;
• The minor is at risk of committing suicide and requires hospital admission.
• Although minors age 14 and older can access outpatient mental health and chemical dependency services independently, parents are expected to be involved in their treatment at some point.
• Involvement does not mean that adults always have access to a minor’s mental health or chemical dependency records.
• Federal regulation 42 CFR 2.14 states that if a minor is able to self-consent for drug or alcohol treatment, the minor's treatment records cannot be disclosed without the minor's written consent (including to the parent or guardian).
Family planning/sexual and reproductive health (ORS 109.610, ORS 109.640)
Minors of any age are allowed to access birth control-related information and services as well as testing and treatment for sexually transmitted infections (STIs) including HIV, without parental consent.
109.640 Right to medical or dental treatment without parental consent; provision of birth control information and services to any person. Any physician or nurse practitioner may provide birth control information and services to any person without regard to the age of the person.
According to the 2009 Oregon Healthy Teens Survey of 11th grade students:
• Forty-eight percent have had sexual intercourse.
• Of those, 58 percent reported using a condom. Ensuring that young adults have proper resources and information on sexual activity is important for them to make healthy choices.
109.610 Right to treatment for venereal disease without parental consent. A minor who may have come into contact with any venereal disease may give consent to the furnishing of hospital, medical or surgical care related to the diagnosis or treatment of such disease, if the disease or condition is one which is required by law or regulation adopted pursuant to law to be reported to the local or state health officer or board. Such consent shall not be subject to disaffirmance because of minority.
The consent of the parent, parents, or legal guardian of such minor shall not be necessary to authorize such hospital, medical or surgical care and without having given consent the parent, parents, or legal guardian shall not be liable for payment for any such care rendered.
Confidentiality of minor health care services
When a minor self-consents for health care services, providers are encouraged to use their best clinical judgment in deciding whether to share information with the parent or guardian (ORS 109.650).*‡
However, most people, minors included, expect some level of confidentiality when receiving health care services. Providers and adolescent patients should discuss usual confidentiality practices, as well the types of information that providers are required to report. This will have an impact on a minor’s willingness to seek health care services they may have otherwise avoided
Oregon law does protect providers from civil liability when a diagnosis or treatment is provided to an authorized minor without the consent of the parent or legal guardian of the minor. (ORS 109.685).
If diagnosis or treatment services are provided to a minor pursuant to ORS 109.675 (Right to diagnosis or treatment for mental or emotional disorder or chemical dependency without parental consent) without consent of the minor’s parent or legal guardian, the parent, parents or legal guardian of the minor shall not be liable for payment for any such services rendered. [1985 c.525 §4]
Oregon Minor Consent Laws
Oregon law applies to all clinics and hospitals, including school-based health centers (SBHCs).
The oldest provisions of the law have been in place for more than 40 years, since 1971.
The law is intended to protect the health of adolescents and to protect public health and to avoid negative health outcomes that would result from a lack of care.
Key provisions of Oregon’s minor consent laws:
-- Those age 14 and up have the right to consent to mental health services.
-- Those age 15 and up have the right to consent to physical health and dental services without permission from their parents or guardians.
-- Those of any age can consent to diagnosis, treatment, and care related to sexually transmitted infections, and may consent to care for reproductive health and family planning services.
--Any physician/provider may provide birth control information and services to any person regardless of age.
-- Providers may advise parents and guardians of services without consent of the patient unless it poses a risk to the patient.
---At 14, minors can consent to addiction and mental health services but parents should be involved by the end of the treatment.
Payment & Confidentiality
When a minor who has the right to consent to his or her own treatment presents for care, a provider should assure they are asked how they wish to pay for their treatment. Minors should always be informed that if their chart records their parents' insurance and the insurance is billed for the visit, their parents will receive notification from the insurer that the visit occurred. Offer the minor the option to make other payment arrangements to maintain the confidentiality of their treatment.
Havilah Brodhead, RN, MSN, FNP
Hearthside Medicine Family Care. Bend OR
Family Nurse Practitioner
Havilah provides full family primary care and accepts most insurances.