DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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+Handbook 13: Cross Program Protocols
13-6  Emergency Medical Orders

 

Cross Program Protocols
13-6  Emergency Medical Orders
Reference Points
Overview
Criteria for Emergency Medical Procedures
Notification to the CANC hotline
Emergency Response Intervention
Arranging a Court Hearing at the Hospital
Follow-up Procedures
Dependent Intake (DI) Responsibilities


Reference Points
Effective Date: 03/01/06
Last Updated: 2/14/13
 Legal Basis:
Popup Window Welfare and Institutions Code (WIC) § 300(b)
Popup Window WIC § 369
Popup Window WIC § 306
 Non CWS/CMS Forms:
MS Word Declaration of Reasonable Efforts
MS Word Notification of Temporary Custody for Child in Hospital (SC155A)
PDF Recommendation of Physician for Medical or Surgical Care
PDF Application Requesting Authorization for Medical Care and Declaration of Social Worker
PDF Order Authorizing Medical Care and Treatment
 CWS/CMS Forms:
bullet Referral Management Section
bullet CAT - Emergency Response Assessment Tool


Overview   There are occasions when the Screening social worker or the After-Hours social work supervisor/coordinator receives a call from a hospital administrator or physician, indicating that a minor child in his/her facility needs treatment, and the parents refuse to authorize the necessary medical treatment.  The common situation under which this occurs is that of parents refusing to allow their child to have a blood transfusion because of religious reasons. The Department of Family and Children's Services (DFCS) initiates Juvenile Court action that allows the child to receive the required treatment, under authority of Welfare and Institutions Code (WIC) § 300(b) and 369. .
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Criteria for Emergency Medical Procedures  

The criteria for identifying a referral as one that requires Emergency Medical Orders are that:

  • The child is in need of immediate medical treatment. 
    • The attending physician must make that statement over the telephone and be willing to sign a statement that this procedure is necessary to alleviate severe pain or is needed to treat a condition which, if not immediately diagnosed and treated, would lead to serious disability or death, and
  • The parents have made a statement that they are aware of the required medical treatment and refuse to grant consent for such treatment.

 

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Notification to the CANC hotline  

Intervention by DFCS begins when the Screening social worker or the After-Hours supervisor/coordinator receives the call from hospital medical staff and obtains the following information from the caller:

 

    • Child's name
    • Birth date and age
    • Name(s) of parent(s)
    • Family's address and telephone number
    • Physician's name and telephone number
    • Hospital or medical institution's name, ward and telephone number
    • Summary of the medical problem
    • If the doctor has considered any alternative treatment options (for example “blood-less” treatment options). If so, has the parents considered any other options suggested by medical doctor.
    • How immediate is the need for medical intervention.

 

Note: If the Screening social worker or After-Hours supervisor/coordinator receives a call indicating that there is a child who is in need of emergency treatment and the parent/legal guardian is not available, the screener or After-Hours supervisor/Coordinator advises the caller that treatment may be rendered under the doctrine of implied consent. However, this is a medical decision that must be made by medical personnel, not by the DFCS.


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Emergency Response Intervention  
The referral is assigned to an Immediate Response (IR) or After-Hours social worker who responds in-person to the hospital.

 

  • In the event that a Juvenile Court hearing may be required, the social worker takes the following forms to the hospital:
    • Recommendation of Physician for Medical or Surgical Care
    • Application Requesting Authorization for Medical Care and Declaration of Social Worker
    • Order Authorizing Medical Care and Treatment

       

  • Upon arriving at the hospital, the social worker:

     

    (a) Meets with the physician and parents, if the parents are available, and with the child, if the child is of sufficient maturity.

    (b)  Verifies with the physician that:

      • The recommended treatment is necessary to alleviate severe pain or is needed to treat a condition which, if not immediately diagnosed and treated, would lead to serious disability or death, and
      • The parents have stated that they will not grant consent for the treatment.
     

(c) Discusses the situation with the parents  to ensure they understand the medical options. Further, the social must explain to the parents that if the child’s life is at risk without the necessary treatment, the Department of Family and Children’s Services will seek a Court order for the requested treatment.


Refer to Table I for further direction


Table I.

If.. then..
the parents consent to the required procedure

no further action is necessary.

The social worker documents the details of the assessment and outcome of the Department intervention in the CWS/CMS Investigation Narrative.

the parents are not present and not available

the social worker places the child in temporary custody.

Proceeds to step (d).

the parents continue to refuse to give consent

the social worker determines how soon the medical treatment is needed.

Proceeds to Table II.

 

 

Table II.

If the parents continue to refuse to give consent and.. and.. then the social worker..

treatment

is not needed immediately

there is no risk the parents will interfere with the treatment if ordered by the court

prepares and files with the Court an

out-of-custody petition.

 

treatment is not needed immediately there is a risk the parents will interfere with the treatment if ordered by the court

places the child in temporary custody.

Proceeds to step (d).

treatment is needed immediately           n/a

places the child in temporary custody.

Proceeds to step (d).

 

 

(d)  If the child is placed in temporary custody, the social worker:

 


 

(e) Asks the physician to prepare a brief written statement that includes the following:

  • Description of the child's condition
  • What the recommended treatment is and why it is needed
  • The expected duration of the needed treatment
  • Prognosis, if treatment is not performed

(f) Informs the physician, parents and child of sufficient maturity that a Juvenile Court Hearing will be arranged and that their presence will be necessary at the hearing.

  • If the physician will not be available for the hearing, then another physician familiar with the case must be present.
  • The judge will decide whether the hearing will be conducted at court, at the hospital or over the telephone.

(g) Completes the Application Requesting Authorization for Medical Care and Declaration of Social Worker.

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Arranging a Court Hearing at the Hospital  
  • Once the child is placed in temporary custody or an out-of-custody petition has been filed, the social worker contacts the Juvenile Judge as follows:

 

    • (a) If the medical emergency occurs during the Court's working day, the IR social worker contacts the Juvenile Dependency Judge (408-491- 4870).
      • If the presiding Juvenile Judge is unavailable, the IR social worker requests assistance from the Juvenile Clerk's Office (408 -491- 4711).
    • (b) When the medical emergency occurs outside of the Court’s working day, the social worker calls the County Communications dispatcher (408-299-2501) and requests a call from the duty Judge.
  • The judge determines when, where and how the hearing will be conducted.
  • The social worker advises the parents, child of sufficient maturity and the physician(s) participating in the hearing regarding the logistics of the hearing.
  • The social social submits documents to the Court.
  • The court makes a ruling on the request for an order for emergency medical treatment.
    • If the request for treatment is granted, the court signs the order.
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Follow-up Procedures  

Directly after the Court Hearing, the social worker:

 

  • If the child was placed in temporary custody, notifies the Receiving, Assessment and Intake Center (RAIC) by telephone at (408)792-1850 that the child is in temporary custody.
    • The time of temporary custody is the time when the social worker told the parents or medical staff, if the parents were not present, that the child was being placed into temporary custody.
  • Proceeds to the RAIC or W. Julian office to write-up the details of the assessment and Hearing in the CWS/CMS Investigative Narrative.

The following judicial day, the social worker:

  • Locates the Judge, if the Judge was not present at the Hearing.
  • Has him/her sign the Order Authorizing Medical Care and Treatment.
  • Takes the three original, signed documents to the County Clerk's Office at the Terraine Street Court house and has the County Clerk file the documents:
    • Recommendation of Physician for Medical or Surgical Care signed by the physician
    • Application Requesting Authorization for Medical Care and Declaration of Social Worker signed by the social worker
    • Order Authorizing Medical Care and Treatment signed by the Judge
  • Makes enough copies of the filed documents to attach to each 300 Petition (one set for the child and each of the child's siblings) and leaves the original, signed documents with the County Clerk.
Locates the Dependency Investigations Social Worker assigned by contacting the Dependent Intake clerical (408-501-6400) and hand-carries or sends the copies of the three legal documents to the appropriate place, so that the documents can be attached to the referral.

 

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Dependent Intake (DI) Responsibilities  

A DI social worker is assigned the referral/case and initiates further investigation.

  • If the child is in temporary custody, the child's condition is still acute and the physician recommends continuation of the ordered treatment, the DI social worker:
    • Files a WIC § 300(b) Petition and attaches copies of the original Court papers.

    • Ensures that the petition describes the minor's condition and the parents' refusal to authorize the required treatment.

    • Attaches copies of the original Application Requesting Authorization for Medical Care and the orders signed by the Judge to the 300 Petition and Petition Worksheet.

    • Ensures that the case proceeds along the lines of a regular WIC § 300 matter.
     
    • If, within the 48 hours after putting the child into temporary custody, the child's condition improves to the point that the child can be released from the hospital, assesses whether the child may be released to the parents and/or whether continued child welfare services are necessary.


  • If an out-of-custody petition was filed, the DI social worker assesses the case to determine whether the case needs to proceed to jurisdiction or whether the medical emergency has been ameliorated by the authorized procedure.  If the medical emergency has been ameliorated, the social worker requests that the court dismiss the petition, either by Application for Order or at the next regularly scheduled hearing, if that hearing is set to occur within the next few days.
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Other References  
bullet2 OPP Chapter 2-7.1: Notifying Hospital Staff of Placing a Child in Temporary Custody
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