O2152: Medical Rights of Children Under Law Enforcement Custody Vary by State

Background: In the United States, approximately 60,000 children are incarcerated in juvenile jails and prisons. Among this population Black boys are disproportionately represented. Children who are evaluated by medical professionals while under the custody of law enforcement (LE) are a doubly vulnerable population, specifically because these minors are often not accompanied by a parent. The provision of health care is complicated by lack of clarity about the legal rights of these children, including who can consent to their medical care, whether contacting a child’s parent(s) is appropriate, if medical status can be disclosed to LE, and whether LE officers may interrogate a child without the presence of a parent or attorney. We previously reported that at our institution, many children who present to the hospital under LE custody are evaluated for traumatic injury; thus, pediatric surgeons need to understand the law surrounding rights of children, which vary from state to state and evolve over time. For instance, state law indicates whether children are allowed to consent for their own medical care. Except in special circumstances, these include legal reasons (emancipation, status as married, incarceration), medical reasons (reproductive issues/pregnancy, venereal disease, mental health, or substance use care), or attainment of a certain age. Because these laws are left to individual states, we sought to assess the variability of rights afforded to children.

Methods: Federal statutes, state statutes, and state case law surrounding rights of minors for consent, privacy of health information, and questioning by LE were reviewed by a medical and legal interdisciplinary team.

Results: Children can consent to medical care under the following circumstances: attainment of a certain age (18 states), financial independence (15), married, pregnant, or parent (26), or emancipated (12). Care for mental health, sexually transmitted infections, and substance use allows the minor to consent in 20 states. In 3 states, incarceration allows a minor to consent for their own medical care. Although children have Miranda rights, in 24 states LE may question a minor under medical care without the presence of a parent or legal representative, including administration of these Miranda rights. Federally, HIPAA prohibits LE from gaining access to health information without release signed by a parent/guardian, subpoena, or court order. Parents retain legal rights to make decisions about a child’s medical care unless those rights were previously terminated by court order; therefore, physicians should make every effort to contact a parent prior to providing medical care except in emergency situations.

Conclusion: Legal rights of children vary by state, including the right to consent to treatment and the right to have a parent present during interrogation. Understanding rights for children in LE custody enhances their care and minimizes liability.