CASE
3: ABUSIVE BEHAVIOR
Case 3:
A pediatrician wanted to terminate the care of a 17-year-old
female whose mother was abusive to the office staff. She called to ask
whether to direct a termination letter to the patient or to her
mother.
There are a couple of issues
here. First, is the mother also abusive to the patient?
Questioning the patient in the absence of the mother might lead to
disclosure of a pattern of abuse at home. That would make
termination unwise until help could be obtained for the daughter.
Secondly, the pediatrician needs to consider discussing the situation
with the mother, letting her know that she will be asked to seek medical
care for her daughter at another location if the mistreatment of the
staff does not end.
If termination is the only option,
the letter should go to the mother because unless the daughter is
considered emancipated, she is still a minor who is under the control of
a parent. Emancipation varies from state to state. In some
states a child who is married, serving in the armed forces, or is
totally self-supporting is considered emancipated. In other areas,
emancipation is not a factor of circumstance but a declaration of the
courts.9 Physicians must be familiar with the statute in their
state before treating a minor as emancipated. In this case, if the
patient meets none of the criteria for emancipation in her state and has
not received a declaration of emancipation from the courts, the letter
should go to the mother.
Depending upon the maturity of the
patient and the physician’s relationship with her, the
pediatrician might discuss with the patient the need to
terminate–and then send her a copy of the termination letter sent
to the mother.
Next Page: Case
4: The Unhappy Patient
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