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09207 Obtaining Consent for Medical Treatment

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­­TCRC Procedure  │ Service Coordination  │ Procedure # 09207

Obtaining Consent for Medical Treatment

Link to TCADD Policy 9201

SCOPE:

This procedure applies to all employees of Tri-Counties Regional Center (TCRC). The Welfare and Institutions Code, Section 4655, authorizes the Director of a Regional Center or her/his designee to give consent to medical, dental and surgical treatment of an individual served by TCRC and provide for such treatment to be given to the person served by TCRC, under certain conditions.

As a rule, TCRC does not provide consent for minors. The parent, or other legally authorized person, must provide such consent. When medical consent is required for adults, the service coordinator will make every attempt to locate or encourage the medical facility/physician desiring consent to locate and/or contact the person’s parents, conservator or other involved relatives, with the service coordinator’s assistance. If and only if the search is unsuccessful and the health and safety of the person-served is at risk will the service coordinator then proceed with asking the Director or his/her designee (Services and Supports Managers, Assistant Directors and Directors) to give consent to such treatment.

PROCEDURE:

When a community medical professional determines that an adult who receives services from TCRC is incapable of giving informed consent for a necessary medical procedure, the TCRC Executive Director, or designee, may provide the needed consent.  This can be done only when TCRC determines that no involved family member or legally responsible person is available to grant consent; or such family member or legally responsible person does not respond within a reasonable time.   

During normal business hours: 

The process for requesting consent from the TCRC Executive Director or designee is as follows:

  1. The service coordinator, manager, or on-call manager attempts to contact family using all information in the TCRC chart as well as all contact information available through current service providers.
  2. The service coordinator, manager, or on-call manager documents that every effort has been made to locate parents, conservator, or involved relatives or that if none exist [in the case of an un-conserved adult] parents or relatives, if found, agree that the Director or her/his designee should give consent to the treatment. 
  3. The service coordinator or manager consults (in-person, by phone, text, or email) with the TCRC Physician or Contractor Physician [for the office of the manager with whom the manager has a working relationship] and/or the Director of Clinical Services (if needed).
  4. The TCRC Physician, Contractor Physician or Director of Clinical Services will:
    1. Review the case record as needed to further explore the medical issue,
    2. Discuss the proposed procedure with the treating physician,
    3. Review the situation for contradictions or risks,
    4. Reviews the proposed procedure and prepares a written summary of the procedure and a recommendation to the Director or her/his designee regarding whether consent should be given, to be filed in the case record.
    5. When needed, call the Director or her/his designee to discuss their recommendation.
    6. The staff physician, contractor physician, and/or Director of Clinical Services do not give consent; it is their responsibility to give guidance and a recommendation to the Director or her/his designee (Services and Supports Manager), and it is the Director or her/his designee (Services and Supports Manager) who gives consent for medical treatment.
    7. The Director or her/his designee (Services and Supports Manager) will contact the community medical professional to give consent or to inform the community medical professional if consent is not given.

The procedure is similar in the case of after-hours calls; however, in those cases the On-Call Manager will first call the TCRC staff physician.  If contact with the staff physician is not made in a reasonable amount of time, then the on-call manager will go through the contractor physician phone list, contacting one of the contractor physicians.  If no contractor physician responds in a reasonable amount of time, then the On-Call Manager will contact the Director of Clinical Services.  The physicians or Director of Clinical Services will proceed as noted above with follow-up documentation of the recommendation in writing on the next business day, however the phone call to the Director or her/his designee with a medical recommendation is paramount and should be done as soon as possible.

In the special case of withholding life sustaining treatment or a Do Not Resuscitate (DNR) order being requested, it is the position of Tri-Counties Regional Center that TCRC does NOT give consent to withholding life sustaining treatment nor giving consent to DNR orders. 

Regional centers give affirmative consent to life sustaining treatment; regional centers do not give affirmation to withdrawal of life sustaining treatment or give consent to not provide such life sustaining treatment.  In such cases the burden of such consent may be provided by the hospital physicians or the hospital bioethics committee, and in such cases the TCRC staff physician, contractor physician, or Director of Clinical Service may give the Executive Director their opinion as to the reasonableness of such a request and whether or not TCRC should state an objection to the request or state that TCRC shall not object to the request [but still does not give such consent].

  1. Review the case record as needed to further explore the medical issue,
  2. Discuss the proposed procedure with the treating physician,
  3. Review the situation for contradictions or risks,
  4. Asks the community medical professional if the hospital or medical group’s bioethics committee has been consulted, and if so, what was the committee’s recommendation?  If the bioethics committee was not consulted or convened, ask why it was not consulted or convened?  If in the staff physician’s/contractor physician’s/Director of Clinical Services’ opinion it appears that the committee should be convened and can be convened in a timely fashion without endangering the life of the person served the question of consent should be referred back to the hospital bioethics committee.
  5. If the bioethics committee has recommended the treatment or the withholding of life sustaining treatment, or if there is not enough time to wait for such a committee to be convened, then the staff physician/contractor physician/Director of Clinical Services reviews the proposed procedure, and prepares a written summary of the procedure and a recommendation to the Director or her/his designee regarding whether consent should be given, to be filed in the case record and will also call the Director or her/his designee with their recommendation.
  6. The staff physician, contractor physician, and/or Director of Clinical Services do not give consent; it is their responsibility to give guidance and a recommendation to the Director, and it is the Director who gives consent for medical treatment.
  7. The Director or her/his designee (Services and Supports Manager) will contact the community medical professional to give consent or to inform the community medical professional if consent is not given.
  8. Special Case: please note that TCRC does not write nor sign off on Physicians Orders for Life Sustaining Treatment (POLST).  That is between a patient and her/his physician, and not between TCRC and the physician. 

Contacting Physicians:

The preferred order of contact is as follows: TCRC staff physician or Contractor physician supporting the office first preference; if staff physician or contractor physician supporting the office does not respond within a reasonable amount of time (which may vary as to the situation and need) then service coordinator or manager may consult with the Tri-Counties Regional Center staff physician/contractor physicians from another office; if the physicians do not respond in a reasonable amount of time (see above) then the service coordinator or manager is to contact the Director of Clinical Services.

NOTE:  The list of phone numbers and email address of the Tri-Counties Regional Center Staff Physician(s), Contractor Physicians, and the Director of Clinical Services will be posted on the Intranet, in Box, and will be updated as any changes are made in information and/or persons to contact as such changes occur with distribution of said list to all managers who take On-Call.

Revision Date: January 2023