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3.2.9 Operative procedures and anaesthetic consent

Last Modified: 28-Jun-2018 Review Date: 01-Oct-2016

Purpose

To inform child protection workers of the delegations for giving consent and procedures to follow when a child is under the parental responsibility of the Chief Executive Officer (CEO) and needs to have an operative procedure and/or anaesthetic (excluding local anaesthetic for dental treatment).

Practice Requirements

  • The child protection worker must determine who has parental responsibility for the child and thus holds the authority to consent on behalf of the child. Refer to the related resource In the CEO’s Care - Parental Responsibility Chart.
  • A negotiated placement agreement (NPA) must be checked on a case-by-case basis to ascertain if it expressly authorises the CEO to consent to operative procedures and/or anaesthetic in lieu of the parents.
  • If the NPA does not authorise the CEO to consent to operative procedures and/or anaesthetic, or where the child has been provided with a placement service under s.32(1)(a) and is therefore in the CEO’s care, parental responsibility still remains with the parents and approval cannot be provided by the CEO. In these two circumstances, written consent for the operative procedure and/or anaesthetic must be obtained from the parents.
  • Where an operative procedure and/or the administration of an anaesthetic is being considered for a child under the parental responsibility of the CEO, reasonable efforts must be made to involve the parent(s) of the child and to include them in the decision-making process. An exception is when a medical procedure is required after hours and Crisis Care staff do not have enough information available about the family situation to contact the parents.
  • If the parent(s) views cannot or should not be obtained, the child protection worker must record this.
Process Maps

Not applicable

Procedures

  • Authority of the CEO to consent on behalf of a child
  • Children under the parental responsibility of the CEO
  • Children in the CEO's care prior to adoption
  • After hours procedures
  • A child under the parental responsibility of the CEO requires an operative procedure in an overseas country
  • Authority of the CEO to consent on behalf of a child

    Section 127 of the Act authorises the CEO to give consent (in lieu of a parent) for a child to undergo an operative procedure and/or anaesthetic where that child is:

    • in provisional protection and care (subject to an interim order - s.29(2))
    • the subject of a protection order (time limited) or protection order (until 18)
    • the subject of a negotiated placement agreement, only  if the agreement authorises the CEO to do so.

    In addition, the CEO is authorised to give consent (in lieu of a parent) for a child to undergo an operative procedure and/or anaesthetic where that child is in the CEO’s care prior to adoption under the Adoption Act 1994 and all consents to the child’s adoption have been either delivered or dispensed with.

    The CEO, as the delegated guardian, is also authorised to give consent for an unaccompanied humanitarian minor (UHM) to undergo an operative procedure and/or anaesthetic - pursuant to the Immigration (Guardianship of Children) Act 1946.

    Delegations of the CEO’s authority to consent

    Except in relation to termination of life support, which requires CEO approval (refer to Chapter 3.2: Termination of life support), the CEO has delegated the authority to Executive Directors to approve a request for anaesthetic consent and/or an operative procedure where:

    • the procedure is related to a termination of pregnancy (refer to Chapter 3.2: Termination of pregnancy); or
    • any of the following factors exist:
      • a parent objects to the child having a general or local anaesthetic or an operative procedure
      • the child’s health will be at high risk if the procedure is not performed
      • the procedure is considered high risk.

    Where none of the above factors exists, the CEO has delegated the authority to assistant district director/​​district directors and the Director Fostering and Adoptions to approve requests for medical procedures that require anaesthetic consent and/or an operative procedure.

    For any dental treatment (including local anaesthetic) or medical treatment not requiring anaesthetic consent and/or an operative procedure (including immunisations), the CEO has delegated authority to consent to child protection workers. In these instances team leader involvement may be required in certain cases. Child protection workers should refer to Chapter 3.2: Medical or dental treatment - including immunisations.

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    Children under the parental responsibility of the CEO

    1. Contact with the medical practitioner

    The child protection worker will contact the medical practitioner to request a report on the:

    • type of operation and/or anaesthetic required
    • expected outcomes and any possible risks or complications
    • possible consequences if the procedure is not performed.

    The hospital or medical practitioner may provide a standard list of risks and complications that cover particular medical procedures. Refer to the Health Facts resource documents in related resources for common risks associated with the insertion of grommets, Adenoidectomy and Tonsillectomy.

    2.  Provide information to the child and consider their wishes and views

    The child protection worker will provide information to the child about the procedure and consider views expressed, having regard to the child’s age and level of understanding.

    In situations involving a preverbal child or a child who has developmental impairment, the child protection worker will undertake an assessment to ascertain the child's needs and best interests.

    A mature minor can provide informed consent for the procedure where a doctor has assessed that he/she has sufficient understanding and maturity to make decisions and give consent – refer to the Gillick Principle  (resource document).

    3. Inform the parent(s) and seek their views (where possible)

    The child protection worker will contact the child’s parent(s) – where possible and appropriate – to inform them of the procedure required, seek their views, and involve them in the decision-making process.

    4. Provide information to the carer(s)

    The child protection worker will provide information to the carer(s) about the procedure and involve them in the process. The child protection worker may need to arrange for support and/or resources for the carer(s) to assist them in caring for the child once the child returns to the placement.

    5.  Complete the necessary documentation

    The child protection worker will access the template 'Operative Procedures and Anaesthetic' from the 'templates' tab within the child's '360 degree view' in Assist (click on the 'Open' button to view and edit the document).  Once opened, add all the relevant details to the template submission.  Refer to the Assist User Guides – Templates relating to children in care.

    The following must also be completed:

    • Form 134 - Consent for Operative Procedures and the Administration of Anaesthetic for Children in the CEO’s Care. Please note: a Form 134a is to be used for UHMs pursuant to the Immigration (Guardianship of Children) Act 1946.   
    • Form 269 - Letter to Medical Practitioner; the letter should include the child’s known medical conditions (for example allergies, genetic implications), with a request that relevant medical staff be alerted.

    Note: If the hospital or medical practitioner provides its own consent form, it should be completed and signed by the district director instead of Form 134. The completed consent form must be forwarded to the hospital/medical practitioner in a timely manner.

    6. Endorsement and approval process

    The endorsement and approval process is completed electronically via email.

    The child protection worker sends the documentation to the team leader to check, consider, endorse and submit to the assistant district director/​district director.

    If appropriate, the assistant district director/​district director approves the submission and signs the consent form.

    If the matter is contentious, the assistant district director/​​district director will forward the submission to the relevant Executive Director to note.

    7. Recording

    Once approved, the child protection worker must scan and save a copy of the approved documents onto the case file in Objective, and forward the original signed documentation to the medical practitioner or hospital. The documentation, including the signed consent form, must be provided to the surgery or hospital promptly.

    The child protection worker must update relevant details in the medical screen of the Record of Child Information (ROCI) in Assist. Refer to the Assist User Guides – Record of Child Information – Medical Information.

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    Children in the CEO's care prior to adoption

    A child may be in the CEO’s care under the Adoptions Act 1994 prior to adoption but the birth parents will have responsibility for giving consent for the child to have an anaesthetic and operative procedure until all the consents to the child’s adoption under s.17(1) have been either delivered or dispensed with. This does not apply where the child is the subject of a protection order (time-limited) or protection order (until 18) because the CEO has parental responsibility and can consent in lieu of the parents.

    The following procedures are to be followed where the CEO has parental responsibility to provide consent for the child.

    1.  Initial procedures

    The child protection worker Adoption Services will follow procedure steps 1 - 4 as outlined above in 'Children under the parental responsibility of the CEO'.

    2. Complete the necessary documentation

    The child protection worker will access the template 'Operative Procedures and Anaesthetic - Adoptions' from the 'templates' tab within the child's '360 degree view' in Assist (click on the 'open' button to view and edit the document).  Once opened, add all the relevant details to the template submission. Refer to the Assist User Guides – Templates relating to children in care.

    The following must also be completed:

    • Form 201a - Consent for Anaesthetic and Operative Procedures – Children Pursuant to the Adoption Act 1994
    • Form 269 - Letter to Medical Practitioner; the letter should include the child’s known medical conditions (for example allergies, genetic implications), with a request that applicable medical staff be alerted.

    3. Endorsement, approval and recording process

    The child protection worker Adoption Services will follow procedure steps 6 and 7 as outlined above in 'Children under the parental responsibility of the CEO’. Note however that the director Fostering and Adoption Services provides the approval, as per the delegations.

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    After hours procedures

    1. Initial procedures

    If a child requires an operation and/or anaesthetic outside of district office hours, Crisis Care Unit (CCU) staff will speak with the medical practitioner or relevant hospital staff to request a report on the:

    • type of procedure required
    • expected outcomes and any possible risks or complications
    • possible consequences if the procedure is not performed.

    CCU staff will take into account any information from the medical practitioner or hospital staff, including if the child has indicated they do not want the operation.

    CCU staff will make contact with the carer, where possible, to advise them about the operation.

    2. Contact with the district director

    CC staff will contact the relevant assistant district director/​district director to advise that consent is required for a child in care to have an operative procedure and/or anaesthetic. CCU staff will provide the district director with the following information:

    • child’s full name and date of birth
    • name of the intended procedure, expected outcomes and any possible risks or complications
    • name and contact details of the medical practitioner who intends to perform the procedure
    • details of any known medical conditions the child may have, as per the child’s ROCI - for example allergies or possible genetic implications.

    3. Assistant district director/district director or CCU staff to contact the medical practitioner

    The assistant district director/​district director contacts the medical practitioner to discuss the reason for the emergency procedure, and any possible consequences if it is not performed.

    If the assistant district director/​district director agrees to the child having the procedure, he/she will give verbal consent and provide the medical practitioner with details of any known medical conditions the child has, and request that applicable medical personnel be alerted.

    The assistant district director/​district director will advise that signed consent for the procedure will be forwarded to the medical practitioner or hospital on the next working day. Please note those circumstances referred to under ‘Delegations of the CEO’s authority to consent’ where approval by an Executive Director is required.

    Note: In some instances, the assistant district director/​district director may authorise CCU staff to contact the medical practitioner on their behalf to provide details of the child’s known medical conditions and give verbal consent for the procedure.

    4. Recording by CCU staff and advice to the child protection worker

    CCU staff will save the case notes onto the Objective case file and send a reference to the relevant child protection worker via email to inform them of the action taken.

    5. Completion of documentation by the child protection worker

    The child protection worker (on the next working day) must complete the following documentation:

    • Form 134 - Consent for Operative Procedures and the Administration of Anaesthetic for Children in the CEO’s Care. Please note: a Form 134a is to be used for UHMs pursuant to the Immigration (Guardianship of Children) Act 1946 
    • Form 269 - Letter to Medical Practitioner: the letter is to be marked to the attention of the medical practitioner advising that verbal consent was given. The letter should state when and who gave verbal consent.

    6. Approval process

    The child protection worker forwards the documentation to the assistant district director/​​district director for approval and sign off.

    Once approved and signed, the child protection worker will promptly forward the documentation to the medical practitioner or hospital.

    7. Recording

    The child protection worker must scan and save a copy of the approved documents onto the case file in Objective and record relevant details in the health dimension of the child’s Quarterly Care Review in Assist (as the case requires).

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    A child under the parental responsibility of the CEO requires an operative procedure in an overseas country

    A child requires an urgent operative procedure while overseas 

    If a child in care becomes unwell or has an accident while travelling overseas and requires an urgent operative procedure, consent would be dependent on the requirements of the overseas country (as to whose consent is appropriate).  The child protection worker should look into the country’s requirements for giving consent as part of the initial planning when a child in care is to travel overseas.

    Travel/medical insurance arrangements must be in place prior to travel and the responsible adult (carer, parent etc.) escorting the child should be provided with a signed authority letter to provide consent should the child require an urgent operative procedure.

    A child needs to travel overseas for an operative procedure

    The child protection worker must follow procedure steps 1 - 4 as outlined above in 'Children under the parental responsibility of the CEO'.

    1. If it is assessed that the child needs to travel overseas for an operative procedure, the child protection worker must have the travel arrangements approved by the assistant district director/​​district director, or relevant Executive Director (Metropolitan or Country Services) if the travel is contentious or the operative procedure is considered to be high risk. The child protection worker should follow the procedures set out in Chapter 3.2: Interstate and overseas travel.
    2. The submission to travel must include all documentation in support of the travel with details of the need to go overseas in order to have the procedure and escort arrangements. The child will need to have a current Passport with at least six months validity remaining beyond the period of the intended stay. This is a requirement of many overseas countries and may be required if the child needs to stay longer than originally planned if medically necessary.
    3. If the travel and escort arrangements are approved, the child protection worker will complete procedure steps 5 – 7 as outlined above in 'Children under the parental responsibility of the CEO’.
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