Setting a Clinic Policy to Decline Minor Patients in Heated Custody Disputes

**elenny** · 10-10-2011, 03:04 PM

My question involves a child custody case from the State of: AK

For lack of a better idea where to put this question, I'm putting it here in this thread. If it belongs elsewhere, please redirect it

My question is this: I work in a small child psychiatric clinic and as a result we often get requests from one parent/family member/social worker to have us see the child while there is a custody battle raging. We do not like to take cases like these as we usually get stuck in the middle and our Psychiatrist is liable to get pulled into court, restricting his ability to care for the other patients in the clinic, not to mention we and/or the child are usually getting fed misinformation about the other party involved in the case.

I need help phrasing a disclaimer on our website/patient agreement form explaining that we may not be able to take a child depending on the severity of the legal issues at stake. I do not know enough to write one easy enough to understand by the common person while still covering all avenues to keep us protected in the event that we see a child without knowing beforehand that there is a legal issue present. If we see a child for any number of visits onto learn later that, say, the mother is fighting against the bio dad for custody and has been insisting that the father is not fit to parent, (though we have never met the father and the child is either too young, confused or otherwise incapable of forming a decision due to mental complications), we would probably opt to drop the parent and child until after the legal problems are resolved. I need to have something that the parent signed explaining that we are within our rights to drop the case if it comes to a situation where we are being used as a weapon against another parent or guardian in a legal battle.

I hope this makes sense, I can certainly try to explain it better if that is not the case. Thanks!

**Dogmatique** · 10-10-2011, 03:26 PM

A disclaimer isn't going to prevent the court from issuing a subpoena for the provider to turn up and testify in court, I'm afraid.

And there is a real question of ethics here - how is it ethical (or good for the child) to drop the child as a patient because their parents are involved in a custody dispute?

**elenny** · 10-13-2011, 04:28 PM

It's more of a disclaimer for patients interested in getting into our clinic. We understand the ethics issue with preexisting patients and it is very rare that something like that would happen now that we are taking precautions against taking them in the first place. We want to make sure parents fighting a custody battle aware that we will see the child only if it is under agreement with both parents or parents vs guardians. If a divorced couple are fighting over their children, the issue usually revolves around putting the child on medications or treatments that the one of the two parties doesn't agree on.

**Dogmatique** · 10-13-2011, 04:36 PM

What happens if both parents initially agree, and then legal custody changes?

**gam** · 10-13-2011, 06:32 PM

I work in the mental health field, happen to work at the moment in a psych hospital. We have a unit for children. 99% of the children that walk in our door are in split situations.

Are you kidding me here, putting in a disclaimer. What patients does this psych have left to treat? Most kids with mental issues or true mental disorders, there home situation if messed up, can lead to them needing treatment.

Why can't your psych figure out how to treat the child, stay out of the middle, find the mess in the split situation and help the child learn to deal with it? Every psych I have worked with and every therapist I have worked with, manages to figure this out and continue to treat children in split situations, even ones who are right smack dab in the middle of a full blown custody case. Does your psych not understand, case is fine today, but tomorrow either one of those parents can file and blow that case wide open again.

Does your psych not understand, that children in split homes, who need mental help, most likely live in a messed up custody situation? They need help, they don't need to be turned away because some psych does not want to get in the middle, maybe end up in court and not do the job they are paid to do.

This is just making me sit here and shake my head, unbelievable. The psych you work for, should not be treating children, end of story.

**Dogmatique** · 10-13-2011, 06:43 PM

I honestly didn't want to go into it that much, but I can't help but agree with you Gam.

**elenny** · 10-14-2011, 05:41 PM

We have an MD and a LPC on staff here at the clinic and we are operating at full capacity. Because we have so few providers and so many interested parties, we have the need to be somewhat picky. I don't wish to impress upon anyone that we deny every patient who has legal problems, because you are correct: most children with behavioral issues are due in part to an unbalanced family situation.

We simply want to make sure that we are not being chosen as a clinic for the sole purpose of one party defaming the other with the child in the middle. We have taken a few patients in the past with complicated legal disputes and have been dragged into it, forcing us to rack up costs and removing our primary practitioner from the clinic, wreaking havoc on our schedule and sacrificing other children with emergent needs because the parents saw fit to try and use us against the other party.

This disclaimer would not be an end-all, we-will-not-take-you-because-of-a-divorce, it's a warning to parents that when we get their paperwork and discuss the case in our weekly meetings, we may not be able to take them if the case is too severe for us.

**Dogmatique** · 10-14-2011, 06:01 PM

Again though, if you begin treating a child and something happens there is no disclaimer in the world stopping the provider from being subpoenaed during a court case.

And honestly? Parents don't take their kids to see counselors solely to screw the other parent. They really don't.

Frankly, from a family law perspective, such a disclaimer would potentially put off "happy family unit" clients.

Further, how do you know if the parents will tell you the truth about their situation? Many parents involved in a custody dispute might simply lie to you. What then?