Question:
Dear Nancy,
We work in an immunization clinic for a county health department that provides immunization clinics for children two days a week. Our concern is uncontrollable clients and the parameters that constitute battery when restraint is necessary. Is it our role to help a parent physically restrain a child? Are we liable if we don't provide a vaccine if the parent cannot restrain their child?
Thanks,
Jack
Nancy Brent replies:
Dear Jack:
According to Black's Law Dictionary, a battery is an intentional tort that occurs whenever there is forceful, unpermitted, and harmful contact with another. In the situation of healthcare being provided, a battery can take place whenever healthcare is provided that is not consented to, for example.
In the situation described in your question, the parent is bringing the child into the clinic for immunizations. Since the parent is the legal consent giver for minor patients (with some exceptions, of course), the parent's consent exists to give the immunization and to do so safely. Reasonable restraint of the child is therefore necessary in some instances.
Clearly, reasonable restraint policies, with continued consent by the parent to use the restraint to administer the immunization safely, are essential. If the parent withdraws the consent (e.g., "Forget about this. It is too scary for my son."), then no further restraint or the administration of the vaccine is possible.
Whatever the circumstances of a difficult situation clinic staff face in administering immunizations, clear, complete, accurate, and timely documentation of the circumstances needs to occur. It is important to include the role of the consent giver. What the consent giver said and did, including a decision to forgo the immunization and/or restraint, is necessary.
A consent form developed and used by staff that is clear and inclusive of what is needed for the immunization to take place is a good tool that can be used by all staff to ensure compliance with the legal requirements of informed consent by the parent or other legally authorized consent giver and to avoid battery allegations.
Sharing your concerns with the clinic CNO, medical director, and risk manager would be a good start in helping staff feel more comfortable with their role in administering immunizations.
Cordially,
Nancy
