The Minor Athlete and Parental Consent
A 16-year-old football player comes to a chiropractic clinic with low back pain after a tackle. He is alone; his mother is at work and has sent a text saying 'it's fine, adjust him if needed.' The coach is in the waiting room and wants him 'cleared for Friday.' The patient has point tenderness at L4, no neurologic deficits, and pain with extension. The chiropractor has treated the family for years. The patient asks that his mother not be called because she will 'worry and pull him from the game.' The clinic's intake form has a line for parent signature, but the patient signed it himself. The chiropractor is not the team physician and has no written authorization from the school. The patient is not emancipated. The chiropractor wants to provide treatment and tell the coach the player is 'good to go.'
1. May the chiropractor treat the minor on the text message and the patient's own signature?
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Not safely. A 16-year-old is a minor under Nebraska law, and chiropractic treatment ordinarily requires consent from a parent or legal guardian unless a specific exception applies, such as emancipation or a medical emergency. This is not an emergency: the patient is stable, has no neurologic deficits, and is asking for treatment and clearance. A text message saying 'it's fine, adjust him if needed' is ambiguous and does not identify the sender or the specific treatment; the patient's own signature on the intake form is not parental consent. The chiropractor should attempt to reach the mother by phone, verify identity, explain the findings and proposed care, and document her actual consent or refusal. If she cannot be reached, the chiropractor may provide only care permitted for a minor without consent, which on these facts likely means first aid and advice to seek evaluation, not manipulation.
2. What should the chiropractor tell the coach, and how should the encounter be documented?
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The chiropractor should not tell the coach the player is 'good to go.' Return-to-play clearance requires an appropriate evaluation and, for a minor, parental involvement; the chiropractor is not the team physician and has no written authorization from the school. The coach should be told only that the chiropractor cannot provide clearance without the parent and that the player should be evaluated further if symptoms persist. The record should include the history, examination findings, the absence of neurologic deficits, the red-flag review, the text message and its limitations, attempts to contact the mother, the patient's request that she not be called, and the advice given. Document that no manipulation was performed if that is the case. Avoid changing the intake form after the fact; note who signed it and why it was insufficient.