Physicians or other medical personnel may call the Child Protection Hotline (CPH) to refer children who are being kept alive with life-sustaining medical equipment and whom they believe should be removed from life support. DCFS may only accept these referrals if one or more of the following conditions are met:

The child’s medical condition is alleged to be the result of abuse or neglect.

The child has been taken into temporary custody pending filing of a Juvenile Court Petition.

A Juvenile Court Petition has been filed on behalf of the child.

The child is a dependent of the Juvenile Court.

When the child does not meet these criteria, the decision to terminate life-sustaining medical treatment is made by the child’s physician and parents.

Once a child has been placed into temporary custody, only the Dependency Court can authorize cessation of life-sustaining medical treatment. The petition is brought by the child’s physician and is heard in the department to which the child’s case is assigned. In no case will DCFS be involved in the decision to terminate life-sustaining medical treatment.

Physicians do not need the court’s consent to terminate life-sustaining medical equipment for any patient who is determined to be brain dead.

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PROCEDURE

Referral Regarding Life Sustaining Medical Treatment

CPH CSW Responsibilities

If there are no allegations of abuse and neglect:

Complete the Emergency Response Referral Document and Screener Narrative.

Advise the reporter to contact hospital legal counsel for advice.

Evaluate out the referral.

If there are allegations of abuse and neglect complete the:

Emergency Response Referral Document

Screener Narrative

CPH SCSW Responsibilities

Upon approving the referral in the case of allegations of abuse and neglect, assign the referral as appropriate.

Responding CSW Responsibilities

Contact the referring party and discuss the basis of the allegations.

If doubt remains as to whether the child’s injuries are the result of abuse or neglect, confer with the Public Health Nurse and ask the nurse to discuss the case with the physician.

If the child is in out-of-home placement, immediately notify the child’s parent(s).

If the allegations are on an open dependency case, notify the child’s attorney.

Conduct the investigation following the appropriate procedural guide:

New referral

Referral on an open case

Child in out-of-home care

Child under DCFS supervision residing in the home of a parent

If the investigation determines that the child’s medical condition is not the result of actions of a parent or legal guardian that would bring the child under the jurisdiction of the Dependency Court:

Refer the child’s physician to the hospital’s legal counsel for guidance regarding cessation of life-sustaining medical treatment.

Close the referral.

If it is suspected that the child’s medical condition is due to the actions of a parent or legal guardian, complete the following:

Take the injured child into temporary custody or place the child on a hospital hold.

Assess the safety of any sibling in the home.

Complete a separate evaluation for each child in the home to determine whether a court order should be used to remove each child.

If any siblings are determined to be at risk of abuse or neglect, place them in temporary custody.

Complete a DCFS 164 and fax it to the hospital social worker.

Advise the child’s physician to contact the hospital’s legal counsel for guidance on how to petition the Dependency Court for permission to cease providing life-sustaining medical treatment.

Prepare the Detention Report.

Detail the child’s medical condition as evidence of the severity of the abuse.

Do not make any recommendation relating to this issue.

Public Health Nurse Responsibilities

Consult with the child’s physician.

Document conclusions reached during the consultation in the Contact Notebook.

Inform the investigating CSW as to the results of the consultation.

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APPROVALS

SCSW Approval

Approving the evaluated out referral or disposition of the referral

CPH SCSW

Approving the referral

HELPFUL LINKS

Forms

CWS/CMS

Detention Report

Emergency Response Referral Document

Screener Narrative

JV 100, Juvenile Dependency Petition

JV 101, Additional Children Attachment – Juvenile Dependency Petition

JV 120-129, Petition Allegations (300 Subdivisions A-J)

LA Kids

DCFS 164, Hospital Hold

Referenced Policy Guides

0070-548.05, Emergency Response Referrals Alleging Abuse In Out-of-Home Care Regarding Children Who Are Under DCFS Supervision

0070-548.06, Emergency Response Referrals Alleging Abuse of Children Who Are Under DCFS Supervision and Residing in the Home of a Parent

0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals

0070-548.20, Taking Children into Temporary Custody

0070-560.05, Joint Response Referral: Consulting with PHN

0300-303.06, Hospital Holds

0300-303.15, Writing the Detention Report

0300-506.05, Communication with Attorneys, County Counsel, and Non-DCFS Staff

Statutes

Health and Safety Code Section 7180 & 7181 – Defines criteria for determination of death and states that determination of death must be independently confirmed by another physician.

Welfare and Institutions Code Section 306 (a) – Describes the legal condition when a CSW can place a child who has an immediate medical need in temporary custody without a warrant.

WIC Section 369(b) – Permits the juvenile court to make an order authorizing performance of necessary medical, surgical, dental, or remedial care for a child in need of such care with no parent or guardian willing to authorize care or treatment.

Los Angeles Superior Court Local Rule 7.5 – Describes the court’s authority to order the withdrawal of Life-Sustaining Medical Treatment for juveniles as well as disabled infants with life threatening conditions, including definitions, required notices, and court procedures. Also includes factors that the court should consider in deciding on a case-by-case basis whether cessation of Life Sustaining Medical Treatment is in the best interest of the child.

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