0300-303.06 | Revision Date: 1/24/22
This policy guide provides information on determining whether a hospital hold is necessary and how to place a hospital hold.
TABLE OF CONTENTS
Detentions and Hospital Holds
Evaluating/Placing a Hospital Hold
Removing a Hospital Hold
Referenced Policy Guides
This policy guide was updated from the 02/25/16 version to clarify the legal implications of placing a hospital hold and provide additional details about parental consent, exigency, and warrants/removal orders.
Detentions and Hospital Holds
When a Children’s Social Worker (CSW) places a "hospital hold" (DCFS 164) on a child who is in the hospital, that action is a detention/removal where DCFS has taken that child into temporary custody. Therefore, prior to a CSW taking a child into temporary custody and removing the child from the custody of the parent or legal guardian by placing a hospital hold on the child, the CSW must:
Conduct a Structured Decision Making (SDM) Safety Assessment and determine that the child who is at the hospital is at risk of abuse/neglect or has been abused or neglected and therefore must be taken into temporary custody or detained/removed from their parent or legal guardian, and
Determine which of the following exist:
- Exigent Circumstances – A CSW may detain the child at the hospital/place a hospital hold without a warrant or court order if the CSW determines that a child is in immediate danger of suffering serious physical injury and there is no less intrusive means of protecting the child. Exigency is present when there is reason to believe a child is at immediate risk of serious physical harm, sexual abuse or physical abuse and there is no time to get a warrant because, in the time it would take to get a warrant, it is likely the child will suffer serious disability or death, or continue to suffer severe pain, or the child will likely suffer serious physical harm if discharged to the parent. For example:
- When the parent refuses to authorize treatment of an emergency medical condition that requires immediate treatment for the alleviation of severe pain or an immediate diagnosis and treatment of an unforeseeable medical, surgical, dental, or other remedial condition or contagious disease which if not immediately diagnosed and treated would likely lead to serious disability or death or continue to suffer severe pain, in the time it would take to get a warrant. In this case, parental refusal may amount to medical neglect.
- When the medical condition of the child is due to the conduct of parents, guardians, a member of the household, or other caretakers who have custody and control of the child and the child is going to be immediately released from the hospital and it is likely the child will suffer serious disability or death, or continue to suffer severe pain, in the time it would take to get a warrant.
- When there is a reasonable belief that the parent may remove the child or infant from the hospital against medical advice and it is likely the child will suffer serious physical harm, disability or death, in the time it would take to get a warrant.
- The child is due to be released to the perpetrator and it's likely the child will suffer serious physical harm, severe pain, disability or death while in the custody of the perpetrator in the time it would take to get a warrant.
- The child is due to be released to a parent who is unable or unwilling to protect the child from the perpetrator and it's likely the child will suffer serious physical harm while in the custody of that parent in the time it would take to get a warrant.
- If exigent circumstances exist, the detention at the hospital or a hospital hold may be placed on the child immediately, regardless if there was face-to-face contact with the family by the ER CSW.
- Consent – A parent/guardian may consent to the removal of their child while the child is in the hospital. Consent must be freely and voluntarily provided by the parent or legal guardian. The CSW should make best efforts to have the parent sign a document for said consent to remove. The CSW should document the parent/guardian's consent.
- Warrant/Court Order – If the CSW does not have either consent or exigent circumstances to detain the child at the hospital with a hospital hold, a CSW must obtain a warrant/removal order before the child can be detained from the custody of parent or guardian while the child is in the hospital.
- Once the child is detained/removed at the hospital with a hospital hold, that child is in the temporary custody of DCFS until the Detention Hearing (although they may physically still be at the hospital). The date and time of the hospital hold becomes the date and time of the detention. If the hospital hold was placed in error, the CSW must consult with their SCSW and/or the Warrant Desk on how to proceed.
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Evaluating/Placing a Hospital Hold
- Discuss with the hospital representative the safety threats and risk factors of the case and evaluate the potential danger to the child in the caregiver’s household using the structure of the SDM Safety Assessment (with particular focus on factors influencing child vulnerability and the impact of any caregiver complicating behaviors).
- Request the hospital complete the DCFS 4158-2, Physician Questionnaire if emergency medical consent is necessary and the DCFS 410, Hospital Medical Summary and Newborn Risk Assessment.
- Discuss the following with the SCSW and the Public Health Nurse (if available) to determine if the child needs to be taken into temporary custody/removed with a hospital hold:
- The safety factors of the case and the potential danger to the child and any other children who may be in the home, utilizing the SDM Safety Assessment tool and all other pertinent information.
- Whether consent/exigency exists or if a warrant would be necessary.
- DCFS 4158-2
- DCFS 410
- Newborn Risk Assessment
- If the child needs to be taken into temporary custody and detained while at the hospital, first determine if exigent circumstances exist or if a warrant will be necessary in order to detain the child at the hospital. If no exigent circumstances exist, obtain parental consent or a warrant/removal order that supports the removal of a child at risk of abuse or neglect.
- After obtaining consent, verifying exigency or a warrant/removal order is granted by the court, detain the child at the hospital with a hospital hold.
- Complete and sign Part 1 of the DCFS 164, Hospital Hold and obtain the SCSW’s signature.
- In emergency situations, fax the DCFS 164 to the medical facility. Inform the medical facility that the child is now in the temporary custody of DCFS pending either a court hearing, or removal from the medical facility when acute care is no longer necessary. Request that the DCFS 164/hospital hold paperwork be placed in the child’s hospital chart.
- Within two (2) hours of initiating the hospital hold, complete the petition referral request in the Intake and Detention Control (IDC) Petition Tracking System located on LAKids. The IDC Petition Tracking System will generate the paperwork due date and hearing date.
- If needed, another CSW (e.g., a duty CSW or SCSW) can enter the required information into the Petition Tracking System.
- In situations where the CSW did not receive an email confirming receipt of the petition request, immediately call lDC 323-881-1303 Monday-Friday before 5:00pm or Emergency Response Command Post (ERCP) 213-639-4500 after-hours.
- Do not wait to complete the Detention Hearing Report before submitting the petition request to the Petition Tracking System.
- If the decision is not to place a hospital hold on the child, notify the hospital and, if needed, provide community resource referrals, and any additional services to the child and their family.
Request any remaining hospital documentation, including the hospital’s recommendation/assessment that the child is no longer at immediate risk of abuse or neglect that required the initial hospital hold, as applicable. (e.g., further medical/forensic evaluation is done by the treating physician, another doctor and/or a medical specialist, and said doctor has subsequently determined and documented the child to not be at immediate risk of abuse or neglect from the parent/guardian).
Continue the investigation and determine whether the child is still at immediate risk of abuse and/or neglect by any parent/guardian. Refer to Investigation, Disposition, and Closure of Emergency Response Referrals for more information.
- Document all contacts with the SCSW, PHN, hospital, parents, etc., in the Contact Notebook.
- If after consultation with CSW and the PHN, a hospital hold is necessary, review and sign the DCFS 164. If not approved, return to CSW for any modification.
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Removing the Hospital Hold
- If the child is medically cleared to leave the hospital and the child has been determined to no longer be at immediate risk of abuse or neglect by any parent/guardian based on the CSW’s investigation, which should include hospital documentation and recommendation that the child is no longer at immediate risk of abuse or neglect that required the initial hospital hold, complete Part II of the DCFS 164 Hospital Hold document.
- If a child 0-59 months old is being released to a parent/legal guardian, after completing the SDM Safety and Risk Assessments and determining the child is not at immediate risk of abuse or neglect based on the CSW's thorough investigation and documentation as indicated above, obtain the signature of the ARA.
- In all other cases, only SCSW approval is required.
- Contact the medical facility’s representative, notify them of the decision, and fax the DCFS 164 to the medical facility.
- Notify the Dependency Investigator (DI), if assigned, that the hospital hold is removed.
- Indicate the discharge date and the child’s placement location.
- If you wish to remove the hospital hold prior to the Detention Hearing, call Intake and Detention Control and the warrant desk immediately at (323) 881-1303.
- Document all contacts in the Contact Notebook.
- Review and sign the DCFS 164.
- If not approved, return to CSW for any modification.
- Review and sign the DCFS 164 when releasing a child between 0-59 months old to parents.
- If not approved, return to SCSW for any modification.
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- DCFS 164, When releasing a child 0-59 months old to parents
DCFS 164, Hospital Hold
DCFS 410, Hospital Medical Summary
DCFS 4158-2, Physician’s Questionnaire
Referenced Policy Guides
0300-303.15, Writing the Detention Report
0600-501.15, Consent for Emergency Medical Care
0070-521.10, Assessment of Drug & Alcohol Abuse
0070-521.11, Assessment of Medical Neglect
0070-548.07, Assessing the Safety and Risk of Newborns for Families Already Under DCFS Supervision
0070-548.10, Investigation, Disposition and Closure of Emergency Response Referrals
0070-548.20, Taking Children into Temporary Custody
0070-548.24, Structured Decision Making (SDM)
0070-570.10, Obtaining Warrants and/or Removal Orders
WIC Section 306 (a) – Describes the legal conditions when a CSW can place a child who has an immediate medical need in temporary custody without a warrant.
WIC Section 309(b) – Describes the condition when a CSW can place a child into temporary custody when that child who is under the care of a physician, surgeon or hospital care and cannot be immediately moved into temporary custody.
WIC Section 319 – Describes reasonable efforts and services that should be made available to the parents and legal guardian in order to eliminate the need to remove the child from the custody of the parents or guardians.
WIC Section 369 – Describes the circumstances when a social worker may authorize emergency medical or dental consent for a child placed in protective custody.
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