Know Legal Requirements for Abuse Reporting

All members of the ED staff, including physicians, residents, interns, and nurses, are mandatory reporters of child abuse and neglect, says Robert D. Kreisman, a medical malpractice attorney with Kreisman Law Offices in Chicago.

"That means that they are required to submit a written report to the appropriate local department whenever they suspect that a child they have observed may have been abused or neglected," says Kreisman. Here are Kreisman's recommendations to reduce legal risks:

Physicians and medical staff should be familiar with the legal definitions of abuse and neglect.

While each state may classify these terms differently, child abuse generally refers to physical or mental harm to a child, says Kreisman. Abuse can include sexual abuse, torture, administering non-prescribed, controlled substances, or placing the child at a substantial risk of being harmed, he says.

Child neglect refers to inadequate nourishment or basic care, such as providing food, clothing, and shelter, or abandonment without providing for proper care, says Kreisman.

Physicians should report any pregnant women who are addicted to alcohol or drugs, or when a newborn's blood, urine, or meconium contains any amount of controlled substances that are not accounted for by medical treatment, adds Kreisman.

The law sets out a few provisions that do not constitute neglect in the absence of any other incidences, says Kreisman: If a child is relinquished under the Illinois Abandoned Newborn Infant Protection Act, if the child is left alone under the care of an adult relative for a prolonged period of time, or if the parents choose to rely exclusively on prayer for the treatment or cure of a medical disease.

If child abuse or neglect is suspected, report it immediately.

Most states have a 24-hour hotline available for making an initial report, says Kreisman, and the process typically involves making an oral report, which is confirmed in a detailed written report within 48 hours.

The initial oral report should include some general information, Kreisman says, including the name and address of the child and his or her guardians, the child's age, the nature of the abuse or neglect, and any other information or evidence that the reporter feels could be helpful in demonstrating that there was abuse or neglect.

The written report also includes the name and address of the child's school, the child's race, the names and ages of other family members living with the child, and the name, occupation, and contact information for the person making the report, says Kreisman.

Specify what actions were taken to document the abuse.

Kreisman says to include whether photographs or X-rays were taken, whether the child was placed in temporary protective custody, and, in the case of a death from suspected abuse, whether the medical examiner or coroner was notified.

Any documentation that raised a suspicion of abuse or neglect should be submitted, in Illinois, to the Illinois Department of Children and Family Services, says Kreisman, including current medical exams, which may contain statements or interviews, scans, laboratory reports, and past medical exams that might have suggested abuse or neglect.

"It is the responsibility of the Department to investigate child abuse," says Kreisman. "The role of the emergency department staff is to faithfully report any suspicions of abuse or neglect."

Remember that the privileged communication relationship that exists between physicians and patients does not excuse the duty to report abuse.

"Once a report has been made, all of the documents in that written report are admissible as evidence in the judicial proceedings that might arise from the reported child abuse or neglect," says Kreisman.

Sources

For more information, contact:

• Robert Broida, MD, FACEP, Chief Operating Officer, Physicians Specialty Limited, Risk Retention Group, Canton, OH. Phone: (330) 493-4443. E-mail: rbroida@emp.com.

• Arthur R. Derse, MD, JD, Professor, Bioethics and Emergency Medicine, Institute for Health and Society, Medical College of Wisconsin, Milwaukee. Phone: (414) 955-8498. E-mail: aderse@mcw.edu.

• Robert D. Kreisman, Kreisman Law Offices, Chicago, IL. Phone: (312) 346-0045. Fax: (312) 346-2380. E-mail: bob@robertkreisman.com. Web: www.robertkreisman.com.

• Edward Monico, MD, JD, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT. Phone: (203) 785-4710. E-mail: edward.monico@yale.edu.

• Gregory P. Moore, MD, JD, Emergency Department, Madigan Army Medical Center, Tacoma, WA. E-mail: GMoore4408@aol.com.