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Reporting Suspected Abuse: A Provider's Call

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Reporting Suspected Abuse: A Provider's Call

By Mark Horgan, Esq, CRICO

Related to: Communication, Emergency Medicine, Primary Care, Nursing, Obstetrics, Surgery

State law requires that healthcare providers report to authorities whenever there is reasonable cause to believe a child has been or is in danger of being abused. The scope of that duty was the subject of a recent medical malpractice trial arising from the savage beating of an infant by her father, not long after her discharge from the care of defendants.

The baby was successfully treated for hyperbilirubinemia, characterized by elevated liver function tests, shortly after her birth.  Two months later, after having been cared for by her father overnight, the baby was brought in by her mother to see non-CRICO-insured pediatricians because the mother was concerned about bruising. The baby’s liver function test was again elevated, but a skeletal survey and examination by an ophthalmologist were negative for signs of abuse. A social worker approved discharge after having been assured of the child’s safety by several family members.

A week later, the child was referred to a CRICO-insured hospital for follow-up of the elevated liver function levels by a pediatric gastroenterologist. A full metabolic work-up was negative for liver problems or abnormalities. Prior to discharge, however, a resident asked that a social worker get involved, after the resident observed bruises. The mother plausibly explained the marks to the social worker; interviews with the child’s grandparents were reassuring; and the family pediatrician indicated to the social worker that the child’s doctors would continue to monitor her.

Two weeks after discharge, the mother returned home to find the baby unresponsive after having been left in the care of her father.  He subsequently admitted assaulting the child, who now suffers from cerebral palsy and will require custodial care throughout her life. 

A court-appointed guardian sued two social workers and four physicians, two of whom were insured by CRICO, on the theory that all had a duty to have reported suspected abuse to authorities.

This was a very difficult case, especially because neither of the investigating social workers interviewed the father. Their decisions not to report the matter were based on the lack of concern by the mother and grandparents, as well as the father’s stable history.

The case was tried for three weeks by a Suffolk County jury. Defendants presented expert testimony that all had responded appropriately to the information available to them, and that even if the State had been informed of the resident’s suspicions, under the circumstances there would have seemed no reason to remove the child from the home. After lengthy deliberations, the jury agreed, and returned a verdict in favor of all defendants.



June 1, 2006
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