In most states healthcare workers not only have a moral responsibility to report suspected abuse, they are required by law to do so. In fact, New Mexico’s statute requires anyone who suspects child abuse to report it and makes failure to do so a misdemeanor. Hospitalists should know in advance to whom to report the suspected abuse.
Consider making a call to a social worker your first step. “Social workers are invaluable,” says Dr. Stucky. “They’re there for the families. They ask the harder questions that allow us to have that medical relationship and continue to care for the child’s needs. They can look up information that we can’t. They can look up child protection history, whether the parent has been incarcerated, things that support the possibility of abuse. They can file the CPS report, allowing the hospitalist to continue caring medically for the child.”
According to Berrenberg, the police should be your second call.
Dealing with child abuse and neglect is a team effort. In addition to the police and a social worker, you need to involve the nutritionist and the primary care pediatrician (if they have one). If you’re lucky, your hospital may have a child abuse specialist on staff. “Be ready to deal with a whole variety of people who may or may not know what else has already happened,” says Berrenberg.
After the Hospital Stay
Although child abuse is all too common, most pediatric hospitalists won’t often see the inside of a courtroom. Dr. Stucky says that cases with which she’s been involved have gone to trial twice during her 10 years as a pediatric hospitalist. And Berrenberg says, “Failure to thrive is not something we charge very often. That’s a difficult thing to prove.”
That said, prepare for the possibility of being called as a fact witness. According to Berrenberg, physicians may be asked to report on not just their observations of the child, but also on statements made in their presence.
“Statements made to physicians and to healthcare personnel are critical—be it by parents, caretakers, or the child themselves in the case of sexual abuse,” she says. “If statements are made in the course of diagnosis and treatment, then those statements can come in under hearsay exceptions. … The doctor can testify about those statements.”
Remember it’s the doctor/patient relationship that’s important. Your patient’s parents have no doctor/patient relationship.
Berrenberg offers the following advice for physicians preparing to testify: “Be patient. Read everything you have on your case. Expect everything to change. When you’re told that you’re going to trial on Monday, expect that to change. If you’ve testified before and there are transcripts available, expect the defense to know about that previous testimony. If you’re basing your opinion on literature, expect the defense attorney to have found that literature and be familiar with it.
“Work with your prosecutor. Know what they want you for. They might only want you for a limited piece; they might want you for the whole gamut. They will tell you what they’re going to expect of you. Spend as much time as you can with them, with the photos, with the file. It’s always what you don’t expect to come up that comes up.”
Pediatric hospitalists should also be prepared for old cases to come back. “We’ll bring you from wherever you are—even if you’re out of the country,” says Berrenberg. “We’ll bring you back if we need you to testify. We’ll find you. If you’re the one who saw the child and were the initial responder, so to speak, no one else can say what you saw.”