Mandated Reporting: “If you see something, say something and DO something…”

…before it’s too late.

On occasion and all too often, forensic pathologists encounter non-accidental traumatic deaths of the young, particularly older infants and young children. In a number of those tragic deaths, a history of injuries that are unexplained or accompanied by inconsistent “stories” as to what caused them is found. Autopsies often reveal blunt force trauma in various stages of healing, from recent bruising or internal bleeding to healing fractures to healed scars on atypical body regions, indicating that the injuries were inflicted at different times 1, 2 . Furthermore, the pattern and location of the injuries are found to be inconsistent with either the developmental stage or typical accidental–type injuries 1, 2 . Review of medical records sometimes reveals that the infant or child had been medically evaluated for “mysterious” injuries or some other ailment that required at least a physical examination if not additional diagnostic work-up. Despite being presented with physical findings that should have prompted concern and action, the suspicion of physical abuse (or physical injury stemming from neglect) was not reported. In other instances, physical findings were missed altogether thus precluding reporting.

Among other professionals, clinicians that treat infants and children whether in the emergency room or in the clinic, are in a unique position to intervene in cases of suspected abuse and neglect by promptly taking the steps to report any reasonable suspicion knowing that certain statutory legal protections exist for them 3 . Steps will (or should) then be promptly taken by child welfare professionals to protect that child and any other child that may be in the home. These steps are vitally important requiring coordinated efforts  that also can involve multiple other agencies including law enforecement. A breakdown in any point of the “system” can and has led to tragedy 4, 5 . Clinical medical education  ensures a heightened awareness of the sentinel signs of abuse and neglect 6, 7.

Through practice in their respective fields, clinicians and forensic pathologists alike continue to play a critical role in quality assurance and improvement of patient care and public health 8 .

References:

  1. Kepron C, Walker A, Milroy C. Are there hallmarks of child abuse? II. Non-osseous injuries. Acad Forensic. Pathol.. Dec. 2016. Available at: http://journals.sagepub.com/doi/pdf/10.23907/2016.057 .
  2. Walker A, Kepron C, Milroy C. Are there hallmarks of child abuse? I. Osseous injuries. Acad Foren. Pathol.. Dec. 2016. Available at: http://journals.sagepub.com/doi/full/10.23907/2016.056 .
  3. US Department of Health and Human Services-Child Welfare Information Gateway : Mandatory Reporters of Child Abuse and Neglect. Available at: https://www.childwelfare.gov/pubPDFs/manda.pdf .
  4. “Child abuse and neglect kills hundreds in view of authorities, AP reports”. Available at: https://www.cbsnews.com/news/child-abuse-neglect-kills-hundreds-in-view-of-authorities-ap-reports/ .
  5. Health and Human Services: Administration for Children and Families. “Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities. Administration”. Available at: https://www.acf.hhs.gov/sites/default/files/cb/cecanf_final_report.pdf .
  6. Tiyyagura G, Beucher M, Bechtel K, et. al. Non-accidental injury in pediatric patients: detection evaluation, and treatment. Pediatric Emergency Medical Practice. Available at: https://www.med.unc.edu/pediatrics/specialties/emergency/uncpemportal/pem-library/child-abuse-nat/nonaccidental-injury-in-pediatric-patients-detection-evaluation-and-treatment .
  7. Christian C W. The evaluation of suspected child physical abuse. May 2015. Pediatrics:135(3). Available at: http://pediatrics.aappublications.org/content/135/5/e1337 .
  8. Armstrong EJ. 2017. Ch. 6-Forensic Pathology: The Forensic Pathologist’s Role in Quality Assurance and Improvement of Patient Care and Public Health. In Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner. Available at: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408 .

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