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Summary: Child abuse is a "reportable" crime. This means when a healthcare worker suspects in the course of their duties that a child has been abused, it must be reported. Procedures are in place in hospitals and other facilities for the reporting of abused children. In this case, it was the expert documentation of a child's statements by a nurse, physician and field agent that made the conviction of an abuser possible.
The mother and child entered the Emergency Department passing on the way an investigator for the Illinois department of Family Services. The child gave a history of "being kicked by a cow." When initially questioned by the physician and nurse with the mother present this "story" was maintained.
"There are behaviors that children who have been victimized exhibit:
Hyperactivity, Depression, Changes in eating habits, Changes in sleeping habits, Difficulty at bath time, Difficulty at bed time, Regression in behaviors, Bed-wetting, Self destructive behaviors, Increase in accidents, Moodiness, Talking nonsense, Bad dreams, Social difficulties, Fall behind in school, Plays violently with dolls, Hurts animals, Lies
Although from time to time, children normally experience some of the above, consistent or prolonged problems should be brought to the attention of a trusted professional, such as a doctor or therapist."2
Physical examination of the child would reveal extensive bruising and obvious signs of being beaten. The physician commented on this to the child. The obvious signs of abuse were evident on the patient's face, buttocks and down the backs of both his legs. These were carefully documented in his chart by both physician and nurse.
"All states require certain professionals and institutions to report suspected child abuse, including health care providers and facilities of all types, mental health care providers of all types, teachers and other school personnel, social workers, day care providers and law enforcement personnel. Many states require film developers to report."3
When questioned in private, the child gave a different history. He reported that it was not a cow, but in fact his Stepfather that had hit him and hit him repeatedly.
The child stated that he didn't want to tell the truth initially with his mom present. He stated his mother had witnessed the beating. She brought the child to the hospital but "had watched and would not help."
When it was clear that the physician and the nurse "already knew" how he had been hurt, the truth was offered. His complete statement was documented in the nurse's notes. The chart would be later offered for admission into evidence.
When the case went to trial, the defense argued that the child's testimony was "unreliable." They further pointed out that the nurse's observations were "hearsay."
Questions to be answered:
1. Were the nurse's observations of physical trauma and charted statements by the child valid and admissible as "evidence."
2. Did the fact that the child "changed his story" make his testimony unreliable?
When the case went to court, the hearsay testimony was "allowed" over objections by the defense. The Stepfather was convicted of a Felony offense.
A medical chart including nurses notes have long been recognized as legal records. The documentation of the child's physical condition and statements clearly indicated an abusive situation.
In reviewing the child's statements and the situation, it was decided it was unlikely his statements were "made up." It was noted that "typically" children are afraid to tell the truth about an abusive situation in the presence of close family that may be involved. The fact that the child told a different story when 'the parent" was not around made it more likely that she was allowing it to occur.
When the testimony was combined with physical evidence of abuse, it simply could not be dismissed. In all, the Family Services Investigator present, his supervisor and the nurse were allowed to testify.
It should be noted that it was the thorough documentation of the incident by the nurse that made the case. Often testimony by "witnesses" can be dismissed or invalidated by an opposing attorney. Clear and concise documentation in a medical chart by a nursing professional carries much more weight. In this case they spelled out, in detail, what was seen, what was said and actions that were taken. Sometimes this is not the case.
"When an injured patient seeks legal advice about filing a medical malpractice lawsuit, the attorney's first task is to review the medical records. The attorney is looking for specific acts of negligence and at the overall quality of the record. The strongest medical malpractice lawsuits are based on well-documented, specific acts of negligence. In most cases, however, the negligence is inferred from documented and undocumented events."4
While the evidence in this case was overwhelmingly suspicious of abuse, any suspicious circumstances by law must be reported.
If the child came and was treated no action might have been taken. If it was repeated, the family could have sued the hospital for not acting on suspected child abuse!
Related Link Sections:
Abuse: Domestic, Physical, Verbal Links
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htmClinical Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htmMedical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htmSources:
1. 39 RRNL 12 (May 1999)
2. Cain, Linda. April 24, 1996. Child Sexual Abuse. Retrieved June 13, 1999 from the World Wide Web: http://www.commnet.edu/QVCTC/student/LindaCain/sexabuse.html
3. Smith, Susan K. June 6, 1999. Mandatory Reporting of Child Abuse and Neglect. Retrieved June 13, 1999 from the World Wide Web: http://www.smith-lawfirm.com/mandatory_reporting.htm
4. Richards, Edward P. Medical Records as a Plaintiff's Weapon. Retrieved June 13, 1999 from the World Wide Web: http://plague.law.umkc.edu/Xfiles/x188.htm
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http://www.nursefriendly.com/nursing/clinical.cases/061399.htmSend comments and mail to Andrew Lopez, RN Created on June 13, 1999
Last updated by Andrew Lopez, RN on Monday, February 28, 2011
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