Posts Tagged ‘red flag’

On reporting battered children, women, and dependent adults

July 29, 2012

A wound without an excuse

In a child or dependent recluse

A red flag will wave

And I have to be brave

To report suspected abuse


Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

Most states have mandatory reporter laws.  Certain professions have the legal obligation to report possible or proven abuse of children and dependent adults. 

We don’t have to report domestic partner abuse. 

Over the course of thirty years I asked every pregnant patient I cared for if she were being battered, and in all that time only one said yes.  I’m sure at least one of the others lied to me.

I am tempted to use gender specific language to say she won’t leave him until she’s ready, but the worst physical battering I ever saw happened to a man beaten by a woman with a baseball bat.  I asked why he didn’t flee, because no barriers impeded him just walking away.  Through swollen, bruised lips he said, “Because I love her.”

In the eyes of the law, battered adults can live with their abusers until they want to leave; the police will not intervene unless someone wants to press charges.  If the abused qualify as dependent, such as the frail elderly, handicapped adults, or children, then the state takes an interest in their protection.  If I even suspect abuse, I have the statutory obligation to report it.

In theory I just have to make a quick phone call to the abuse hotline.  In fact the call rarely takes less than 10 minutes.  If I want to, after I’ve given all the information, I can request to remain anonymous, and my name doesn’t appear on the report.  In practice, the suspected perpetrator has a suspicion and I can count on a minimum 10 minute tongue lashing. 

In the case of children, I can count on losing the family as patients.

Still the red flags demand my attention.  For children, an observed injury incompatible with described mechanism and time requires a report.  For example,  cigarette burns on soles and backs of a three-year-old’s feet cannot be consistent with stepping on lit cigarette butts in the yard. 

And report I must.  Thirty years ago investigations rarely followed reports, and never led to interventions even in cases involving multiple fractures.

For dependent adults, I have to look not only for injury incompatible with described time and mechanism, but also for injury without explanation.  I worry when caretakers won’t let the patient be interviewed alone. 

Now all reports get followed up.  Interventions follow, the state protects the children, and only terminates parental rights in the worst cases. 

Never trained as an investigator, I leave the determination to those who were.