Case #1: Corey

Does the emergency department physician have reasonable cause to suspect that Corey has been abused? Should a report be made?

The emergency department physician was given conflicting information about how Corey was injured (the EMS personnel reported that Corey had been hit with a softball during practice; Corey reports he was "beat up"). However, Corey also has multiple bilateral bruises in various stages of healing. These differing accounts of Corey's injuries are noted by the physician. Corey seems so distressed by his father's presence and the father is very angry at Corey and humiliates him, despite the boy's injury and pain. Corey's father seems to have particular anger towards what he perceives as Corey's shortcomings. As the emergency department physician you report Corey to the Child Abuse hotline.

Case #2: Juanita

As the family nurse practitioner, who knows this family well, you decide to ask mother and daughter about what happened that upset them both so much. Mom does not respond, but Juanita blurts out that she stole some nail polish and lipstick from the drug store and her mother found out once they got home. Mom uses corporal punishment in dealing with Juanita and she slapped the girl across the face as well as grabbed her arm rather roughly. She ordered Juanita to take the items back to the store and to apologize to the clerk at the store. Juanita, although initially minimizing her actions, began to feel guilt and remorse for her actions. She was still recovering from the incident that had occurred earlier today.

After Juanita confessed her crime to the nurse practitioner, Mom confirmed the story and talked about how upset she was that her daughter had stolen from the store. She was angry because she is a religious woman who lives by a strict moral code and feels betrayed by her daughter for not also living by the values she thought she had instilled in her daughter. As the nurse practitioner, you believe the explanation that the mother and daughter provide you and you encourage them to continue to talk about the incident with each other. You decide this is not a case of potential abuse and you do not report this to the Child Abuse Hotline.

Case #3: Sam

As the teacher, you recognize that Sam's clothing, wearing a short-sleeved t-shirt and jeans despite the 30 degree temperature, is inappropriate attire for the season. His family has neglected to seek medical attention for Sam, despite his ongoing difficulty walking, despite your request to have him receive medical attention. Although an adequate student, Sam has poor social skills with his peers; he is even bullied by them. His behavior, including poor eye contact, nervousness and significant startle reflex leads you to think that Sam is likely experiencing, at the very least, neglect from his parents, and possibly also physical abuse. You call the Child Abuse Hotline.

Case #4 Alicia and Martin

As the visiting nurse you recognize the obvious signs of neglect in the Alicia and the signs of abuse and neglect in Martin. You call the Child Abuse Hotline and discuss the immediacy of the need for safety and services (ie. This is the first time you have been in the house in 6 weeks; there is a history of cocaine use; Alicia has lost a significant amount of weight and there is no formula or food in the house; Martin has been abused multiple times and is fearful of adults). You request that immediate action be taken; it is your belief that the children are not safe in the home at this time. You also call law enforcement to take the children into protective custody.

Case #5: Tisha

As the family nurse practitioner in the primary care practice, you must report Tisha to the Child Abuse Hotline. In a child as young as Tisha, only 5 years old, a positive lab test for syphyllis is a strong indication that the child is being sexually abused. You report the positive result to Tisha's mother, who becomes tearful and angry and agrees to cooperate with the report, because she fears that Tisha has been sexually abused and is very upset that she has not been able to keep her daughter safe. She wants to find out how this could have happened.

Case #6: Marcus, Amber and Isaiah

The school nurse meets with the teachers of the Shaw children, requesting their perspectives on whether or not the Shaw children are neglected. She learns that they rarely miss school. Amber and Isaiah are average students, but Marcus is in gifted classes. There has never been any suspicion on the part of the teachers that there may be any abuse in the family. Given what the Shaw children have told the nurse, as well as the teachers' reports, the nurse decides to refer the Shaw children for the school breakfast and lunch programs, seeing this as a financial issue, not a case of denial of care. The nurse does not report the Shaw children to the Child Abuse Hotline, but refers them and their family to the social service office for other potential entitlements.

Case #7: Tim

As the nurse for this residential treatment center and a mandatory reporter, Jean knows that she has a legal obligation report her suspicions of child abuse. This legal requirement overrides any loyalty she may feel towards her employer. She also recognizes that reporting may put her job in jeopardy, since the employer has "investigated" and does not believe the allegations of abuse. Given what Tim has told her, the bloody underwear, and her own discomfort/suspicions when observing staff/client interactions, Jean knows that she has a legal responsibility to report. Ethically and professionally, she also recognizes that she must report, despite whatever ramifications there may be from her employer.

Despite the internal investigation that was conducted by the employer, Jean still has a legal responsibility to report her suspicion of sexual abuse to the Child Abuse Hotline.