A Bone Fracture Leads CPS to Remove Two Girls from Their Home

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Here’s another horrifying case from the Family Defense Center in Chicago. A baby’s fractured leg convinced the Department of Child and Family Services that she has been abused, despite the fact that fractures like hers are common in kids, and there was absolutely no other evidence against the parents.

The state fought tooth and nail to keep the kids. I’m not sure what would’ve happened if the family hadn’t gotten  expert legal help.  (You can donate to the Center here.)   – L.

Family’s 15-Week Nightmare, After DCFS Jumps to Unsupportable Abuse Conclusions, Leads to State Backing Down From Trial Against Loving Parents

In the early afternoon of February 3, “Cassie” S., mother of 13 month-old “Hannah” and 8-year-old “Maya,” first noticed after Hannah got down from her high chair that the toddler wasn’t putting weight on her left leg. Thinking at first that perhaps Hannah’s leg had just fallen asleep, Cassie’s mother put Hannah down for her nap while Cassie left for her nursing school class, calling her husband “Nate” to let him know that she was watching to see if something was wrong with Hannah’s leg. When Hannah continued not to use the leg after waking up, Cassie and Nate called their pediatrician, who advised them to give her Tylenol, keep an eye on her, and bring her to an appointment the next day.

Cassie and Nate decided not to wait: Cassie brought Hannah to the emergency room at Central DuPage Hospital at about 6:15 p.m. while Nate stayed home with Maya, who was recovering from the flu.

X-rays soon showed Hannah had a fractured tibia and fibula (two lower leg bones that commonly break together). Because Cassie couldn’t say for sure how Hannah got the fracture, the hospital staff called the DCFS. Only later did the family learn from two pediatric orthopedics and medical literature that the sort of injury Hannah had is considered to have “low” suspicion for abuse and it is hardly uncommon for parents to witness the incident that caused the fracture(s) to occur.

Unfortunately the x-ray findings, which naturally concerned the parents, marked just the beginning of the family’s nightmare. Without even interviewing Nate, or talking to the hospital’s own child abuse pediatrician, and without Hannah being seen by a single orthopedist (for whom injuries like Hannah’s are fairly routine), DCFS decided to take both children into State protective custody.The investigator went to the S.’s home and made Nate wake Maya, only to remove her from the home and place her and Hannah with a relative as their temporary foster parent. It was the first time either child had slept away from their parents.

The next day — still without talking to the hospital’s child abuse pediatrician, the family pediatrician, other the family members or friends, or Maya’s teachers — DCFS filed a petition to take custody of both children from the S.’s in the Juvenile Court of Kane County. Based on hearsay representations concerning the emergency room doctor’s opinion, the judge ratified the rushed decision that DCFS had made without talking to any doctors who had relevant expertise in toddler tibia/fibula fractures.

The Family Defense Center stepped into the case six weeks later, with a trial date then set for June 2. Aggressively fighting for the family, Center Executive Director Diane Redleaf argued for dismissal of the petition against the family. It was the first time, according to Kane County Judge Parkhurst, that such a motion had been filed in that courtroom for parents. The Judge granted the motion to dismiss, but kept the children away from their parents while the State had to re-file an amended petition that set out facts supporting the conclusion that Hannah was abused.

Eventually, at a deposition, the same emergency room doctor who had caused the Hotline call admitted that, had he known there was an older sibling who sometimes played a bit roughly with Hannah, the hotline might not have been called at all. Even so, the State refused to back down, insisting that it had to investigate the opinions of other doctors when no such investigation had preceded the DCFS decision to take the children in the first place.

At the end of the day, however, the State’s Attorney of Kane County agreed with the family that there was no evidence making abuse a likely explanation for Hannah’s fracture. On May 22, 2015, the State’s Attorney voluntarily withdrew the petition and the children, clinging to their parents’ arms in the courthouse, were returned home that day. This marked only the second time in Family Defense Center history when the State conceded it did not have a case it could take to trial. And Nate and Cassie were told that their case was the first the caseworkers had ever seen in which an outside attorney had advocated for parents in that courtroom — which makes them wonder how many other innocent parents are not receiving the sort of legal representation that might exonerate them.

The family’s 15-week long ordeal was especially traumatic for the oldest daughter who, due to her special needs, could not understand or accept the removal from her home and parents. Maya’s removal from her parents also caused special hardship to her and her family because she requires special transportation to school, which became unavailable during the relative foster care placement. To make matters worse, Cassie was forbidden from transporting her own daughter to school under the Court’s orders that required all of the parents’ contact with their children to be supervised.

The happy ending in the Juvenile Court also did not completely resolve the indicated findings against both parents, which have been registered for 20 years on the state’s child abuse register. As this is being published, the family, with the Center’s help, is still fighting to get the parents’ names off the register because DCFS had “indicated” them for causing Hannah’s bone fracture. Even when the State admits it has no medical evidence against a family, there is no automatic removal of their names from the register. Right now, the S.’s career plans (Cassie’s as a nurse and Nate’s as a police officer who had moved to Illinois to get medical care for Maya, after being a cop in New Orleans) are on hold as they continue to navigate to get their names cleared with the Center’s help.

The S.’s have vowed to help the Center in any way they can, however, so that families like theirs never have to go through the same ordeal of having their precious children suddenly taken without a meaningful medical assessment first.

This sadly reminds me of the new documentary The Syndrome, about Shaken Baby Syndrome. It’s not available to rent yet — still on the festival circuit — but it echoes the theme of never believing a caregiver when a child is hurt, even when the evidence is flimsy…or non-existent. We sure do love to see abuse where only bad luck has struck. – L

Xray vision...but not for justice.

Xray vision…but not for justice.

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101 Responses to A Bone Fracture Leads CPS to Remove Two Girls from Their Home

  1. Crystal June 23, 2015 at 8:57 am #

    That is just hideous beyond belief. A good friend had the same sort of thing happen — her 10-month-old(ish) daughter crashed her walker into a wall and fractured her arm. Texas put them on a “watch list,” giving their daughter to her grandparents and put my friend and her husband through a year of hell trying to get their names cleared.

  2. Havva June 23, 2015 at 9:21 am #

    Nightmare from beginning to the not yet found end.
    The argument I was having back on the story about the 11 year old locked out for 90 minutes comes to mind here once again. How many parents have decent legal representation in these hearings? How much time have these lawyers had to look at the facts vs. how many assume the parents are as guilty as the accusation makes them sound?

    The details of this case seem to indicate, a complete lack of proper representation for families in removal hearings.

    I’ll also add that it doesn’t sound to me like due process is occurring if the courts can’t be bothered to call in the primary sources to be examined at the removal hearings. It boggles the mind that our country would allow a child to be removed over purported medical evidence of abuse, without so much as calling in the examining physician who placed the call to DCFS/CPS to speak at the hearing and submit to cross examination.

  3. Eric June 23, 2015 at 9:27 am #

    At what point is this just about taking kids and the government thinking they know better than parents? How can one not see that the government is an unforgiving, unrelenting, evil beast?

  4. Dan June 23, 2015 at 9:30 am #

    It’s too bad this family is using pseudonyms. This case is outrageous and deserves more mainstream media attention, but it won’t get it if reporters can’t confirm the facts.

    The Meitivs provided a model for this. If you go public with your case – fully public, real names and all – the media will take your side and you will win.

  5. Jill June 23, 2015 at 9:33 am #

    It seems the parents are screwed either way in cases like these. They either know how the injury occurred and are blamed for not doing something to prevent it or they admit that they don’t know and then are under suspicion for lying.
    Three cheers for the Family Defense Center!

  6. SOA June 23, 2015 at 9:46 am #

    wow. This is so scary and I fear CPS way more than I fear a molester in the bushes at this point.

  7. Powers June 23, 2015 at 9:53 am #

    “How can one not see that the government is an unforgiving, unrelenting, evil beast?”

    It’s rather simple when one isn’t blinded by conservative ideology.

  8. Emily June 23, 2015 at 9:54 am #

    I am an ER physician and a mandatory reporter. This injury is suspicious. Normally what I would have done in this case is added a bone scan, or a series of x-rays of the skull, ribs, arms and legs looking for old or healed fractures. If there were any, I would call our social worker who comes in an talks to the family and notifies CPS. It is not our job to decide for sure what constitutes abuse, but if a story sounds fishy, a kid acts more scared, parents act weird, or there is an uncommon or “classic” injury, we err on the side of caution and call. I have called for fractures (especially spiral femur fractures), kids who absolutely freak out when you try to do a genital exam, unbathed children, malnourished children, parents who refuse a spinal tap in a baby less than 6 weeks old to rule out bacterial meningitis, and even once when the family brought home an infant with tons of tubes and lines hooked to him who fell off the parents’ bed when left unattended because he should have been in a crib. It is not a fun position for us to be in, either, as the parents know in real time that we’ve called, have our names on their child’s wrist band, and often have a lot of anger and carry guns in Texas.

  9. Will June 23, 2015 at 9:57 am #

    So, back in the early days of being a Father, my daughter, less than a year old at the time, was getting a bath in the sink. She was learning to stand, and decided to stand up. She slipped. I was hover-handing, but ended up grabbing her arm. She cried a little, I figured maybe some pain, maybe just scared at seeing the faucet heading for her face.

    The next day, she wasn’t using that arm. She would play, wasn’t crying or anything. Just wouldn’t use the arm. When I touched it, she cried.

    Off to the hospital. Turns out, I had accidentally given my daughter a case of nursemaid elbow. Any website will tell you it’s common, can happen from play, often happens when an adult yanks an arm, as I did in my case, to prevent a head trauma, or to keep a kid out of danger, or, of course, if I was an abusive drunken ass who delighted in causing pain to my kids.

    So, let me tell you, that hospital trip was horrifying on more than one level for me.

    But it’s simple to fix, doesn’t even require a cast or anything. The attending nurse popped her elbow right back together, and my daughter was fine.

    What doesn’t help is that once it happens, it can happen again even more easily, until the child grows up a little, and the bones become less likely to separate, or the tendons strengthen, or whatever it is that makes it less likely to happen.

    So, a couple months go by, and she’s about to walk into the street in traffic. So, I grabbed her arm to stop her, I didn’t even yank it, more than just her momentum as she jerked to a stop. That was enough.

    Back to the hospital. If I thought the first visit was uncomfortable, the second was far worse. It got so bad *in my head* that I finally asked the nurse, “Should I be expecting a visit from CPS after this?” She smiled, not condescendingly, not “evilly” or anything, just . . . to put me at my ease . . . and said, “No. First of all, this is a common injury, it’s not enough for me to want to call CPS, even in light of the fact that this is a second visit – it’s even easier to happen the second time. Second, your daughter is *clearly* not afraid of you, and shows *zero* other signs of anything I’d feel compelled to report. And, third, you’re actually worried that I’d call CPS. The really nasty abusive parents are defiant. You’re not. And I need you to not worry any more about this, because I don’t want you to second guess rescuing your child from traffic.”

    I think it’s that last part that is the most important in cases like this: are we really going to now make bad decisions because we’re worried about a visit from CPS? I can imagine these parents thinking, “Well, I’m not going back to *that* hospital ever again.” I don’t want to have to think like that.

    Which is why these freaking CPS involvement laws need to be clearly laid out, and unambiguously enforced, *and* records rapidly and completely purged when no evidence is found. I’m sure the hospital has some dumb “always report it” policy, and CPS has a “always prosecute” policy, because both are considered “for the children”. Well, Helen Lovejoy, the first line of “for the children” should *always* be the parents, and the parents, since we live in a nation of laws and justice, should be given the benefit of the doubt. Which they clearly did not in this case.

  10. anonymous mom June 23, 2015 at 10:06 am #

    I am always secretly happy when my kids get injured when other people are around, because I know there are witnesses should anybody think I caused the injury.

  11. buffy June 23, 2015 at 10:26 am #

    But Emily, this was not a spiral femur fracture, unless everyone is lying. You really don’t see the possibility that kids just, you know, get hurt?

  12. Neil M June 23, 2015 at 10:49 am #

    It’s strange that a family who calls a pediatrician and then takes their child to the ER over a possible problem are seen as abusers, and yet parents who *openly admit* to using corporal punishment are viewed as simply exercising their custodial rights. I feel as though there are not clear guidelines for parents as to what will trigger a CPS investigation and what won’t, which makes for very bad policy.

  13. Kimberly June 23, 2015 at 11:00 am #

    40 years ago my little sister was knocked out of a tree by her best friend by accident. That was a Friday night. All us kids insisted that Sis had broken her wrist (funny thing not one of us said arm – all said wrist).

    Well the adults looked at it. No bruises, no swelling, full range of motion. By adults I mean multiple people with medical training including 2 doctors. That was Friday night. Monday Sis was still insisting it was broken and wrapping it in an ace bandage. She also refused to write at school because it hurt. (the only thing she said hurt) The school nurse said it couldn’t be broken, but maybe there was some type of ligament damage or soft tissue injury. So mom checked both of us out of school and off to the the doctor. Doctor said it wasn’t broken, but Sis was rough and tumble kid and the school was fussing. So an appointment for an x-ray was made. Another boring day off school stuck in the hospital.

    The hospital didn’t want to do the unnecessary x-ray on an obviously unbroken arm. Around and around. They finally did it, scolding Sis somewhat.

    The wrist was broken clear through – but everything was aligned perfectly. It was the 70’s they put a metal splint and wrapped it with an ace bandage. It was supposed to take 6 weeks to heal. After 4 mom called the doctor about getting an x-ray and taking off the splint. Doctor said it needed 6 weeks. MOm told him to set aside a suture kit and be prepared to sew up my scalp – because sis was knocking me upside the head with the metal splint. They did the X-ray it was healed. No mention of CPS through the entire thing. Same thing when she tried to walk on a dislocated knee.

    In the 80’s my cousin asked a neighbor to watch her son. Her daughter and cut her hand and needed stitches. The boy had a black eye from a baseball game (little league supervised) but cousin a teacher, didn’t want to chance the ER with both injuries.

    The daughter now worries that they might be on CPS’s radar or a neighbor might call in because of multiple 911 calls. Her two youngest have life threatening carry an epi allergies. They have had to call 911 for asthma attacks in the middle of the night and fire ant bites that sent the youngest into full on reaction.

    I’m a teacher I’ve reported abuse. 1 case the parent thanked me, because they got help they needed. In another case the older child had hidden a serious injury from his parents who were each working 2 jobs each to keep a roof over their heads. We were able to work with district social workers to get them medical coverage and get his broken hand treated.

    I’ve also had parents that were very scared that we would report typical childhood bruise (to the shins for example). I’ve explained I’ve seen their kid in action on the playground and not worry. One kid ran into a door and had a huge black eye. I once told him to go next door – pointing to the teacher’s room. Instead of going out the door, he turned to the wall I had pointed to and walked into it. So I could totally see that. The kid was gifted & talented but didn’t have a lick of common sense.

  14. Nadia Williams June 23, 2015 at 11:05 am #

    I have a question. Isn’t taking a child from their parents a form of abuse? Should the whole fight against this insanity not include understanding of how spectacularly traumatising these actions are to children, and an overhaul of the CPS’s approach to work from a place where they realise how deeply damaging removal is, and that it should be an absolute last resort if there is certainty it is the best thing to do?

  15. Becky June 23, 2015 at 11:16 am #

    Emily,

    I don’t know if you will read my response, but I feel compelled to write a comment (something I have never done on this website) in hopes that you will.

    I appreciate that you have a difficult job and are often in a tight spot. Here are two points I wish to make that you hopefully already know consider when dealing with possible cases of abuse/neglect.

    Number one, the idea that it doesn’t hurt to call CPS just to check things out is not true. Law professor David Pimental addresses some of the reasoning behind this in an excellent paper called “Fearing the Bogeyman:How the Legal System’s Overreaction to Perceived Danger Threatens Families and Children.” Among other things, he points out that CPS has financial incentives to remove children from homes and that 41% of children removed from homes are later found to have not been maltreated. Some might think, “better safe than sorry,” and call CPS when they have even the smallest doubt of parents, but the trauma this puts kids through can affect them for years, and can induce anxiety and depression in children. There are certainly times it is obvious that CPS needs to be called and it is there for a reason, but I would want some pretty solid evidence first.

    Secondly, I must admit that I am astonished that it sounds as if you can perform extra tests just because you have what sounds like sometimes not very strong suspicions? There are times when one of my kids might have been playing outside all day and get quite dirty as a result, and if he/she suddenly injured him/herself and needed an ER visit, there would be no time for a bath, obviously! But this might get me extra tests? As a person who tends to have high deductible health plans and cringes at the thought of needing an x-ray/ER visit and what that bill would look like, if I took a child in and found out that I was charged extra for a bone scan or extra x-rays just because a physician was suspicious, I would be livid, not to mention concerned for the unnecessary radiation exposure.

    One more point–if you ever have a parent skeptical of doing tests that you want to do “just in case,” keep in mind that it might not be because the parent is hiding something (hopefully you don’t jump to this conclusion; I’m not saying you do), but because the parent is both trying to keep unnecessary medical costs down and keep the child from undergoing anything unnecessary. I grill my doctors before I subject any member of my family to a procedure or test (I’m perfectly happy to do it if it truly is medically necessary or prudent), and it amazes me how many times the doctor and I decide something is not necessary. Hopefully this wouldn’t earn me the label of suspicious or combative in your ER. Around where I live, the physicians have been very receptive and respectful of my viewpoint on this.

    Good luck in your endeavors as a physician and thanks for letting me express my concerns.

  16. Beth June 23, 2015 at 11:24 am #

    Becky for the Internet win!!

  17. Cherub Mamma June 23, 2015 at 11:42 am #

    This comment is for Emily as well,
    THANK YOU for taking the necessary steps and ordering extra x-rays when you have a concern. I’m currently parenting a 22 month old baby boy who was taken to the ER with what Mom thought was a “bug bite”. It was a broken arm. Further x-rays revealed a total of FIFTEEN fractures all in different stages of healing. That, along with severe malnourishment and extreme build-up of filth on the baby FINALLY brought him into foster care. He was 17 months old and weighed less than 10 pounds. His feet were black with crust. He had two scull fractures, three broken ribs, fractures in both arms and legs (in various stages of healing) and he had a lacerated liver.
    I am totally free-range. And stories like the one Lenore posted scare me to death!
    But there are times when it’s necessary to rule out abuse too. Because sometimes kids really do get abused. I’m a foster parent. Most of the time I hate CPS. I dislike “dancing” this close to them. But I’ve parented kids that NEEDED to be removed.

  18. SteveS June 23, 2015 at 12:14 pm #

    Nadia, I think it is well established that removing children from their families and placing them in foster care is traumatic and damaging. The presumption is that it is less damaging than suffering ongoing abuse or neglect. In this case, the evidence seemed very minimal, so I would question whether it was justified.

    While the actions of the reporters and child services were questionable, I am also very disappointed in this judge. It appeared that they just rubber stamped what child services was alleging, instead of providing some level of due process. Instead of returning the children after granting the motion to dismiss, they kept them where they were and gave child services another chance to “try and get it right.” Shameful.

  19. sigh June 23, 2015 at 12:27 pm #

    Emily says that refusal of a spinal tap to rule out meningitis is a red flag for her.

    Hm. My 14-year-old was suffering from unexplained high fever, and neck stiffness, so I brought him to the ER. There were many tests: blood tests, urine tests, chest and sinus X-rays. No offending microbe could be located. The spinal tap was the last test to rule out the dreaded meningitis. The doctor said it was optional, he said the chance of meningitis was not high, but it would rule it out. He made it clear that I could be a good parent and refuse it.

    I chose to do it. I was horrified at the process. I wanted to scream out for them to stop after it was clear that not one, but five full vials of fluid would have to be taken, and that it was a long, painful process for my stoic son, who never really even winced. But I nearly fainted. And if he had developed an infection from doing the test (in our case possibly more likely than finding an existing bug in there), or lost mobility, oh my God. He’s a high-level athlete.

    They didn’t find meningitis, and I felt stupid for going ahead with the test, as it had been truly invasive and horrifying, and no, he didn’t have that issue anyway, as the doctor had said, slim chance.

    I suddenly understood the refusal of certain medical tests or treatments, and I am grateful that that doctor we saw, at least, was compassionate about it being a choice.

  20. sigh June 23, 2015 at 12:30 pm #

    “Guilty until proven innocent” is what the “alleged abuse / removal of children from their families” scenario sounds like to me.

    “Land of the free” indeed.

  21. Pickles June 23, 2015 at 12:41 pm #

    Hey Sigh,

    I’m so happy your son didn’t have that horrible disease. Mine did, and yes, he had the spinal tap as well. I’m very glad we had the spinal tap done or he would not have survived – the disease was caught just in time. We were told that if we had waited another hour or so he probably would not have made it.

  22. Reziac June 23, 2015 at 12:48 pm #

    I recently read a paper that laid out why “shaken baby syndrome” is mostly bogus: nothing to do with the baby being shaken, but rather (IIRC) is the result of a metabolic defect.

    I don’t have this reference to hand either but I remember the gist: The average toddler sustains 22 fractures before they are two years old, most so minor that they go unnoticed, or are thought to be just a bruise. But once their existence was discovered (by way of xrays on toddlers whose fractures were noticeable, and which revealed they were not isolated fractures), they were commonly thought the result of parental abuse. One pediatrician could not convince himself that so many parents were that abusive, and investigated further. And he found that these fractures occur during normal play (most notably, when the child is swinging from something) and were NOT the result of abuse.

    We’re so glad to leap into a witch hunt, that we’re failing to see medical truth, even medical truths that may be critically important. Personally I’d speculate that the high fracture rate may be secondary to feeding soy-based baby formula, since it seems to parallel the era when that was popular, but we don’t hear so much about it now that breast-feeding has made a comeback.

  23. buffy June 23, 2015 at 12:53 pm #

    @Cherub Mama, the situation you describe with your child is nothing like the story above; at least I didn’t see anything about malnutrition and filth. Maybe the mandatory reporters need to look at the whole picture instead of one tiny, tiny portion of it?

  24. Michael June 23, 2015 at 12:55 pm #

    Report parents of unbathed children? Report parents who refuse a certain medical test? Seems like reporting someone just because you don’t agree with their parenting choices. This (mandatory or not) reporting is what is the real danger to kids as way too many innocent families have to go through hell because of them. The bureaucracy has a vested interest in pulling as many families into the system as they can to continue their own existence. Just like with so many zero tolerence BS there is no justification to report a healthy looking child just because he is dirty and gets brought in with a broken ankle or something like that just because people don’t use their common sense to distinguish that from a child who looks truly neglected or abused.

    The dreaded “if it saves one life…” should apply here. This nonsense has to stop if it saves just one life because the parents weren’t too afraid to seek timely medical help in fear of loosing their children or delayed their child in getting medical help in order to bathe him.

  25. Shalae June 23, 2015 at 12:56 pm #

    This is to the er physician Emily. I have 4 boys! Four rough and tumble boys. They climb trees, jump off high things, wrestle, play team sports and sports in the yard. Thankfully this summer nothing has happened yet requiring emergency room visit but there have been summers I am in the emergency room for broken arms and a week later my most rambunctious son tried to be Tarzan off the kitchen table with my horizontal blinds and before I could get to him blind fell off and he fell backwards and hit his head on the table… Back to same er for staples. Every time I worry because of overzealous physicians that must report. My now 6 year old has no fear! And I will not hover over him and put fear in him. He is what boys used to be.
    Here is also something I must say about a spiral fracture of the femur… My second son was 3 at the time, just turned 3. We were at the park with friends and he was doing what the older boys were doing jumping off the high bleachers. He was having a blast! We got home and waited to take my older son to baseball while he was riding his scooter. He fell put his foot down to push scooter and fell over. Not much pressure at all. He was crying.. And he never cries. I picked him up and his leg flopped to the side. We took him to the er. They did xrays. He had a spiral fracture of his femur. I am going through nursing school I know the femur is the strongest bone in the body and difficult to break but he had cysts in his bone that caused the break. From what the orthopedic surgeon said this kind of fracture is common in kids with bones cysts….which cannot happen from abuse!!!! Seriously. Parents today are too afraid to let their kids play because the er physicians that call and dcfs that take kids away. I want my kids to play and have fun. Not live in fear. Also…my boys play outside ALL day…they get dirty. If it’s an emergency I’m not going to make sure they are immaculately clean before I bring them in. I have seriously seen child abuse….nothing happens for these kids but the kids with loving parents that have bad luck that’s who I see the worst happen to.

  26. Shalae June 23, 2015 at 12:59 pm #

    Oh and one more thing for the medical tests. When nurses can’t hit a vein on my kids or try to retract my uncircumcised 6 month old to get urine I will refuse testing too. You are causing more stress to my baby. I think that is another ridiculous reason to call. A spinal tap on a baby!?! Seriously. I would refuse too.

  27. anonymous mom June 23, 2015 at 1:02 pm #

    I’m also a bit concerned that “freaking out” about a genital exam is considered a reason to call CPS. Given the outright hysteria about sexual abuse right now, I’m sure many children have it drilled into their heads that nobody should ever see or touch their genitals. I would expect that some children would internalize that so completely–even if “except a doctor” is given as an off-hand exception–that the idea of anybody touching or looking at their genitals will send them into a panic.

    I can certainly understand a doctor sometimes needing to call CPS. But I hope that would be based on a number of indicators, rather than one or two (an unbathed child, a child who is afraid of a genital exam, a “fishy” story or “weird” parents) that in all likelihood do not indicate any problem.

  28. Connie June 23, 2015 at 1:04 pm #

    When our now 37 year old son was 2 years old he suddenly began limping. My mother said his shoes were too tight and bough him new ones. We then discussed the limp at his 2 year check up. Doctor said to wait 5 days which we did. Then x-rays were done showing a fractured tibia. Immediately there was the question of abuse which the boys’ doctor said was absolutely impossible. Fortunately they weren’t quite as fast to jump to conclusions then, since our pediatrician stopped any questioning at our HMO . Trip to the orthopedic surgeon started us on a long, very difficult journey since the break was caused by a rare complication of a rare genetic disorder. Many times I have thought what might have happened if our pediatrician was not so adamant the we would not have abused him or his younger brother.

  29. Michael June 23, 2015 at 1:09 pm #

    @Buffy “Maybe the mandatory reporters need to look at the whole picture instead of one tiny, tiny portion of it?”

    That’s the problem, common sense is gone. A pop tart gets treated like a loaded AK-47, an 8 year old in a car in Minneapolis in January while the parent drops a letter in the mailbox gets equated with a baby (intentionally?) left in a car for seven hours in summer and a child with a broken bone that is a quite common occurence and no sign of anything else wrong gets equated with a filthy 10 pound child with 15 previous fractures. Disrupt families first, ask questions later and even when nothing is found keep investigating or hounding the family.

  30. Dee June 23, 2015 at 1:31 pm #

    I think DCFS reacted far too quickly and severely. That said, I think it’s quite common for emergency room docs to call them. My friend’s son burned his hand on oven TWICE when the door was open. The emergency room docs had to call DCFS both times. They were cleared of anything, however, as it sounds like this family should’ve been.

  31. Sue Luttner June 23, 2015 at 1:45 pm #

    Thank you, Ms. Skenazy, for taking on the difficult but important topic of how our system handles child abuse allegations. This case illustrates how easily CPS can remove children from their homes, even without clear medical guidance. I am so glad you also mentioned shaken baby syndrome, a flawed theory that is targeting the parents of children with rare or poorly understood medical conditions as abusers.

    While the brain findings that have come to define shaken baby syndrome can result from battering, they can also result from a long and growing list of medical conditions, including stroke, bleeding and metabolic disorders, vitamin deficiency, seizures, and certain kinds of infection. For the story of a family torn apart when their son’s genetic condition was misdiagnosed as shaking injury, please see the prolog to the book I am writing, http://onsbs.com/prologue/

    The truth is emerging, slowly, but the professionals who have seen their opinions confirmed in court for 30 years are rejecting all criticism of their theory—for details, do a browser search on the Washington Post’s expose in March, “A Disputed Diagnosis Imprisons Parents” and the responses.

    Now a coalition of affected families and the professionals who defend them is circulating a petition calling for a formal review by the National Academy of Sciences of the evidence base for today’s guidelines for diagnosing child abuse. The petition is intended to be signed by anyone whose family or community has been disrupted by a misguided medical diagnosis of child abuse. The petition is at http://tinyurl.com/InnocentFamilyPetition

  32. Susan Goldsmith June 23, 2015 at 2:06 pm #

    Great work Lenore, as always! Anyone interested in this subject should check out our film, The Syndrome (www.thesyndromefilm.com), which Lenore mentions in the piece. We are screening at festivals all over the country and worked closely with the Family Defense Center at a screening in Chicago earlier this year. The Center is doing phenomenal work. Please check out our film and help support us and spread the word.

  33. Warren June 23, 2015 at 2:39 pm #

    The problem is having mandated repoters, because they end up being like Emily, in the ER. They get paranoid, and instead of using their heads, they just hide behind better safe than sorry. Covering their sorry butts by reporting everything.

  34. Donna June 23, 2015 at 3:05 pm #

    When will The Syndrome be available? I currently have a shaken baby criminal case and would love to see it.

  35. Tsu Dho Nimh June 23, 2015 at 3:05 pm #

    Good grief … it’s common enough it’s called a “Toddler Fracture”.

    http://radiopaedia.org/articles/toddler-fracture “Toddler fractures typically occur between 9 months and 3 years of age, and are believed to be the result of new stresses placed on the bone due to recent and increasing ambulation.”

    It’s a non-displaced spiral fracture of the lower tibia and occasionally fibula, usually heals quickly and with no problems.

    http://images.radiopaedia.org/images/581209/fe7bb45cfae74bf9cfc5f3a9a72db6.jpg

    =========
    You won’t see the child clutching its leg and falling over in agony … the inflammation and pain takes a while to set in, and a grump, limping or unwilling top walk child is what you see.

  36. Barry Lederman June 23, 2015 at 3:09 pm #

    Great. Another reason to fear hospitals.

  37. Tsu Dho Nimh June 23, 2015 at 3:13 pm #

    @becky “There are times when one of my kids might have been playing outside all day and get quite dirty as a result, and if he/she suddenly injured him/herself and needed an ER visit, there would be no time for a bath, obviously! But this might get me extra tests?

    There’s a difference in looks and smell of a child who gets bathed reasonably often but is brought in from the playground, covered in playground dirt and baseball sweat, with a busted bone versus a child who has gone several weeks with no bath.

  38. Mike June 23, 2015 at 3:19 pm #

    This sounds eerily familiar to my family’s story. Not a single DR or even our lawyers said this was a common injury. They insisted it was only the result of intentionally motivated abuse! But this was the exact injury my son had. How can I share my story. I am paranoid if we have another child this will happen again. Is it genetic? I’d love to share my story. I need an outlet. Any recommendations?

    Thank you.

  39. Melissa June 23, 2015 at 3:34 pm #

    This gives me shivers. I fell down the stairs carrying my 5-month-old. I didn’t drop her, and she didn’t hit her head (I thought). I smashed up my knees and elbow something awful, as I twisted to stop from falling ON her. I took her with me to the emergency room to have my knees checked out and to have them check her because she seemed fine, except she was crying when I lifted her legs to change her bum.

    Turned out she had a fractured femur from me gripping her tightly as we fell. She also had a fractured skull, which showed up as a big lump as we waited at the ER. She must have hit the floor as I twisted after all. Luckily the skull fracture didn’t harm her at all, and the leg fracture healed with 5 weeks in a soft brace.

    We have a pediatric hospital whose ER only sees children. I am INCREDIBLY lucky that the doctor seeing her realized the “grip fracture” was not uncommon in infants whose parents fall, and I’m probably also lucky that I was severely injured. With bad luck and bad timing there could have been just such a mistaken investigation against me.

    The guilt was bad enough.

  40. Eric S June 23, 2015 at 4:20 pm #

    The CPS really needs to be kept in check and accountable for their actions. And sadly, the only way organizations like this can be held responsible for their actions, is to sue them. It’s so funny how many people learn to STOP and THINK after getting hit with a lawsuit. When all they had to do was stop and think in the first place to avoid all this litigation.

    I’m sure there are plenty of abuse issues. That’s not in question. What is in question is the knee jerk attitude of CPS and police. That an injured child in their minds, is automatically being abused. AND even after investigations, there was no evidence of abuse, and plenty of evidence and witness to say it was a common mishap, CPS continues to pursue actions against the parents. WHY??? Are they that much of assholes to put a family through unnecessary hardship. And for “smart” people, they don’t seem to realize this unfounded accusations, and removal of children, are hardest on the kids. THEY are doing more harm to the children, than what they are accusing the parents of doing.

    And now they are going to put the parents on a child abuse list? After they have been found innocent? That’s like telling a prisoner who was acquitted of a crime, that he’s going to have to spend another year in jail regardless. Ridiculous. I bet they do that so that when another common mishap happens to the children, it will be easier to accuse the parents of child abuse, because they are already in the system for it. Even though it’s a false accusation.

    I hope S’s sue. Really. Fight fire with fire. The being nice and understanding that they are “only doing their jobs”, is being taken for granted. Time to start pushing back against bullies. That’s what CPS in these cases are being. Bullies. Sanctimonious, ignorant, self-serving bullies.

  41. Donald June 23, 2015 at 5:47 pm #

    It’s a matter of consequence

    If “S” is guilty, and CPS don’t remove the children, INDIVIDUALS MAY HANG! Their career is over and they may face jail. Further abuse will happen and the News will seek out how CPS failed to act.

    If “S” is not guilty then this is a gross injustice. CPS will weather a storm. However, INDIVIDUALS WILL NOT HANG!

    In the CPS perspective, it’s safer for them to risk gross injustice.

  42. Emily June 23, 2015 at 6:02 pm #

    Hi all, I’d love to respond to your comments as best I can. First, I’d just like to say that my original comment was to bring to light that mandatory reporting of an injured child by an ER physician is not the same as a nosy neighbor calling CPS because an 11 year-old is playing basketball alone outside their house. Not the same at all. In 12 years of practice, I have called social work about 10 times and they did not always feel CPS involvement was necessary so I left that to their discretion. There are some injuries which are pathognomonic for child abuse and are basically considered abuse until proven otherwise. That is just reality. A tibia/fibula fracture in a 15 month old is not…a spiral femur fracture in a non-ambulatory child–yes. Sometimes it turns out that the child has some sort of a medical condition that causes spontaneous fractures such as osteogenesis imperfecta, which is also good information to have. Furthermore, we are mandatory reporters for LOTS of kinds of things. If Fido bites his owner, we have to call animal control. This is in case owner tries to sell Fido who then bites another person. If there is any kind of a gun shot wound–even if self-inflicted and accidental by report, we have to call the police. An ER physician and other staff were terminated in NYC for not calling on a celebrity in that situation. The logic is that they need to track the ballistics in case there is an active shooter somewhere who comes to the ER for care, has an unregistered gun, etc. We also have to call Adult Protective Services if we suspect elder neglect or abuse–usually patients are found in unkempt homes, covered in feces, etc and we get a report from EMS and often they need placement in a nursing home. Sometimes, the neglect or abuse happens at the nursing home. We also have to call poison control on certain poisonings so they can track patterns of certain drugs or become aware of new drugs. None of it is fun, but there is logic behind it. And the examples that I gave most certainly have more background to them than just a laundry list. It is not something that I or any colleague I know takes lightly and I for one try to give the parent the benefit of the doubt because, as in this story, CPS is not always so reasonable, and I took and oath to first do no harm. Sometimes calling CPS can do more harm than good, I agree, but there are other times we have to call. And, unfortunately, non-accidental trauma is not so rare.

    BUFFY, this was not a spiral femur fracture, but rather a “toddler’s fracture.” Not necessarily a sign of abuse, but may warrant further investigation and certainly a complete exam to check for other injuries/bruising, and in a child under 2, maybe even a skeletal survey to look for other previous fracture. Here is a nice case example involving almost the same patient. https://www.hawaii.edu/medicine/pediatrics/pemxray/v4c18.html

    WILL, radial head dislocations are bread & butter toddler emergency medicine, and anyone who would report you for one of those is an idiot, even on a second or third occurrence. They are actually one of my favorite things to see in the ER because I feel like a magician. Kid crying in pain, parents always feel terrible and are so worried and in about 30 seconds everyone is happy and the kid is grabbing for a popsicle or a sticker. Parent satisfaction is nearly 100% for those patients and “thank yous” are common which we don’t hear a lot of anymore.

    KIMBERLY, Keep on keeping on. You have to use common sense. I have no statistics on whether there are more calls to CPS by physicians or teachers than 30-40 years ago, but I think we can both agree that there has been a huge rise of anonymous reports by nosy neighbors that are unsubstantiated. Quite a bit different scenario.

    BECKY, thank you for your thoughtful and respectful comment. First, I don’t think I implied anywhere that I think a call to CPS is not a very serious matter, or that I would call without serious suspicion. As a mandatory reporter, we still follow the guideline of a reason to call of which I gave a few examples out of context. Furthermore, note that I’ve never personally called without getting social work involved for their input first as they have more time and training to talk to the family, and at that, I’ve called about 10 times in 12 years…not very often at all. But, in 2012, an estimated 1,640 children DIED from child abuse and neglect, and 70% of them were under 2 as was the child in this case. It should at least raise an eyebrow. The diagnosis can never be made without an index of suspicion. Your second concern was about bone scans and their cost/radiation to the parent. I will refer to you an article from the official journal of the American Association of Pediatrics which specifically addresses this issue. In summary, in children under 2 years-old (as in this case), fractures are very uncommon and further imaging is necessary to rule out abuse and is considered standard of care. “The skeletal survey is mandatory in all cases of suspected physical abuse in children younger than 2 years. The screening skeletal survey or bone scan has little value in children older than 5 years. Patients in the 2- to 5-year-old group must be handled individually based on the specific clinical indicators of abuse.” http://pediatrics.aappublications.org/content/105/6/1345.full So, it’s a narrow range of children we’re discussing, and as I cited above, the age group that accounts for the vast majority of child abuse deaths, so there’s reason and lots of evidence behind it. Children in this age group have really bendable bones, so they rarely fracture and any fractures are often due to excessive force from a parent. And, sadly, the bone scans often find rib fractures, skull fractures, other old healed fractures, etc. 🙁 A dirty 7 year-old with a broken arm because they were climbing a tree is not the same as an absolutely filthy 18 month-old with a suspicious fracture who is malnourished and covered in bruises and has been to the ER before for an injury. Nothing occurs in a vacuum of course. They use a very low dose of radiation for these scans–nothing like a CT or anything, and sometimes even do an MRI which has no radiation risk at all. As for the billing, I am honestly not sure how that works as I get paid an hourly wage, but I can tell you that the typical abuser is not an insured person with a good job who is worried about co-pays. More often than not, the hospital eats the cost or it is billed to Medicaid. Of course, this is not 100%, but child abuse is way more common in people of lower socioeconomic status–just a reality. As for your third point about not wanting unnecessary testing for your children, I fall into the same camp, which is of course a minority of parents. The majority of parents that I see want lab tests, x-rays, antibiotics, etc. because they feel that their child’s fever of 100.8 for an hour cannot just be a virus, “heard West NIle was going around,” etc. I am definitely not a CYA physician, and usually a 5 minute conversation that the unnecessary head CAT scan and risks of sedating the child to get a good study way outweigh the odds that a little forehead goose eggs is an intracerebral hemorrhage that would require a neurosurgeon (as CAT scans don’t diagnose concussions–doctors do), is enough to appease parents who are as reasonable as you. Finally, I just want to add that the case of a parent refusing a spinal tap in a 3 week-old baby for example is not at all the same as refusing any old suggested test. Babies under 6-8 weeks with a fever of unknown origin are very susceptible to meningitis and sepsis and the mortality for those babies is sky high. It is a very unique and vulnerable population, and parents are always so emotional so we use great caution to explain why it really isn’t optional. In fact, i have a friend whose 3 week-old had meningitis diagnosed right away and was treated, but at almost 6 years old cannot sit/stand, is blind and deaf, has seizures and problems regulating body temperature, eats with a feeding tube, etc. and is in the PICU about 1 week every month. Neonatal meningitis is rare but absolutely catastrophic and must be caught very early. Totally different than a well-appearing 10 year-old with a 101 fever, fully vaccinated, and a little headache.

    CHERUB MAMA, Thank you for what YOU DO, too. So very hard to care for these children. Unfortunately, my gut instinct is almost always right on. Not a fun job at all.

    SIGH, see my comment a few lines up to Becky about spinal taps in children who are under 6-8 weeks old (as I mentioned in my initial comment) vs. other children. Bacterial meningitis is much less common in a 14 year-old. Most is viral, and has no treatment anyway, so I rarely do a spinal tap in someone that age. In the case of your son, I might have casually offered the spinal tap “if you really want a diagnosis or to rule out viral meningitis for which there is no treatment,” but would not have pressured you in any way. I would have simply charted our conversation and moved onto the next patient. But again, it is comparing apples and oranges to a neonate where a “full sepsis work-up” including blood work and culture, catheterized urine and cultures, chest x-ray, spinal tap, 48 hours of IV antibiotics, seasonal tests such as flu and RSV swabs, and 48-72 hour admission are considered standard of care.

    REZIAC–Shaken Baby Syndrome signs are usually retinal hemorrhages and intracerebral bleeding, not bone fractures. Are you sure you aren’t referring to osteogenesis imperfecta?

    MICHAEL, Please read the above to see my clarification regarding the specific examples I cited. And I do not think 10 calls in 12 years is excessive. I completely agree with you that not all suspicions are created equal, however there are some injuries that are labeled as child abuse until proven otherwise. There is a huge gray area and it does require time, energy, and common sense to make a judgment call. I do not take the responsibility lightly. Unfortunately, some of the “children with 15 previous fractures” are only picked up when someone casts a shadow of doubt in the first place. I personally do not subscribe to the “better safe than sorry” and “if it saves one life” theory. There are patterns to follow.

    SHALAE–If you are in nursing school, you too will soon be a mandatory reporter. Not a fun position to be in. Broken wrists fro falling out of a tree, bruised shins, stitches, etc. in children are common and not an indicator of abuse at all. Nor is a spiral femur fracture in a 3 year-old with bone cysts that weaken the bone (you’d see them on x-rays), but on a child that isn’t walking yet a spiral femur fracture without abuse is essentially impossible. There are subtle differences that only a trained medical professional can know. I was just giving a few quick examples of the very infrequent calls that I have made. Do you really believe that parents are more scared of emergency physicians calling CPS on them than the nosy neighbor? And that would be a reason not to let your child play? I think the completely unsubstantiated and often anonymous “helpful” calls in the absence of injury are a way bigger threat than the “overzealous physicians that have to report” on a child who has already been injured. As for refusing other testing, I completely understand your point. My very specific example is in a neonate with a fever of unknown origin in which sepsis and meningitis are extremely common and very fatal if not diagnosed and treated almost immediately. It is quite different.

    ANONYMOUS MOM–the one time I called social work about a child refusing a genital exam, it turned out the child was already in foster care but they were not aware of any potential sexual abuse. His complaint was genital pain, and it was not just a “well, I don’t want you to look down there,” it was kicking and screaming like I had never seen in the previous 11 years…because he had been sexually abused, and so my instinct was correct. I did not force the exam on him. From a medical perspective, the best thing for parents to do is NOT to yell your child that NO I ONE should touch them down there. You should be teaching them the anatomical names for their genitalia (not “wee wee” or “muffin,” and that they are private except for their parents/caregiver (for young child) and a doctor in the presence of a caregiver. I’ve never HAD to “force” a genital exam on any child–and I didn’t force it on this one either, but the situation raised more red flags in an already bad situation. As for my exam, I explain to the child that I need to look at their penis, vagina, etc which are normally very private but that it is okay because I’m a doctor and mommy or daddy are here, too. There are heaps of evidence that convictions for abuse are much easier when children can specifically address where they were touched than just “their privates.” In general, anything covered by a bathing suit should not be touched by anyone other than a parent/caregiver or physician in the presence of a caregiver. And if the child is at all resistant to my exam, I just have them show their genitals to their parents and l peek over their shoulder. Easy peasy. I’m not into traumatizing kids more than I have to.

    Again, thanks to all for your questions and comments. I hope that we can get back to the bigger Free Range issues such as completely unsubstantiated and anonymous calls in unharmed children.

  43. James Pollock June 23, 2015 at 6:28 pm #

    I went through the meningitis scare, and yes, my daughter got the spinal tap. It is very scary… you know full well that bacterial meningitis is life-threatening and, although viral meningitis is much more common and far less severe, you don’t know for sure which it is in the first 48 hours. So your infant is in the hospital (mom, too, if she’s nursing the baby) getting massive doses of antibiotics while you wait for the cultures that will tell you if it was one or the other.

    As it turns out, she’s a tough kid. We got her into school a year early, which meant that her vaccination schedule was abruptly accelerated, and she had to go into the pediatrician’s office and get a bunch of shots. We explained it to her (at 4) and she went in and got a year’s worth of shots all at once, without complaint.

    She also broke her arm while playing, and it was hard to tell. She was still favoring the arm in the morning, so I sent her to school and made an appointment at the pediatrician’s office for after. That set off a rush across town to the fracture clinic to get it set and casted before the clinic closed for the day. I missed the fact that the arm was broken, but so did the pediatrician, until the x-rays came back, showing an obvious break.

  44. Vanessa June 23, 2015 at 6:44 pm #

    It really freaks me out to think of doctors calling CPS just because a child is afraid during an exam. Up until she was about five, my daughter was terrified of strangers, which to her meant anyone who wasn’t me or her father (sorry, Grandma), and she had a LOT of extreme phobias, one of which was doctor visits – she would scream and cry hysterically even when they asked her to step on the scale or read the eye chart, never mind actually examining her. It was a phase that she grew out of on her own around the time she started kindergarten, but we would have been in a world of hurt if someone had decided that her fears meant we were secretly beating or abusing her.

  45. Neil M June 23, 2015 at 7:11 pm #

    Emily:

    Thanks for your comments. Let me say that I know that, as a mandatory reporter, you’re in a tight spot yourself, although it sounds like you exercise good judgment in raising red flags (or not). I can’t speak for anyone but me, but I think what is troubling is that in these situations good judgment is often lacking. The system has a built-in incentive to escalate; after all, if one reports abuse that is later cleared, he/she will be praised for “looking out for children.” If one does NOT report abuse that is later proven to have occurred, he/she will be shamed, punished, fired, etc.

    Certainly, there need to be mechanisms to notice and report neglect and abuse, but I think there also need to be very clear guidelines about just what qualifies. Life experience clearly doesn’t qualify, because there are people being arrested for leaving kids in cars for ten minutes, which when I was a child was considered perfectly OK. Common sense won’t work either, because what is common sense to me might appear to my neighbor to be folly. I wish we could put together some kind of coherent policy so that parents know what is off-limits and what isn’t, instead of finding out only after CPS knocks on the door.

    Anyway, that’s my two cents. Thanks for contributing to the discussion.

  46. MichelleB June 23, 2015 at 7:36 pm #

    “As for the billing, I am honestly not sure how that works as I get paid an hourly wage, but I can tell you that the typical abuser is not an insured person with a good job who is worried about co-pays. More often than not, the hospital eats the cost or it is billed to Medicaid.”

    Emily, what about the parents who aren’t abusers? Do these extra tests ALWAYS turn up abuse? I’m not worried about how the real abusers out there are going to pay their medical bills, but what about the injuries that were really an accident? The hospital is going to turn that account over to collections before they eat the cost.

  47. sigh June 23, 2015 at 7:48 pm #

    Thanks for the education, Emily. Your description of how a doc would handle our spinal tap sounded exactly like our experience. It was overkill for sure, and I regretted it hugely.

  48. Jessica June 23, 2015 at 7:51 pm #

    A coworker had an awful experience some years ago. They were relocating across the country and his wife went ahead of him and stayed in a hotel while they looked for an apartment. Their little one (I think around 7 months?) fell out of bed while co-sleeping in the hotel. We are a co-sleeping family too so I get it – I’m sure the little one would not settle anywhere else and it made sense to mom in the moment even if the bed was not an ideal setup.

    Anyways, little one was injured and Mom took him to the ER – and baby got removed from her immediately. Dad rushed cross-country and was able to get custody of the baby so he was with family – but he was not allowed to see Mom. The couple had to be apart and fight this battle in an area where no one knew them and could support them. It all ended well and the family reunited but turned out to be a nightmare for months. My coworker told me the number one thing he learned – if your kid gets hurt, get your pediatrician involved ASAP if you have to go to the ER. They can vouch for you and they typically know your family well enough to know that you care for your child and don’t have a history of issues.

    I have not had to deal with this yet, even though I have 2 active boys, Because of this story I make sure to cultivate a relationship with my ped should anything ever happen…

  49. James Pollock June 23, 2015 at 8:16 pm #

    “Emily, what about the parents who aren’t abusers? Do these extra tests ALWAYS turn up abuse? I’m not worried about how the real abusers out there are going to pay their medical bills, but what about the injuries that were really an accident? The hospital is going to turn that account over to collections before they eat the cost.”

    Depends, in part, on what they find.
    If they find bone cysts, they’ll charge it to the insurance carrier, along with treatment costs. In most cases, it’ll be treated as diagnostic, and therefore medical.

    If it turns up nothing at all, an insurance carrier MIGHT deny payment due to the scan being “not medically indicated”. If that happens, I would assume that the hospital would eat the cost as operating expense (since it’s done to satisfy regulation) and charged off against income for tax purposes.

  50. Beth June 23, 2015 at 8:58 pm #

    “typical abuser is not an insured person with a good job who is worried about co-pays.” You also said about the above situation “this injury is suspicious”.

    But this HAS to be a typical parent with an injured child, such as the above story and the ones relayed by commenters. A typical loving non-abusive parent should not have to fear their child being removed from their care because of a childhood accident, nor fear guilty-until-proven innocent rounds of extensive, expensive testing. I’m sorry, but this DOES sound like if-it-saves-one-child it was worth ruining the family lives of 20 others.

  51. Donald June 23, 2015 at 9:00 pm #

    I keep chanting, “bureaucracy is the problem”. I say it so often that I must sound like a vinyl record that skips. We have created a system so that people are not allowed to use their judgement. The other problem is the world of ‘experts’. CPS go through so much training that abuse is all that they can see.

    The invisible gorilla shows how that gross injustice can become just as invisible as the gorilla in the experiment. The people focused so hard on the white tee shirts and ignoring the black ones that they miss the black hairy gorilla that walks through center stage!

    http://www.theinvisiblegorilla.com/videos.html

    This experiment is so powerful that it’s been copied hundreds of times. I have even seen an experiment where the gorilla stops in the center and dances. He still gets missed by 50% of the observers!

    Thanks to people like Lenore and Philip Howard, we’re starting to see how harmful this has become.

  52. FreedomForKids June 23, 2015 at 9:02 pm #

    I took my little girl to the ER when she was around five or six with a piece of glass in her foot. I’d dropped a bottle of vitamins that morning, swept and vacuumed up, but apparently a piece shot far from the drop site and my daughter stepped on it. It was in deep and there was no way I was going to get it out myself. Well, the doctor ordered X-rays of her foot–several–even though there was a clear and visible entry wound. I wish I’d had the presence of mind to question the necessity of this; I didn’t, even though I thought it seemed stupid. NOW I sure wish I’d refused them because of the radiation exposure as well as the cost. With our high deductible the cost of removing a little piece of glass from a foot was more than two thousand dollars.

    If I’d refused would I be considered a potential abuser?

  53. James Pollock June 23, 2015 at 9:27 pm #

    “I keep chanting, “bureaucracy is the problem”. I say it so often that I must sound like a vinyl record that skips. ”

    Bureaucracy is NOT the problem. People who abuse kids are the problem. It would be nice if everybody who abused kids would come down to the courthouse and voluntarily surrender their access to kids (their own and others’) but they seem reluctant to do this. So we ask people to sort out the people who are just fine, but have kids who were injured, the people who want to do what’s best for their kids but just don’t know how, the people who are temporarily unable to care for kids, the people who should never, ever be around kids. Oh, and do it quickly and with as little information as possible, because obtaining information takes time and money and both are woefully short. Sometimes, they get it wrong, and kids are left in terrible situations. Sometimes, they get it wrong and children are removed from perfectly good homes. Each example is an opportunity to learn, and get better at making hugely important decisions quickly and with little information to go on.

  54. James Pollock June 23, 2015 at 9:29 pm #

    “I wish I’d had the presence of mind to question the necessity of this; I didn’t, even though I thought it seemed stupid. NOW I sure wish I’d refused them because of the radiation exposure as well as the cost.”

    You get more ionizing radiation from going outside in Denver than you get from having an x-ray taken in Orlando.

  55. SOA June 23, 2015 at 10:02 pm #

    Freedomforkids: as a chronic glass foot magnet I am going to say the x rays probably were needed. Glass can break into tiny tiny almost microscopic slivers and get into your foot. Happened to me twice in my life. The worst time I was a child and the doctor had to use the x rays to see where the glass was because it was too small to see but I knew it was in there because it hurt every time I put pressure on it. He finally found it and removed it with a microscope and tweezers and scalpel.

    Other times they x rayed me to make sure they got all the glass and found none. So I don’t blame that doctor for wanting to be through and make sure all the glass was out Because if he missed some you would have had to come back and that is expensive too.

  56. Donna June 23, 2015 at 10:06 pm #

    “But, in 2012, an estimated 1,640 children DIED from child abuse and neglect, and 70% of them were under 2”

    Where exactly is this statistic coming from? Deaths from abuse and neglect would be homicide and according to the CDCs, childhood deaths by homicide don’t even come close to the numbers you are giving. In fact only 339 children between the ages of 1-4 died by homicide in 2012. Even if they ALL were abuse and neglect, we are nowhere near the numbers you gave.

    “Of course, this is not 100%, but child abuse is way more common in people of lower socioeconomic status–just a reality.”

    Or is it just suspected, investigated and accused more often in lower socioeconomic status? Are those the people who usually give in because they can’t afford to properly fight an abuse allegation such as this and they have no access to resources like the Family Defense Center (I understand that the representation is free, however, it takes a certain savvy that the poor generally don’t have to find them and get them on their case). As an appointed attorney, I can assert that appointed attorneys run the gambit between good and bad and even the best are limited in what they can do since the court is not going to give them money to hire experts to attack the ER doctor’s conclusions.

    This makes me remember the What Would You Do? episode where an angry mother left her two kids on a bench and told them to walk home. When the family looked poor (ratty clothes, beat up car), several bystanders called the authorities. When the family looked wealthy (BMW, designer clothes) nobody called and some even cheered on the mother. Exact same actors and script both times. We see what we want to see. And half your indicators of “abuse” equally apply to simply being very poor.

    “but on a child that isn’t walking yet a spiral femur fracture without abuse is essentially impossible.”

    A good friend of mine’s son had one when he was dropped by an older child who picked him up off the bed. Fracture spiraled completely up his leg. My daughter was right there and saw it happen. Our doctor didn’t even bat an eye. Didn’t bat an eye when she brought her second child in with a broken leg less than a year later (trampoline accident). He just laughed and asked if they had any more children with legs to break. Sometimes I much prefer 3rd world countries.

    “Do you really believe that parents are more scared of emergency physicians calling CPS on them than the nosy neighbor?”

    Definitely. Medical opinion carries far more sway than that of some busybody looking out her window. If a doctor says that an injury must be abuse, it is an almost guaranteed conviction and termination of parental rights whether it is true or not. And there is always the possibility that it isn’t true. Take your spiral fracture example that I’ve seen occur accidentally despite your insistence that it is essentially impossible.

  57. Rina Lederman June 23, 2015 at 10:26 pm #

    WT?!?!??!?!?!?!?!

  58. Rina Lederman June 23, 2015 at 10:27 pm #

    What The?!?!??!?!?!?!?!

  59. Nicole June 23, 2015 at 10:34 pm #

    This reminds me of the time my sister discovered a bump on her youngest daughter’s head while nursing her one day. She brought her to their regular doctor and discovered a cracked skull. DCS was called and they were investigated, even though there was no history of injuries or abuse. The only thing we could figure was that the baby bumped her head on a measuring tape in her dad’s pocket when her older sister was handing he over to him. Fortunately, they were cleared, but it was scary wondering if he kids would be taken away over a freak injury.

  60. Haylie June 24, 2015 at 12:55 am #

    Exact same thing happened to me in Texas. My 9 month old daughter had a healed rib. Her brother was 2 yrs older then her and was pretty rough. I didn’t know she broke a rib until she had horrible chest congestion. Worse 8 months of my life. Had to take parenting classes and everything while my babies couldn’t be alone with us 🙁 we finally got a lawyer and poof everything went away! Wth?!

  61. George June 24, 2015 at 12:58 am #

    Mandatory reporting deters parents from seeking medical care for their children. It’s simply a matter of incentives.

    This is why we should get rid of mandatory reporting. Responsible medical workers (and irresponsible, for that matter) will still call CPS, but their hand won’t be forced.

    That situations like this occur makes an informed parents less likely to seek medical care for their children. This is because they have to balance the very real dangers (yes, dangers–read David Pimentel’s articles–) of possible CPS involvement with the relative good that medical treatment might do.

    Take this family, for example. Five, maybe ten years from now, maybe Hannah’s playing outside and falls. Do you think that Cassie and Nate will think twice before going to the doctor a week later if Hannah’s ankle isn’t doing better?

    Mandatory reporting is part of the intrusive, freedom-robbing system that makes children’s lives more dangerous, not safer.

  62. hineata June 24, 2015 at 1:21 am #

    @Melissa – ditto on the femur fracture. …my husband ‘did’ the exact same thing to Boy when he was seven months. Slipped while carrying him down a driveway. Terrible parents, we didn’t take the poor kid to A&E for 2 days, as he was a fussy kid anyway, and would cry with fright at the smallest thing. And bugger, we had chosen that very night of the injury to try the ‘cry-it-out’ method to get him to sleep through the night! Poor kid cried and cried….

    I honestly didn’t think it was possible to snap a femur just with your arm. Ironically it was because he was so quiet the next 2 days, so much so that even the rellies noticed, that we even took him to A&E at all. Of course the surgeon was concerned and asked the usual probing questions, but there were no other breaks (thank God) and so they let us go home with him and there was never any follow up. Just a month of Boy having fun turning his plaster into both a weapon to get toys off other sitting babies, and as a drum. There were ample tears when he rediscovered the pain of a solid thump from a metal spoon after the plaster was removed! 🙂

  63. Emily June 24, 2015 at 1:22 am #

    VANESSA–Fears of the doctor are super common and I’ve been bitten, kicked, and the like. Again, only 1 time in 12 years was there something suspicious, and it turned out the child was in foster care and there was evidence of sexual abuse. So to say that it is common or something that should worry the average parent is farfetched.

    MELISSA–I think any physician who would report you (also injured) for any sort of injury your child sustained knowing the history surrounding the injury would be very inappropriate. It is much different than a child with a suspicious fracture and head injury where the parents make up a story that they believe is realistic to account for the injury sustained but is developmentally impossible for the child. Another common one is burns in the certain areas of the body or of a certain character. For example, a hot liquid burn to the arm or chest from a toddler pulling a pot of boiling water off the stove is not a CPS case, but an “immersion burn” with finite lines where the child has obviously been dipped into scalding water buy an adult is an automatic referral. Same with genital burns as people will naturally bring their knees together to protect their genitals if they are being burned. Here is some interesting info on that. https://www.ncjrs.gov/pdffiles/91190-6.pdf

    NEIL M–I totally agree with you. It’s very hard and unfortunately, a lot of it comes down to gut feeling which is definitely not the best way to know. But again, once the process has started, it is difficult to stop. And it is a very fine line because you can be sued/fired for NOT reporting or missing something, turned into the medical board anonymously by ANYONE (including medical staff or parents of children who you report, etc.) There is not a clear set of guidelines. And it is definitely harder as the ER physician because you have no rapport with the family like the pediatrician does which makes suits way more likely, as does the nature of our job because there is already some sort of an injury. Giving the child’s pediatrician a call is one way to help make a decision as they have seen the child more than you have. Unfortunately, there are just some injuries that absolutely require an investigation (see comment to Melissa above regarding burns). But there is a LOT of grey area. Honestly, I think underreporting is probably more common than overreporting. My biggest fear is that I miss an opportunity to help a child in trouble and them see them come back dead. Hasn’t happened yet, but then again, I haven’t called much, ether. I guess the thought is that we get lots of training in medical school and residency, plus we rely on input from radiologists, experienced nurses, social workers, etc. It is definitely not usually just one person’s judgment call, but the attending physician definitely carries the liability. I doubt that many people want the government to come up with more guidelines and another checklist to determine whether the call is appropriate. Here is the Arizona Attorney General’s suggestion for what Physician Assistants must report. Clear as mud! https://www.azpa.gov/PDFs/Alert%20to%20Physician%20Assistants.pdf

    MICHELLE B–I think James Pollock’s answer is probably correct regarding the billing issue. No, they don’t ALWAYS find other abuse, but unfortunately if the physician even has abuse on the radar to be thinking about further testing, they tests often come up positive. For the PR of the hospital, I’m sure they would eat the cost of the study, and apologize profusely for the intrusion, if the scans were negative or it would be a huge PR nightmare. It is certainly just part of keeping the hospital open and it’s not like the parents would be happy to begin with if they felt they were being suspected of abuse. Not a fun situation for anyone at all.

    JESSICA–definitely good to have a working relationship with your pediatrician. They know you and your family, and can be of great assistance to the ER physician as well. I have called them for more info about situations on several occasions, just as I like to make sure that any child in the ER with an injury has good follow-up with their pediatrician. Closing the loop is best medical practice. Not that you asked, but the case I referred to in my original post where the infant was left unattended on the bed was a red flag because special needs/sick children are way more likely to be abused than healthy children. (Same way pregnancy is actually a huge risk factor for domestic abuse). It wasn’t just co-sleeping or anything like that. Although I did have a pronounce a baby once who was smothered by the mother’s morbidly obese girlfriend while co-sleeping. One of the most horrible days of my career. 🙁

    BETH–I’m not sure what else you want me to say. I have called a few times in my life. It’s the law. And a call does not necessarily mean the children gets removed from the home. I have seen abuse that would make you vomit. Those cases still haunt most of us. I have seen elder abuse that would make you cry. There are some times where a call is required because the specific injury or situation mandates it. Given that I’ve only called about 10 times in a dozen years, I think it difficult to believe that I’ve ruined many lives to try to save one child or that the typical, loving parent needs to fear being reported for a broken arm or a cut requiring stitches. Or forgo medical care. Even the people who are abusing their children still bring them into the ER knowing their injuries are from abuse. Would you rather mandatory reporters didn’t exist at all? Is that a better society?

    DONALD–Very interesting video. My input would be that as an ER physician, I see fevers, broken bones, lacerations, ear aches, etc. all day every day in pediatric patients. Part of what our very specific residency training is to do is to recognize and diagnose common medical problems, yet not miss the more rare but more deadly problem either. For example, first trimester vaginal bleeding is almost always just a threatened miscarriage, but if you send home the ruptured tubal pregnancy, she is likely to die. Get an ultrasound and have close follow-up. The old saying goes, “If you hear hoofbeats in Texas, think horses, not zebras.” But sometimes you have to at least remember that zebras DO exist in emergency medicine or you’ll miss them 100% of the time. In the case of suspected child abuse and mandatory reporting, something has to really stand out in order even raise my eyebrow as evidenced by the few number of calls I’ve made. In the end, it does involve a bit of a judgment call. More laws and bureaucracy passed down from the government may actually increase the number of people who we are required to report and eliminate any judgment whatsoever. I now see signs on the side of the interstate here that say “Child left in car–Call police immediately” even though our specific law says that 5 minutes is legal.

    FREEDOM–My nanny’s husband was in a car accident last week where the ER doctor did not x-ray his forearm before stitching it up…landing him back in the ER 5 days later with 2 pieces of glass embedded in there that they couldn’t see, and now he’s stuck with that bill. Retained foreign bodies are pretty common, and they are one of the most common malpractice lawsuits. In your case, I’d offer the x-ray and then document your refusal and move on. Not the same as a neonate with a fever whose parents are refusing medical intervention as one doesn’t often die within 24 hours from a piece of glass that was missed. As someone else pointed out, the amount of radiation is very tiny from a foot x-ray or two. It was also only a small portion of the charge. The facility fee, physician bill, and separately billable procedure of “foreign body removal” likely accounted for most of your bill.

    JAMES POLLOCK–Thanks. Just thanks. You get it.

    DONNA–Sorry, I forgot my source regarding statistics. It came from https://www.childhelp.org/child-abuse-statistics/, the National Child Abuse Hotline. As for the socioeconomic status part, those are just statistics, just as it is more likely in teen mothers, by parents who were victims themselves, domestic violence is higher during pregnancy, etc. The causality is not precisely known. Here is a very good academic paper that tries to tease out the causes. http://www.irp.wisc.edu/publications/dps/pdfs/dp138510.pdf. We probably miss child abuse that is ongoing in families of higher socioeconomic status because we are less likely to judge. There is actually evidence showing that non-accidental head trauma is more likely to be missed in Caucasian children from intact families. Here is a classic article: http://jama.jamanetwork.com/article.aspx?articleid=188786 I don’t think I for one have over-reported. There is probably some reporting bias present as well, but usually there is more than one factor that raises an eyebrow as I’ve cited numerous times above: suspicious fracture and totally bogus story, head injury and lots of old bruises in an infant, etc. The only two indicators I gave that at all relate to wealth are filthy children and malnourished children. Most people who are quite poor do not have malnourished children thanks to SNAP. And again, these are not in a vacuum, they are pieces of a puzzle (along with the injury that prompted the ER visit) that make me SUSPECT abuse and call the social worker to look into things further, which is not the same as calling CPS. It’s not like I’m walking around Wal-Mart calling CPS saying “Filthy child in aisle 10, you’d better come investigate.” As for your friend with the spiral fracture, even the child abuse expert would still think the fracture is suspicious, as I mentioned in a NON-AMBULATORY CHILD, but not necessarily equate it with abuse. “Spiral fractures imply a twisting or torsional force applied to the bone. These can occur accidentally or be inflicted. Certainly, in pre-ambulatory young children, such forces are hard to self-inflict. Thus, a lack of history of a twisting force would make a spiral fracture of a femur highly suspicious of abuse. ” He also addresses some of your other concerns about socioeconomic status and the harm of involving CPS unnecessarily. http://pediatrics.ucsf.edu/blog/are-lower-extremity-spiral-fractures-indication-abuse#.VYo4teea4qc Having a relationship with your pediatrician is definitely a good idea, as there is evidence that they actually UNDER-REPORT child abuse by about 21%. http://www.academicpedsjnl.net/article/S1876-2859%2811%2900227-0/abstract Certainly it takes a village, and calling the pediatrician can be quite helpful if they know the family well. The nosy neighbor doesn’t have any medical training of knowledge to back up his/her claims, so I would hope that a physician’s suspicions would be taken more seriously. I suspect the false positive rate among physicians is also much lower than that of the nosy neighbor. As for wanting to live in a 3rd World country, I agree, but mostly because it would mean fewer lawyers.

    NICOLE–When my cousin was about 3-4 years ago, my brother felt a soft spot on his head and told my aunt, who is a pediatric nurse practitioner. She took him the ER and he had a skull fracture which he had gotten 10 days prior when he fell from one of those 25 cent race cars you used to be able to do at the grocery store. She hadn’t taken him in because he was acting normal after, but he wore a helmet for about 6 weeks after and she felt terrible. No one reported her because the injury was consistent with the story and there were no other red flags. Making the call if you aren’t 100% sure is very scary as well because nothing good can come out of a child being taken away from loving parents.

  64. Steve June 24, 2015 at 1:37 am #

    Donald said:

    “I keep chanting, “bureaucracy is the problem”. … We have created a system so that people are not allowed to use their judgement. The other problem is the world of ‘experts’. CPS go through so much training that abuse is all that they can see.”

    Yes, Donald. I agree. Bureaucracy IS a big problem … in so many areas. It’s hard to fight a bureaucracy. And how often will a bureaucracy admit to a mistake or crime?

    CPS guidelines for when and why to remove children from homes “apparently” are either very open to interpretation, or they are constantly changing and growing much like the DSM (Diagnostic and Statistical Manual of Mental Disorders.) When the DSM was first published it was a thin booklet. In the old days, the general impression of what constituted a mental illness pinpointed extreme behavior. Today, mental illness has been expanded to cover all sorts of behaviors that used to be called “normal.” Today, almost everyone could be labeled with a “disorder.” Most teenagers could be diagnosed with Oppositional Defiant Disorder. You can find a number of references on the net referring to “The medicalization of everyday life.” And with CPS, ( encouraged by busybodies and other nasty people who call in reports) it appears their guidelines for what constitutes a suspicious and potentially abusive family situation might be called, “The criminalization of good parenting and ordinary everyday accidents.”

    I’m glad you mentioned “the invisible gorilla.” (great book!) That’s an excellent example of how people looking “hard” for one thing are totally blind to something else that should have been obvious.

    Dan Ariely has a chapter in his book, PREDICTABLY IRRATIONAL, that deals with “The Effect of Expectations” (“Why the mind gets what it expects.”) He presents several studies that proved – “if you tell people up front that something might be distasteful, the odds are good that they will end up agreeing with you–not because their experience tells them so but because of their expectations.”

    That tendency is being played out again and again with these terrible CPS cases. They go in expecting abuse, then only look for signs pointing to abuse.

    Of course this is the same thing going on with Helicopter parents. They start with a belief that the world is too dangerous to allow their children any real freedom, then they focus only on fears and what ifs. To them, danger is everywhere.

  65. hineata June 24, 2015 at 1:37 am #

    As for the poor being more likely to be abusive, that’s dependent on your classification of abuse. I have worked in private and upper-decile public schools and schools in very poor areas. The private school kids were far more likely to be neglected, raised by nannies etc., or dumped in ‘good’ childcare/after school care for 12 plus hours a day. Parents barely seemed to interact with some of them. A much higher proportion was doing this than was giving their kids ‘the bash’ in the poorer schools.

    Thanks to their resources, the wealthier can outsource parenting. The poor don’t get the same chance to do that. And no, the poor are not always, even often, poor because of their ‘life choices’.

  66. James Pollock June 24, 2015 at 1:45 am #

    “That situations like this occur makes an informed parents less likely to seek medical care for their children.”

    Of course, failure to seek medical care is ITSELF evidence of criminal child neglect (depending on where you are). This is a law that targets faith healers, but it seems like it could be applied here, as well. (Being reluctant to seek medical care looks FAR guiltier than does the injury, BTW.)

    (Speaking personally, if my child needs care, my child needs care. Trivialities like “what does this look like to a family court” and “how am I going to pay for this” come far, far later down the list. I might delay seeking care for myself, but not for my child.)

  67. sexhysteria June 24, 2015 at 1:53 am #

    Such arrogant CPS employees should be charged with kidnapping.

  68. Stella o Malley June 24, 2015 at 4:18 am #

    Horrible, just horrible. There is a court case on going here in Ireland, and an expert has declared that ‘shaken baby syndrome’ has little research or science to back it up. Fascinating how we can accept the nasty stuff into our mindset but we tend to dismiss the kind stuff

  69. Donna June 24, 2015 at 7:52 am #

    “Most people who are quite poor do not have malnourished children thanks to SNAP.”

    You do understand that the S in SNAP stands for SUPPLEMENTAL, meaning that it is only designed to cover a portion of a person’s nutritional needs. However, a large portion of people who receive SNAP benefits have no additional money to contribute to food. They live exclusively on their SNAP benefits, which generally amount to less than $4 per day. You try to eat on less than $4 per day for years and see how you turn out. But, in fact, most poor families are both malnourished and obese because foods like ramen and mac & cheese are cheap. They are also high in calories and provide virtually nothing by way of nutrients.

    “I mentioned in a NON-AMBULATORY CHILD, but not necessarily equate it with abuse.”

    A little backpedaling here, isn’t it? What you said exactly was: “but on a child that isn’t walking yet a spiral femur fracture without abuse is essentially impossible.” However, I provided an instance of a non-ambulatory child getting a spiral fracture without any abuse involved and I know that with 100% certainty. And I refuse to believe that this is the ONLY time in the history of the world that this is occurred. However, if this had been your ER, you would have called your social worker and come into court and testified that it was “impossible” that this injury occurred outside of abuse, and lives would be destroyed because of nothing more than your opinion that was 100% wrong. In this case, we would have had 5 child eyewitnesses, 4 of which were unrelated to the family, but how often does that happen?

    Doctors need to 100% be out of the business of diagnosing how injuries occurred. It is not their forte. Shaken Baby Syndrome has proven that. Thousands of people in prison and yet not a single incidence of shaken baby has ever been viewed by a witness. While much child abuse happens in secret, there are always cases that are known. A passerby sees it through a window. A sibling views it. The abuser has such control over the house that s/he doesn’t care in the least who in the house sees and does it in the open. Parents are in it together. Yet, there has never been a single prosecution for shaken baby in which someone saw it occur. The hallmark belief in shaken baby is that the caregiver just momentarily lost control and yet this apparently has NEVER happened in the history of shaken baby when someone else was in the room? People lose control and smack children, shove children, throw children when others are in the room, but can somehow control their shaking instincts 100% any time someone else is in the room? And nobody has ever even once believed everyone to be out of the room, but had someone who could see in – had a line of vision into the room, walked into the room as it occurred, walked by outside and glanced in a window at just the right time, had an older child hiding in the room?

  70. Ariel Landres June 24, 2015 at 9:28 am #

    I feel strongly about it and love reading more on this topic. If possible

  71. Warren June 24, 2015 at 12:07 pm #

    Emily,
    So you are okay with ripping innocent families apart, to cover your ass, and to be better safe than sorry?

    Your description of all the mandatory reporting you are required to do, how do you find time to treat patients?

    Mandatory reporting needs to stop. Until it does innocent people will suffer, and there is no way that can be justified.

  72. JulieC June 24, 2015 at 12:49 pm #

    Emily thank you for your willingness to engage people here. You’ve made excellent points.

    If people are upset by the idea of mandated reporters, then the answer is to lobby legislators to change the law. Badgering people who are required by law to report suspected abuse is just silly. Why should Emily put her career, her no-doubt expensive education, and her freedom at risk because somebody in this forum thinks all she is doing is covering her ass? And by the way, I believe she made the point (twice) that in 12 years she has called social workers 10 times. That’s not exactly someone who is just itching to report people.

  73. Buffy June 24, 2015 at 1:06 pm #

    But yet, she was itching to say “This injury is suspicious” after reading an article on this site, which included statements such as “Without even interviewing Nate, or talking to the hospital’s own child abuse pediatrician, and without Hannah being seen by a single orthopedist (for whom injuries like Hannah’s are fairly routine)…” and “the same emergency room doctor who had caused the Hotline call admitted that, had he known there was an older sibling who sometimes played a bit roughly with Hannah, the hotline might not have been called at all” and “the State’s Attorney of Kane County agreed with the family that there was no evidence making abuse a likely explanation for Hannah’s fracture”.

    But still, without ever looking at the patient or communicating with the family….”this injury is suspicious”.

  74. JulieC June 24, 2015 at 1:12 pm #

    Oh no! She was itching to type something on a website!

    You can’t tell the difference?

    Emily very patiently explained her reasoning. Responding by observing that she was itching to type something here is absurd.

  75. James Pollock June 24, 2015 at 1:13 pm #

    “But yet, she was itching to say “This injury is suspicious” after reading an article on this site,”

    And?

    “suspicious” doesn’t mean “guilty”. It means “worthy of more investigation”. You yourself list off several avenues of investigation that could be pursued.

  76. James Pollock June 24, 2015 at 1:17 pm #

    “Mandatory reporting needs to stop. Until it does innocent people will suffer, and there is no way that can be justified.”

    Oddly enough, it is because innocent people were (are) suffering that mandatory reporting became law in the first place.

  77. Lisa June 24, 2015 at 1:34 pm #

    My sister and BIL and 3 kids are going through something similar to this in Illinois right now. My one year old niece fractured her femur bone when she was 9 months old. This all begin in March of this year for them. They don’t know what happened, but like this couple took her to the ER and the ER doctor reported them to DCFS. They removed all 3 girls from my sister and my BIL. The funny thing is my niece has no teeth at all and is 1 years old, she just started crawling and has bowed legs. My sister and her husband believe she has bone issues and may even have rickets or some other form of bone disease. She was tested at the time at the ER and at the time she showed signs of Vitamin D deficiency. She is on special formula too and was premature. DCFS believes it is child abuse which it is not. DCFS has doctors from Peoria, IL look at the children of these cases, but don’t think it is due to bone disease or rickets which a lot of factors say something is seriously wrong with her. My sister and BIL are fighting to have a doctor in Springfield, IL look at their youngest daughter and do more testing on her since he knows all about rickets and bone diseases. My sister was on several different medicines while she was pregnant that her OB/GYN said were safe. She was on Zofran and other meds. My sister has always been vitamin D deficient, anemic, and had always had problems with kidney stones since she was 15. It is horrible thing to go through something like this. I pray they will find out what is wrong with my niece so my sister and BIL can get her 3 kids back.

  78. JP Merzetti June 24, 2015 at 2:04 pm #

    We put men on the moon and become techological gods………..
    yet we can’t come up with something better than what’s described above?
    A system that is bent upon value-adding children, instead of properly serving their needs.
    We are not all of us, perfectly educated in legal or medical knowledge – nor should we have to be.
    In the midst of all this, are many good people trying to do their jobs, and many more trying to raise healthy children.
    Within a socio-economic construct that should serve families – not the other way around.
    The child-saving industry is far too prone to serving itself.
    Propaganda stalks the land. (We all know this.)
    Whatever the real tip of the iceberg is……it will always be pushed to the breaking point, and just managed to be kept upright, without falling over.

    In the meantime, business as usual carries on. And kids who need saving don’t get saved.
    And kids who don’t need saving……..still don’t get saved. (Although some would like to think differently.)

  79. Warren June 24, 2015 at 2:38 pm #

    James,
    You proved my point Jackass. Mandatory reporting doesn’t work.

  80. JulieC June 24, 2015 at 2:50 pm #

    I believe the innocent people James is referring to are the innocent victims (children) of child abusers.

    Or have we decided now that child abuse does not occur?

  81. Warren June 24, 2015 at 3:34 pm #

    Julie C,

    Oh I know what he meant.

    And as usual James is wrong in his conclusions. Mandated reporters haven’t stopped child abuse, but they have created victims.
    So Julie you can belive in a system that destroys innocent people, on the foundation of “if it saves one”, I will not.

    And James is still an idiot, needing a tune up.

  82. TM June 24, 2015 at 3:59 pm #

    Mandatory reporting absolutely prevents people from seeking medical attention. As Emily pointed out, one of the things ER docs are reporters on are dog bites. This past year, our dogs got into a fight with one another. It was completely our fault as we had been dealing with other life issues and neglecting the fact that our dogs were getting increasingly testy with each other. We went to stop the fight, and my wife put her hand in between the two dogs. As you would expect, she got bit. A good solid wound. And after the initial shock wore off, she decided she didn’t want to go to the ER to have it checked out. It seemed small enough that we could close it with a few butterfly stitches but it probably could have used real stitches. But she decided against it specifically because she was worried about the mandatory reporting.

    I get the need for wanting medical personnel to report problems when they see it. I just strongly dislike the fact that it seems to be accompanied by the removal of any sort of judgement and common sense.

    @ Donna,

    Yes, the average SNAP benefit amounts to $125 per person per month (which is actually a touch more than $4 / day not less). Which means for 2 adults, it’s $250 a month. The average monthly grocery bill for my wife and I is ~$275 / month. More in months when we add in the dog food and toiletries and less in months when we don’t. And we eat just fine and could do so on a reduced budget if we had to. Vegetables, chicken, steak, ground beef, pork, bread, cereal, milk etc. There is absolutely a need for a basic starting set of spices and bulk basics that you can’t afford all at once if you start on SNAP (and I’ve often thought when you get on SNAP you should get an initial “signing” bonus specifically to get you flour, sugar, rice, cooking oil and spices). One of the greatest disservices we do in this county is convince people that eating healthy and cheaply are mutually exclusive and time consuming. It is neither, you just have to know what to do and how.

  83. JulieC June 24, 2015 at 4:19 pm #

    Warren:
    I don’t believe mandated reporting could ever prevent all child abuse.

    My point is that Emily explained, at great length, the thought process she uses as a physician to determine when an injury requires further investigation and yet you complained that she spent too much time thinking about it to the point that you wondered when she got any work done. You can’t have it both ways. There are children who show up in ERs with injuries that they sustained as the result of a beating by a parent or relative (or more likely, mom’s boyfriend). And there are many cases, sadly, of people who noticed something bad going on with a child and those people said and did nothing.

    In my community, we had a middle school teacher who was sexually abusing female students. The principal was informed about it and did nothing. The teacher went on to abuse many more girls during the several years, until several students reported it to a vice principal and police were finally called in. The school district had to pay out a lot of money years after the fact, after it came to light that the principal, a mandated reporter, had done nothing about it. I’m vastly oversimplifying what was a complicated case, but the fact remains that had the principal done what he was supposed to do, fewer girls would have suffered.

    I too, am troubled by the swiftness with which CPS seems to swoop in to take children from loving parents. But I am also sure that there are cases where CPS should take children from abusive parents. I think reform of CPS is in order (especially in Maryland). More protections for the civil rights of parents is also imperative.

  84. Havva June 24, 2015 at 4:48 pm #

    You know we are arguing about mandated reporters and if any injury is inherently suspicious. And those are all of that is worth talking about from time to time. But here, it is so petty compared the large failures of justice illustrated here.

    Doctors are never going to be perfect. They don’t have all the info. But our justice system is supposed to be better than this.

    If we suspect the crimes of child abuse, or child neglect, we need proper criminal justice. Not just child protection activities with a thin veneer of judicial oversight. Not the secrecy that CPS always clings to. These removals and accusations must not be allowed to exist separate some accompanying base level of evidence of parental guilt. If you don’t have evidence enough for an indictment, how is that evidence enough seize the children?

    If the police aren’t eager to remove the kids, why do the social workers get to use them to do that? And even if there are times that should be the case, when and where should the bounds on that be?

    Why are social workers getting the power to make such damaging accusation, and wield the power of the cops without the training, diligence, and oversight of detectives?

    There is also the issue of proper defense of the family unit. The right to representation and to defend oneself?

    HOW ON EARTH is this “the first the caseworkers had ever seen in which an outside attorney had advocated for parents in that courtroom”? How was this the first time a petition for dismissal was ever filed in that courtroom?

    HOW did “DCFS filed a petition to take custody of both children from the S.’s in the Juvenile Court of Kane County. Based on hearsay representations concerning the emergency room doctor’s opinion, the judge ratified the rushed decision that DCFS had made without talking to any doctors who had relevant expertise in toddler tibia/fibula fractures.”

    HOW is any of this process acceptable enough that, even here, people are glossing over all this to fight about what doctors should or shouldn’t be calling about? Proper justice should be able to withstand an error, a lone point of suspicion that adds up to nothing. This isn’t proper justice, and that is an enormous problem. That courtroom has processed more suspicions than that doctor. That courtroom is where justice is supposed to occur. What happens in that courtroom is the thing most urgently needing discussed and fixed.

  85. David June 24, 2015 at 4:51 pm #

    Once again this is the result of an overzealous application of the precautionary principle, summed up in the maxim ‘if it saves one child’. So if it might save one child from abuse we must introduce a system of mandatory reporting of anything that could conceivably be imagined to suggest child abuse, no matter how many innocent families are torn apart as a result. If it might save even one child from abduction we should radically restrict the freedom of all children, no matter what developmental damage this causes.

    I often wonder if this is due to the decline in religious belief. No longer believing in God, we imagine ourselves gods and capable of solving any problem. No longer believing in Heaven or any sort of afterlife we try to turn this present world into Paradise.

    But we are not gods and cannot solve every problem. We need to accept that, including that we cannot prevent every instance of child abuse. That does not mean we should just shrug our shoulders and do nothing. But in considering any strategy to ameliorate the problem we must assess the costs as well as the benefits. As more extreme measures are considered a point will inevitably be reached where the proposed cure is actually worse than the disease. What this case and other like it show is that we have already passed far beyond that point.

  86. James Pollock June 24, 2015 at 5:00 pm #

    When you have abuse in an institution, the institution may act to protect itself rather than the victims… it may do so by silencing those who know of the abuse. This was at the heart of the Catholic sex abuse scandal, and it is allegedly behind the systemic under-reporting of rape on college campuses.

    Mandatory reporting takes the conflict out of the equation when a person who knows or suspects abuse is ordered to keep silent by a supervisor.

  87. James Pollock June 24, 2015 at 9:15 pm #

    “And James is still an idiot, needing a tune up.”

    I post under my real name, my address shouldn’t be too hard to find. Feel free to stop by, and we both laugh at the lame threats. Or maybe even pretend to take it seriously, if I can keep a straight face.

  88. Anon June 25, 2015 at 4:26 am #

    My daughter broke her arm while bike riding with a friend. The ER asked her several times how she broke it. I was questioned and even had to go into specifics like the exact location of where it happened. I thought for sure they were going to say I did it. I was so grateful and relieved that I wasn’t there and that there were witnesses!!!

    They didn’t set the bone right and she had to go into the doctor a week later. They had to rebreak it. While in there, my daughter was again grilled on how she broke her arm. They asked her like 8 different times. I am sorry, but I am not sure where they were going with that unless they believed the break was suspicious. It is like playing doctor roulette with overzealous mandatory reporters, except the odds are not in the parents favor in they judge something is subjectively ‘suspicious’. Again, thank God there were witnesses!!!!

    We no longer go to the doctors unless it is an absolute emergency, because the risk of losing our kids. The risk of the perceived illness or injury has to outweigh the risk of losing our kids or being deemed ‘suspicious’ for us to even consider going in. How many others feel this same way?

  89. Warren June 25, 2015 at 9:25 am #

    James,
    The moment you mandate reporting, you compromise the system. Now you are forcing people to protect themselves. Which leads to innocent people being investigated and harmed. That is the inevitable, it is human behavior.

    You are one of those morons that believes following protocol is more important than doing the right thing. Just another mindless sheep.
    I wasn’t making any threats, just making an observation.

  90. Beth June 25, 2015 at 9:36 am #

    What Havva said. Very good points.

  91. James Pollock June 25, 2015 at 11:33 am #

    “The moment you mandate reporting, you compromise the system. Now you are forcing people to protect themselves. Which leads to innocent people being investigated”

    So, let’s see. BEFORE mandatory reporting, you have the situation where the Catholic Church can (and did) act to cover up abuse within the church, by ordering people not to report to civil authorities. Your argument suggests you’re in favor of this… you don’t want the system “compromised”.

    Why? Because innocent people could be investigated. Eek! How horrible! (One wonders what you imagine happens to people who want to adopt, people who want to be foster parents, who seek custody of their own kids in in a divorce. Yep… they get investigated, and most of them are (gasp) innocent.)

  92. Buffy June 25, 2015 at 3:19 pm #

    I just want to take my son to the ER and not have it be assumed that I beat him. That innocent people are investigated and have their children immediately removed (a finding of “guilty”, apparently), is not an “eek”. How demeaning.

  93. James Pollock June 25, 2015 at 4:01 pm #

    “I just want to take my son to the ER and not have it be assumed that I beat him.”
    Alas, there’s never been a law that requires people to think well of you.

    “That innocent people are investigated and have their children immediately removed (a finding of “guilty”, apparently), is not an “eek”. How demeaning.”

    You’ve joined two VERY different things together here.

    Let’s work through the possibilities:
    1. You get investigated, you’re not guilty, the investigation proves that. I don’t have an objection to this.

    2 You get investigated, you ARE guilty, the investigation proves that. I don’t have an objection here, either.

    3. You get investigated, you ARE guilty, the investigation is wrong. I do have an objection here.

    4. You get investigated, you’re not guilty, the investigation is wrong I have an objection here, too.

    So, for BOTH your points, I only have an objection to 50% of the possible outcomes.(2 of 4 outcomes of an investigation, and 1 of 2 outcomes where they take your kids) However, the actual incidence of these four outcomes is not an even distribution. Most of the time, an investigation reaches the correct conclusion. The cases where it doesn’t don’t indicate a need to stop investigating, they indicate a need to get more accurate results from them.

    What would get me worked up would be if they took kids WITHOUT an investigation.

  94. Chuck99 June 25, 2015 at 6:54 pm #

    If the judge, the investigating agent, and the doctor who made the report without proper investigation, all lost their jobs, people might start showing a bit more common sense in cases like these. Instead, people risk having their lives destroyed, and it’s all swept under the rug because they were just ‘defending the children’.

  95. James Pollock June 25, 2015 at 7:15 pm #

    “If the judge, the investigating agent, and the doctor who made the report without proper investigation, all lost their jobs, people might start showing a bit more common sense in cases like these.”

    I’m with you 2/3 of the way. If the investigator isn’t doing proper, thorough investigation before making recommendations, they absolutely should lose their job. If the judge is just rubberstamping applications, the judge should be removed. But I want the doctors reporting.

    If you get rid of the panic reactions (I can’t get my kids medical care because CPS will take my kids away), you get rid of some of the false signs of abuse (like, avoiding or delaying medical care because CPS) that cause them to get it wrong in the first place.

  96. Warren June 25, 2015 at 10:23 pm #

    James,
    An idiot to the end. Mandated reporters have not stopped abuse, but have created fear, and made victims themselves.

    Only mindless minions such as yourself support a system that victimizes innocent people while hoping to save others. That is a trade off rational people won’t accept.

    Causing innocent people to have their lives turned upside down, and possibly destroyed, because in the end you have to cover your butt, is a flawed system.

  97. Alex June 26, 2015 at 3:47 am #

    I’ll just leave this story here: http://www.seattlepi.com/news/article/Persecuted-parents-or-protected-children-1092970.php

    And a link to the guys current job here: http://www.seattlechildrens.org/medical-staff/kenneth-w-feldman/

    Until all you defending the system show a way to put this guy on the street (or jail might be better) there is no justification for mandated reporting.

  98. SOA June 26, 2015 at 8:33 am #

    Anon: I would have started questioning them like I was investigating them for child abuse since they fucked up the first time and were going to have to rebreak her arm. Asking them “Where did the initial incorrect bone setting happen?” “No let her tell me” ” and how did this happen?” Threw their bullshit right back in their faces. I don’t tolerate that kind of nonsense.

  99. Tsu Dho Nimh June 28, 2015 at 9:32 am #

    @FreedomForKids said, “Well, the doctor ordered X-rays of her foot–several–even though there was a clear and visible entry wound.”

    There could easily have been several fragments inside that entry wound. And they don’t stay put.

    I broke a glass while washing it – my hand was inside the glass and I had a “clear and visible” entry wound at the base of my little finger with a clearly visible fragment. I removed the fragment and thought nothing of it. Several YEARS later a fragment of glass (same color as the one I broke) was removed from a painful abcess near my thumb.

  100. Ralph July 5, 2015 at 9:11 pm #

    Why viewers still use to read news papers when in this technological globe all
    is available on net?

  101. Mary July 6, 2015 at 3:26 pm #

    For once I have a positive anecdote. My husband dropped our 4 month old baby onto the concrete floor, in a bizarre incident I witnessed. Out 3 year old ran full force into him, in doing so dislodging the baby from his arms. I rushed her to the ER where I thought for sure they’d call cps. They did not. The Dr recounted his mother walking away from him on the changing table and him falling off, getting a fractured femur, and being in a body cast until he was 1.