Physician Legal Alert:
Abuse, Abanadonment, Cruelty & Neglect: Pediatrics Reporting Obligations in NJ

By: Michael J. Schoppmann, Esq., Kern Augustine Conroy & Schoppmann, P.C.

A recent trend involving the investigation of suspected cases of abuse, abandonment, cruelty and/or neglect of a child prompts the recommendation that every physician, especially pediatricians, examine their understanding of the law regarding the reporting of suspected cases of child abuse and the potential ramification of failing to do so.

Under New Jersey state law, "Any person having reasonable cause to believe that a child has been subjected to child abuse or acts of child abuse shall report the same immediately to the Division of Youth and Family Services by telephone or otherwise.

Such reports, where possible, shall contain the names and addresses of the child and his parent, guardian, or other person having custody and control of the child and, if known, the child's age, the nature and possible extent of the child's injuries, abuse or maltreatment, including any evidence of previous injuries, abuse or maltreatment, and any other information that the person believes may be helpful with respect to the child abuse and the identity of the perpetrator."

Each investigation of child abuse, regardless of the source of the allegation, now carries with it a new line of inquiry - what was the level of knowledge held by any child's treating physicians? What was the child's medical history? Were there events that should have triggered a reporting? If so, why was there no prior reporting?

For physicians, the exploration, and corollary investigation, of those issues carries the risk of severe penalties ranging from significant civil litigation, loss of license through the New Jersey State Board of Medical Examiners, even criminal charges. Unquestionably, every physician needs to maintain diligent attention to his or her reporting obligations, prepare careful documentation of a child's relevant history and apply careful consideration toward reporting any cases of potential abuse.

Toward that end, in a publication by the State of New Jersey Department of Children and Families, Division of Youth and Family Services, the basic parameters for reporting are outlined as follows:

What is child abuse, abandonment, cruelty or neglect? How do I recognize it?
Child abuse inclueds physical abuse, physical neglect, sexual abuse or emotional abuse of a child less than 18 years of age by a parent or other caretaker.

Abuse consists of acts such as: (a) inflicting physical injury or allowing physical injury to occur to a child other than an accident; (b) allowing the protracted impairment of physician or emotional health to the child, (c) employing a child in a vocation or occupation that is illegal, could cause death or injury, or is dangerous to the morals of the child; (d) the habitual use of profane, indecent or obscene language in the presence of a child; (e) performing or permitting the performance of an indecent, immoral or unlawful act or deed in the presence of a child or that might harm the morals of a child; or (f) restraining a child with excessive force where the child's behavior is not harmful;

Abandonment consists of acts or omissions of a person having custody or control of a child such as exposing a child to physical or moral risk. Failing to provide for a child such that the child must be supported and maintained at the expense of the public or other organization or entity is also considered abandonment.

Cruelty to a child consists of any willful act or omission that causes unnecessary suffering ot emotional or physical pain upon a child. The child may inform you of or you may see evidence of severe corporal punishment. The child might suffer habitual torment which you may witness or might be informed of by the child. Exposing a child to unnecessary hardship, fatigue, or mental or physical strains that may tend to injure the health or physical or moral well-being of such child is also considered cruelty to a child.

Neglect of a child is a parent's failure to give the child good, clothing, hygiene, medical care, or supervision. You may see a very young child routinely left alone at hoe. You may know that a severe illness or injury is not being medically treated. A neighbor's child may frequently turn up at your door - inadequately dressed for the weather - saying his or her parent told him or her to stay away. Physical neglect can be hard to determine: Sometimes what you see is simply poor judgment but not neglect; sometimes what you see is the result of poverty and not parental neglect.

How do I recognize child abuse and maltreatment?
The list that follows contains some common indicators of abuse, neglect or maltreatment. This list is not all-inclusive, and some abused or maltreated children may now show any of these symptoms.

Indicators of Physical Abuse Can Include:

Physical Indicators:
- Injuries to the eyes or both sides of the head or body (accidental injuries typically only affect one side of the body);
- Unexplained bruises and welts on the body in various stages of healing. These bruises may cluster, forming regular patterns or reflect the shape of an object such as a belt buckle;
- Unexplained burns, such as cigarettes burns (especially on the soles, palms, back or buttocks), rope burns, immersion burns (on buttocks or genitalia) or patterned burns (such as an iron burn or electric burner);
- Unexplained fractures to the skull, nose and face, in various stages of healing or multiple spiral fractures;
- Unexplained lacerations or abrasions to the mouth, lips, gums, eyes or external genitalia.

Behavioral Indicators:
- Destructive, aggressive or disruptive behavior;
- Passive, withdrawn or emotionless behavior;
- Fear of going home or fear of parent(s).

Indicators of Sexual Abuse Can Include:

Physical Indicators:
- Symptoms of sexually transmitted diseases;
- Injury to genital area;
- Difficulty and/or pain when sitting or walking.

Behavioral Indicators:
- Sexually suggestive, inappropriate or promiscuous behavior or verbalization
- Expressing age-inappropriate knowledge of sexual relations;
- Sexual victimization of other children;
- Withdrawal, fantasy or infantile behavior;
- Poor peer relations;
- Reports of sexual assault by caregiver.

Indicators of Emotional Maltreatment Can Include:

Physical Indicators:
- Habit disorders such as sucking, biting or rocking;
- Conduct disorders such as antisocial behavior or destructive behavior;
- Neurotic traits such as sleep disorders, speech disorders

Bahavioral Indicators:
- The present of behavior extremes such as compliant/passive or aggressive/demanding.

Indicators of Physical Neglect:

Physical Indicators:
- Obvious malnourishment, listlessness or fatigue;
- Lack of personal care - poor personal hygience, torn and/or dirty clothes;
- Untreated need for glasses, dental care or other medical attention

Behavioral Indicators:
- Stealing or begging for food;
- He or she states there is no caregiver;
- Frequent absence from or tardiness to school;
- Child inappropriately left unattended or without supervision;
- The child or teacher reports that the child regularly falls asleep during class;
- Alcohol or drug abuse.

When Do I Call To Make a Report?
You need to have a reasonable cause of child abuse, not to prove it or be absolutely certain. You might be mistaken, but it is better to err on the side of the child. Not reporting your suspicions may mean that abuse will continue. If you make a report in good faith, you are immune from civil or criminal liability. The inherent difficulty in defending an action or investigation involving an alleged failure to report child abuse is that each case carries the horrible, foregone reality that a child has been abused. Where a treating physician's responsibility lies in those who may have failed that child will be determined through the pre-judged prism of hindsight. Balancing not only the risk of enabling further harm to a child but also the overwhelming liabilities for failing to report, every physician should inherently and consistently lean toward reporting.

Where Do I Call To Make a Report?
In New Jersey, the Department of Children and Families, Division of Youth and Family Services (DYFS) is the state agency that receives and investigates allegations of child abuse and neglect. DYFS is also responsible for arranging for the child's protection and the family's treatment if necessary. As soon as you have reasonable cause to suspect abuse or maltreatment, you must report your concerns by telephone to the State Central Registry by calling the Child Abuse Hotline. The hotline is open 24 hours a day, seven days a week, to receive your call. The timeliness of your call is vital to the timeliness of intervention by the local DYFS unit. The telephone number to report abuse or maltreatment is: 1-877-NJ ABUSE (652-2873), 1-800-835-5510 (TTY/TDD). Indicate that you are a physician and confirm whether a copy of your report will be provided to the Department of Human Services or to whom you are required to report the suspected abuse to at the Department of Human Services. Record the name of the person you spoke to, the time and date of your call and the Incident Report Number if available.

What Should I Include in My Report?
You should report (a) the names and addresses of the child and the names of his or her parents, guardians or other person(s) having custody or control of the child and, if known, (b) the child's age, (c) the nature and the extent of the child's abuse and (d) any other pertinent information regarding the suspected assailant or the nature of the abuse.

Kern Augustine Conroy & Schoppmann, P.C., Attorneys to Health Professionals, has offices in NJ. NY, FL, PA and IL. The firm's practice is solely devoted to the representation of health care professionals. Mr. Schoppmann may be contacted at schoppmann@drlaw.com.