We had met about one year before. She was a quiet, sheltered 16-year-old from West Africa who had recently settled with her family in San Francisco. I was a first-year resident in pediatrics.
The young woman came to my teen clinic frequently, sometimes for allergies, sometimes for rashes that I couldn’t see. I wondered if, like a lot of my female teen patients, she might be coming primarily to chat.
On what was to be our final visit before she left for college, I refilled her allergy medications and we said our good-byes. As she turned her head on the way out the door, I noticed minor swelling around her eye.
When I asked about it, she said, without hesitation, “Oh, my father hit me.”
Like all pediatricians, I am mandated by law to report any concern of child abuse. The laws differ by state, but in most places they require professionals in contact with children to report all suspicions of physical, sexual and emotional abuse or neglect in those younger than 18, whether or not there’s substantiating evidence. The laws were clear that I should report the young woman’s father. My conscience wasn’t so certain.
This case was different
Each year in the United States, an estimated 2,400 children die as a result of mistreatment, and more than 500,000 are seriously injured or disabled. Certainly, mandatory reporting protects children, and, until this case, I’d never questioned my role in the system. In my short career, I’ve filed dozens of suspected child abuse reports, mostly for young children with suspicious breaks or burns. In medical school I attended seminars about how to recognize abuse patterns and the requirements for reporting.
This case was different. This time my patient was only months away from her 18th birthday, at which point mandatory reporting laws would no longer apply. Never before had I explained the reporting process without a parent present. (Her mother, through an interpreter, had given me permission to see the teen on her own.) Never before had a patient urged me not to report her father, insisting that although he had intentionally bruised her, it was an acceptable punishment in her culture. Never before had I thought seriously that reporting a case of abuse might not be in my patient’s best interest.
I wasn’t sure what to do. On one hand, I had more than just suspicion of parental violence against a child under age 18. On the other, reporting the abuse would clearly undermine this patient’s trust in me and possibly disrupt her life.
I asked my supervisor for help. “This is why mandatory reporting exists,” she told me. “The law helps you make the right decision despite your emotional connection to the child and the family. Your job is to recognize and report child abuse. It is Child Protective Services’ job to weigh the nuances of what you described and to determine if they need to intervene.”