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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
1x Speed
2x Speed
2. Abuse: Child, Elder & Intimate Partner
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Make a habit of two things: to help, or at least to do no harm.
~ Hippocrates
Deadly Silence
The Tragic Consequences of Failing to Report Abuse in Healthcare
Chapter 1: The Case
Dr. Emily Peterson, a pediatrician at the local hospital, had noticed something strange about one of her patients, a 10-year-old boy named Jacob. The boy had come in for a routine check-up, but Dr. Peterson had noticed some bruises on his arms and legs. When she asked him about them, he became visibly nervous and avoided eye contact. Dr. Peterson suspected that the boy was being abused at home and decided to report it to Child Protective Services (CPS).
However, when Dr. Peterson arrived at work the next day, she was shocked to find that her patient, Jacob, had died overnight. The cause of death was unclear, but Dr. Peterson suspected foul play.
Chapter 2: The Investigation Begins
The police were called in to investigate Jacob’s death, and Dr. Peterson was questioned about her suspicions of abuse. She told the police about the bruises she had noticed on Jacob and how she had reported it to CPS.
As the investigation continued, the police discovered that Jacob’s father had a history of domestic violence and had been arrested for assaulting his wife in the past. The police suspected that Jacob’s father had killed him and had staged it to look like an accident.
Chapter 3: Lessons Learned
As the investigation continued, it was discovered that Jacob’s father had been seeing a healthcare provider for several years and had never been reported for his history of domestic violence. The healthcare provider had been hesitant to report the abuse, thinking it was not their place to interfere in a family’s personal matters.
The healthcare provider’s failure to report the abuse had tragic consequences, and it became clear to everyone involved that mandatory reporting laws were essential to protecting vulnerable populations like children and the elderly.
Chapter 4: The Conclusion
As the investigation came to a close, Jacob’s father was arrested and charged with his murder. Dr. Peterson was hailed as a hero for her bravery in reporting the suspected abuse to CPS, and healthcare providers across the community were reminded of their obligation to report suspected abuse.
The case of Jacob’s death became a turning point for the healthcare community, as they learned the importance of mandatory reporting laws and the role they play in protecting vulnerable populations. It was a harsh reminder that silence can be deadly, and that healthcare providers have a responsibility to speak up and protect those who cannot protect themselves.
Abstract
Medical practitioners are required by law to report any suspected child or elder abuse to protective services. This is to protect vulnerable populations who cannot give informed consent or make medical decisions. This reporting is part of the patient-practitioner social contract and is not considered a breach of confidentiality. Intimate partners with decisional capacity are not considered vulnerable populations, and the practitioner must get their expressed consent before reporting abuse. If the victim is being coerced, the practitioner can make an exception based on professional principles of doing good and not causing harm. The government’s role in healthcare is to implement justice by protecting vulnerable populations and reducing healthcare disparities. In 1974, Congress passed the Child Abuse Prevention and Treatment Act which requires all states to prevent, identify, and treat child abuse and neglect.
**
Think
[2:1] Medical practitioners are mandatory reporters of child and elder abuse because minors and elders are considered vulnerable populations. There is no discretion as to whether or not to report abuse. By law, child and elder abuse must be reported. This social policy has been put in place so that protective services can immediately interview, judge, and intervene to protect and prevent any further harm to the victim. Although the practitioner has no authority to remove a child from parental custody, child protective services do have that authority. If the practitioner is sincerely and honestly reporting the suspected child or elder abuse to protective services, then there will be no legal liability, even if it turns out that there was no abuse.
[2:2] Confidentiality and privacy are two of the central components of the patient-practitioner relationship. Mandatory reporting laws are not justifiable breaches of that trust; rather, mandated reporting laws are part of the patient-practitioner social contract. This means that if a practitioner does not report a child or elder abuse incident, that would be a violation of the patient-centered, patient-practitioner social contract.
Assess
Patient: 1) Autonomy
[2:3] Informed consent is the practical application of the moral principle of autonomy which means self-rule. Competent adults have the legal, professional, and moral right to provide informed consent for practitioner authorization to provide medical treatment.
[2:4] Children are a vulnerable population because they cannot give informed consent or make medical decisions. The elderly, in contrast, are legally competent but may have compromised decisional capacity because of aging and their dependency on those who provide residence and care. Because minors lack competency, and the elderly may have diminished decisional capacity, and because both children and the elderly are dependent on others for their protection and care, both children and the elderly are legally categorized as vulnerable populations.
[2:5] Practitioners are mandated by law, profession, and morally to report to Child or Adult Protective Services if there is any reasonable cause to suspect that a child or elderly person has been abused or neglected no matter what the family members or other care givers may say in their own defense. In addition, even if the elderly person with decisional capacity objects to the report and does not provide informed consent, the practitioner is still mandated to report the potential elder abuse to Adult Protective Services. This is not a breach of patient-practitioner confidentiality because, by law and medical standards of care, child and elder abuse reporting is part of the patient-practitioner social contract.
[2:6] However, intimate partners, such as a spouse, with decisional capacity are not considered a vulnerable population. As a result, practitioners do not have the authority and legal protection to go against the victim’s lack of consent. Practitioners must get the expressed consent of the victim and document the consent authorization to report in the medical records before reporting to the police, or any other authority, as to do otherwise would be a breach of confidentiality and privacy of the patient-practitioner relationship, and a violation of autonomy (informed consent).
Practitioner: 2) Beneficence & 3) Nonmaleficence
[2:7] Based on the professional principle of beneficence (do good) and the professional principle of nonmaleficence (do no harm), the practitioner has the mandatory professional obligation to report child abuse to Child Protective Services and elder abuse to Adult Protective Services. This is based on the notion that reporting would be consistent with what a reasonable person would consider being in their best interests. Therefore, failure to report child or elder abuse violates the patient-practitioner relationship because mandated reporting laws are part of that social contract.
[2:8] In contrast, the practitioner with a possible intimate partner abuse must use the victim’s reasonable goals, values, and priorities when trying to determine what would be in the victim’s best interests. However, since the victim is generally the best person to know and assess what would be in their own best interests, it follows that the victim’s autonomous decision will generally be the standard for whether or not to report.
[2:9] If the practitioner judges that it would be best to report and the intimate partner victim does not consent or give authorization for the practitioner to report, then the practitioner should:
- 1. professionally enquire as to why and how the patient has arrived at their decision,
- 2. encourage the victim to report the abuse, and
- 3. make sure the patient has a safe place to retreat.
[2:10] However, if it is determined that the intimate partner victim is being coerced into not consenting to the reporting of the abuse, then that denial is not a freely determined autonomous refusal, and an exception can be made based on professional principles of beneficence (do good) and nonmaleficence (do no harm). When abuse is reported, patient confidentiality and privacy must be protected as much as possible by disclosing the minimal amount of information necessary.
[2:11] Every practitioner needs to know about and be able to direct the abused patient to community and private healthcare resources and safe locations in order to help avert any further harms caused by violence and abuse.
Public Policy: 4) Justice
[2:12] The role of government in healthcare is to implement justice (fair distribution of benefits and burdens) concerning health care disparities, including protecting vulnerable populations.
[2:13] In 1974, Congress passed the Child Abuse Prevention and Treatment Act, which required all states “to prevent, identify and treat child abuse and neglect.” State governments meet this requirement with Child Protective Services (CPS), also known in some states as the Department of Children and Family Services (DCFS). Adult Protective Services (APS) provides social services for abused, neglected, or exploited older adults and adults with significant disabilities.
[2:14] The Belmont Report, formalized by the National Commission for the Protection of Human Subjects, was implemented into federal law by the Department of Health, Education, and Welfare, in 1979 as Common Rule 45CFR46. The Belmont Report defines five categories of vulnerable human populations that require increased protection:
- 1. children,
- 2. pregnant females,
- 3. prisoners,
- 4. mentally disabled, and
- 5. other vulnerable groups.
[2:15] Common Rule 45CFR46 also provides federal protections for confidentiality and privacy concerns that are part of the patient-practitioner protected health information (PHI) and legislates that whenever there are audio and video recordings, extra precautions must also be in place in order to make sure confidentiality and privacy are not breached.
[2:16] Mandating reporting is an attempt of the government to assure that federal and state services are available for interviewing, judging, and intervening to protect vulnerable populations that are found to be at risk by the very people whose duty was to protect, nurture and provide care.
Conclude
[2:17] Medical practitioners that sincerely and honestly suspect elder or child abuse must always report the incident to Child or Adult Protective Services regardless of others’ explanations in their defense. Responses such as: “encourage the victim to report” or “encourage discussion” will always be incorrect. In contrast, with an intimate partner or spousal abuse, the correct response would be: “encourage the victim to report.”
[2:18] In summary, medical practitioners must be vigilant in recognizing and reporting suspected abuse cases involving children, the elderly, and intimate partners. Mandatory reporting is a crucial aspect of the patient-practitioner social contract, aiming to protect vulnerable populations and uphold the principles of beneficence and nonmaleficence. For cases involving intimate partners with decisional capacity, practitioners should encourage the victim to report the abuse and provide resources for support. Ultimately, healthcare professionals play a crucial role in safeguarding the well-being of those who may be unable to protect themselves.
(For more information on mandatory reporting, see: 22. Gunshot Wounds)
**
2. Review Questions
1. Practitioners have the authority to remove a child from parental custody if the practitioner sincerely and honestly believes that the child is being abused.
2. Before reporting to Child or Adult Protective Services, it is legally, professionally, and ethically mandatory for practitioners to inquire with family members and caregivers to get an explanation.
3. Failure to report child or elder abuse violates the patient-practitioner relationship because mandated reporting laws are part of that social contract.
4. Mandatory reporting requires that the practitioner reports intimate partner abuse regardless of whether or not the victim consents.
5. In 1974, Congress passed the Child Abuse Prevention and Treatment Act, which requires that all states: “prevent, identify, and treat child abuse and neglect.”
6. If a practitioner sincerely and honestly suspects elder or child abuse, then the correct answer will be which of the following:
7. If a practitioner sincerely and honestly suspects intimate partner abuse, then the correct answer will be which of the following:
**
CORRECT! 🙂
[2:1] Practitioners are mandatory reporters of child and elder abuse because minors and elders are considered vulnerable populations. There is no discretion as to whether or not to report abuse. By law, child and elder abuse must be reported. This social policy has been put in place so that protective services can immediately interview, judge, and intervene to protect and prevent any further harm to the victim. Although the practitioner has no authority to remove a child from parental custody, child protective services do have that authority. As long as the practitioner is sincerely and honestly reporting the suspected child or elder abuse to protective services, there will be no legal liability, even if it turns out that there was no abuse.
Wrong 😕
[2:1] Practitioners are mandatory reporters of child and elder abuse because minors and elders are considered vulnerable populations. There is no discretion as to whether or not to report abuse. By law, child and elder abuse must be reported. This social policy has been put in place so that protective services can immediately interview, judge, and intervene to protect and prevent any further harm to the victim. Although the practitioner has no authority to remove a child from parental custody, child protective services do have that authority. As long as the practitioner is sincerely and honestly reporting the suspected child or elder abuse to protective services, there will be no legal liability, even if it turns out that there was no abuse.
CORRECT! 🙂
[2:5] Practitioners are mandated by law, profession, and morally to report to Child or Adult Protective Services if there is any reasonable cause to suspect that the child or elderly person has been abused or neglected no matter what the family members say in their defense. In addition, even if the elderly person with decisional capacity objects to the report and does not provide their informed consent, the practitioner is still mandated to report the elder abuse to Adult Protective Services. This is not a breach of patient-practitioner confidentiality because, by law and medical standards of care, child and elder abuse reporting is part of the patient-practitioner social contract.
Wrong 😕
[2:5] Practitioners are mandated by law, profession, and morally to report to Child or Adult Protective Services if there is any reasonable cause to suspect that the child or elderly person has been abused or neglected no matter what the family members say in their defense. In addition, even if the elderly person with decisional capacity objects to the report and does not provide their informed consent, the practitioner is still mandated to report the elder abuse to Adult Protective Services. This is not a breach of patient-practitioner confidentiality because, by law and medical standards of care, child and elder abuse reporting is part of the patient-practitioner social contract.
CORRECT! 🙂
[2:7] Based on the professional principle of beneficence (do good) and the professional principle of nonmaleficence (do no harm), the practitioner has the mandatory professional obligation to report child abuse to Child Protective Services and elder abuse to Adult Protective Services. This is based on the notion that reporting would be consistent with what a reasonable person would consider being in their best interests. Therefore, failure to report child or elder abuse violates the patient-practitioner relationship because mandated reporting laws are part of that social contract.
Wrong 😕
[2:7] Based on the professional principle of beneficence (do good) and the professional principle of nonmaleficence (do no harm), the practitioner has the mandatory professional obligation to report child abuse to Child Protective Services and elder abuse to Adult Protective Services. This is based on the notion that reporting would be consistent with what a reasonable person would consider being in their best interests. Therefore, failure to report child or elder abuse violates the patient-practitioner relationship because mandated reporting laws are part of that social contract.
CORRECT! 🙂
[2:6] However, intimate partners, such as a spouse, with decisional capacity are not considered a vulnerable population. As a result, practitioners do not have the authority and legal protections to go against the victim’s lack of consent. practitioners must get the express consent of the victim and document the consent authorization to report in the medical records before reporting to the police, or any other authority, as to do otherwise would be a breach of confidentiality and privacy of the patient-practitioner relationship, and a violation of autonomy (informed consent).
Wrong 😕
[2:6] However, intimate partners, such as a spouse, with decisional capacity are not considered a vulnerable population. As a result, practitioners do not have the authority and legal protections to go against the victim’s lack of consent. practitioners must get the express consent of the victim and document the consent authorization to report in the medical records before reporting to the police, or any other authority, as to do otherwise would be a breach of confidentiality and privacy of the patient-practitioner relationship, and a violation of autonomy (informed consent).
CORRECT! 🙂
[2:13] In 1974, Congress passed the Child Abuse Prevention and Treatment Act, which required all states “to prevent, identify and treat child abuse and neglect.” State governments meet this requirement with Child Protective Services (CPS), also known in some states as the Department of Children and Family Services (DCFS). Adult Protective Services (APS) provides social services for abused, neglected, or exploited older adults and adults with significant disabilities.
Wrong 😕
[2:13] In 1974, Congress passed the Child Abuse Prevention and Treatment Act, which required all states “to prevent, identify and treat child abuse and neglect.” State governments meet this requirement with Child Protective Services (CPS), also known in some states as the Department of Children and Family Services (DCFS). Adult Protective Services (APS) provides social services for abused, neglected, or exploited older adults and adults with significant disabilities.
CORRECT! 🙂
[2:17] For the Medical Board exams, if the practitioner sincerely and honestly suspects elder or child abuse, then the correct answer will be that the practitioner must always report the incident to Child or Adult Protective Services regardless of other’s explanations in their defense. Answers such as: “encourage the victim to report” or “encourage discussion” will always be incorrect. In contrast, if a question comes up regarding intimate partner or spousal abuse, then the correct answer will usually be: “encourage the victim to report.”
Wrong 😕
[2:17] If the practitioner sincerely and honestly suspects elder or child abuse, then = the practitioner must always report the incident to Child or Adult Protective Services regardless of other’s explanations in their defense. Responses such as: “encourage the victim to report” or “encourage discussion” will always be incorrect. In contrast, with regard to intimate partner or spousal abuse, then the correct response will usually be: “encourage the victim to report.”
CORRECT! 🙂
[2:17] If the practitioner sincerely and honestly suspects elder or child abuse, then the practitioner must always report the incident to Child or Adult Protective Services regardless of other’s explanations in their defense. Responses such as: “encourage the victim to report” or “encourage discussion” will always be incorrect. In contrast, with regard to intimate partner or spousal abuse, then the correct response will usually be: “encourage the victim to report.”
Wrong 😕
[2:17] If the practitioner sincerely and honestly suspects elder or child abuse, then the practitioner must always report the incident to Child or Adult Protective Services regardless of other’s explanations in their defense. Responses such as: “encourage the victim to report” or “encourage discussion” will always be incorrect. In contrast, with regard to intimate partner or spousal abuse, then the correct response will usually be: “encourage the victim to report.”
2. Clinical Vignettes
1. Ms. Aurora Cooper, an 8-year-old elementary student walks into a clinic, and the practitioner notices bruises and signs of abuse on the patient's body. The practitioner suspects that the patient is a victim of child abuse and is mandated by law to report it to child protective services. What is the practitioner's role and responsibility in this situation, according to the laws and regulations surrounding mandatory reporting of child abuse?
2. A practitioner is conducting a routine check-up on Ms. Lila Hensley, an 82-year-old female who lives with their adult daughter. During the examination, the practitioner notices bruises on the patient's arms that are inconsistent with the explanation given by the daughter. The daughter asserts that the bruises result from a fall and that the patient is “clumsy." What should the practitioner do in this situation?
3. Ms. Greta Green, a 26-year-old musician comes to you seeking medical treatment for an injury they sustained during a physical altercation with their intimate partner. The patient does not want to involve the police or any other authority and refuses to provide informed consent for you to report the incident. What is the practitioner's most appropriate course of action?
4. Mr. Tony Roberts, a 79-year-old retiree comes to you with bruises and other signs of physical abuse. After a thorough evaluation, you suspect the patient is a victim of elder abuse. The elderly victim refuses to provide informed consent for you to report the abuse. How does mandatory reporting of elder abuse impact informed consent in the patient-practitioner relationship?
5. Mr. Eli Adams, a 9-year-old elementary student comes to the clinic with multiple bruises and other signs of physical abuse. After a thorough evaluation, you suspect the patient is a victim of child abuse. What are the main purposes of the Child Abuse Prevention and Treatment Act (CAPTA) and the role of Child Protective Services (CPS)?
Wrong 😕
Explanation: The practitioner's role and responsibility in reporting suspected child abuse is governed by laws and regulations surrounding mandatory reporting. According to these laws, the practitioner's duty is to report the suspected abuse to child protective services, and they are protected from legal liability if they are sincerely and honestly reporting the abuse [2:1]. However, practitioners do not have the authority to remove the child from parental custody, nor are they allowed to choose not to report the suspected abuse, even if they are uncertain of its validity [2:1]. Failure to report any suspicion of child abuse to child protective services can result in legal consequences [2:1].
CORRECT! 🙂
Explanation: The practitioner's role and responsibility in reporting suspected child abuse is governed by laws and regulations surrounding mandatory reporting. According to these laws, the practitioner's duty is to report the suspected abuse to child protective services, and they are protected from legal liability if they are sincerely and honestly reporting the abuse [2:1]. However, practitioners do not have the authority to remove the child from parental custody, nor are they allowed to choose not to report the suspected abuse, even if they are uncertain of its validity [2:1]. Failure to report any suspicion of child abuse to child protective services can result in legal consequences [2:1].
Wrong 😕
Explanation: In this situation, the practitioner has a legal and ethical obligation to report any suspicion of elder abuse to Adult Protective Services, even if the patient objects and the daughter provides a defense for the bruises [2:5]. Failure to report the suspected abuse can result in harm to the patient [2:5]. The patient's objection or the daughter's explanation for the bruises does not absolve the practitioner of their responsibility to report the suspected abuse [2:5]. Asking the patient for permission to report the suspected abuse is not necessary because the practitioner has a mandatory reporting requirement and does not need the patient's consent to make the report [2:5]. Ignoring the bruises and not reporting the suspected abuse is not a responsible or ethical course of action [2:5].
CORRECT! 🙂
Explanation: In this situation, the practitioner has a legal and ethical obligation to report any suspicion of elder abuse to Adult Protective Services, even if the patient objects and the daughter provides a defense for the bruises [2:5]. Failure to report the suspected abuse can result in harm to the patient [2:5]. The patient's objection or the daughter's explanation for the bruises does not absolve the practitioner of their responsibility to report the suspected abuse [2:5]. Asking the patient for permission to report the suspected abuse is not necessary because the practitioner has a mandatory reporting requirement and does not need the patient's consent to make the report [2:5]. Ignoring the bruises and not reporting the suspected abuse is not a responsible or ethical course of action [2:5].
CORRECT! 🙂
Explanation: In this scenario, the practitioner's most appropriate course of action is to respect the patient's wishes and not report the incident to the police or any other authority, as the patient has not provided informed consent [2:6]. However, the practitioner should document the patient's report of intimate partner violence and their refusal to involve the police or other authorities in the medical records [2:6]. The practitioner should also provide the patient with information on available resources for victims of intimate partner violence, including counseling and advocacy services [2:11]. The practitioner should not refuse to treat the patient and refer them to another practitioner, as this may put the patient at further risk of harm [2:6]. The practitioner should provide information to the patient about available resources, including safe places to go, and offer support and referrals to appropriate services [2:11]. The practitioner should also document the patient's report of intimate partner violence in the medical records [2:6].
Wrong 😕
Explanation: In this scenario, the practitioner's most appropriate course of action is to respect the patient's wishes and not report the incident to the police or any other authority, as the patient has not provided informed consent [2:6]. However, the practitioner should document the patient's report of intimate partner violence and their refusal to involve the police or other authorities in the medical records [2:6]. The practitioner should also provide the patient with information on available resources for victims of intimate partner violence, including counseling and advocacy services [2:11]. The practitioner should not refuse to treat the patient and refer them to another practitioner, as this may put the patient at further risk of harm [2:6]. The practitioner should provide information to the patient about available resources, including safe places to go, and offer support and referrals to appropriate services [2:11]. The practitioner should also document the patient's report of intimate partner violence in the medical records [2:6].
Wrong 😕
Explanation: The mandatory reporting of elder abuse does not necessarily impact informed consent in the patient-practitioner relationship because it is part of the patient-practitioner public policy social contract which includes compliance to the law and the professional principles of beneficence (do good) and nonmaleficence (do no harm) [2:2]. While the patient has the right to refuse informed consent for reporting the abuse, the practitioner has a legal and ethical obligation to report suspected elder abuse to the appropriate authorities [2:7]. This obligation is based on the duty to protect vulnerable individuals from harm and prevent further abuse or neglect [2:7]. In cases where the patient is unable or unwilling to provide informed consent, the practitioner should follow the legal and ethical requirements for mandatory reporting of elder abuse and ensure that the patient is aware of their rights and available resources [2:5]. Reporting elder abuse does not necessarily go against the principle of confidentiality, as reporting is typically done in a confidential manner and with respect for the patient's privacy [2:2].
CORRECT! 🙂
Explanation: The mandatory reporting of elder abuse does not necessarily impact informed consent in the patient-practitioner relationship because it is part of the patient-practitioner public policy social contract which includes compliance to the law and the professional principles of beneficence (do good) and nonmaleficence (do no harm) [2:2]. While the patient has the right to refuse informed consent for reporting the abuse, the practitioner has a legal and ethical obligation to report suspected elder abuse to the appropriate authorities [2:7]. This obligation is based on the duty to protect vulnerable individuals from harm and prevent further abuse or neglect [2:7]. In cases where the patient is unable or unwilling to provide informed consent, the practitioner should follow the legal and ethical requirements for mandatory reporting of elder abuse and ensure that the patient is aware of their rights and available resources [2:5]. Reporting elder abuse does not necessarily go against the principle of confidentiality, as reporting is typically done in a confidential manner and with respect for the patient's privacy [2:2].
CORRECT! 🙂
Explanation: The main purposes of the Child Abuse Prevention and Treatment Act (CAPTA) are to prevent, identify, and treat child abuse and neglect, and to ensure that states have the necessary resources to fulfill this purpose [2:13]. The role of Child Protective Services (CPS) is to investigate reports of suspected child abuse and neglect and to provide social services and support to families in need [2:1]. CPS works with law enforcement and other agencies to ensure the safety and well-being of children who have been victims of abuse or neglect, and may remove children from their homes if necessary to protect them from further harm [2:1]. Additionally, CAPTA provides funding for research on child abuse and neglect and supports the development of effective prevention and intervention programs [2:13]. The ultimate goal of CAPTA and CPS is to ensure that all children are safe and protected from abuse and neglect [2:1].
Wrong 😕
Explanation: The main purposes of the Child Abuse Prevention and Treatment Act (CAPTA) are to prevent, identify, and treat child abuse and neglect, and to ensure that states have the necessary resources to fulfill this purpose [2:13]. The role of Child Protective Services (CPS) is to investigate reports of suspected child abuse and neglect and to provide social services and support to families in need [2:1]. CPS works with law enforcement and other agencies to ensure the safety and well-being of children who have been victims of abuse or neglect, and may remove children from their homes if necessary to protect them from further harm [2:1]. Additionally, CAPTA provides funding for research on child abuse and neglect and supports the development of effective prevention and intervention programs [2:13]. The ultimate goal of CAPTA and CPS is to ensure that all children are safe and protected from abuse and neglect [2:1].
Wrong 😕
B. The practitioner must report suspected elder abuse after informed consent.
If possible, the practitioner should encourage the suspected abused patient to give informed consent. However, because the practitioner is a mandatory reporter, regardless of getting or not getting informed consent, the practitioner must report the suspected abuse to state Adult Protective Services (or some other name) as mandated by federal law.
Wrong 😕
C. Family inquiry is important before reporting suspected elder abuse.
As a mandatory reporter, the practitioner must report suspected elder abuse regardless of any communication or justification by family members. It is the responsibility of Adult Protective Services to conduct an inquiry.
**
2. Cases: 2a, 2b
Instructions
1. Read Prompt, 2. Think, Assess, & Conclude (TAC), then 3. Select an answer that mirrors the TAC conclusion.
Note: After success, select each of the wrong answers to understand why each of them is wrong.
2a
An elderly patient presents with a fractured wrist and oval-shaped bruises on the patient’s arms. The patient’s adult offspring, who provides a place to live and cares for the patient, reports that the patient fell. The patient was admitted to the hospital six months earlier with a dislocated shoulder. In a private conversation with the patient, it is revealed that the patient’s offspring caused the injuries, but the patient is adamant about not reporting the situation as the patient is dependent on this offspring for housing, food, and care.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2b
An adult with a spouse comes into the office for a routine physical check-up. The patient has new and old bruises. In a private conversation with the patient, it is revealed that the spouse caused the injuries, but the patient is adamant about not reporting the situation as the patient is dependent on the spouse for housing, food, and care.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
CORRECT! 🙂
THINK (Question)
Does the practitioner have to report suspected elder abuse?
ASSESS
- • Patient Autonomy (informed consent)
Children and the elderly are considered vulnerable populations, giving more weight to Federal and State protection laws than to informed consent. - • Practitioner Beneficence (do good) & Nonmaleficence (do no harm)
Practitioners are mandatory reporters for suspected child or elder abuse. - • Public-Policy Justice (be fair)
Federal and State law requires practitioners to report suspected child and elder abuse to Child and Adult Protective Services (or something similar), who are charged with conducting their investigation.
CONCLUDE
The practitioner must report suspected elder abuse.
Wrong 😕
D. With sufficient explanation it is not necessary to report suspected elder abuse.
As a mandatory reporter, the practitioner must report suspected elder abuse regardless of any communication or justification by family members. It is the responsibility of Adult Protective Services to conduct an inquiry.
Wrong 😕
A. The practitioner should immediately report the suspected intimate partner abuse.
Since the patient is not a protected, vulnerable population, the practitioner should first encourage the patient to report the abuse. If the patient refuses to report, then the practitioner should offer to report the abuse for them, if and only if the patient provides informed consent.
Wrong 😕
B. The practitioner should perform a citizen’s arrest on the perpetrator of the suspected intimate partner abuse.
Making arrests is not part of the medical practitioner’s professional responsibilities as a healthcare provider.
Wrong 😕
C. The practitioner should report the suspected intimate partner abuse as the intimate partner is economically vulnerable.
Economic dependency is not a federal or state category of a vulnerable population.
CORRECT! 🙂
THINK (Question)
Does the physician have to report intimate partner abuse?
ASSESS
- • Patient Autonomy (informed consent)
Since the patient is not part of a recognized vulnerable population, the practitioner must get the expressed consent of the victim and document the consent authorization to report the abuse in the medical records before reporting to the police, or any other authority, as to do otherwise would be a breach of confidentiality and privacy of the patient-practitioner relationship, a violation of autonomy (informed consent). - • Practitioner Beneficence (do good) & Nonmaleficence (do no harm)
If the suspected intimate partner abuse patient does not want to report the abuse, then the practitioner has the professional responsibility to:
1. enquire as to why and how the patient has arrived at their decision,
2. encourage the victim to report the abuse, and
3. make sure the patient has a safe place to retreat in order to help avert any further harm caused by violence and abuse. - • Public-Policy Justice (be fair)
The practitioner does not have the legal authority and protections to go against the victim’s lack of consent.
CONCLUDE
The practitioner should get informed consent before reporting the suspected intimate partner abuse.
