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This article prepared by family law specialists outlines the implications for the medical profession of the mandatory reporting of child physical and sexual abuse. Although focused on recent Victorian Government legislation, the context is relevant to all doctors in Australia subject to mandatory reporting legislation.
Most Australian jurisdictions have mandatory reporting legislation to compel members of selected professional groups, including nurses, to report suspicions that a child has been or is likely to be subjected to abuse or neglect. This article details the legal obligations of nurses in each jurisdiction, and highlights differences between jurisdictions. Problematic features of the laws are identified, including the use of ambiguous concepts like "reasonable" suspicion and "significant" harm. Literature is reviewed to identify what is known about nurses' legal knowledge, actual reporting practice, and the practical problems that arise for nurses in this context. It is concluded that empirical research needs to be conducted, because it is not known if the laws are practically effective, whether nurses have sufficient training in, and knowledge of, their reporting duties, or what factors influence sound reporting. Such research can inform both the development of sound training systems and recommendations for legal reform.
STUDY OBJECTIVE: As of March 1994, 45 states had laws that, to varying extents, required health practitioners to report cases of domestic violence (DV). Colorado passed a mandatory DV reporting law in 1995. Laws that mandate police involvement in cases of DV injuries have been criticized because of concerns that these laws deter victims from seeking medical care. We hypothesized that these laws would deter DV victims from seeking medical care. METHODS: A questionnaire was administered in 3 stages: stage 1, convenience time blocks at 2 emergency departments and a primary care clinic; stage 2, prospective randomized blocks at an inner-city ED; and stage 3, a targeted population of women at risk for DV. All English-speaking, noncritical adult patients who presented during the time blocks were eligible to participate. RESULTS: Five hundred seventy-seven patients participated; 55% of the patients were aware of the mandatory DV reporting law. Twenty-seven percent of the patients would be more likely to seek medical care because of this law. Only 12% of patients stated that they would be less likely to seek medical care for a DV-related injury because of this law (15% of men and 9% of women; P =.001). There was no difference between ED patients and targeted female patients at risk for DV in seeking medical care ( P =.833). CONCLUSION: Only rarely did mandatory reporting laws appear to adversely affect a patient's decisions to seek medical care in this study. The benefits of mandatory reporting must be measured to assure that they justify deterrence to a small minority of patients.
In Switzerland, the first case of bovine spongiform encephalopathy (BSE) was diagnosed in November 1990. Case numbers peaked in 1995, with a total of 352 BSE cases identified by 30 April 2000. Reporting of clinically suspect cattle is currently the most commonly used method world-wide to detect BSE cases. The effectiveness of mandatory reporting depends on a variety of factors; for other diseases passive surveillance underestimates the incidence of clinical cases. The efficiency of passive surveillance systems for BSE will remain unknown until screening tests able to identify clinically affected cattle have been applied in several countries. This paper provides the first detailed description of a targeted screening programme for BSE. Two populations of cows >24 months of age were included in the targeted screening: (i) cows found dead or culled on site where the carcass was submitted to rendering (fallen stock) and (ii) cows with health-related problems unfit for routine slaughter that were slaughtered under emergency procedures (emergency slaughter). Between 1992 and 1999, on average 81 clinical BSE suspects per year were reported to the veterinary authorities (passive surveillance), of which 43% were confirmed with BSE. A total of 30 clinical cases were captured by passive surveillance and an additional 20 BSE cases detected by targeted screening between May 1999 and April 2000. The odds of finding a BSE case was 49 times higher in the fallen stock and 58 times higher in emergency-slaughtered cattle when compared to passive surveillance. The targeted screening of fallen stock and emergency-slaughtered cattle considerably increased the number of detected cases in this 12-month period. Targeted-screening cases were on average 4 months younger than the clinical suspect cases. In conclusion, post-mortem testing of fallen stock and emergency-slaughtered cows >24 months for BSE is an important active surveillance element within a total surveillance system that principally is based on mandatory reporting of clinical suspect cases. Without ante-mortem screening tests to detect BSE-infected cattle during the incubation period, a combination of effectively functioning passive and active BSE surveillance strategies might be the only approach to assess the BSE situation reliably in a given country or region - and it is necessary to substantiate claims of freedom from the disease.
We evaluated physicians' responses to state elder abuse reporting statutes. Most statutes require reporting without providing for adequate investigation and service delivery. The Alabama Protective Services Act of 1976 is typical. Survey responses by Alabama physicians suggest that they have reservations about their ability to diagnose abuse, the operation of the law, and their willingness to report abuse. It appears that, in Alabama, mandatory reporting by itself is counterproductive because the statute fails to provide for adequate investigation and service delivery or to command knowledgeable compliance.
Mandatory reporting laws have created a difficult dilemma for many mental health providers (MHPs). Professional ethics, confidentiality, and the best interests of the client are often seen as conflicting with the legal obligation to report child abuse. The receptivity of child protective service (CPS) agencies to three alternative MHP reporting strategies was assessed in a national survey. The results indicate strong support for the current model of reporting and marginal support for alternatives that supply the MHP and the family with more latitude in determining when to report and how reports are handled. The results are discussed in relation to what many MHPs see as the need for more integrated, flexible, and cooperative approaches to the protection of abused and neglected children.
This article presents a unique approach to analyzing the issue of mandatory reporting suspected child abuse from an ethical decision-making perspective with a nursing model. Sometimes nurses confront this problem in their own families or in their neighborhoods or social groups. Clearly, deciding to intervene is a challenging and difficult process. Yet reporting is mandated by law. A model of ethical decision-making may guide the clinician in this process.
In New South Wales Australia, in July 1987, the category of professionals required to report suspected cases of child sexual assault to the Department of Family and Community Services was extended to include teachers and other school professionals. This paper reports on the impact of the process associated with the enactment of the new mandatory reporting requirements on the reporting behavior of the new mandatory notifiers. There was a significant increase in the number and proportion of reports of suspected sexual assault received from teachers. At the same time there has been no change in the quality of teachers' reports, as measured by the percentage of reports which are verified on assessment.
In Switzerland and in the Federal Republic of Germany the reporting of HIV infections is based on an anonymous mandatory reporting system for laboratories. In Switzerland, physicians have to complete a questionnaire on the patient's clinical status and risk behaviour. To make a rough estimate of the prevalence of HIV infections in the general population at low risk, data on blood donations are used in both countries. In Switzerland, additional data with information on positive and negative test results have been obtained since 1985 from anonymous test sites. In both countries, the data do not show evidence of an increasing incidence of HIV infection. The number of positive test results reported by the laboratories and physicians remains stable, and the rates of HIV-positive blood donations are declining. In the Federal Republic of Germany, homo-/bisexual men play the most important role in the epidemic, whilst in Switzerland, injecting drug users contribute most to the burden of HIV infection, and the proportion of persons probably heterosexually infected is increasing steadily. Possible selection biases need to be further discussed.
Psychiatric home healthcare nurses (PHHNs) work directly with clients and their families in the community and serve as consultants to other home health nurses when concerns of mental health arise. They must be able to identify areas of possible or actual family violence or abuse and intervene appropriately. They must be cognizant of the laws regarding abuse reporting in their states. Decisions to report abuse are practical and moral and, when combined with legal imperatives, create ethical dilemmas for healthcare professionals. Guidelines are presented to help PHHNs understand the complex issues associated with mandatory reporting of abuse.
Human babesiosis, caused by parasitic protozoa of erythrocytes, has escaped usual associates--lower mammals. Thriving in tick guts, it has spread inland from the coasts of America, adopting mankind as a host. Babesia spp. threaten life quality of unsuspecting humans in quickly expanding territories worldwide, including the state of Pennsylvania, USA. The causative spirochetes of Lyme disease often similarly co-exist in ticks. Singly or together they may, by causing persistent and chronic infections, duplicate any symptom in the medical literature--including depression and hypochondriasis. Physicians practicing throughout Pennsylvania have identified patients with symptomatic babesiosis, but without governmental surveillance or health registries that require doctors to consider and report babesiosis, these cases have not prompted epidemiological concern. Misunderstandings such as, "Isn't that an obscure tropical disease?" are usual responses when doctors are asked about babesiosis, inadvertently trivializing patients and disease. Mandatory reporting of babesiosis should now be considered a medical necessity.
Alabama emergency department personnel were surveyed in 1988 concerning elder abuse and Alabama's mandatory reporting and protective services law. Most ED personnel did not understand the requirements of the law. While emergency physicians, registered nurses, and licensed practical nurses had seen cases of elder abuse in their careers, differences existed in their satisfaction with the disposition of cases reported to state authorities. Licensed practical nurses and physicians reported greater satisfaction with the response received; registered nurses were much less satisfied. However, all accepted responsibility for reporting elder abuse. ED registered nurses and emergency physicians were divided on the degree to which they could diagnose elder abuse, did not believe there were sufficient services to care for those who had been abused, and were unsure whether there were procedures for reporting cases of elder abuse. All ED personnel need to know that cases they report will result in protection of abuse victims.
BACKGROUND: In 2004, the Commonwealth of Pennsylvania mandated hospitals to report healthcare-associated infections (HAIs). The increased workload led our Infection Control staff to collaborate with Atlas, a group of chart abstractors. OBJECTIVE: The objective of this study was to assess our first year of experience with mandatory reporting of HAIs--specifically, to assess Atlas' contribution to surveillance. DESIGN: Cases were selected if they had 1 or more of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes designated by Pennsylvania as a possible HAI. After training by the Infection Control staff, Atlas applied National Nosocomial Infection Surveillance (NNIS) system case definitions for catheter-associated urinary tract infections (UTIs) and surgical site infections (SSIs), and they applied NNIS chest imaging criteria to eliminate cases that were not ventilator-associated pneumonia (VAP). To assess Atlas' performance, Infection Control staff conducted a parallel review. RESULTS: For discharges from the hospital during the fourth quarter of 2004, a total of 410 UTIs, 59 SSIs, and 56 VAPs were identified on the basis of state-designated ICD-9-CM codes; review by Atlas/Infection Control determined that 15%, 15%, and 16% of cases met case definitions, respectively. Of cases reviewed by both Infection Control and Atlas, 87% of the assessments made by Atlas were correct for UTI, and 96% were correct for SSI. For VAP, Infection Control concluded that 39% of cases could be ruled out on the basis of chest imaging criteria; Atlas correctly dismissed these 12 cases but incorrectly dismissed an additional 6 (error, 19%). Surveillance was not timely: 1-2 months elapsed between the time of HAI onset and the earliest case review. CONCLUSIONS: With ongoing training by Infection Control, Atlas successfully demonstrated a role in retrospective HAI surveillance. However, despite a major effort to comply with mandates, time lags and other design limitations rendered the data of low utility for Infection Control. States that are planning HAI-reporting programs should standardize an efficient surveillance methodology that yields data capable of guiding interventions to prevent HAI.
OBJECTIVES: This study describes active duty military (ADM) women's beliefs and preferences concerning domestic violence (DV) policy in the military. METHODS: Telephone interviews were completed with 474 ADM women from all services, 119 of whom had experienced DV during their military service. RESULTS: A majority (57%) supported routine screening. Although 87% said the military's policy on mandatory reporting should remain the same, only 48% thought abuse should be reported to the commanding officer; abused women were significantly less likely than nonabused women to agree with this aspect of the policy. ADM women's beliefs were similar to those of women in a previously studied civilian sample, except that 73% of ADM compared to 43% of civilian women thought routine screening would increase women's risk of further abuse. CONCLUSIONS: ADM women recognized both advantages and disadvantages of current DV policies. More research is urgently needed about actual outcomes of screening and reporting policies.
As of January 1994, California physicians are required to report to police all patients who are suspected to be victims of domestic violence. This article describes the results from a focus group study of abused women (n = 51) that explored their experiences with and perspectives on medical care. The eight focus groups included two Latina (total n = 14), two Asian (total n = 14), two African-American (total n = 9), and two Caucasian (total n = 14) groups of women who had been the victims of domestic abuse within the previous 2 years. The women were recruited through community-based organizations in the San Francisco Bay Area. With regard to physician reporting of domestic violence to police, five themes were identified: fear of retaliation by the abuser, fear of family separation, mistrust of the legal system, desire for police protection, and preference for confidentiality and autonomy in the patient-health professional relationship. Our results indicate that mandatory reporting may pose a threat to the safety and well-being of abused women and may create barriers to their seeking help and communicating with health care professionals about domestic violence.
OBJECTIVE: Hepatitis C is a major cause of liver disease in European countries. We aimed to assess the current and future disease burden of hepatitis C. SETTING: A representative data set of hepatitis C was applied to a validated computer model. METHODS: The mandatory reporting of positive hepatitis C virus (HCV) test results by all medical laboratories in Switzerland and the clinical data obtained by questionnaire for each positive test from the treating physicians created a unique, representative epidemiological database allowing the determination of the age distribution of acute (i.e. newly acquired) and chronic HCV infections. Based on these data and a simulation model of the natural history of hepatitis C, we estimated the prevalence of HCV infection, future morbidity/mortality from cirrhosis/hepatocellular carcinoma and costs. RESULTS: Our analysis estimates a prevalence of anti-HCV in Switzerland of 1.25-1.75%, which is slightly higher than prior reports (0.5-1%) derived by extrapolation from selected populations. Although new HCV infections decreased after 1990, our analysis predicts that HCV-related morbidity and mortality will increase by 70-90%, reaching a maximum in 2015-2020, largely from complications in cases already prevalent in 1998. The model predicts that the incidence of cirrhosis will begin to decrease after 2005-2010. Antiviral treatment reduces disease burden by approximately 5%. Undiscounted HCV-related annual direct costs will more than double and reach a maximum of almost US$33 million in 2020. CONCLUSIONS: The incidence of HCV-related cirrhosis is predicted to decrease after 2005-2010, while disease burden and costs due to complications are estimated to continue to increase until 2015-2020.
OBJECTIVES: To assess emergency physician reporting patterns in Oregon before and after the passage of a mandatory intoxicated driving reporting law. METHODS: A one-page survey was mailed to 504 emergency physicians in Oregon in April 2004. Data on reporting frequency were collected using a four-point ordinal scale regarding motor vehicle crash-involved drivers (MIDs) and intoxicated persons attempting to drive away from the emergency department (DAEDs). Paired observations were assessed for a stated increase in reporting activity following passage of the law using the Wilcoxon signed-rank test. Associations of postlaw reporting and demographic and knowledge factors were sought using Spearman rank correlation analysis. RESULTS: Of the 504 surveys mailed, 298 (59%) were adequate for analysis. Many respondents (57%) were already aware of the law. Most (92%) agreed that physicians should be mandated to report some crimes. MIDs were always reported by 18% of physicians before the law and by 47% afterward, whereas DAEDs were always reported by 56% of physicians before the law and by 69% afterward. Emergency medicine-trained physicians, higher emergency department census, and increased years of experience were associated with a significantly higher increase in reporting pattern after passage of the law for both MIDs and DAEDs. CONCLUSIONS: Although 44% of responding emergency physicians in Oregon were unaware of a mandated reporting law for intoxicated drivers presenting to the ED, most physicians stated an increase in their reporting practice.