Sexual abuse and mandatory reporting.
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ECT in Texas: 19 months of mandatory reporting.
BACKGROUND: Texas law requires that all non-federal clinical facilities providing electroconvulsive therapy (ECT) report every treatment to the state's mental health agency. The resulting data provide total population information about treating physicians and hospitals; payment source; patient age, sex, ethnicity, diagnosis, and admission/consent status; symptom severity and response; numbers and types of treatments; and untoward events occurring within 14 days after treatment. METHOD: We reviewed all reports of ECT between September 1993 and April 1995 (2583 reports, approximately 15,240 treatments). RESULTS: About 6% (N = 117) of Texas psychiatrists performed ECT during the period, at 50 hospitals. One of 13 state-funded mental institutions performed ECT on-site; some occasionally contracted with private hospitals. Almost all patients (88.1%) were white. Some older age groups received proportionately more ECT than younger groups, but no sharp increase was associated with eligibility for Medicare. Five patients were less than 18 years of age; 70.3% were female. Virtually all patients (99.0%) consented to the treatment themselves (rather than by guardian), including committed-but-consenting patients (1.5%). Reports (5.8%) described multiple-monitored treatment (MMECT, not depatterning). Group data indicated generally good-to-excellent response, as measured by a five-point symptom-severity scale. Eight patients died within 14 days of a treatment, 2 possibly of anesthesia complications and 3 others in accidents or by suicide. Four were receiving maintenance treatments (generally about every other week). No death appeared related to ECT stimulus or seizure. CONCLUSION: ECT in Texas is performed by a small minority of psychiatrists and is unavailable to many patients who need it. It is most accessible to white patients who receive care outside the public sector. Our data support the common finding that ECT is generally safe and effective.
Adolescent↗
Effects of statutes requiring psychiatrists to report suspected sexual abuse of children.
OBJECTIVE: Reporting of child sexual abuse is mandatory in all 50 states. Conceptual distinctions between privileged communications and mandatory reporting are reviewed, and the impact of recent changes in Maryland's reporting laws is examined. METHOD: Beginning in 1964 Maryland law required reporting if abuse was suspected when a physician examined a child. In 1988 reporting of disclosures by adult patients about child sexual abuse that occurred while they were in treatment was mandated. In 1989 all patient disclosures, even about such abuse that occurred before treatment, became reportable. During the period of statutory changes, the Johns Hopkins Sexual Disorders Clinic had kept track of adult patients who referred themselves for treatment and adult patients' disclosures of child sexual abuse. This allowed analysis of the impact produced by changes in the reporting requirements. RESULTS: 1) Mandatory reporting of disclosures about prior child sexual abuse deterred undetected adult abusers from entering treatment. The rate of self-referrals when such reporting became mandatory in 1989 dropped from approximately seven per year (73 over a 10-year period) to zero. This may have caused some unidentified children to remain at risk. 2) Mandatory reporting deterred patients' disclosures about child sexual abuse that occurred during treatment. In 1988 the disclosure rate during treatment dropped from approximately 21 per year to zero. This deprived clinicians of information important for early intervention. 3) Mandatory reporting failed to increase the number of abused children identified. The number identified secondary to such disclosures was zero. CONCLUSIONS: Optimal protection of children, as well as treatment for adult patients, may be better accomplished by legislation that supports options other than reporting.
Adult↗
Mandatory physician reporting of drivers with cardiac disease: ethical and practical considerations.
Many jurisdictions in Canada have enacted legislation that requires physicians to report their patients to the Ministry of Transport if they have a medical condition that may put them at increased risk to operate a motor vehicle. The Canadian Cardiovascular Society has published guidelines that are designed to assist physicians and policy-makers in their decision-making. Legislation is designed to protect society, and the guidelines are designed to fulfill that mandate. However, in the present paper, important issues that have not been addressed to date are discussed. What is the efficacy of mandatory reporting legislation? What are the harms done to patients who are restricted from driving? What are the costs of the mandatory reporting system? How can the scientific/technical assessment of risk be reconciled with the social/ethical view of risk assessment? Until these issues are addressed, important questions about the ethics, efficacy and cost of mandatory physician reporting will remain unanswered.
Accidents, Traffic↗
Consent for prenatal testing: a preliminary examination of the effects of named HIV reporting and mandatory partner notification.
The effect of named reporting and mandatory partner notification in New York State on the rate of consent for prenatal HIV testing was examined by retrospective chart review. In the six months prior to the introduction of mandatory partner notification and named reporting, 318/328 patients (96.95%) accepted HIV testing. In the six months after implementation, 303/305 patients (99.34%) accepted HIV testing. Although limited in power, no significant decline in the rate of consent for testing or the number of patients receiving testing was detected. [RR 1.02 (1.00 < RR < 1.05)].
AIDS Serodiagnosis↗
Named reporting and mandatory partner notification in New York State: the effect on consent for perinatal HIV testing.
The impact of the implementation of named reporting and mandatory partner notification on the percentage of patients not accepting prenatal human immunodeficiency virus (HIV) testing or deferring prenatal care has been examined in only a preliminary fashion. This retrospective, population-based cohort study of 5,007 patients admitted to a tertiary care labor-and-delivery unit in Central New York State between December 15, 1999, and March 14, 2001, is the first study to address the impact of named reporting and mandatory partner notification on prenatal HIV testing and prenatal care seeking. The percentage of patients who did not undergo prenatal HIV testing was significantly increased after the institution of named reporting and mandatory partner notification: 118/4,030 preimplementation, 59/966 postimplementation, with relative risk (RR) = 2.09 (1.54 < RR < 2.83). This remained significant after logistic regression controlled for confounding variables, with odds ratio (OR) = 1.5 (1.07 < OR < 2.10). The percentage of patients who did not receive prenatal care was significantly increased after the institution of named reporting and mandatory partner notification: 14/4,030 preimplementation, 18/966 postimplementation, with RR = 5.36 (2.68 < RR < 10.75). This remained significant after logistic regression controlled for confounding variables. OR = 3.77 (1.84 < OR < 7.72). There is a strong indication that the institution of named reporting and mandatory partner notification has significantly impacted the willingness of pregnant women to undergo HIV testing and prenatal care. Further analysis of the impact in perinatal populations is needed before the continued implementation of this controversial public policy initiative.
AIDS Serodiagnosis↗
Epilepsy and motor vehicle driving--a symposium held in Québec City, November 1998.
BACKGROUND: This report summarizes an invitational symposium on epilepsy and Canadian laws governing motor vehicle driving held in Québec City in November 1998. METHODS: Invited neurological experts from Canada, the USA, and Europe; and representatives of provincial and territorial licensing bodies, the Canadian Council of Motor Transport Administrators, the Canadian Medical Protective Association, and the Canadian Medical Association participated. An edited version of transcribed audiotapes was prepared. Specific issues discussed were whether or not a physician should be required to report a patient with epilepsy to the licensing authority (mandatory reporting), the nature and quantification of the risks posed by epileptic drivers, and what would be a reasonable law regulating driving by people with epilepsy in Canada. RESULTS: The consensus among medical experts was that mandatory reporting should be abolished in Canada and that a 6-12 month seizure-free period was appropriate before most patients could return to driving private cars. Experts also believed that these standards should be uniform across Canada. There was strong disagreement with the recommendation of the Canadian Medical Association that all such drivers be reported to provincial licensing authorities even in provinces without mandatory reporting rules. CONCLUSIONS: Physicians should be familiar with and follow the rules regarding epilepsy and driving in the provinces where they practice. Nevertheless, current evidence is against mandatory physician reporting of drivers with epilepsy and the neurologists recommended that this be abolished throughout Canada. Shorter seizure-free intervals should also be considered before resuming driving of private cars.
Automobile Driving↗
Reporting alcohol-impaired drivers: results from a national survey of emergency physicians.
STUDY OBJECTIVE: The purpose of this exploratory study was to learn of physicians' opinions on mandatory reporting of alcohol-impaired drivers they encounter in the course of their clinical work to the police or authorities from the Division of Motor Vehicles. DESIGN AND PARTICIPANTS: Two thousand four hundred sixty-four physicians randomly selected from the American College of Emergency Physicians were sent an anonymous, one-time only, self-administered questionnaire seeking demographic information and assessing attitudes toward mandatory reporting and alcohol treatment. MEASUREMENTS AND MAIN RESULTS: One thousand fifty-five physicians returned the survey. Seventy-eight percent of respondents agreed with mandatory reporting. More than half expressed strong agreement. Through canonical discriminant analysis we are able to identify the complex factors influencing attitude toward mandatory reporting. CONCLUSION: Although our preliminary results must be interpreted with caution, it appears that with the appropriate legal safeguards, physicians are supportive of mandatory reporting of the alcohol-impaired driver encountered in the course of clinical work.
Adult↗
Elder abuse policy: considerations in research and legislation.
Elder abuse has become the most recently "discovered" form of intrafamilial violence. Most states have enacted elder abuse statutes or have amended their adult protection acts to specify the elderly. A majority of jurisdictions have included mandatory reporting requirements within their statutes. Commentary has been fiercely opposed to mandatory reporting for a variety of reasons. Compelled reporting does not appear to increase the number of reports filed, while enforcement of the schemes depletes much of the funds devoted to elder abuse. Definitions of elder abuse are contradictory and vague. Mandatory reporting requirements suggest that legislators believe elders are unable to determine whether reporting is in their own best interests and thus is an ageist response to the problem of elder abuse. Finally, few services are available to families in which elder abuse has been verified and even fewer program evaluations have been performed to assess these services. Mandatory reporting to identify elder abuse is not appropriate in the absence of programs found to be helpful.
Aged↗
Are researchers bound by child abuse reporting laws?
OBJECTIVE: To discuss issues concerning mandatory reporting of child abuse in research settings. METHOD: An overview of existing Federal and State statutes regarding mandatory reporting of child abuse is presented. A critical review of the literature addresses the following issues: (1) whether researchers have a moral duty to place the health and safety of children above concerns about confidentiality and the benefits of obtaining new knowledge; (2) whether the Certificate of Confidentiality preempts reporting requirements; (3) whether researchers who are not health professionals (such as child developmentalists, psychobiologists, neuroscientists) should be required to report; and (4) whether researchers should be required to expand their protocols to include more in-depth investigation of potential abuse. RESULTS: Existing child abuse reporting laws do not specifically designate researchers as among the category of individuals mandated to report suspected child abuse. Currently, Human Subject Protection Committees and Federal funding agencies are tending to interpret reporting laws as applying to researchers, including requiring that research subjects are informed of this responsibility in consenting procedures. It is unclear whether the Certificate of Confidentiality preempts child abuse reporting laws. CONCLUSION: The authors recommend that legislatures specifically designate researchers as mandated reporters to ensure more uniform reporting practices in research settings. For both investigators and Human Subject Protection Committees, inclusion of researchers among the categories of those mandated to report would also help address issues of immunity from civil and criminal liability for "good faith" reports that turn out to be false and injurious.
Child↗
Impact of a mandatory physician reporting system for cardiac patients potentially unfit to drive.
CONTEXT: Sudden cardiac incapacitation of a driver may lead to the death or serious injury of passengers or bystanders. This has raised public safety concerns and has led to the creation of legislation to protect the public. Some jurisdictions in Canada and the United States have introduced mandatory physician reporting of patients who may be unfit to drive for medical reasons. The impact on motor vehicle accident (MVA)-related morbidity and mortality of mandatory physician reporting for at-risk cardiac patients is unknown. OBJECTIVE: To determine the impact of mandatory physician reporting legislation (for cardiac patients) in Ontario (population 10.3 million) on MVA-related morbidity and mortality. DATA SOURCES: Reporting data were obtained from the Ontario Ministry of Transportation. Incidence and prevalence data were taken from Ontario Ministry of Health sources and from the literature (MEDLINE). Data for modelling were taken from the literature (MEDLINE) and from the Canadian Cardiovascular Society's Consensus Conference document on cardiac illness and fitness to drive. DATA EXTRACTION: Licence suspension data (correlated with medical illness) were taken directly from government documents. These were then applied to a 'risk of harm' formula used to calculate the risk posed to bystanders and passengers by the suspended patients if they had continued to drive. Canadian licence suspension guidelines were then reviewed in conjunction with cardiac disease incidence and prevalence data to arrive at the number of patients who should have been suspended. Physician compliance with the legislation was then calculated, along with the potential impact on MVA-related morbidity and mortality in the scenario of 100% physician compliance. STUDY SELECTION: All Ontario drivers who had licence suspensions in 1996 for reasons of cardiac disease were included in the analysis. DATA SYNTHESIS: Nine hundred and ninety-four licences were suspended for cardiac reasons in 1996, compared with an estimated 72,407 that should have been suspended if Canadian guidelines had been followed (1.4%). Less than one death or serious injury was avoided as a result of the legislation (from the 'risk of harm' formula). If all drivers with cardiac illness had been suspended from driving, up to 29.2 such events could potentially have been avoided. However, only 13 of 929 (1.4%) road fatalities in Ontario in 1996 were attributed to a driver with a medical illness. CONCLUSIONS: Mandatory physician reporting of patients with cardiac illness has a negligible impact on MVA-related morbidity and mortality.
Accidents, Traffic↗
Medical conditions & driving: legal requirements & approach of neurologists.
Licensing of drivers with health problems, particularly epilepsy, has medical, social and legal implications that vary from country to country. Legislation and medical guidelines are based as much on empirical as on statistical data. A questionnaire regarding neurological disorders and driving was given to all adult neurologists in Canada (n = 494) and an assessment made of opinions of neurologists working under mandatory reporting legislation compared to those in a discretionary reporting environment. Of 289 (59%) neurologists responding, 50% reported patients with seizures to the Department of Motor Vehicles compared to only 4% for stroke/TIA, 26% for dementia and 8% for other neurological disorders (p < .0001). In the five provinces with mandatory reporting laws, seizures were reported most of the time by 84% compared to only 19% in the five provinces with discretionary reporting laws (p < .0001). An overall minority agreed with mandatory reporting (44%) but this percentage differed in the provinces with and without mandatory reporting legislation (63% vs. 37%, p < .0001). Seizure disorders are selectively reported more often than other neurological conditions. There is considerable variability in the attitude and practice of neurologists in regard to reporting of medical conditions.
Adult↗
Mandatory public reporting of healthcare-associated infection rates.
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Cross Infection↗
Mandatory physician reporting of drivers with medical conditions: legal considerations.
BACKGROUND: Physicians are facing ever-increasing legal obligations in all Canadian jurisdictions to report patients believed to be unfit to drive a motor vehicle or pilot an aircraft. In most Canadian jurisdictions these statutory obligations are mandatory; in others, they are discretionary. OBJECTIVES: To provide a legal perspective on a physician's duty to report in the various jurisdictions in Canada. METHODS: Reporting legislation and case law from each of the Canadian jurisdictions were compared with respect to reporting requirements, physician protection and the production of medical reports. Federal legislation was examined in respect of the duty to report pilots deemed unfit to fly. Lastly, provincial guidelines and medical standards were examined for their impact on standard of care issues. RESULTS: While the obligations vary slightly from one jurisdiction to another, the majority of Canadian jurisdictions provide for mandatory reporting. Additionally, courts have been willing to apply and give considerable weight to medical guidelines, such as those formulated by the Canadian Medical Association and other provincial medical bodies, to determine the scope of a physician's obligation to report. CONCLUSIONS: In all jurisdictions, a physician who fails to report in circumstances where the physician is of the opinion that a driver is unfit faces potential quasi-criminal liability, civil liability and/or College disciplinary proceedings. The current statutory provisions and professional guidelines leave little room for the exercise of discretion on the part of the physician.
Aircraft↗
Evaluating modifications in epidemic surveillance systems: a method and an application to AIDS surveillance in Switzerland.
A method is presented for evaluating the impact of a modification in a surveillance system for an epidemic disease among reporting sources susceptible to the modification. The approach requires a control series with reports from sources that are not affected by the modification. The measure of effect is the reporting odds ratio (ROR) which estimates the ratio of reporting proportions (completeness) before and after the change. The proportions themselves remain unknown. Various potential biases are identified and an investigation of one potential bias is proposed. The method may prove useful in supplementing techniques that estimate absolute values of completeness of registry systems. The application to AIDS surveillance data in Switzerland shows that the transition from voluntary to mandatory reporting had an impact that was enhanced by the 1987 revision of the Centers for Disease Control case definition for AIDS. Reporting sources were 1.9 (95% confidence interval [CI]: 1.4-2.6) times more likely to report their patients after introduction of mandatory reporting. It is estimated that 15% of all reports were attributable to mandatory reporting.
Acquired Immunodeficiency Syndrome↗
Epilepsy and driving: a survey of Canadian neurologists.
BACKGROUND: A seizure is the most common cause of loss of driving privileges for medical reasons but there is variability in how physicians and the authorities who regulate driving approach this issue. METHODS: A questionnaire regarding epilepsy and driving was sent to all adult neurologists in Canada (n = 494). RESULTS: Of 289 (59%) neurologists responding, 50% usually report patients with seizures to the department of motor vehicles compared to only 4% for stroke/TIA, 26% for dementia and 8% for other neurologic disorders (p < 0.0001). In the five provinces with mandatory reporting laws, seizures were reported most of the time by 84% compared to only 19% in the five provinces with discretionary reporting (p < 0.0001). Nationwide, 44% agreed with mandatory reporting but this also differed in provinces with and without mandatory reporting legislation (63% vs. 37%, p < 0.0001). Only 49% agreed with the current recommendation of at least one year seizure free interval before resuming driving. CONCLUSIONS: Seizures are disproportionately reported compared to other neurological conditions. Many neurologists disagree with the recommended Canadian standards for duration of driving restriction after seizures. Variability in the attitude and practice of neurologists in regard to reporting of seizures is confirmed.
Adult↗
The perceived likelihood of dental hygienists to report abuse before and after a training program.
PURPOSE: The rise of abuse, mandatory reporting, and penalties for not reporting abuse make this study significant for oral health care personnel. The purpose of this research was to determine survey results pertaining to the likelihood of dental hygienists reporting abuse before and after a training program, in order to influence and encourage similar training programs in other locations and to impact dental hygiene curricula. METHODS: Exempt status was obtained from the University of New England Institutional Review Board for the Protection of Human Subjects. A convenience sample was taken of registered dental hygienists who attended a training program and who volunteered to complete a 10-item statement form. A three-category ordinal Likert-type scale was employed. The statement form was filled out before and after a tested training program for the recognition and reporting of abuse (violence) and neglect. The terms family violence, child abuse, and elder abuse were defined as umbrella terms to encompass all abuse, except where explicit. This study explores two research questions: Do dental hygienists perceive the likelihood to make a report if confronted with suspected abuse, and would training make a difference in the perceived likelihood to report? The 10 statements were grouped into three sets for analysis: 1) training and experience in reporting, 2) knowledge of responsibilities, signs, symptoms, and interviewing, and 3) likelihood of making a report. Data were analyzed using descriptive statistics to explain the population's knowledge characteristics and the likelihood of reporting abuse. RESULTS: Twenty-six surveys were administered and 25 surveys were returned for a 96% response rate (n=25). Survey results supported training to increase compliance with mandatory reporting. Of the subgroup having experience with reporting (n=5; 20%), over half (n=3) knew all aspects of abuse. The entire group knew more about child abuse than elder abuse. Prior to training, 40% definitely knew that they would likely report abuse, 40% somewhat knew that they would likely report it, and 20% didn't know or said it would be unlikely that they would report. Only 5% stated that they definitely knew how to make a report before the training. After training, 100% reported that they would be likely to make a report, an overall increase of 60%. In the pre-survey, 60% said they did not know how to make a report, compared to 96% indicating in the post-survey that they knew how to make a report after training. CONCLUSION: Evidence from the dental hygienists attending a continuing education program supports that training increases the self-perceived likelihood to report abuse. This study also acknowledged areas for investigation of curricular augmentation, such as providing more information on elder abuse and presenting a guide for filing a report of abuse to the appropriate agencies. It is imperative for educators to include adequate information in dental and dental hygiene curricula for training in reporting abuse. It is also incumbent upon dental hygiene clinicians to identify their own educational needs and to seek out appropriate continuing education. These identified outcomes are an important reinforcement to providing adequate instruction in dental hygiene curricula.
Curriculum↗
A comparison of physicians' attitudes and beliefs regarding driving for persons with epilepsy.
OBJECTIVE: The purpose of this survey was to compare attitudes and opinions regarding driving restrictions for persons with epilepsy (PWE) between internal medicine and general practice physicians and neurologists. METHOD: A questionnaire aimed at eliciting physicians' perspectives related to driving with epilepsy was developed that focused on physicians' experiences and opinions with respect to driving issues for PWE. Three groups of physician subspecialties were targeted based on the likelihood of persons with epilepsy in their practice: neurologists, family practice physicians, and internal medicine practitioners. Questions asked about driving with controlled and uncontrolled seizures, predictable auras, nocturnal seizures, seizures without loss of consciousness, patient reporting, seizure-related accidents, and patient justifications for driving. RESULTS: Error rates were high with respect to knowledge of state reporting practices, especially among family practitioners and internal medicine physicians. Family practitioners and internists were less likely than neurologists to support driving for people with uncontrolled seizures under specific conditions and more likely to support a minimum seizure-free period before issuing a driver's license and mandatory reporting of seizure information. Physicians who thought they were from states with mandatory reporting were more supportive of mandatory reporting of seizure information and setting a minimum seizure-free period before a driver's license is issued. Physicians having fewer patients with epilepsy were more likely to oppose driving in persons with intractable seizures. CONCLUSION: Nonneurologists have more restrictive beliefs regarding driving for PWE, who are in fact allowed to drive in many states. Nonneurologists, in particular, demonstrated poor knowledge of state reporting requirements for PWE. The data from this study support a significant effort to promote education of all physicians regarding state regulations and aspects of epilepsy related to driving.
Adult↗