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If on routine examination of a minor or aged client, the podiatrist is suspicious of physical abused do they have a legal obligation to report their suspicions?

Cameron

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Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

It does not matter if you have or not legal obligation to report. If you are suspicious of this subject you must report to the authorities.

Javier

Hi Javier,

That may be so in Spain. But if for example a DOCTOR OF MEDICINE was to do this without due consideration of his Hippocratic oath with effect to his patient there could be some serious repercussions.

Considering my position as a podiatrist? To withhold evidence by not reporting something proven as a crime in societies eyes could be similar to hiding and giving succour to a known offender! It could be similar to a principle in the first or second degree in a known crime. Becoming involved by doing nothing where a known crime has been committed, aiding and abetting by doing nothing? Do we for instance possess the expertise to know when a crime suspected by say me, is a crime concluded or is it a continues crime still being committed perchance? We in the UK. would need guidance from English Law on this! At the moment I for one am very rusty re what Act and what Section?

In our NHS. there could already be guidance and instructions on which procedures need to be carried out here, and when. I am not privy to these procedures. A good start to this one Javier anyway! Anyone, what's the answer?

Remember Javier, your society is probably still just coming out of a dictatorship and the English appear to be steadily drifting into one if various new offences in Parliament go through being discussed today in our legislation???

Regards,

Colin.

PS. How the high and mighty have already fallen making decisions on what is abuse and what is not abuse in the UK.!!!

Different jurisdictions will have different legislations. Some Acts I have seen in Australia, specifically state that certain professions (ie registered medical practitioners; do gooders .... whoops, I mean social workers; clinical psychologists) have a legal obligation to report it. One state in Australia (I can't recall which) specifically stated all registered health professionals (so that includes us) have a legal obligation.

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Dear All,

If memory serves me right.

Here in the UK when an NHS employee sees:

" Suspicious marks on a child then they are supposed to ask the parent how the child got the markings"

Now i am a born coward so i think that if a parent is able to cause deliberate injury to their CHILD then i will not ask as they will definitely do unto me.

Fortunately in my Community Hospital the Child Protection team have their office so the last time i had suspicions i went to speak to the Consultant. A very kind and compassionate chap.

I told him of my concerns described the marks on the childs legs and arms and gave name address and telephone no.

Unfortunately i saw his eyes roll ever so slightly over.

The family were known to the Child Protection Team.

The investigation took place .

As this is such a sensitive area i will never be told the outcome. Quite rightly so.

It is sufficient to know, that despite breaking policy, that the appropriate team was informed of suspicions and were able to act on my information to protect an at risk child.

I would not challenge a parent.

Years ago i did ask the parents of a 12 year old boy how he got his bruising on his legs and arms and why his choice of reading when attending my clinic was a religious story book. They were Jehovahs witnesses.

I had a formal complaint made against me for religious bigotry etc.

I was not disciplined as child was abused by his parents for his ungodly conduct and so had to be punished.

The child did not attend school because of parents religious beliefs so he would not have been picked up at school by the teachers.

It was a sorry tale and fraught with danger for the child and health care professionals as the parents were prepared to destroy any health care worker who intervened in their religious practice.

The religious story book was of Janet and John style which i was reading at 5 years of age . So he obviously at 12 had a reading age of approx 5 years.

So when in doubt be very careful.

If in PP then approach the GP. They will sensitively deal with your concerns and approach the relevant bodies. There are usually previous incidents so you may not be the first to see the evidence. You will be providing additional evidence to support the relevant authorities in their task of child protection.

A very sad aspect of this topic is the fact that the children still love their parents and just want the abuse to stop. So action may not be taken to prosecute the abuser. But dealing with the abusers behaviour may be the way of dealing with this problem

regards David

Many thanks for the responses it has been very helpful.

Cheers
Cameron

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Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

Terribly sad David and just goes to show there are some real nutcases out there.

Best wishes
Mark

Hi Cameron,

Yes, a most interesting Thread!

I hope you do not mind me adding this Aside?

As David has mentioned for Private Practitioners the first port of call is usually the Patient's GP. re. suspicion!

We have the old and the new still operating within restrictions and limitations with regard to children and the elderly today. Not to long ago the Police had it as part of their duties to enforce the Criminal Law as Parliament intended on behalf of Society! Now we have a major part of these Police Functions transfered to Social Workers, Clinical-psychologist etc.

THE DIFFERENCE BEING,

1. The Police used to enforce the Criminal Law having due deference to what Senior Medical Staff stated to them about specific cases. They the Medical Staff were treated by the police as Expert Witnesses whether or not that case in fact got to court? The Social Worker etc. appeared after the conclusion of the case to give the Judge trying it that which he needed to hear so that he could come to a safe and just conclusion with regard to the defendant and the Victim? (This was usually after conviction of the defendant for a criminal offence, (Part of defendants antecedent/history!)).

2. Now Social Workers, etc. apply and interpret the case in question via their set procedures and views, (Opinions perhaps?). How they view the safety of the child or elderly person for example with the police advising and possibly influence case meetings usually behind closed doors with no defencive input from what would have been defendants stating their case physically in open Court for all to hear, under court and police procedures???

3. Interpreting the Law used to be the prerogative of Judge and Jury, directly under the Judiciary! Now it is applied by Social Workers on behalf of the Victim. I for one have always been very uncomfortable with this relatively new procedure and the secretive operations of Social Workers mostly behind closed doors? But there does not seem to be any opposition to this! It is accepted by Society as a good thing perhaps?

Regards,

Colin. (A very small cog in a very large machine!).

PS. For instance today the Judges are been asked by Government to support a Breach in Magna Carta. Sounds like the 1930's in the Third Reich all over again to me! We blamed the Bombers, Hitler blamed the Communists! What think you?

Hi Colin,

My response was based on a moral belief not a legal opinion. We can discuss about legal matters on the subject but every country have their own specific regulations on the subject and of course we can also discuss about if a law is
fair or not.

From my point of view, If I ever have to deal with a terrible fact as child abuse I will remember a famous poem about compromise (it is related to Hitler's period also):

They came for the Communists, and I
didn't object - For I wasn't
a Communist;

They came for the Socialists, and I
didn't object - For I wasn't a Socialist;

They came for the labor leaders, and I
didn't object - For I wasn't a labor leader;

They came for the Jews, and I didn't
object - For I wasn't a Jew;

Then they came for me -
And there was no one left to object.

Martin Niemoller, German Protestant Pastor,
1892-1984

Javier

Hi Javier,

Yes, no problem with your Posts. I was suddenly confronted with Cameron's Question referring to Podiatry rather than my other life. I was automatically locked into the Legal route rather then the MORAL!

I can go both ways you see with this a foot in both camps even now when I'm retired out of one of them for a while now! My moral duty would be the same as yours but with the added rider which authority? The patient's Doctor would be always my route of first choice. With a phone call to my local C.I.D. my close second if the injures were more than just a scratch and a bruise. I specialised in this kind of thing years ago, really does feel like another life!

The MORAL high ground is still the only place to be if confronted by something like this God forbid!

Martin Niemoller, German Protestant Pastor. I can never remember his name? Maybe I'll get it in there this time. I read this years ago when I spent a little time on Bonhoeffer. He quoted it in the Gestapo Cells just before the S.S. murdered him! That is Christianity, Martyrdom for what he believed in!!!

Regards,

Colin.

PS. Hope this doesn't offend your ruling Admin.?

Hi Colin,

Martin Niemoller died in 1984, long after the end of WWII. He was a controversial man (it is not clear if he applied to himself his own poem's compromise) and he did not suffer martyrdom.

I prefer to consider this poem as an exemple with human rights compromise rather than a religious belief. At least, I think our compromise as a health practitioners is to our patients welfare and child abuse affect this welfare.

Javier

Many years ago, while finishing my residency in the U.S I co-authored an article for the Journal of the American Podiatry Association.

I don't know if the article would be available anywhere since it was done in the late 1980's. If you have access to a medline search, perhaps you could find it. The title was "child abuse, a primer for the podiatric physician" I don't have any copies of the article.

It is your moral and ethical duty, at least here in the states, to report suspected cases. If for nothing else, you could be the one to save a childs life should things escalate out of control.

Best of luck

Summer

I suppose you refer to:

I Weiner and CM Gastwirth
The abused child. A primer for podiatric physicians
J Am Podiatr Med Assoc 1988 78: 452-454.

I have not found an abstract on Medline neither on JAPMA.

Javier

You found it............I guess you all know my real name now!!!!!!!!!!!

Hi Javier,

No wrong one, Deitrich Bonhoeffer was the one murdered in 1945, he quoted the poem just before the execution! Yes the poem is spot on for what happened in the 1930's Hitler took out his opposition one by one and nobody in the German people bothered until it was their turn, (Some had no where to go of course!). Bonhoeffer realised to late for him but new the poem. Both of them Pastors I suspect in the same German Church. Bonhoeffer was the one Martyred!

Regards,

Colin.

In the UK there is some Legislation and guidance available to us all.
The Children Act 1989 and 2004, Adoption and Children Act 2002, Human Rights Act 1998, and Data Protection Act 1998.

There have been a number of serious case reviews in the relitavely recent past, from Maria Caldwell in 1973 to Victoria Climbie in 2000. The upshot of all these case reviews was that lack of adequate inter-agency communication ultimately led to the deaths of these children.

It is a sad fact that it takes a child to die before there is a change in the law.

Themes which have been highlighted are:
The child is paramount, and their voice must be heard. Multi-agency working must have effective communication (ALL TYPES).

The following is an extract from:
Agency roles and responsibilities (taken from Chapter 3 Working Together to Safeguard Children)

Role of Health Services
3.18 All health professionals within the NHS, private sector, and other agencies, play an essential part in ensuring that children and families recieve the care, support and services they need to promote children's health and development. Because of the universal nature of health provision, health professionals are often the first to be aware that families are experiencing difficulties in looking after their children.
3.19 The health authority should take the overall strategic lead for health services in local inter-agency working on child protection matters.

Role of named Doctor
3.23 Each NHS Trust is recommended to identify a named doctor and a named nurse or midwife who will take a professional lead within the Trust on child protection matters. The named doctor and nurse should have expertise in children's health and development, the nature of the maltreatment, and local arrangements for safeguarding children and promoting their welfare.
3.24 All hospitals and community health staff should be alert to the possibility of child abuse or neglect, be aware of procedures, know the names and contact details of the relevant named and designated professionals.
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Here are some facts:

1889 was the first charter for child protection (67 years AFTER the first charter for animal protection)

Today in the UK there are on average 4 child deaths per week as a result of child abuse / neglect. (in 1978 it was 2 per week)

97% of abused children are abused by someone known to them.

Abusers very rarely abuse only one child.

On average only 10% of cases get as far as Court. This is usually due to the fragile nature of evidence, AND that it must be in the best interests of the child. Civil proceedings run in tandem with criminal proceedings, and it is the civil ones which will further aid child protection in the future.

I think we all have a duty of care to at least discuss our suspicions with a member of our local child protection team.