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DCFS opinions?

Nurses   (5,078 Views | 77 Replies)

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I work as an ER nurse. I encountered a parent who brought a child in to be evaluated because the child suddenly developed heart palpitations. The child was complaining of a racing heart. After evaluation it turned out their heart was beating well above the normal range. The child was awake, and responding appropriately, the other vitals were good. 

I informed the doctor immediately and was later given verbal orders. I then let the parent know that we needed labs, I was informed by the parent that the child admitted to taking a piece of an Edible brownie laced with marijuana.

The parent states that they themselves had consumed the brownie but wasn't aware that the child had come in contact with it. I told the doctor that I needed to contact DCFS due to the fact that a minor ingested a drug laced brownie. The doctor didn't think it was necessary and wanted to immediately discharge. Drug test was positive for THC. I contacted DCFS.

What could have been done differently?

Staff note.... This has been edited and may not reflect in the initial replies 

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dream'n has 27 years experience as a BSN, RN and specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

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Honest answers: did you order the drug screen with the Drs consent?  I don't work in an ER or actually have taken care of patients for a long time, so I may be wrong about state reportables, but I doubt I would have called DCFS for this. A 13 year old positive for Marijuana?  It's legal in my state to have marijuana in the home for adults and 13 year olds, well they aren't always the most upfront and truthful.  I think the mom showed some responsibility by bringing the teen in for evaluation.

Edited by dream'n

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507 Posts; 2,309 Profile Views

Is it legal for a 13 yo to be ingesting marijuana?  No.  Are you a mandatory reporter?  Yes.  You did right.

Edited by Elaine M

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7 hours ago, dream'n said:

Honest answers: did you order the drug screen with the Drs consent?  I don't work in an ER or actually have taken care of patients for a long time, so I may be wrong about state reportables, but I doubt I would have called DCFS for this. A 13 year old positive for Marijuana?  It's legal in my state to have marijuana in the home for adults and 13 year olds, well they aren't always the most upfront and truthful.  I think the mom showed some responsibility by bringing the teen in for evaluation.

Yes it was ordered under the doctors consent. As an healthcare worker we are all mandated reporters. 

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1,886 Posts; 18,916 Profile Views

By reporting this you did not decide the parent was culpable.  You decided it as a reportable event.  Once you come to that conclusion, you have no real choice.

Curious- how many here would do the same for a minor that got into the liquor cabinet?  The parents of every kid I hung out with would have been investigated with that standard.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

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The sentence that sticks out to me is "I ordered a drug screen under the doctors name which came back positive for THC. " So did the doctor actually order the drug screen or did you order it? 

If the doctor ordered it and you reported based on the test results  you are technically doing the right thing within your role as mandated reporter.  Personally I don't think reporting a family to DCFS because a 13 year old got hold of an edible that probably isn't an illegal substance for an adult was necessary but  I suppose it could be reportable since a minor had access to it.

I have to agree with hherrn on this one. I don't know too many teenagers that didn't raid their parents liquor cabinet at some point, would you have reported that offense as well? 

On the other hand,  if you decided to enter the order under the doctor's name despite the doctor clearly indicating he didn't think testing or reporting was necessary  I definitely don't agree with your actions.  You could even get in a boatload of trouble for ordering the test under the doctor's name in the first place if the doctor wanted to make a stink about it. 

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Emergent has 25 years experience.

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Would you report this incident if a 13 year old had gotten into his dad's beer?

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56 minutes ago, Emergent said:

Would you report this incident if a 13 year old had gotten into his dad's beer?

If the CHILD was having clinical symptoms and visibly intoxicated, with positive ETOH in blood, absolutely. As a mandated reporter I would. Just to cover my ***. You can't assume and when it comes to kids you can't take a Pragmatic approach at situations like this you need to act accordingly as a professional and report things like this. It's not my job to investigate or assume. That's DCFS job to do. 

Edited by dianah
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Emergent has 25 years experience.

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Hopefully the case worker will do a good job. They are awfully overwhelmed.

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dream'n has 27 years experience as a BSN, RN and specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

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OK, I posed this situation to an adolescent psychiatrist that I personally know.  Their response was "why didn't they speak with the mother about keeping marijuana out of the teens access?  And unless this was a repeat occurrence, I don't see this as a reportable offense."

But the fact that you believe it is reportable, makes all the difference.  Reporting this is your belief and your understanding of the law, therefore you did what was correct.  All of us speculating weren't there, and you did what you felt is best.

Edited by dream'n

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14 hours ago, hherrn said:

By reporting this you did not decide the parent was culpable.  You decided it as a reportable event.  Once you come to that conclusion, you have no real choice.

Curious- how many here would do the same for a minor that got into the liquor cabinet?  The parents of every kid I hung out with would have been investigated with that standard.

Your right! Maybe there would be less child abuse cases and kids dying from accidental poisoning or drug ingestion if we raised the standards. 

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52 minutes ago, dream'n said:

OK, I posed this situation to an adolescent psychiatrist that I personally know.  Their response was "why didn't they speak with the mother about keeping marijuana out of the teens access?  And unless this was a repeat occurrence, I don't see this as a reportable offense."

But the fact that you believe it is reportable, makes all the difference.  Reporting this is your belief and your understanding of the law, therefore you did what was correct.  All of us speculating weren't there, and you did what you felt is best.

Yes I spoke with a lawyer and another doctor about this case and they both agreed that this was a reportable incident.

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