DCFS opinions?

[Rasberry_RN_]

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

[Guest219794]

To be clear about your relationship with the doc-

Sounds like you ordered something you know he doesn't want then documenting that he ordered it.

That could be a problem.

As far as whether the doc thinks something should or should not be reported does not alter your status as a mandatory reporter.

[Rasberry_RN_, BSN]

14 hours ago, hherrn said:

To be clear about your relationship with the doc-

Sounds like you ordered something you know he doesn't want then documenting that he ordered it.

That could be a problem.

As far as whether the doc thinks something should or should not be reported does not alter your status as a mandatory reporter.

Again the doctor gave verbal permission for the drug screen.

[Emergent, RN]

11 hours ago, Rasberry_RN_ said:

Again the doctor gave verbal permission for the drug screen.

Any ER doc worth his salt will drug screen a child with these symptoms. I don't doubt that he gave you a verbal order, it's very common in the emergency room.

I don't know why people are doubting the original poster here. Any good ER doctor will back up his or her nurse. We had several inadvertent cases of substance ingestion by minors. CPS was contacted. It doesn't mean the child was removed then and there.

When people are stoned it makes them more careless. Some people just need a wake up call of a visit by CPS. I don't think that is unreasonable. They're not going to put the child into foster care, unless there is something very blatant. In the cases that I saw the parent was concerned enough to bring the child into the emergency room. The cases I'm referring to were involving toddlers, and the substance was cannabis, legal in my State.

[Guest219794]

11 hours ago, Rasberry_RN_ said:

Again the doctor gave verbal permission for the drug screen.

I think the OP may have been confusing:

I got a lot of push back from the doctor, in which he wanted to discharge the child right away without continuing to monitor her or even check her urine for other drugs.

I re read the post, and still missed it. But, if he ordered the drug screen, and you believe this to be reportable, you did what you had to do.

Would you consider a 15 year old getting into the liquor cabinet reportable?

BTW- I am not disagreeing with your actions. I think it is an interesting question where we draw the line. I think that personally, I might base it on my judgement.

• A 2 year old eats a pot brownie off the coffee table while mom is making out with her meth dealer. Report.
• A 17 year old with a history of drugs and alcohol steals the keys to the liquor cabinet and gets hammered. Don't report.

I think your example is between these two. I am interested in rationales for going either way.

[Emergent, RN]

I think we can all agree that parents should not leave pot brownies around.

[Rasberry_RN_, BSN]

I am not the kind of nurse that will override a doctor's order or simply order something that a doctor didn't want or wasn't according to our protocol. In the Emergency room we have protocols and standing orders In place so that we can expedite patient care. Example: Patient comes in with Chest pain and sob in triage. As a triage nurse I would order Cardiac enzymes and ekg per protocol/Standing orders). Those are put into to place so that we can get patients cared for and treated in a timely fashion. Emergency rooms are often busy so we need to move quickly.

After verbalizing my concerns to the doctor they DEFINITELY gave me the verbal OK to do the drug screen, what doctor wouldn't do that after a CHILD ingested a DRUG , who knows what else the CHILD could have gotten a hold of.

In this case I was definitely concerned because the child had been exposed to drugs ( whether legal or not) in the home and I also wanted to cover myself in case something (God forbid) happens in the future. I was being an advocate for my patient.

The parent seemed responsible and I didn't think the child was in immediate danger. I just felt it was my duty to report this. It's not my duty to assume, investigate, discriminate, rationalize, or insinuate. Child got a hold of and ingested a drug while at home with parent who also was ingesting drugs, point blank period. When it comes to kids there is no line to be drawn, anytime there's a concern about the safety of a child its needs to be reported. Doesn't matter how old the CHILD is and whether it was alcohol or drugs. It still needs to be reported because you don't know what else could be going on in the home. It's called being a MANDATED REPORTER. ( feel free to look up the laws yourself). I don't know about you but I don't want to end up in jail for not doing the right thing.

[Nunya, BSN]

Maybe those of you who wouldn't report a teen getting into their parents' alcohol is one reason why we have so much alcoholism in the US.....

[Emergent, RN]

9 hours ago, Elaine M said:

Maybe those of you who wouldn't report a teen getting into their parents' alcohol is one reason why we have so much alcoholism in the US.....

I doubt it.

I don't have the statistics in front of me, but Europe is more liberal with alcohol for young people and I don't think our alcoholism rates are much different. In fact, they probably are higher in many instances.

There is a huge genetic component to alcoholism. Some ethnicities have a protective gene. This has been proven scientifically. Other ethnicities have a genetic vulnerability to alcohol.

[JadedCPN, BSN, RN]

On 4/27/2020 at 9:15 AM, Rasberry_RN_ said:

In this case I was definitely concerned because the child had been exposed to drugs ( whether legal or not) in the home and I also wanted to cover myself in case something (God forbid) happens in the future. I was being an advocate for my patient.

Assuming you’re in a state where it is legal - if the kid had ingested, for example, their parent’s lisinopril instead, would you have reported it? Or was it the fact that it was an edible? I’m just genuinely curious what type of impact that would have.

For what it’s worth, I don’t think what you did was wrong. You did what you felt was appropriate.

[hppygr8ful, ASN, RN, EMT-I]

In California you must report if you have a reasonable suspicion of abuse neglect or endangerment. It is DCFS job to investigate and decide what measures are to be taken. BTW free access to the liquor cabinet is reportable as endangerment. I started my decent in alcoholism at the tender age of thirteen - My dad had a copious liquor cabinet with everything including beer on tap. I may or may have become an alcoholic if those things were secured but it certainly didn't help.

You did the right thing. Unless there is previous reports to DCFS it is unlikely the child will be removed from the home. However the parents will be on notice to keep their Marijuana out of reach of children.

Hppy

[Rasberry_RN_, BSN]

54 minutes ago, JadedCPN said:

Assuming you’re in a state where it is legal - if the kid had ingested, for example, their parent’s lisinopril instead, would you have reported it? Or was it the fact that it was an edible? I’m just genuinely curious what type of impact that would have.

For what it’s worth, I don’t think what you did was wrong. You did what you felt was appropriate.

It depends on the situation, if I had reason to believe that neglect occurred yes I would. In my case I had reason to believe that the parent neglected to keep marijuana brownies out of The reach Of the child. Maybe the parent hid the Brownies and the child found it, maybe the brownies were out in the open available to the child, maybe the parent gave the child the brownie and the kid lied. IDK. The parent was also visibly under the influence and we all know being UNDER THE INFLUENCE decreases your judgment and awareness. It’s not my job to investigate. I’ve witnessed many times in my life where parents let children drink alcohol just to get a laugh out of it and I’ve heard stories of parents who blew marijuana smoke in their child face for whatever reason. There are cases out there where parents have been arrested for neglect after their child ate an edible.

[Guest219794]

I have reported an abuse case in which the doc disagreed. She is smart, well intentioned, and well educated.

But- her opinion did not release me from my obligation. there is nothing in the wording of the lae in my state that has anything to do with the opinion of another professional.