DCFS opinions?

Nurses General Nursing

Updated:   Published

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

4 minutes ago, FolksBtrippin said:

Sure.

To me, a kid taking a bite of his parent's pot brownie is not neglect or abuse on the part of the parent, and the parent did the right thing by bringing the kid to the ER.

If the parent refused medical treatment for the child, or gave the kid the pot brownie, I would feel differently.

The fact that the parent eats pot brownies is not neglect. This was a kid taking something he shouldn't have either knowingly or unknowingly.

Why do you think it was neglect or abuse?

Would you question yourself on how the child got a hold of the brownie?

How would your opinion change if its was a piece of heroin/Cocaine or an ecstasy pill that he thought was candy ? And the parent stating he doesn't know who they got it ?

0 Votes
Specializes in ER.

An isolated moment of carelessness does not necessarily mean neglect. Let's say this was a car accident or a near-drowning where the parent should have been more vigilant or careful, but wasn't. Mom was updating her post on facebook instead of watching the child carefully by the pool.

What mother hasn't had those moments? If an accident happens, do we turn them in to the authorities?

The obvious difference between marijuana, other than severity, is that you say that it is legal in your state.

2 Votes
Specializes in Psychiatry, Community, Nurse Manager, hospice.
1 hour ago, Rasberry_RN_ said:

Would you question yourself on how the child got a hold of the brownie?

How would your opinion change if its was a piece of heroin/Cocaine or an ecstasy pill that he thought was candy ? And the parent stating he doesn't know who they got it ?

I would not question myself on how the child got a hold of the brownie. I would question the child. As I stated before, if there is no evidence the parent gave the child the brownie on purpose, there's no evidence of neglect.

As to your second question:

If it was heroin, cocaine or ecstasy and the parent stated he doesn't know how the child got it, I would again question the child. Depending on the child's answer, I would possibly call DFS and possibly not call DFS. An accidental poisoning is not always a reason to call DFS.

Incidentally, a UDS is not a legal determination of substance use as false positives occur frequently. A UDS is a screen... it gives an idea, but is not diagnostic. That also may be why the doc did not want you to do it. It really isn't evidence to give to DFS.

3 Votes
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

If I remember correctly from the original post, the patient was a teenager. Also the mother did not state that she (mother) had used marijuana, but the OP felt the mother was "high."

In my thinking, the original post did not rise to the level where I would suspect abuse or neglect and that is why I stated I wouldn't report it to DCFS.

The age of the patient makes a huge difference. Teenagers have a much different ability to reason, act, and think than say a toddler. For example, a 16 year old comes in with an STD versus a 6 year old. Very different situational approach.

6 Votes
Specializes in Psych, Addictions, SOL (Student of Life).

I never saw the original post which would have been helpful. A large part of my practice is working with at risk teens , In California the law for reporting is clear. A mandated report MUST report any reasonable suspicion of abuse, neglect or endangerment. Recreational Marijuana is legal in California and it is a somewhat grey area as almost all the kids I see are positive for marijuana. It's also not uncommon to find Benzo's, Meth etc.... As another poster stated the uds result is presumptive not conclusive. Marijuana can increase the heart rate by 20-50 beats per minute because the body is trying to compensate for a reduction in blood pressure.

I do a tremendous amount of DCFS reporting because my employer feels if it falls under reasonable suspicion it must be reported. DCFS investigates and about 50% of cases come back completely unfounded. That still means the 50% come back as founded and need action.

I am actually beginning the think that this is a student question due to the continued demand for Rationales and rebuttals. If this is the case please give us your rationales of your actions as well as your detailed rebuttals to comments to you original post. You will find we can be quite helpful if we understand why you are asking

As for defending such an action in a court of law, let's play this out.

Scenario A: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels their is reasonable suspicion of neglect or endangerment and so files a report. This is ER so the nurse may never find out the result. If called defend action say lawsuit for filing a false report - the nurse need only recite Mandated reporter law with no further testimony required.

Scenario B: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels this was a one time incident as adolescent is now stable and sent home with parent who has also received education about safe storage of medication to prevent further events. 1 week later this adolescent is brought back to ER this time by ambulance and expires due to drug OD. Nurse is charged by DA for not following mandated reporter laws. Loses the case and ends up losing license and possible gets jail time.

I am going to side with the practice that aims to keep adolescent safe. Let DCFS investigate and determine if neglect or endangerment exist.

That way my conscience is clear and my license protected.

Hope this helps

Hppy

2 Votes
9 minutes ago, hppygr8ful said:

I never saw the original post which would have been helpful. A large part of my practice is working with at risk teens , In California the law for reporting is clear. A mandated report MUST report any reasonable suspicion of abuse, neglect or endangerment. Recreational Marijuana is legal in California and it is a somewhat grey area as almost all the kids I see are positive for marijuana. It's also not uncommon to find Benzo's, Meth etc.... As another poster stated the uds result is presumptive not conclusive. Marijuana can increase the heart rate by 20-50 beats per minute because the body is trying to compensate for a reduction in blood pressure.

I do a tremendous amount of DCFS reporting because my employer feels if it falls under reasonable suspicion it must be reported. DCFS investigates and about 50% of cases come back completely unfounded. That still means the 50% come back as founded and need action.

I am actually beginning the think that this is a student question due to the continued demand for Rationales and rebuttals. If this is the case please give us your rationales of your actions as well as your detailed rebuttals to comments to you original post. You will find we can be quite helpful if we understand why you are asking

As for defending such an action in a court of law, let's play this out.

Scenario A: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels their is reasonable suspicion of neglect or endangerment and so files a report. This is ER so the nurse may never find out the result. If called defend action say lawsuit for filing a false report - the nurse need only recite Mandated reporter law with no further testimony required.

Scenario B: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels this was a one time incident as adolescent is now stable and sent home with parent who has also received education about safe storage of medication to prevent further events. 1 week later this adolescent is brought back to ER this time by ambulance and expires due to drug OD. Nurse is charged by DA for not following mandated reporter laws. Loses the case and ends up losing license and possible gets jail time.

I am going to side with the practice that aims to keep adolescent safe. Let DCFS investigate and determine if neglect or endangerment exist.

That way my conscience is clear and my license protected.

Hope this helps

Hppy

AND THAT WAS MY REASONING FOR CALLING CHILD PROTECTIVE SERVICES! ?

I wish we all thought this way when it comes to cases like this. We are not lawyers, we are not detectives, we are not judges. We are nurses and we are advocates. It’s our job to protect our patients.

1 Votes
4 hours ago, Emergent said:

An isolated moment of carelessness does not necessarily mean neglect. Let's say this was a car accident or a near-drowning where the parent should have been more vigilant or careful, but wasn't. Mom was updating her post on facebook instead of watching the child carefully by the pool.

What mother hasn't had those moments? If an accident happens, do we turn them in to the authorities?

The obvious difference between marijuana, other than severity, is that you say that it is legal in your state.

The fact that you don’t believe it’s neglect when a parent fails to look after a child near a pool is literally breaking my heart

0 Votes
1 hour ago, dream'n said:

If I remember correctly from the original post, the patient was a teenager. Also the mother did not state that she (mother) had used marijuana, but the OP felt the mother was "high."

In my thinking, the original post did not rise to the level where I would suspect abuse or neglect and that is why I stated I wouldn't report it to DCFS.

The age of the patient makes a huge difference. Teenagers have a much different ability to reason, act, and think than say a toddler. For example, a 16 year old comes in with an STD versus a 6 year old. Very different situational approach.

And all teenagers mature at the same level?

0 Votes
Specializes in ER.
10 minutes ago, Rasberry_RN_ said:

The fact that you don’t believe it’s neglect when a parent fails to look after a child near a pool is literally breaking my heart

I'm also extremely sad at your lack of insight into the reality of life. God Bless...

6 Votes
On 4/26/2020 at 12:27 PM, Emergent said:

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

Their work load has nothing to do with mandated reporters and the rules we are required to follow.

In this case, the nurse doesn't know what else might be going on in that home, in that child's life.

2 Votes
Specializes in Psychiatry, Community, Nurse Manager, hospice.
8 hours ago, hppygr8ful said:

I never saw the original post which would have been helpful. A large part of my practice is working with at risk teens , In California the law for reporting is clear. A mandated report MUST report any reasonable suspicion of abuse, neglect or endangerment. Recreational Marijuana is legal in California and it is a somewhat grey area as almost all the kids I see are positive for marijuana. It's also not uncommon to find Benzo's, Meth etc.... As another poster stated the uds result is presumptive not conclusive. Marijuana can increase the heart rate by 20-50 beats per minute because the body is trying to compensate for a reduction in blood pressure.

I do a tremendous amount of DCFS reporting because my employer feels if it falls under reasonable suspicion it must be reported. DCFS investigates and about 50% of cases come back completely unfounded. That still means the 50% come back as founded and need action.

I am actually beginning the think that this is a student question due to the continued demand for Rationales and rebuttals. If this is the case please give us your rationales of your actions as well as your detailed rebuttals to comments to you original post. You will find we can be quite helpful if we understand why you are asking

As for defending such an action in a court of law, let's play this out.

Scenario A: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels their is reasonable suspicion of neglect or endangerment and so files a report. This is ER so the nurse may never find out the result. If called defend action say lawsuit for filing a false report - the nurse need only recite Mandated reporter law with no further testimony required.

Scenario B: 13 year old Brought in by parent after ingesting a mood altering substance. Parents state they do not know how said adolescent gained access to the substance. Nurse on duty feels this was a one time incident as adolescent is now stable and sent home with parent who has also received education about safe storage of medication to prevent further events. 1 week later this adolescent is brought back to ER this time by ambulance and expires due to drug OD. Nurse is charged by DA for not following mandated reporter laws. Loses the case and ends up losing license and possible gets jail time.

I am going to side with the practice that aims to keep adolescent safe. Let DCFS investigate and determine if neglect or endangerment exist.

That way my conscience is clear and my license protected.

Hope this helps

Hppy

Scenario B has never happened. And thank god, because I would turn in my license right now if this were the actual practice environment. We aren't fortune tellers.

Look up for yourself how often anyone, nurse or not, has been charged under mandated reporter laws and what the actual circumstances were before you spread fear based nonsense.

If you think you need to report a parent every time a teenager hurts himself, you are sadly part of the problem. When we start blaming them, they stop looking to us for help.

2 Votes
Specializes in Community health.
16 hours ago, Rasberry_RN_ said:

What's your rationale for not reporting this situation. How would you explain this to a group of nursing students, asking you the same question ?

What's your rebuttal?

Of course I don’t have all the details and I wasn’t there. Based on just what you wrote, I would not have reported. And yes, obviously that means I would be comfortable “in court” later. Sometimes a parent needs education— “this is why it is important to keep your drugs and alcohol in a safe location.” Teenagers are curious and they also love brownies haha.

Just like when a toddler ingests a medication because they think it is candy. I do not call DCF for that. I explain that toddlers have a tendency to put things in their mouth, so it is important to keep medications out of reach.

I imagine that when DCF went to the house, assuming the child wasn’t also locked in a closet or something, that’s what they did. Caseworkers spend most of their day educating parents (my mother was a caseworker). So, whether you reported so that DCF could go educate the parents, or whether you educated them yourself, it likely amounted to the same thing.

2 Votes
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