in a difficult situation with "natural med" friend

[anon456]

I have a dear friend who I have known for 10 years. I attended and supported her through her two natural childbirths including one at home (just as the friend, not the midwife!- she had one of those). I have answered her called in the the middle of the night when she was a new mom and baby was crying or she was having trouble nursing. I was not a nurse then-- I am just now a new RN. We differ on a lot of things including the fact that I have put my trust in conventional medicine, esp after one of my children was born with a complex medical issue and needed lots of medical intervention that homeopathy would not have touched and may have even caused more harm.

So last year she called me saying her child was having some breathing trouble, fast respirations, retractions. I told her to immediately take her to the ER. She didn't listen. Finally a couple of days later she took her to the naturalpathic doctor, who called an ambulance from the office and the girl was admitted for several days with asthma. She was given instructions to give the child medicine and breathing tx, but has not done either. And yet she calls me all the time asking what she should do, and I always tell her to take the child in and she doesn't.

Last week she called again in the middle of the night. Her child had a high (103) fever for a few days which did not respond to Tylenol. She called only when the child was complaining of a stiff neck and was not lucid, seemed to be having hallucinations and was sleeping a lot in between these fitful waking periods. Once again I told her take the child to ER but she didn't. Instead she gave the child phosphorus which was something she had read about in a book. She also started to wake the child more often to offer fluids. The next AM she called to say the fever was gone and the child was better and she was glad she didn't bring the child in, they would have just done the spinal tap and put the child through needless suffering. I say she had a very close call with this child! It could have been serious. And to add insult, she changed to the subject of asthma since I have a cough right now, and suggested that the chiropractor could cure my asthma with a few adjustments! I have been suffering my whole life and know how to manage it with meds and doctor visits.

She's planning to go to a third world country with the children in a few months. I educated her once again about vaccines and encouraged at least the Dtap and polio. She did finally relent on those after me telling her horror stories of children I had seen in this same country when I traveled there several years ago. Polio is alive and well.

ow

I don't know why this friend keeps calling me. I don't know if I'm obligated, now that I'm an RN, to report her lack of action with a child who's ill, esp. the last time when it could have been very serious. I love her and I know she loves her children but it's just hard to watch. I know I have to report abuse but does this count as abuse?

Thanks for listening.

[hiddencatRN, BSN, RN]

There was a nurse in our area who did not report suspected abuse (medical neglect is abuse) and she faced jail time for it. Just another side to that coin.

I think this needs to be emphasized. We are mandated to report suspected abuse. We don't investigate or make the final determination, we recognize situations where neglect or abuse may be occurring and alert those who do the investigation. You wouldn't have posted here if you weren't concerned about what was going on (or not going on).

[NurseSnarky]

Whoa?! Neglect? That's harsh. Neglectful parents don't seek medical advice, nor do they seek alternative treatments...they NEGLECT and don't care. It sounds like she wants to know what it "might be" and then she can find an alternative way to treat it. Do I agree? I don't have to. Everyone has the right to make INFORMED DECISIONS about their care or their children's care. She calls for your opinion and then decides to treat her kids another way. I've dealt with a few friends like this also...when I saw the writing on the wall, that they did not want to use the albuterol or steroid, yet still had issues...that's fine. I will not judge because I look at all options myself and then make an informed decision for my own healthcare and those of my kids. However, I only will tell friends to consult their PCP or go to ER and it's out of my hands.

[pawsomepooch47]

You are a mandated reporter of abuse and neglect, which means you could be in big trouble for NOT reporting her. I would do it if I were you. You'll sleep better knowing you did the right thing. I have done it myself. It only hurts for a minute.

[pedicurn, LPN, RN]

You are a mandated reporter of abuse and neglect, which means you could be in big trouble for NOT reporting her. I would do it if I were you. You'll sleep better knowing you did the right thing. I have done it myself. It only hurts for a minute.

It's been a thin line so far ... and it doesn't seem the Mom has crossed the line to 'abuse and neglect' territory.

Nearly ...but not quite

Seems this Mom will likely have more close calls and you don't want to be on the radar.

I would limit my interaction with this person

[OCNRN63, RN]

I would tell her it is not in your scope of practice to give medical advice, and she should seek care from the medical provider of her choice. And then I would tell her to stop calling me with questions about her child's health in the future.

[elkpark]

It's been a thin line so far ... and it doesn't seem the Mom has crossed the line to 'abuse and neglect' territory.

Nearly ...but not quite

Medical neglect is a specific category of neglect, and, IMO, the situations described in the OP could easily be considered (or, at the very least, suspected to be) medical neglect -- and, therefore, reportable by mandated reporters. The official, government definition of medical neglect:

"Medical Neglect

Medical neglect encompasses a parent or guardian's denial of or delay in seeking needed health care for a child as described below:

Denial of health care--the failure to provide or to allow needed care as recommended by a competent health care professional for a physical injury, illness, medical condition, or impairment. The CAPTA amendments of 1996 and 2003 contained no Federal requirement for a parent to provide any medical treatment for a child if that treatment is against the parent's religious beliefs. However, CAPTA also designates that there is no requirement that a State either find or be prohibited from finding abuse or neglect in cases where parents or legal guardians act in accordance with their religious beliefs. While CAPTA stipulates that all States must give authority to CPS to pursue any legal actions necessary 1) to ensure medical care or treatment to prevent or to remedy serious harm to a child or 2) to prevent the withholding of medically indicated treatment from a child with a life-threatening condition (except in the cases of withholding treatment from disabled infants), all determinations will be done on a case by case basis within the sole discretion of each State.21

Delay in health care--the failure to seek timely and appropriate medical care for a serious health problem that any reasonable person would have recognized as needing professional medical attention. Examples of a delay in health care include not getting appropriate preventive medical or dental care for a child, not obtaining care for a sick child, or not following medical recommendations. Not seeking adequate mental health care also falls under this category. A lack or delay in health care may occur because the family does not have health insurance. Individuals who are uninsured often have compromised health because they receive less preventive care, are diagnosed at more advanced disease stages, and, once diagnosed, receive less therapeutic care."

http://www.childwelfare.gov/pubs/usermanuals/neglect/chaptertwo.cfm

And Mrs. Sparkle Pants is right -- healthcare professionals do sometimes end up getting charged (criminally) and convicted as accessories when it turns out that they were aware of child abuse/neglect and didn't report it, as mandated by law.

[pedicurn, LPN, RN]

As an adult your friend is free to refuse medical treatments, although she's not legally able to refuse medical treatments to the same extent when it comes to her infant. Even Jehova's Witnesses are usually required to submit blood transfusions for their children by court orders unless the child is a "mature minor" and considered able to make those decisions for themselves, which is usually considered to be at least 12-14 years old.

Your license isn't on the line simply for having relationship with someone who is hesitant to use traditional medicine. You've encouraged her in the past to seek medical help when it seems appropriate which is consistent with "reasonable and prudent" behavior for a nurse, so you're license is safe, cutting off ties with her would just mean one less reasonable voice speaking for this infant.

Yes there is a dilemma here

- one less reasonable voice advocating for the child or one less nurse with a license and a job?

If it were meningitis and the child died - Mom would go to court and would quite possibly say something like ' my nurse friend said it was ok'. She's going to be grasping at straws and not functioning well due to the grief and guilt

Then ... how would the OP prove otherwise? She has to go to court too and meanwhile suffers the loss of reputation, pay and even employment .... even if not shown to be complicit.

The Mom is a nutjob ....who cares for their child and lets it suffer for two days with a high fever and stiff neck ? Mom is a fine line away from neglect

[neuroms]

I think the ones more responsible for the child's neglect are the naturopaths who--while shunning medical treatment--make false and exaggerated claims of efficacy with nothing but fables and anecdotes to support their views, convincing those who aren't versed in medical research and statistics of an equivalence with medical treatment. These are the ones that advise against immunization as pertussis rates rise and claim all other types of cures as patients decompensate, delaying appropriate care. They shouldn't be charged with manslaughter when they kill patients, but murder, very well knowing the dubious and wanton nature of what their so-called "treatment." Sorry.

[anon456, BSN, RN]

have you considered Munchausen's by proxy? Getting a secondary reward at the child's expense????

I'm not an expert on this, but I do know that her child was hospitalized with asthma for several days and that was not made up. The father is also an asthmatic . . as far as the other things I'm not sure. It seems more like she's hesitant to trust doctors and does not believe dx rather than seeking attention. Maybe I'm misunderstanding what you are saying.

She had some bad personal experiences in the past, which is one reason she chose to homebirth. She avoids doctors and medical intervention but in her mind she is not unreasonable to seek it if needed-- for example when her child cut her finger and needed stitches, she took her right away.

That being said I am going to have a talk with her about my license and my duty to report, and it how it would be best for everyone's sake to stop asking me my opinion or telling me about her kids' medical stuff.

This has been a really good discussion and I thank you all for your great input and advice. I'm so glad I asked about it!

[debstmomy]

I haven't read all the responses, but thought I would respond. I lean to the natural side of things & try not to medicate my kids. I get where your friend is coming from.

One thing that strikes me odd in your post is you say she does not used medicine, but called you in the middle of the night when a fever did not respond to Tylenol? Curious why she gave Tylenol if she uses only holistic ways. Most wait until fever is higher than that to medicate.

Anyway....since she calls all the time & does not do what you say, I think you need to have a conversation that explains that while you understand that she calls you for advice, because you are an RN. But since she clearly does not follow said advice, ask her not to call about medical issues any more. She can call her Naturalpath, her Chiro, her acupuncturist instead. Tell her it is your license.

Good Luck!!!

[NurseMaybeBaby]

I see your dilemma, but I would absolutely do something. That poor child could end up severely ill or even dead someday. You are going to lose a lot more sleep over that situation than you will this one.

[cherrybreeze, ADN, RN]

1. She is endangering her daughter's life.

2. She is endangering your license.

If, God forbid, something were to happen to this child, and this were to end up in court it would be very easy for her to say "Well I asked Suzy and she's a nurse." Bye bye license.

There was a nurse in our area who did not report suspected abuse (medical neglect is abuse) and she faced jail time for it. Just another side to that coin.

I think this is a little extreme.

Yes, it WOULD be easy for her to say "well I asked so-and-so and she's a nurse...." but so-and-so didn't tell her not to do anything (or that the chiro would be fine for an asthma attack, or whatever). Sure, she can lie, but someone's license is not going to get yanked because of hearsay. It's not that simple. So-and-so gets on the stand and says, "no, THIS is what I told her (get the child to the doc, whatever)" and you can't prove one way or another. That's the least of the issue.