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Discussion

Mandatory Reporting

Nursing student here, and there is some disagreement in our class regarding mandatory reporting. I know suspected child or elder abuse must be reported. But if an adult presents with injuries and confides it is domestic abuse but doesn't want to involve police.....isn't that protected info via HIPAA? Or must you report it to the police as abuse?

Having had a good friend in the middle of a contentious divorce "disappear" 5 years ago and never be heard from again leaves me concerned either way. Mandatory reporting may worsen a situation I have little insight to, but it also may create a history or pattern that is indicative of a problem even if the injured doesn't press charges.

Thoughts, experiences? Thanks

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    Each state has their own rules. If someone presents to the ER or Physicians office I do believe you need to report it. Some states now will prosecute even if the victim doesn't press charges. You could always ask the police if they would check on your friend due to your concerns, but if you haven't made any contact in 5 years they might not.

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    Here is the difference:

    Mandatory reporting is designed to protect those who are UNABLE to protect themselves.

    1. A child...cannot exactly pack up and leave, get a job and get out.

    2. Mentally handicapped, are particularly vulnerable.

    3. Elderly...may have dementia and also, have limited resources.

    But the mother who has a husband that goes to work every day and comes home and beats her up? That is a CHOICE. She can call the police herself, she can go to a women's shelter, there are options for her, but it is a CHOICE. This is a free country and if someone wants to stay in an abusive relationship they are allowed to stay in one...however, I would report to social services if they have children, ON BEHALF OF THE CHILDREN, because it is very, very rare that an abuser will be abusing the wife and not the kids and it's not an appropriate environment.

    You also do not have to have your employer's permission to report, nor worry about enough proof...that is not for you to decide...if you suspect, you report and let them sort out the legalities.

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    • Author

    Oh, I'm sure my friend is deceased. The police and FBI have been looking for her for years.

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    It is varies by state. My state is NOT a mandatory reporting state for DV and IPV. Sometimes mandatory reporting can cause problems in these situations.

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    While I understand how mandatory reporting can make things worse, here's how I thought the whole DV thing played out. Woman/man (yes, men can be victims too) comes to ER/clinic/office and you get spouse/significant other/parent/adult child away from them (either sending them on errand or taking pt for a test, etc.) and ask them about DV. If you find that they are a victim of DV, you usually ask them about if they have a safe place to go. If not, then you give them resources (best way to give them a number is to give them a number in an inconspicuous object). Then, you follow the mandatory reporting laws (if you have them in your state).

    Children, elderly, mentally handicapped are the most vulnerable. Pregnant women are at pretty high risk too due to possible jealousy that the woman will give more attention to the baby than the abuser.

    Jory is right though. There is a choice there. It can be hard though just because the victim loves the abuser and many times they think they'll change. Or fear of retaliation.

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    Each state has it's own mandated reporting requirements. We report elder/child abuse, animal bites, gunshots, injuries from commission of a crime. We do not report on knife/baseball bat, or any other type injury. We also don't report domestic violence or rape, which are tough on most of us!

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    • Experts

    Mandatory reporting laws vary state to state. The absolute reporting laws for abuse are children, handicapped/disabled, and the elderly. As Jory has already pointed out "adults" in an abusive relationship make a "choice" If it a mandatory reporting issue you are legally obligated to notify the authorities and do not need the permission of your employer......there are state forms made available as well as hot line numbers for immediate action......like the removal of a child from a family situation that puts them in danger.

    There are other mandatory reporting laws like for penetrating injuries such as Gunshot wounds and stabbings. In some states your are a mandated reporter for MVC with injuries and alcohol is involved and drawing blood alcohol is mandatory....you can hand the BAL right over to the police in the ED as legal evidence.

    In asking the domestic violence question you are using it as a screening tool......you can report the children in danger and offer the adult female services and get them seen in the ED or to call the police to report a crime but there is no official reporting just official asking......in some stares. Now if they come in really beaten up, again depending on the state, it is felonious assault making it a reportable crime. HIPAA does not apply. HIPAA actually makes provisions where crimes are permitted and mandatory reporting occurs that allow you to notify the authorities......but the "need to know" comes into play here. You can notify them of the crime but not reveal other "health" information like they have a substance abuse issue in their past.

    I once had a domestic violence case involving a police officer. I mean he really beat the snot out of her......It was obvious felonious assault the police were notified and arrested the offender and pressed charges themselves. She personally never pressed charges. At the trial she did not testify and could not be made to as it was her husband. I was witness for the prosecution....without the wife testifying at the bench trial (smart defense lawyer) the judge ruled not guilty and they handed the abuser his gun right in front of me. He did eventually kill her....sad really.

    In domestic abuse cases....it is a fine line. You call social services to speak with the victim and you can call the police to report a crime and to have them speak to the victim when they present with physical harm. You can get services if you think the children are in danger, otherwise you just offer them domestic violence information and a list of shelters.

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    I wouldn't necessarily call a woman staying in an abusive relationship a "choice"... she may believe that she has no choice or that if she tries to leave it will get worse. Regardless, a competent adult can make the "choice" to stay in an abusive relationship. Working in pediatrics, I had a few situations over the years where the mother viewed a child's illness as an out and disclosed domestic abuse upon admission. Once it was disclosed, Social Work and the hospital's Domestic Violence program could step in and try to help. BUT, if the woman didn't disclose or did and refused help, there wasn't much to be done. Competent adults can refuse help. I'm fairly certain that my across the hall neighbor at my last building was in an abusive relationship... I'd often hear screams for help when I was sleeping after a night shift, another neighbor would call the police and then when they came, she'd make some excuse and send them away. I always felt odd seeing her boyfriend in the hallway because of the things I suspected but, then again, I didn't know this woman and when people tried to help/intervene, she seemed to jump to her boyfriend's defense. If there were children in the home, I would have called DCF and perhaps more could have/would have been done.

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