Non-compliance/medical neglect in a child with an open case with protective services

[JustBeachyNurse, LPN]

Is/Are the physician(s) all aware of the medical neglect/non-compliance? Clearly the extended family are non-qualified caregivers if the had no intention of giving the poor child his scheduled feeds.

I know CPS is reluctant to pull complex kiddos as there often aren't qualified caregivers to accept an emergent removal. I did a home visit /parent education visit series earlier this year for my agency at the request of CPS. It was a complicated situation and while not a perfect home at least while I was there mom demonstrated knowledge & competency with medication importance, administration & safety though there were significant child safety concerns (child was consuming inappropriate foods for her complex needs, climbing on wall units & cabinets and that's only what I saw in my short home visits) All prescriptions appeared to be filled appropriately and timely (confirmed with pharmacy) and appointments maintained.

This was 6 months ago, child discharged from our care. I got a call the other day from my agency asking if I had availability for shift work since I knew the case (it's an agency that does both traditional pedi home health ( intermittent visits) and PDN shift work) as the child & siblings was being removed by emergent court order as we spoke. The CPS solution was to find a foster family that could take all siblings and have 24hr PDN/CHHA care at foster home until a suitable, more permanent situation could be found.

This situation is out of control and it seems mom is either delusional with her lack of compliance or beyond clueless. Unfortunately it seems there are not competent caregivers within the family either that urgent removal may be the only option at this time.

I feel bad for the child.

[KelRN215, BSN, RN]

The medical team is aware. I have been communicating with the primary all along and I started communicating with the Neurologist myself recently as well, as it became clear to me that primary care was not sharing what was going on with neurology.

Bottom line, I do not think the child is in a safe place. He needs a competent adult to care for him and he's not going to get that at home. I have felt removal from the home is necessary for quite some time. Something I said got through to the team today as I had both the Social Worker and the NP scheduling emergency meetings with the family and the CPS worker at least agrees it's time for another meeting with all parties involved.

P.S. After my day ended with this nightmare late last night, it started early this morning with my first patient's mother telling me that he ate a cigarette the other day. Oh the life of an inner city nurse....

[KelRN215, BSN, RN]

Ugh and now today I basically get told that I'm the bad guy because the kid's Mom told his providers that she lies to me because she doesn't want to get in trouble. (And yet, shockingly, I always see through the lies and she gets herself into more trouble.) And I'm the only one over here thinking, "well if she admits that she's lying to protect herself, clearly the truth is she's not taking care of her kid and that's a problem." Apparently I'm the only one who was unaware that "mandated reporter" meant that you could ignore blatant medical neglect so that the kid's parents would like you better.

[nursel56]

Poor kid. This is just awful. Sounds like you are his only true advocate. I think I can only offer you appreciation by proxy for what you are doing on his behalf, because the people who are supposed to help you are actually obstructing you. ((hugs))

[xoemmylouox, ASN, RN]

Ugh and now today I basically get told that I'm the bad guy because the kid's Mom told his providers that she lies to me because she doesn't want to get in trouble. (And yet' date=' shockingly, I always see through the lies and she gets herself into more trouble.) And I'm the only one over here thinking, "well if she admits that she's lying to protect herself, clearly the truth is she's not taking care of her kid .[/quote']

I have been in similar situations. You are the bad guy because CPS doesn't want to find a placement for this complex kiddo. The providers don't want to deal with mom. If it wasn't for you the situation wouldn't change until something terrible happened and then everyone could act all surprised. You are forcing the issue and are doing what's right for that child. I hope he is removed, but you probably still have to battle on his behalf. Good luck and keep being the bad guy and holding mom accountable!

[TerpGal02, ASN]

Interagency meetings are THE MOST frustrating things. I have never been to one that I thought productive. It's all the agencies involved passing Tue buck to the next while agreeing "This is a terrible situation". Never been involved with apedi case, but an APS case with a very somatically and mentally ill individual that could not/wouldbnot take care of himself in Tue community. Severe depression, abject poverty, advanced O2 dependant COPD and a new lung CA dx. Wouldn't feed himself appropriately, house so full of bed bugs you could visualize them crawling on him during the day, daily use of EMS, non med compliant, smoked with his O2 on and blew his face up requiring intubation 3x. We were a mental health agency and took the brunt of keeping him alive until the sister stepped forward to take care of him. He WAS the first person I ever saw GAIN weight on chemo after that. He's still alive and kicking, and that was over a year ago.