On being a mandated reporter

[KelRN215, BSN, RN]

I have been a pediatric nurse for nearly seven years. For the first five years of my profession, I took for granted that I never had to act on my mandated reporter status. I worked in a large pediatric hospital and we had social workers and a child protection team that did the dirty work.

I don't have any of that at my current job. And working inner city, I definitely have a higher population of patients who have, shall we say, social concerns. Somewhere around 10-20% of my caseload has open cases with our state's CPS. Well, things got VERY out of hand with one of those cases this week. There have been ongoing concerns in this house for some time. Things get better then they get worse. Without going into too many details, this week marked the 2nd and 3rd times that a significant volume of a controlled substance that the child takes went missing. Last month, 1/3 of the bottle just went missing. This week, someone obviously had diluted the bottle with water or with God knows what to try to throw me off as they are aware that I look at the volumes every time I'm there. I filed with the state because of this given that I had no idea what was added to this bottle (water? rubbing alcohol?) or what whoever did it's intentions were. Was that person trying to take some of this medication for himself and then just replacing the volume hoping the nurse wouldn't notice? Or was someone trying to hurt this child with what was added to the bottle?

They actually did respond and were granted legal custody of her but for reasons no one outside of the department understands, they left physical custody with the family. Well, they confiscated the bottle that was tampered with when they went in a few days ago and arranged for the family to get a new supply (no one believed me that just giving a family that steals this med more was the worst idea ever). And what do you think I notice today when I go over there? There's already more than 10% extra missing from the bottle. When I reported this AGAIN they basically didn't want to hear it, despite the fact that the agreement they came to in court yesterday specifically stated that if any further discrepancies were noted with this medication they would immediately remove the child from the home.

This is in a state where CPS has been under fire lately and FOUR kids have died under their care/due to their failures since December. UGH. Worst week ever. I thought last week was bad. After this week, I don't remember why.

[CapeCodMermaid, RN]

You must be in Massachusetts. All you can do is keep trying to help the child. You won't win with CPS.

[KelRN215, BSN, RN]

Every experience I have with them is worse than the last. The agency is a disgrace. It's shameful, really.

[Susie2310]

xxxxx

[CapeCodMermaid, RN]

Most of the regulatory agencies in Massachusetts could use an overhaul.

[~PedsRN~, BSN, RN]

It's not just in MA. I have yet to see a positive outcome where DSS was involved.

[tapeitup]

Random thoughts.... Contacting the police that a controlled substance is missing? So sorry for you and the child.

[tapeitup]

PS- can you contact the court?

Another thought - years ago I was given great advice... Start at the top... a letter stating your concerns for the child's safety to the interim DCF commissioner OR even the governor and let it trickle down. Ignoring your concerns would put them in a legal situation. It will probably ruffle some feathers.

[Not_A_Hat_Person, RN]

You're in Massachusetts, right? The mess that is DSS is an embarrassment. I went to high school in Fitchburg, and it doesn't surprise me that 2 DSS kids who died were from Fitchburg.

Anyway, I've done a few peds cases, and I've had to make the dreaded phone call. The client's mother clearly loved her very much, but she also had big problems.

[amoLucia]

PS- can you contact the court?

Another thought - years ago I was given great advice... Start at the top... a letter stating your concerns for the child's safety to the interim DCF commissioner OR even the governor and let it trickle down. Ignoring your concerns would put them in a legal situation. It will probably ruffle some feathers.

I like this, but am thinking - could you go to a local politician? They can get involved.

I know newspapers and TV stations like these kinds of issues also.

[Not_A_Hat_Person, RN]

Would that be a HIPAA violation?

[OwlieO.O]

Talk to your senators and see if they will finger involved. Also, pharmacies should be able to color things like morphine liq. That would be harder to inconspicuously replace.