Legislation in all provinces and territories requires physicians to report suspected child abuse to child protection authorities when there are reasonable grounds to believe or suspect that a child has been abused, is being abused, or is at risk of abuse. Child abuse may be emotional, physical, sexual, or mental in nature and includes involvement in child pornography.
Although the CMPA is aware of some cases in which physicians have been the subject of legal actions or complaints to regulatory authorities (Colleges) for having made a report, concerns about potential medico-legal difficulties must not discourage physicians from fulfilling their statutory obligation to report reasonable concerns of abuse. Physicians who fail to meet their responsibility to report suspected child abuse in a timely manner may be at risk of a legal action or College complaint.
In the CMPA's experience, Colleges and courts are rarely critical of a physician's decision to report suspected abuse. Indeed, the legislation that establishes the reporting duty typically protects physicians from legal liability when a report is made in accordance with the legislation, in good faith, and without malice.
The threshold for reporting suspected child abuse is based on a reasonable suspicion or belief, not actual proof of abuse. You are not required to know for certain that the situation represents abuse, nor do you necessarily need to know the identity of the alleged abuser. The duty to report generally applies even if you are aware that similar concerns have already been reported by another person.
Case scenario – A physician suspects abuse
A previously well 18-month-old patient was brought to their family physician by their mother.
The physician was concerned about penile bruising and buttock bruising for which the mother had no explanation. The mother raised the possibility that the injuries were sustained at daycare. Unable to find a medical explanation, the family physician consulted with a pediatrician. Before assessing the child, the pediatrician advised the family physician to report their concerns to the local child protection authority.
After their evaluation, the pediatrician also had concerns about the injuries. They discussed this with the child's mother and advised that further medical testing was necessary. They made a report to the child protection authorities, advising that in-hospital evaluations would take place the following day.
Later that evening, RCMP officers accompanied the child protection worker to the family home to conduct an investigation. The child protection worker told the parents they could not be alone with the child until the medical and social investigations were completed. The family had to arrange for in-house supervision and the child underwent an extensive medical workup over the ensuing days. No other injuries were found, and the pediatrician provided a report to the child protection worker stating the bruises were concerning but that no conclusions could be drawn as to their origin.
The mother complained to the College, alleging that the physicians overreacted. She alleged that the medical investigations were excessive, had unduly exposed her and her child to diagnostic radiation, and required her to take time off work to comply with medical testing and attend interviews by child protection authorities.
The College dismissed the complaint against both physicians, acknowledging they had acted in the best interests of the child and in accordance with their legal obligation to report suspected abuse.
Making a report
Some physicians may question whether their concerns are reasonable and meet the threshold for reporting.
If you are unfamiliar with reporting child abuse and have concerns about suspected abuse, call the CMPA for advice. Our physician advisors can help you through the decision-making process. They can also inform you of the appropriate authority for reporting, and help you minimize the chance of a complaint or legal action.
Although the legislation varies among jurisdictions, reports must generally be made to child protection authorities in a prompt manner. You may also choose to report to the police if you have reason to believe there is an imminent risk of serious bodily harm or death to a child.
Discussions with the family
A professional, straightforward, and sensitive discussion with family members about the rationale for reporting may help maintain a positive relationship. While it is generally preferable to be honest and transparent in these circumstances, it may not always be appropriate to inform caregivers in advance of your decision to report. Consider the safety of all those involved, including the child, the child’s siblings, yourself, and your staff.
If you do decide to notify family members in advance of making a report, consider discussing the following:
- the nature of, and reasons for, your concerns
- the statutory duty to report, emphasizing that it is not discretionary
- the threshold for reporting, which is based on the suspicion or belief of abuse or the risk of abuse, even if it is unproven
- the goal of the reporting requirement, which is not to be judgmental, but to protect children
- your role, which is limited to reporting concerns, not investigating.
Be sure to document your concerns, any discussions with family members, and the reasons for your decision to report. Discussions with child protection authorities and others in the context of making the report should also be documented. Accurate documentation can be important in establishing facts and reasoning if a complaint or legal action is later launched.
Being reported of suspected child abuse is difficult for families. After making a report, consider whether a trust relationship still exists that will allow you to continue to provide care to the child and other family members.
Disclose relevant information only
If you need to disclose patient information when making a report, you will not generally be faulted for breaching confidentiality. Provide only the relevant information necessary to make a proper report, including the facts and circumstances giving rise to the suspicion of abuse.
In response to requests from child protection authorities for additional clinical information, you should determine what the authorities are legally entitled to receive. In most jurisdictions, child protection authorities are not entitled to a copy of the clinical record without appropriate authorization. In these circumstances, you may wish to advise the child protection authority that, while prepared to cooperate, you are not able to provide the requested information without the consent of the patient, the patient’s legal guardian, or a court order. You are encouraged to contact us for advice in responding to such requests.