[humanser] Indiana child abuse warnings not being made

[Mary Ann Robinson]

    Indiana child abuse warnings not being made
A doctor suspected abuse. He never reported it. Six months later, a
toddler was dead.
9:41 PM, Aug. 29, 2012  |
6 Comments
Description: Jayden Noel died six months after he was taken to an
emergency room
with bruises.
Jayden Noel died six months after he was taken to an emergency room with
bruises.
/ Photo provided by Jerraco Noel
mailto:tim.evans at indystar.com
Written by
Tim Evans
How to report
Indiana
 law requires any "individual who has reason to believe that a child is
a victim
of child abuse or neglect shall make a report" to the Department of
Child Services
or a local law enforcement agency.
Reports can be made at any time of the day or night by calling local law
enforcement
or the DCS hotline at (800) 800-5556. If it's an emergency, call 911.
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Violating child abuse reporting law rarely results in punishment
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Documents: Jayden's file
Jayden Noel's ear was bruised and discolored. There was another bruise
on the side
of the baby's face. His lip was cut.
The emergency-room physician who examined Jayden in July 2011 at Major
Hospital
 in Shelbyville was initially suspicious the injuries might have been
signs of abuse.
The doctor asked "very direct specific questions about any child abuse,"
according
to
hospital records obtained by The Indianapolis Star
. But ultimately the doctor determined the family's explanation was
plausible.
Their story: The mother's boyfriend tossed a toy into Jayden's crib, not
realizing
the 7-month-old child was in it.
"Do not feel at this time," the physician wrote, "that a state of abuse
exists."
Six months later, Jayden was dead, another victim of deadly abuse who
appears to
have fallen through the cracks in a system designed to protect innocent
Hoosier children.
Star investigations repeatedly have uncovered instances that call into
question the
diligence of the Department of Child Services in investigating reports
of abuse and
neglect. But Jayden's death raises an additional concern: It prompted a
Marion County
judge to call out the emergency-room doctor who treated Jayden last
summer, an unusual
jab that more broadly highlights growing concerns about Indiana's
mandatory child-abuse
reporting law.
An autopsy revealed Jayden died from "multiple blunt-force traumatic
injuries to
the head." It described numerous bruises, as well as signs of another
recent head
injury and an older, healing collar bone injury.
Investigators were unable to determine who was responsible for the skull
fracture
that killed Jayden in January, but his mother, Chelsea Taylor, 20, and
her then-boyfriend,
Ryan Worline, 29, are charged with neglect resulting in death.
In the wake of the toddler's death, The Star filed a public-records
request to obtain
DCS records detailing the agency's involvement with Jayden.
Marion Superior Court Judge Marilyn Moores approved the request. Such
rulings are
typically boilerplate in nature, but not this time. Moores
 made a point of specifically chastising the emergency-room doctor,
saying he "failed
to make a report of suspected child abuse."
"When you have a pre-verbal child with bruising that seems inconsistent
with the
injury, living in a home with a (mother's) boyfriend who is not the
father, err on
the side of caution,"
Moores said of her reason for noting the actions of the ER doctor.
Indiana law requires anyone "who has a reason to believe a child is a
victim" of
abuse or neglect to file a report with police or DCS.
The physician, Dr. Chris Loman, works for EmCare, a Texas-based company
that contracts
with the hospital to provide emergency-room doctors. Through a hospital
spokesman,
Loman declined to comment.
Jack Horner, president and CEO of Major Health Partners, said that in
the case of
Jayden's emergency-room visit, "I do feel like we did handle our policy
correctly."
It's unclear whether the physician will face legal consequences. Shelby
County Prosecutor
Kent Apsley said he was unaware of Moores
' order, which The Star shared with him. He did not respond to follow-up
messages
seeking a response, including whether it was a matter he might pursue,
after reviewing
the judge's comments.
The reality is that even in this time of rising awareness of the
responsibility to
report suspected child abuse, many suspected cases of abuse and neglect
go unreported.
Child advocates say that must change.
"People need to follow the law and err on the side of the child," said
James M. Hmurovich,
a former Indiana
 child-welfare official who now serves as president and CEO of Prevent
Child Abuse
America. "It is an adult's responsibility to keep a child safe."
Records in Jayden's DCS file, which was reviewed by Moores
 before she approved its release to The Star, indicate that Loman
initially suspected
abuse.
That suspicion, Moores
 said, should have been enough to prompt a call to the DCS hotline, even
though Loman
ultimately concluded there was no abuse.
"That's the purpose of the statute," she said.
Even though the ER doctor did not notify DCS, the agency did open an
investigation
-- at the request of Jayden's father.
Jerraco Noel, 23, who was not married to Taylor and did not live with
her at the
time, called DCS when he learned from his son's mother -- three weeks
after the fact
-- that Jayden had been taken to the emergency room.
By that time, Moores noted in her order, "all evidence of the injuries
was gone."
Records in the DCS file indicate that such lack of evidence contributed
to the agency
clearing Jayden's mother and her boyfriend, Worline, in the incident
last summer.
A DCS spokeswoman did not respond to requests for comment.
Records in the DCS file, however, also raise concerns about the agency's
role.
Those records indicate that even after the father notified the agency,
the investigation
was "not initiated timely due to mom being out of town."
Although DCS did obtain records from the 2011 emergency-room visit,
there is no indication
in the file that the investigator spoke directly with Loman or anyone
else at
Major Hospital who saw Jayden during the emergency-room visit.
Instead, the final report that cleared Taylor and Worline says Taylor
and her mother
reported to the DCS investigator that "the doctors medically cleared
Jayden."
The file also documents discrepancies in the stories Taylor
 told the DCS investigator, explanations that didn't match what she and
Worline told
Loman during the emergency-room visit.
The story Taylor initially told the DCS investigator was that Worline's
daughter
-- not Worline -- threw the toy that struck Jayden.
Three days later, Taylor
 "apologized to (the DCS case manager) for giving a false story on
08/05/11, in regards
to the child's injuries," according to the worker's notes. Her new
explanation: Jayden
rolled over on a toy that Worline placed in the crib.
She never told the DCS worker that Worline threw the toy into the crib,
hitting Jayden,
even though Worline later told the investigator that is what happened.
Although the different stories are detailed in DCS records, the
discrepancies are
not cited in the agency's final report that cleared the couple.
That report concluded: "After interviewing all parties there is a lack
of preponderance
of evidence to support that the allegations of physical abuse is true."
Jayden's father was stunned.
"It's like the whole system failed my son -- from the hospital to DCS,"
Noel said.
"They just didn't put the incentive and effort into figuring out what
was going on."
Noel said he hopes Jayden's death can be a wake-up call for the medical
community,
DCS and the public.
"There are too many cases of things happening to children," he said,
"when people
have complained and then nothing happens."
There is no guarantee Jayden would still be alive if Loman had reported
his suspicions
to DCS, Moores told The Star.
But, she said, a report of suspicion from the physician might have had
an impact
on the outcome of the DCS probe.
"If I were the hospital," Moores said, "I would have a lot of questions
for the physician."
Horner, the president and CEO of Major Health Partners, said he was
baffled by the
judge's comment. Hospital officials and Loman were unaware of the
judge's criticism
until contacted by The Star.
"We do have a policy," Horner said, "where we do attempt to err on the
side of protecting
the child."
The hospital reported more than 50 suspected cases of abuse and neglect
in 2011,
Horner said. The staff cooperated with the investigation DCS opened
after Jayden's
father contacted the agency, he said, providing records the agency
requested.
Horner said the nature of emergency-room work, particularly when dealing
with a child
who is too young to explain what happened, means a physician almost
always starts
out from a position of considering all possibilities.
"You have to immediately suspect child abuse," Horner said, "but then
you try to
interview the family and others and weight that into your decision."
Horner said records show Loman did "not feel" the injuries were caused
by abuse.
That final determination, he believes, absolved the physician of the
reporting requirement.
It is not unusual for doctors to suspect abuse and not file a report
with police
or child protection agencies.
A sample of more than 300 physicians across the United States revealed
they did not
report more than a quarter of the injuries they considered "likely" or
"very likely"
the result of abuse, according to research published in 2008 in
Pediatrics, the journal
of the American Academy of Pediatrics.
Those doctors also declined to report more than three-quarters of the
injuries they
considered "possibly caused by child abuse," the study found.
One of the most common reasons cited for not reporting was "a lack of
certainty,"
while some physicians believed they could intervene more effectively
than child-protection
agencies.
Many study participants also reported struggling with the concept of
what constitutes
"reasonable suspicion." Some believed there would have to be a 95
percent likelihood
of abuse; others thought a 10 percent likelihood would meet the
threshold.
There is no clear rule of thumb in Indiana
 regarding what level of suspicion and confidence is needed to trigger a
report.
There also are no continuing education requirements for
Indiana
 physicians regarding child-abuse identification and reporting or, for
that matter,
any other topics.
Individual facilities where physicians practice often have some ongoing
educational
requirements, but such requirements and the topics they cover vary.
Frances Watson, a professor at the Indiana University Robert H. McKinney
School of
Law in Indianapolis, said Indiana
 lawmakers set a low bar for the reporting requirement when they used
the term "a
reason to believe."
"That doesn't take much," Watson said. "It is a minimal term."
Still, she said, she can understand why some people might struggle with
the standard.
"To some people, 'a reason to believe' might mean they should report any
suspicion,"
she said. "Others would require more facts."
Watson said Moores
 appears to be sending a not-so-subtle message with her order -- a
message that says
people should err on the side of reporting.
"The judge is trying to light a fire under people to get them to
report," Watson
said. "That's why (legislators) wrote the law: It was not getting done
otherwise.
And we still have issues with that."
This situation is on the radar of the Indiana State Medical Association,
said Communications
Director Adele Lash.
The association has a family violence committee that provides training
on the reporting
law, but it is not mandatory, she said.
Lash was unfamiliar with the case involving Jayden and could not discuss
it. She
said the association has printed three articles specifically on
identifying and reporting
child abuse in the past year, along with others that touch on the
subject, in its
publication for physicians.
A Feb. 21 article noted "recent reports of alleged child sexual abuse at
Penn State
and Syracuse University, in addition to several incidents in
Indiana
, provide a good reminder of your duty to report child abuse." It spells
out requirements
in the law and also explains that reports can be filed anonymously and
that reports
made in good faith are protected from civil or criminal liability.
Another article in March called reporting suspected abuse "a doctor's
moral, professional
and legal obligation" and included information on how to recognize signs
of abuse.
"This is something we have targeted," Lash said.
Dr. Roberta Hibbard, director of the Indiana University Child Protection
Program
at Riley Hospital
 for Children at IU Health, said she is working to secure funding to
provide training
to enhance physicians' knowledge of child maltreatment, including how to
identify,
report and medically evaluate suspected abuse cases.
Now, she said, there is wide variation across the state in how doctors
interpret
and respond to the reporting law. Although some report nearly every
child injury,
Hibbard said she also is aware of "several cases in
Northern Indiana
 where (physicians) saw and documented suspicions but didn't make a
report."
"We really need a call to action for medical providers to be well
informed," she
said.
Jayden's father agrees.
"They've got to have some sort of mandatory training for doctors each
year," Noel
said, "on how to identify and report abuse."
Call Star reporter Tim Evans at (317) 444-6204 and follow him on Twitter
at @starwatchtim.
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