Child Abuse or Neglect; Medical Consultation Services
Requires a qualified medical facility selected by the director of human services to provide direct medical consultation to the child protective services agency regarding cases of reported child abuse or neglect that are under investigation by that agency. Appropriates funds.
HOUSE OF REPRESENTATIVES
TWENTY-FIRST LEGISLATURE, 2002
STATE OF HAWAII
A BILL FOR AN ACT
relating to child abuse or neglect.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that child maltreatment is a major public health problem in our society. In 1998, over 2,800,000 children were reported to child protective services agencies across the country, representing a ninety-eight per cent increase since 1986. Approximately thirty per cent of victims of serious physical abuse have evidence of prior episodes of abusive injuries. In addition, recidivism, or re-abuse after child protective services investigation, has been reported at over fifteen per cent. The result of this lack of recognition of abuse is the unnecessary suffering and death of our nation’s children.
Between 1996 and 1999 on Oahu, the number of reports made to child protective services, which operates as a unit of the department of human services, that received investigation increased by forty-five per cent to 3,237. At the same time, child abuse has emerged as an area of specialized expertise within pediatrics; this area of expertise is referred to as forensic pediatrics. There is a rapidly growing body of knowledge in the field; the number of published articles in the medical literature on child abuse has risen seventy per cent in the last fifteen years. National organizations have been formed to promote training and education in this area. Due to the increase in medical knowledge in the field of child abuse, the investigation of children who are reported to child protective services has become more complex. The accurate diagnosis of child abuse relies on the joint work of both medical and social service specialists in the field of child abuse. Recognizing the need for collaboration, centers are being established throughout the country to provide forensic pediatric consultation to child protective services agencies.
In Hawaii, state funding has limited the availability of medical consultation in the area of child abuse. Currently, only two groups of children receive child abuse medical evaluations during their child protective services investigation:
(1) The seriously injured children who are hospitalized;
(2) The small number of children who present to child protective services with a history of acute (within the last seventy-two hours) sexual abuse.
Despite the availability of medical experts in this field, a child abuse physician examines only three per cent of the children being investigated by child protective services. The lack of such medical evaluation results in injuries being improperly documented and missed altogether.
Accordingly, the purpose of this Act is to require a qualified medical facility to provide direct expert medical consultation to the child protective services agency on cases of reported child abuse or neglect that are under investigation by that agency, and to appropriate funds for this purpose.
SECTION 2. Chapter 350, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§350- Medical consultation services in child abuse or neglect cases. (a) The director of human services shall select a qualified medical facility to provide direct medical consultation to the department's child protective services agency on cases of reported child abuse or neglect that are under investigation by that agency.
(b) The medical facility shall be selected by the director of human services on the basis of that facility's expertise in the areas of medical diagnosis and evaluation services relating to child abuse or neglect.
(c) The designated medical facility shall provide medical consultation services including:
(1) Medical diagnosis and evaluation services, including the provision or interpretation of x-rays and laboratory tests, related services as needed, and the documentation of findings; and
(2) Medical evaluation related to child abuse or neglect.
(d) The child abuse or neglect reports that are referred by the department to the designated medical facility for medical evaluation shall include cases involving:
(1) Bruises, burns, or fractures in a child of any age;
(2) Injuries to a child’s head;
(3) Reported malnutrition of a child and failure to thrive;
(4) Reported medical, physical, or emotional neglect of a child; and
(5) Reports of any family in which one or more children have been pronounced dead on arrival at a hospital or other health care facility, or have been injured and later died, as a result of suspected child abuse or neglect, when any sibling or other child remains in the home."
SECTION 3. Section 350-2, Hawaii Revised Statutes, is amended to read as follows:
"§350-2 Action on reporting. (a) Upon receiving a report concerning child abuse or neglect, the department shall proceed pursuant to chapter 587 and the department's rules.
(b) The department shall inform the appropriate police department of all reports received by the department regarding a case of child abuse or neglect, including reports received under section 350-1.1; provided that the name of the person who reported the case of child abuse or neglect shall be released to the police department pursuant only to court order or the person's consent.
(c) The department shall inform the appropriate police department or office of the prosecuting attorney of the relevant information concerning a case of child abuse or neglect when the information is required by the police department or the office of the prosecuting attorney for the investigation or prosecution of that case; provided that the name of the person who reported the case of child abuse or neglect shall be released to the police department or the office of the prosecuting attorney pursuant only to court order or the person's consent.
(d) All child abuse or neglect cases transmitted for investigation to child protective services shall be simultaneously transmitted for review by the department to the medical facility designated pursuant to section 350- . Of these cases, those that meet the criteria in section 350- (d) shall be timely reviewed by a board-certified pediatrician with experience in child abuse or neglect (hereinafter, a "child abuse pediatrician"), or a certified pediatric nurse practitioner under the supervision of that pediatrician, for the purpose of determining whether a face-to-face medical evaluation by a child abuse pediatrician is necessary. A face-to-face medical evaluation shall not be deemed necessary only if the child was examined by a child abuse pediatrician for the alleged child abuse or neglect, and a consultation between the child abuse pediatrician or the nurse practitioner and the examining physician concludes that a further medical evaluation is unnecessary.
(d)] (e) The department shall maintain a central registry of reported child abuse or neglect cases and shall promptly expunge the reports in cases if:
(1) The department has found the reports to be unsubstantiated; or
(2) The petition arising from the report has been dismissed by order of the family court after an adjudicatory hearing on the merits pursuant to chapter 587.
For purposes of expungement under paragraph (1), a report is unsubstantiated only when the department has found the allegations to be frivolous or to have been made in bad faith.
However, the department may retain records and information of alleged child abuse and neglect with respect to the child who is the subject of the alleged abuse.
(f) The department shall adopt rules as may be necessary in carrying out this section."
SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ , or so much thereof as may be necessary for fiscal year 2002-2003, for a qualified medical facility to provide direct medical consultation to the child protective services agency within the department of human services on cases of reported child abuse or neglect that are under investigation by that agency, as provided in this Act. The sum appropriated shall be expended by the department of human services.
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect on July 1, 2002.