Case Study Outcome
1. An 87 year-old male arrives via ambulance from a
local nursing home with bruising on his neck and wrists. Although you
are not completely sure, you suspect abuse based on the bruising
patterns and similar past injuries document in the patient’s
medical record.
Massachusetts law requires that
any physician who has reasonable cause to believe that an elderly person
(60 years of age or older) has been abused must immediately report such
abuse to the Department of Elder Affairs (M.G.L. c. 19A § 15). The
physician need not be positive that abuse has occurred. Rather, the
physician merely needs reasonable cause to believe that abuse has
occurred. In this instance, certain bruising patterns and a history of
like injuries should suffice. If it were later determined that there was
no abuse, the mandatory reporting law would protect the physician from
any criminal or civil liability for making the report.
2. A 26 year-old female presents with injuries
consistent with forced sexual assault. The patient informs you that she
has been raped, but does not want to report the rape or press charges on
the assailant.
Physicians are only required to
report the abuse of patients who are under 18, 60 and over, disabled, or
in a long-term care facility. If the patient does not fall into one of
these categories, it is solely the patient’s decision whether or
not to report. In this instance, since the patient does not wish to
report, the physician must respect her wishes. However, Massachusetts
law does require that treating physician report the incident to the
Criminal History Systems Board and to the police of the town where the
rape or sexual assault occurred (M.G.L. c. 112 § 12A½). This
report must not include the patient’s name, address, or any other
identifying information.
3. A 17 year-old male
presents with a small-caliber gunshot wound to the foot. He states that
he was just "messing around" with a couple of friends, and the shooting
was an accident.
Massachusetts child abuse law
requires physicians to report suspected abuse of patients under the age
of 18 (M.G.L. c. 119 § 51A). Assuming there are no additional facts
or history regarding this shooting, it does not appear that there is
reasonable cause to suspect abuse, and thus the physician would likely
not be required to report this incident based on child abuse law.
However, Massachusetts law does require that physicians report all
gunshot wounds to state and local police (M.G.L. c. 112 §
12A).
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