By Andrew F. Angelino, MD
[Winter 2006; Vol. 32, No. 2; Pg 9, 13]
You’ve
read this before, but since the issue is still here, so are my reports.
Once again, I will begin with a position.
Child abuse, in any form, is wrong.
As a father of two adorable children (objectively speaking, of course), I
wish that child abusers would be stockaded in the streets for public ridicule,
and then possibly tortured (my apologies to Mr. McCain).
As a psychiatrist, I am sworn to take a position of recommending
treatment of abusers to rehabilitate them whenever possible.
I feel for the victims.
There is no doubt in my mind that they will suffer terrible emotional
scars and I sincerely hope, for their sakes, they will receive treatment.
Over
the summer, or the “off-season” as we refer to it in legislative terms, a
group of psychiatrists and others, led by Shira Rubenstein, MD, met to discuss
the issues raised by a bill proposed in the last three years’ legislative
sessions.
The bill in question would make it a misdemeanor crime, punishable by a
fine of up to $1,000.00, to knowingly fail to report any suspected child abuse
or neglect by phone within 24 hours, and follow up with a written notification
within 48 hours.
There
are three issues at stake here: one clinical, one societal and one political.
The clinical one you may have read about in my last report – the
attorney general of Maryland has interpreted the law to say that any suspicion
of child abuse, no matter when it happened, must be reported immediately.
Here is the update. The above-mentioned Task Force on Child Abuse
Reporting met with the author of the proposed bill and one of its strongest
advocates.
In so doing, we discovered a very interesting fact.
The proponents of the bill believe strongly that there are many cases of
child abuse that are
unrecognized and unreported (we knew that) and they were not really
thinking about the consequences of mandated reporting on our psychiatric
patients who were now adults, struggling with issues of long-past abuse (we also
knew that).
But, most interesting was their rationale for doing whatever is necessary
to increase child abuse reporting.
They were fairly disinterested in catching child abusers to stop child
abuse.
Their main interest lies in identifying
more victims.
Second, these non-psychiatrists then instructed us that compelling our
patients to report their child abuse would actively enhance their recovery,
since they would be helping to identify more victims and would feel more pride
in themselves.
From
a clinical standpoint, these proponents fail to see that the psychotherapeutic
relationship is compromised when psychiatrists are told to force patients, who
are barely able to talk about this sensitive issue, to publicize it.
They clearly have only the most rudimentary understanding of the process
of recovery from such a trauma (if that) and express no desire to understand.
From
a societal standpoint, the issue is quite interesting.
The proponents of the bill argue that unidentified abused children are
more important than identified, abused and traumatized adults.
They advocate for saving the children, yet offer no strong advocacy for
identifying and stopping abusers.
So the societal values they play upon are “Save the Children,”
leaving it unclear how child abusers will be stopped.
Meanwhile, unwilling traumatized adults are forced to be re-traumatized.
As advocates for the abused, we might be concerned for all the identified
victims, and not be so quick to sacrifice their recovery process in the hope of
finding more victims (whose rights will be later violated by this law).
We will, however, need to explain this carefully to the public, since it
seems socially awkward to go against “Save the Children at All Costs.”
To put it simply, we will not look our best if forced to yell out, as I
did at the last Task Force meeting with the bill proponents “I am not willing
to sacrifice every one of my patients for every one of your potential
victims!”
Further,
the bill raises an interesting social issue – why should healthcare
professionals be held to a higher standard than other people.
Why not have a criminal penalty for the neighbors, who have suspicions
based on the yelling they hear through the walls or across the yard.
Healthcare professionals already have penalties – board sanctions, loss
of licensure and ability to practice, etc.
Why the hostility toward us?
Last,
we need to think politically (this will be uncomfortable for most of you).
This bill is an easy issue for politicians – pass it and you look tough
on child abusers and sensitive to children (even though the bill does neither of
those things directly).
The bill’s proponents hint that it is unlikely that there will actually
be any criminal charges filed.
We have heard, in contrast, that there are five court cases in Rhode
Island where physicians are facing criminal penalties.
So why pass this bill?
The answer is simple – it costs nothing and looks good.
No increased spending for which we need a budget, no increased taxes or
cuts to cover the costs, no real outcomes except, you guessed it, more votes.
When
you talk to legislators and others about this bill, please remember these
issues:
we want to help the children and
the adults, we already have penalties for bad care and non-reporting and they
work, and we need to do something real to reform Child Protective Services, not
overtax an already broken system, even though it may cost something.
Perhaps, with your help, we can put this issue to rest.