Connecticut ruling protects doctors investigating abuse

Doctors in Connecticut who examine a child that the state suspects of being abused won't have the fear of a negligence or medical malpractice lawsuit hanging over their heads.

Connecticut's law, like those in most other states, clearly protects doctors who initially report suspected child abuse, even if it turns out that the child is not being abused. But a December 2004 Connecticut Supreme Court ruling took that protection a step further, applying the law to doctors who aren't the initial reporters but who examine a child at the request of the Dept. of Children and Families.

"The decision is reassuring and shows that there is protection in these situations," said emergency physician Gordon Van Nes, MD, the medical director at William W. Backus Hospital in Norwich, Conn.

Without such protection, physicians may be less willing to report suspected abuse and less willing to examine a child that the state suspects is abused, Dr. Van Nes said. The state's high court agreed with that logic in its recent ruling in Manifold v Ragaglia.

The case stemmed from a 2001 investigation. Based on an anonymous call from a pediatrician's office, the state sent a social worker to visit the home of a 2-year-old boy and a 3-year-old girl. He noted that both children were dirty and had bruised foreheads and that the boy also had extensive bruises on his back and a rash on the front and back of his torso.

The social worker took the children to William W. Backus Hospital, where emergency physician Robert Creutz, MD, examined them. Dr. Creutz ordered an x-ray on the boy and determined that there were no fractures. But he concluded that the bruises were typical of inflicted -- rather than accidental -- injuries.

The children then went to a licensed foster care home, and a pediatrician examined them while they were separated from their parents. The pediatrician ordered a blood test on the little boy that ultimately led to a diagnosis of idiopathic thrombocytopenic purpura. The bruising was consistent with that disease, and the state dropped their allegations of physical abuse.

The children's parents sued the state as well as Dr. Creutz and the hospital in 2002. They alleged the doctor and hospital committed medical malpractice for not ordering the blood tests that eventually ruled out the suspected child abuse. In a deposition, Dr. Creutz said that even if the blood tests had been positive, the physical findings alone raised a high suspicion of child abuse.

Based on the case, the Connecticut Supreme Court ruled in favor of protecting physicians who investigate child abuse. The law "that affords immunity to physicians aiding the department in the investigation process encourages medical professionals to help with this highly sensitive task, rather than to avoid a role in this process out of fear of liability when the department arrives at the hospital with a child who potentially has been abused," the court said.

No liability loophole, court says

An attorney for the children's parents did not return phone calls. But according to court records, they argued that the court's decision to grant immunity would create a loophole for physicians who commit medical malpractice against children.

The court disagreed and explained that immunity would be limited to damages that "arise from the physician's act of reporting and investigating child abuse." For example, the court said, if the state asks a physician to treat a child's broken leg and determine whether the child was abused, the immunity would be limited to the abuse determination.

"Contrary to the plaintiffs' concerns," the court wrote, "the extension of immunity ... does not give [the physicians] carte blanche to commit malpractice with respect to the diagnosis and treatment of any underlying medical conditions."