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Suspected Child Abuse Reporting in Texas
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Kenneth Totz DO, JD, FACEP

Every state in the union has some form of mandatory reporting for suspected child abuse. In spite of this uniformity, each state has some unique requirements that should be known by health care professionals to keep them out of the cross hairs of criminal liability. Most of us count on our malpractice insurance to cover our civil liabilities during our clinical encounters. Malpractice insurance, though, will not cover criminal activities that may arise from our acts of commission or omission during the course of job performance. In the following paragraphs, I will highlight the relevant features of Chapter 261 of the Texas Family Code that are most pertinent to emergency physicians in Texas. For a detailed view of the law online, please go to:

What Does the Word “Abuse” Mean?

Abuse encompasses those physical, mental, and sexual acts of commission or omission that actually or may reasonably result in observable and material impairment upon a child’s growth, development, or psychological functioning. Acts of commission that would fall within the sphere of abuse would be: non-accidental physical injury to a child beyond reasonable disciplinary measures, any photography or acts of a sexual nature with a child, and persistent emotional disparagement of a child. Some illustrative acts of omission examples would be: failure to ensure proper food, clothing, shelter, or medical care, allowing a child to be placed in a situation whereby they would be sexually exploited, and failure to protect a child from the physical acts of another.

During What Time Period Should an Emergency Physician Make a Suspected Abuse Report?

If an emergency physician has cause to believe that a child has been abused, neglected, or may be abused or neglected, the physician is required to make a report no later than 48 hours after the physician first suspects the abuse or neglect. The physician primarily caring for the child suspected of being abused is ultimately responsible for the report being carried out. Delegating the responsibility to another person (nurse, resident, social worker, etc.) will not absolve the physician’s culpability if the report is not timely made. If it is assuredly known that a report has already been made by one of the members of the care team, the physician is not obligated to make an additional report

What Should be Included in a Report to the Authorities?

A report should reflect the physician's belief that a child has been or may be abused, neglected or has died of abuse or neglect. When making the report, the physician will need the following information: the name, address, and telephone number of the child, the name, address, and telephone number of the person(s) responsible for the care, custody, or welfare of the child, and any other pertinent information concerning the alleged or suspected abuse or neglect. A “face sheet” from the patient’s medical record will provide most of the useful demographic information requested.

Where Should the Emergency Physician Make the Report?

If the emergency physician feels that the child is in immediate danger, as opposed to a suspicion of abuse, the physician may notify any local or state law enforcement agency. A call to The Texas Abuse Hotline of the Department of Family and Protective Services at 1-800-252-5400 may also be made for immediate assistance. An online “E-report” may also suffice if there is only a suspicion of abuse or neglect. Setting up an account with the Texas Health and Human Services is quick and easy to allow online E-reports. Go to the following link and then bookmark the site in your browser for easy future usage: The reports can typically be done in less than ten minutes if all the above information is gathered ahead of time. If there are ever difficulties reaching any protective agency, consider admitting the child to the hospital or transferring to a children’s hospital to remove the child from harm’s way. The admission or transfer though, will not transfer the obligation for the initial emergency physician to make the required report.

What Immunity Protections are Afforded to a Physician Making a Report?

A physician acting in good faith who reports or assists in the investigation of a report of alleged child abuse, neglect or who testifies or otherwise participates in a judicial proceeding arising from a report, petition, or investigation of alleged child abuse or neglect is immune from civil or criminal liability that might otherwise be incurred or imposed. Conversely, a physician who reports abuse or neglect of a child or who acts in bad faith or with malicious purpose in reporting alleged child abuse or neglect is not immune from civil or criminal liability.

What Penalties Might Be Imposed for Bad Faith Reporting or Not Reporting?

If a physician makes a report in bad faith, without foundation, or with a malicious purpose, they may be obligated to pay the defendant’s attorney’s fees in defense of the claim and any other expenses related to the defense of the claim. A physician may be subject to criminal liability if he/she fails to make a required report and knowingly fails to make the required report. Failure to make a required report is a Class A misdemeanor. This is the most serious class of misdemeanors and may carry monetary fines and jail time if convicted. Alternatively, if it is shown on the trial of the offense that the child was a person with an intellectual disability who resided in a state supported living center and the physician knew that the child had suffered serious bodily injury as a result of the abuse or neglect, the offense will be prosecuted as a felony. Further, if it is shown on the trial of the offense that the physician intended to conceal the abuse or neglect, a felony conviction similarly may result. In addition to stiffer fines and jail time, a felony conviction will result in a report to the National Practitioner Data Bank and the Texas Medical Board for review of continued licensure.

Texas law mandates that all emergency physicians shall report suspected abuse or neglect. The reporting process can easily be accomplished online during or after a shift, but must be performed within the allotted 48-hour window required by The Texas Family Code. Failure to report known or suspected abuse carries very harsh monetary fines and/or jail time. In an effort to keep oneself out of the scrutiny of the criminal court system, always be on the lookout for the possibility of child abuse, take this mandate very seriously, and promptly complete the reporting yourself.

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