Non-accidental injury of a child

Business Dilemmas

Dr Kathryn Leask

Dr Kathryn Leask answers a consultant’s query about what to do if you are contacted by the local authority about a child protection case.

 

 

 

 

Dilemma 1

What does this invitation mean?

QAs a consultant paediatrician specialising in respiratory medicine, I have been involved in the care of a child who is now suspected of having a non-accidental injury. 

I examined the child during a routine follow-up appointment for their asthma. 

Following this, I was contacted by the police to inform me that the father was arrested two days later in relation to unexplained bruising found on the child’s chest by a health visitor.  

I provided a factual report stating that I had not noticed any bruising when I examined the child’s chest.

Now I have been contacted by the local authority in relation to a court hearing regarding the welfare of the child and I have been invited to intervene. I was unsure what this meant and whether it had any implications for me.

A Where child protection proceedings are taking place and a healthcare professional receives documentation from a solicitor or a local authority inviting them to intervene, it suggests that allegations have been made against them with regards to how the child sustained the injury. 

In this case, the father may have alleged that the injury to the child was caused when you examined the child’s chest. As this could result in criminal liability for you, it is important that you contact your medical defence organisation as soon as possible.  

You may need legal representation to protect your interests and represent you at the hearing.

It will be necessary for your legal representative to request full disclosure of documents being relied upon in court so that the exact nature of the allegations can be established and who the allegations have been made by.

This type of case emphasises the importance of good medical record-keeping.  

In situations like this, the doctor would have had no reason to know that child protection concerns would be raised after their consultation with the child. 

The notes will be vital with respect to providing evidence and the fact that there was no report of bruising, or other injury, during the examination and that no concerns were raised about the nature of the examination at the time.

  


When clinical photos show intimate images

Dr Kathryn Leask

A paediatrician’s colleague advises that it is a criminal offence to keep certain photographs of a patient taken for medical purposes. So what should he do? Dr Kathryn Leask gives her response. 

 

 

 

Dilemma 2

What do I do with the pictures?

Q I am a private paediatrician and regularly consult with a family over video, where appropriate. 

On this occasion, the patient is a five-year-old girl. Her mother was concerned about skin lesions that had developed on the child’s thigh and emailed photographs of them to my practice with an e-consultation form, as she was unable to attend a face-to-face appointment. 

The photographs are due to be uploaded by my administrative staff to the child’s record.

I have had a video consultation with the mother and child as well and found the photographs useful in reaching a diagnosis and being able to initiate treatment, as the lesions were difficult to see on video. The mother was aware these were to be added to the records and had agreed to this.

One of the photos included part of the child’s external genitalia, as one of the skin lesions was high up on the inner thigh. 

A colleague has advised me that it is a criminal offence to keep images of children where intimate areas of the body are showing. Please could you advise as to what I should do with the images I have?

A Your colleague is correct in that receiving and storing intimate images of a child could constitute a criminal offence, if the image was regarded as indecent. 

Where images are for the purposes of medical care and treatment, the defence of ‘legitimate reason’ could apply.

A legitimate reason may arise where the photograph is clinically important to help reach a diagnosis. It may be important to store the photograph in the patient’s notes so that there is a record of the lesion and to show any progress in treatment. 

It is important that the parent – or patient in the case of an older child or adult – is aware of the intention to store the image in the records and the reasons for this. Their consent should be documented.

Photographs should be sent to you securely and only those that are clinically necessary should be kept. 

If there is more than one photograph and the image which shows the child’s genitalia is not needed for the purposes of having a record of the lesion, this should not be uploaded. 

Once the photographs that are to be used have been uploaded to the records, the emailed images should be deleted.

Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union