mssmem.com

nyclu_pub_child_abuse_reporting

The New York Affiliate of the American Civil Liberties Union ? Tom Frey, President ? Donna Lieberman, Executive Director
125 Broad Street, 19th Fl.
New York, NY 10004
212.607.3300
212.607.3318
www.nyclu.org
Reproductive Rights Project
CHILD ABUSE REPORTING AND TEEN SEXUAL ACTIVITY:
CLARIFYING SOME COMMON MISUNDERSTANDINGS
(Updated March 2009)
New York laws about “statutory rape” and child abuse reporting are confusing. This list of
frequently asked questions (FAQ) describes when to make a report to the Statewide Central Register of
Child Abuse and Maltreatment (the reporting hotline for child abuse and neglect) based on a minor’s
sexual activity.
This FAQ explains that according to New York courts and guidance from the Office of Child &
Family Services (“OCFS”), parental knowledge of a minor’s voluntary sexual activity does not
necessarily give rise to reasonable suspicion of abuse or neglect and should not be reported to
the Statewide Central Register, absent other indications of abuse or neglect.
This memorandum is not intended to provide individualized legal advice. A mandated reporter or
young person who faces a specific legal problem should consult with an attorney.
1. What is reportable as child abuse?
New York’s child abuse reporting law mandates certain professionals to file a report when
they either have reasonable cause to suspect or become aware of abuse or maltreatment (neglect)
committed by a “parent, guardian, custodian or other person legally responsible” (hereinafter
referred to as “parent or caregiver”) for a child’s care.1 Abuse or maltreatment means that the
parent or caregiver directly harms the child or acts in a way that allows the child to be physically or
emotionally harmed or sexually abused.2
Under New York law, a child abuse report is only required if the abuse is committed by a
parent or caregiver, because they are the only ones that can be ‘the subject of a report.”3 Therefore,
the Statewide Central Register should only commence an investigation in a case involving suspected
child abuse or maltreatment against a parent or caregiver, and not in a case involving a person who
is clearly not considered a person legally responsible for the child’s care,4 even if that person harmed
a child.5
Harms committed by strangers or peers are therefore not mandated reports, unless a parent
has allowed a third party to harm the child. The word “allow” means that a child’s parent or
caregiver knew or “should have known about” abuse to the child by a third party and “did nothing
to prevent or stop it.”6 To determine whether abuse or neglect has occurred, New York courts
require a showing that a parent or guardian failed to exercise a minimum degree of care and
therefore generally consider “whether a reasonable and prudent parent would have so acted (or
failed to act) under [the] circumstances” that existed at the time.7
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
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2. Who must report cases of child abuse?
Mandatory reporters are health and educational professionals who are legally required to report
suspected cases of child abuse or neglect to the Statewide Central Register when they have a reasonable
suspicion that a child whom they see in their professional capacity is an abused or neglected child.8
Mandatory reporters are:
? physicians (including residents and interns), physician assistants, and registered nurses;
? mental health professionals (including social workers, psychologists, substance abuse
counselors, alcoholism counselors, and licensed creative arts therapists);
? other health professionals (including dentists and dental hygienists, podiatrists, emergency
medical technicians, osteopaths, optometrists, chiropractors and Christian Science
practitioners);
? hospital personnel involved in patient admissions, examinations, care or treatment;
? school officials (including teachers, coaches, guidance counselors and principals);
? social services workers;
? employees or volunteers in certain residential care facilities;
? child care and foster care workers; and
? law enforcement officials (including police officers, peace officers, district attorneys,
assistant district attorneys and investigators employed by the district attorney’s office).9
Note: A provision added in 2007 now requires the mandated reporter to personally report
suspected child abuse to the Statewide Central Register and inform the director of his or her agency or
institution. This is a change from previous law, which called for a medical staff member to first report to
a designated agent for the agency or institution, who then was responsible for making the report.10
3. When must a mandatory reporter make a child abuse report?
Mandatory reporters must report a reasonable suspicion of child abuse or neglect immediately to
the Statewide Central Register.11 A reasonable suspicion must be based upon “articulable facts
which, when examined objectively, would lead others to the same conclusion” that a child whom
they see in their professional capacity has been abused or neglected.12 Therefore, a proper report is
based upon a reasonable suspicion that a parent or caregiver harmed – or allowed a third party to
harm – the child.
Social service workers who are either employed by or have contracts with local social service
districts are under an additional obligation to report child abuse or maltreatment if a third party
comes to them in their official capacity and provides the social worker with information that, if true,
would render a child abused or maltreated.13
4. Should a mandatory reporter file a child abuse report if he or she learns that a minor
is engaged in a sexual relationship with a parent, guardian or person legally
responsible —even if the minor says that it is consensual?
Yes. A minor engaging in a sexual relationship with a parent, guardian or person legally
responsible for their care —even if the minor considers the relationship consensual—is a proper
basis for a child abuse report.14
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Child Abuse Reporting Q&A, March 2009
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5. Can a child abuse or neglect report be made against the parent or caregiver solely
on the grounds that a teen in their care is sexually active?
No, absent other allegations of abuse or neglect, a minor is not an abused or neglected child
merely because she or he is sexually active.15 Without other evidence of abuse, mandatory
reporters should not report sexually active or pregnant minors to the Statewide Central
Register.
Situation #1: The parent is unaware of his or her child’s sexual activity.
Generally, there is no abuse or neglect if a parent or guardian is unaware of a teen’s sexual
activity. In Matter of Toni D, the court concluded that a parent must know that his or her teen is
engaging in sexual activity in order to consider a charge of child abuse or neglect.16 In that case, an
appellate court affirmed the lower court’s dismissal of charges against the parents of a 13-year-old
girl whose boyfriend was 23, because no evidence had been presented to suggest the parents knew
of the sexual relationship.
Additionally, recent guidance from OCFS further affirms that “no report will be registered
by the Statewide Central Register where the caller fails to provide a reasonable cause to suspect that
a parent was aware of sexual activity or should have reasonably been aware of the activity, absent
other indications of child abuse or maltreatment.”17
Situation #2: The parent or caregiver is aware of his or her teen’s sexual activity.
The phrasing of the child abuse reporting law has confused some mandatory reporters about
their duty to file a report in cases where the parent is aware of a minor’s voluntary sexual activity.
Under the child abuse reporting law, caregivers who allow a sexual offense to be committed against
a child may be considered abusive or neglectful. New York Penal Law broadly prohibits sexual
activity with a minor under the age of seventeen, commonly known as “statutory rape,” even when
the activity is voluntary and even when the minor engages in sexual activity with a peer who is also
under 17, because a person under 17 is deemed incapable of consent as a matter of law.18
Recent guidance from OCFS makes clear that a mandated reporter should make a case by
case determination that considers not only the parent’s awareness but also whether the parent or
caregiver’s response was appropriate under the circumstances. OCFS further clarifies two points: (a)
the mere reoccurrence of the sexual activity “does not in and of itself,” mean that the parent’s
response is inappropriate or that a report is required and (b) a parent’s support of or involvement in
the teen’s accessing sexual or reproductive health care services may be a reasonable response, and
therefore does not by itself give to a reasonable suspicion of child abuse or neglect.
New York courts that have considered the question of whether a parent’s knowledge of a
teen’s sexual activity constitutes child abuse have found that it is not child abuse for a parent to
know that a minor child is sexually active if they have responded appropriately under the
circumstances.19
For example, in In re Leslie C., a mother was charged with abuse and neglect because her
daughter was sexually active with, and became pregnant at the age of 14 by, a 20-year-old boyfriend.
The court dismissed the charges and concluded that Leslie’s sexual activity and pregnancy did not
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Child Abuse Reporting Q&A, March 2009
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support a child abuse finding against her mother. The court found that while statutory rape laws
serve a strong social policy purpose, child abuse liability cannot reasonably be extended to the
parents of all sexually active minors.20 The court extensively discussed the policy reasons against
imposing particular moral or religious values under the pretext of child protection, and the practical
problems involved in convicting thousands of parents—including responsible and involved
parents—of child abuse because of their children’s sexual activity.21 The court concluded that any
abuse or neglect charges should be “limited to those parents who fail to intervene in forced sexual
relationships of which they have personal knowledge.”22
In summary, parents of sexually active or pregnant minors should not automatically be
reported for suspected child abuse or neglect, even if they know of such activity.
6. Should a mandatory reporter file a child abuse report against the parents of a
sexually active minor solely on the basis of the child’s sexual activity with an older
partner?
No. In order to report a possible case of child abuse or neglect, a mandatory reporter must
have a reasonable suspicion that such abuse or neglect is occurring.23 Because courts have found
that failure to prevent a child’s voluntary sexual activity does not constitute abuse under New York
law, this situation in and of itself cannot give rise to a reasonable suspicion of child abuse.
While the age of the minor may be taken into account in determining whether sex was
voluntary, a conclusion should not be based solely upon the age difference between the partners. In
Leslie C., the court concluded that the six-year age difference between the 14-year-old minor and her
20-year-old partner did not itself warrant finding the parents guilty of child abuse. The court left
open the question of “whether, on different facts, an abuse finding should be made.”24 A court
might reach a different finding in a case involving, for example, a 12-year-old in a sexual relationship
with a 25-year-old, despite claims that it was voluntary and consensual.
Therefore, health care, educational and other facilities should not impose policies requiring
blanket reporting of all sexually active or pregnant teens to the Statewide Central Register because a
determination of reasonable suspicion of child abuse should be made on a case by case basis
depending on the specific circumstances of a situation.
7. How does a health provider’s duty of confidentiality affect the reporting obligation?
Most health care providers are prohibited from disclosing information about a patient
learned in their professional capacity without the patient’s permission, unless otherwise required by
law.25 Providers who disclose such information without patient authorization or other legal
permission commit professional misconduct and can be sued, fined, and have their licenses
revoked.26 However, as discussed above, one of the legal exceptions to this duty of confidentiality is
the requirement to report information to the Statewide Central Register when that information is the
basis for a reasonable suspicion of child abuse or neglect.
As described above, New York courts have held that most cases of voluntary teen sexual
activity do not give rise to reasonable suspicion of child abuse or neglect. When a health provider
does not have a reasonable suspicion of child abuse or neglect, there is no legal basis to breach a
patient’s confidentiality to file a report. A health care provider or other professional with
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Child Abuse Reporting Q&A, March 2009
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confidentiality obligations who makes a child abuse report without reasonable suspicion of abuse or
neglect commits professional misconduct. This can subject such providers to professional sanctions
for breaching patient confidentiality, in addition to potential liability for committing the crime of
false reporting (see Question # 9, below).
8. Should a mandatory reporter report teen sexual activity to law enforcement or the
police as statutory rape without the patient’s permission?
No. Even though the minor may be the victim of a statutory sex offense, there is no
blanket requirement that all crimes be reported to the police.27 Furthermore, a health care
provider who reports a minor’s sexual activity to the police without the patient’s permission (or the
parent’s permission if the minor is unable to consent to the health service) has breached patient
confidentiality, committed professional misconduct and made herself vulnerable to lawsuit by her
patient and to professional licensing sanctions. Hospital policies that mandate or permit reporting
of “statutory rape” to the police (or to child protective services without further evidence of abuse)
also make the hospital vulnerable to a lawsuit.
9. Can a mandatory reporter be sued or charged with a crime for making or failing to make
a child abuse report?
Maybe.
Situation #1: Penalties for mandatory reporters who make good faith, false or
negligent reports.
A mandatory reporter who makes a child abuse report in good faith cannot be sued by a
parent for injury to his or her reputation.28 Good faith is presumed unless a mandatory reporter acts
with willful misconduct (makes a report knowing that it is false) or gross negligence (makes a report
without exercising even slight care or diligence to determine its validity).29
Although good faith mandatory reporters cannot be sued, it is unclear whether a good faith
mandatory reporter who incorrectly reports suspected abuse can be charged with a crime for making a false
report. New York Social Services Law immunizes good faith mandatory reporters from being charged
with a crime.30 However, a conflicting New York Penal Law makes it a misdemeanor if a personmakes a
false report of “an alleged occurrence or condition of child abuse or maltreatment which did not in fact
occur or exist” to the Statewide Central Register either directly or indirectly.31 While this statute seems to
state that it can be a misdemeanor to file a false report regardless of situations where the suspicion of
abuse was reasonable and the report was made in good faith, no court has addressed this contradiction
and it appears that the law was not originally intended to apply to mandated reporters.32 Therefore, it is
unlikely that a good faith mandatory reporter would be prosecuted, even if the report turned out to be
unfounded. A cautious mandatory reporter may wish to consult an attorney before making a report.
Situation #2: The mandatory reporter fails to make a report.
On the other hand, a mandatory reporter who suspects abuse or neglect and deliberately fails
to report it may be guilty of a class A misdemeanor and can be sued for damages resulting from the
failure to report (for example, the continued abuse of the child).33
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Child Abuse Reporting Q&A, March 2009
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Endnotes
1 N.Y. SOC. SERV. LAW § 413 (McKinney 2006). “Persons legally responsible” for a child’s care include a child’s
guardian, custodian (any person regularly found in the child’s household) or other person responsible for the child’s care
at the relevant time. FAM. CT. ACT § 1012(g) (McKinney 2006). See also Matter of Case, 120 Misc. 2d 100, 102 (Oneida
Co. 1983) (finding a 19 year old brother with whom minor lived with was not a person legal responsible for her within
the meaning of the statute noting that “the mere fact that two persons are residing in the same household at the relevant
time does not create a presumption that the older is exercising any type of parental control over the younger”).
2 A caregiver commits child abuse if he or she: (1) inflicts or allows the infliction of a non-accidental, physical injury that
causes substantial risk of serious physical or emotional harm; or (2) creates or allows the creation of substantial risk of
non-accidental physical injury that is likely to cause serious physical or emotional harm; or (3) commits or allows to be
committed a sexual offense against the minor. N.Y. SOC. SERV. LAW § 412(1) (McKinney 2006); FAM. CT. ACT §
1012(e). A caregiver is guilty of child neglect when he or she fails to exercise substantial care, and thus causes or creates a
substantial risk of physical harm to the child or causes a substantial reduction in the child’s psychological or intellectual
functioning. N.Y. SOC. SERV. LAW § 412(2); FAM. CT. ACT §§ 1012(f), (g).
3 N.Y. SOC. SERV. LAW § 412(4) (McKinney 2008). See In re Catherine G., 3 N.Y.3d 175 (2004) (dismissing claim for
failure to report abuse of child by 14-year-old boy because boy was not a parent, caregiver, or person legally responsible
for the child’s welfare and therefore could not be the subject of the report pursuant to the law); see also Page v. Monroe, 488
F. Supp. 2d 219, 221 (N.D.N.Y. 2007) (finding that a report against a half-brother was not legally justified as a report of
child abuse or maltreatment because the half brother “could not be the subject of a report”) affirmed in part, reversed in part
by 300 Fed. Appx. 71 (2d Cir. 2008) (affirming the holding that there was no showing of a statutory duty to report under
the mandatory reporter law but reversing the grant of summary judgment for the medical malpractice claim because
there existed genuine issues of material fact as to whether the pediatrician otherwise breached her duty of care).
4 Teachers and other school employees are not considered persons “legally responsible” under New York child abuse
laws. However, abuse committed by a school employee against a student in a school setting is governed by another set
of laws. School employees must report any allegations of such abuse to school authorities, but not to the Central
Register. N.Y. EDUC. LAW, Art. 23-B (McKinney 2006).
5 See supra n.3.
6 In re Katherine C., 122 Misc. 2d 276, 278-279 (N.Y. Fam. Ct. Richmond Co. 1984) (finding a mother guilty of neglect
because she should have known that her daughter was being sexually abused by the stepfather and failed to act to
protect her). See also Besharov, Practice Commentaries, McKinney’s Cons. Laws of N.Y., Book 29A, Family Ct. Act §
1012 at 314 (1999) (“‘Allowing’ a child to be abused includes taking no appropriate protective (or preventive) action
after being warned of the danger to a child”).
7 See Katherine C., 122 Misc.2d at 278. See also, Page, 488 F. Supp. 2d at 221 (finding no statutory duty to report an
instance of abuse against a child committed by someone who could not be the subject of a report when there is no
showing that the mother was incapable or unwilling to protect the child from further potential abuse); In re Katrina W.,
171 A.D.2d 250 (2d Dept. 1991) (finding that daughter was an abused child because her mother was unwilling or unable
to protect her from being sexually abused by her older brother).
8 N.Y. SOC. SERV. LAW § 413(1) (McKinney 2006).
9 Id.
10 N.Y. SOC. SERV. LAW § 413(1)(a) (McKinney 2008).
11 N.Y. SOC. SERV. LAW §§ 413(1); 415 (McKinney 2008).
12 Vacchio v. St. Paul’s United Methodist Nursery Sch., NYLJ, July 21, 1995, p. 32, col. 2 (Sup. Ct. Nassau Co.) (Alpert, J.),
citing People v. Brooks, 88 A.D.2d 451, 454 (2d Dept. 1982).
13 N.Y. SOC. SERV. LAW § 413(1)(b) (McKinney 2008). “Social service worker” is defined by OCFS as professional or
paraprofessional staff either employed by, or who have contracts with, local social service districts to provide services to
children and/or families. New York Office of Children and Family Services, Administrative Directive, 07-OCFS-ADM-
15 (Dec. 13, 2007). The information that is provided to the social service worker should be accepted at face value, and
should be reported to the State Central Register so long as it would constitute child abuse assuming it were true. Id.
14 See supra n.2.
15 For example, in In re Philip M., a state appellate court affirmed a lower court’s decision noting that a 15-year-old with a
sexually transmitted infection could not be presumed to be the victim of child abuse because the minor’s age indicated
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Child Abuse Reporting Q&A, March 2009
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that he could have been engaged in “consensual sexual activity.” 589 N.Y.S.2d 31, 32 (1st Dept. 1992) aff’d on other
grounds, 82 N.Y.2d 238 (1993)
16 In re Toni D., 179 A.D.2d 910 (3d Dept. 1992).
17 Letter from Charles Carson, Assistant Deputy Counsel, NYS Office of Children & Family Services to Galen Sherwin,
Director, NYCLU Reproductive Rights Project, dated January 16, 2009, available at http://www.nyclu.org/node/2294.
18 Article 130 of the New York Penal law identifies sexual offenses including sexual misconduct, rape,
sodomy, and sexual abuse. The categories of offenses are based on the ages of the participants and the type of sexual
activity involved. Because New York law provides that persons 16 years old and younger generally do not have the
capacity to consent to sexual activity, anyone under the age of seventeen who engages in vaginal, anal or oral sex is the
victim of at least the misdemeanor crime of sexual misconduct, and may be the victim of a felony sexual crime
depending on the age of his or her partner. N.Y. PENAL LAW § 130.00 (McKinney 2006). However, it is important to
remember that this penal law scheme does not automatically implicate mandatory reporting obligations. Courts have
found that a statutory sex offense based on a minor’s voluntary activity does not in and of itself constitute abuse or
neglect by the parent or caregiver. See cases cited infra note 20.
19 Comm’r of Social Serv. ex rel Leslie C., 161 Misc. 2d 600, 609-610 (Kings Co. 1994); Page, 488 F.Supp.2d at 221 (finding
that in order to establish that a parent ‘allowed’ abuse to occur to their child, the appropriate standard is to determine if
“the parent or guardian failed to exercise a minimum degree of care, such as failing to take any appropriate action to
protect their child” and noting that “if the parent is responding appropriately and acting to prevent harm to their child,
then there is no grounds for a report and no justification for state involvement”).
20 Leslie C., 161 Misc. 2d at 608.
21 Id. at 607-608.
22 Id. at 610 n.15 (emphasis added).
23 N.Y. SOC. SERV. LAW § 413(1) (McKinney 2006).
24 Id. at 610.
25 Professionals who are licensed or certified by the State, including nurses, doctors, physician assistants, nurse
practitioners, pharmacists, social workers and psychologists, are bound by confidentiality obligations. 8 N.Y.C.R.R.§
29.2 (2006). See also N.Y. C.P.L.R. §§ 4504 (privileging doctor-patient communications); 4507 (psychologist) 4508 (social
worker); 4510 (rape crisis counselor).
26 Revealing personal information obtained in a professional capacity without the prior consent of the patient constitutes
professional misconduct and is punishable by fine, reprimand or license revocation. 8 N.Y.C.R.R. § 29.1 (2006); N.Y.
EDUC. LAW §§ 6509(9), 6511 (McKinney 2006). Providers who breach confidentiality without patient authorization may
be sued by their patients for resulting damages. See, e.g., MacDonald v. Clinger, 84 A.D.2d 482 (4th Dept. 1982).
27 There are a few narrow exceptions where a report may be required. For example, New York law mandates that
hospital workers report to the police injuries involving firearm discharge or life-threatening stab wounds. N.Y. PENAL
LAW § 265.25 (McKinney 2008).
28 N.Y. SOC. SERV. LAW § 419 (McKinney 2008) (immunizing good faith mandatory reporters from civil liability).
29 Id.; Gentile v. Garden City Alarm Co., Inc., 147 A.D.2d 124 (2d Dept. 1989). Courts have also defined “gross negligence”
as involving egregious conduct. Gandianco v. Sobol, 171 A.D.2d 965 (3d Dept. 1991); Spero v. Board of Regents of University of
State, 158 A.D.2d 763 (3d Dept. 1990). For example, in Vacchio, the court held that a teacher was not necessarily
immune from liability because her immediate reporting of a student’s black eye without first inquiring as to the cause of
the black eye could support a finding of gross negligence, and thus was made without “reasonable suspicion” that child
abuse had occurred. However, “reasonable suspicion” is a far lower standard than certainty. In Kimberly S.M. v. Bradford
Cent. Sch., 226 A.D.2d 85 (4th Dept. 1996), a sixth-grade student told her teacher (a mandatory reporter) that an uncle
sexually abused her while she was living with him during school vacations over the course of two years. On the
mistaken theory that the uncle was not reportable as a “person legally responsible” for the child, the teacher did not
report the allegation, and the student continued to spend her school vacations at her uncle’s house. The appellate court
ruled that the teacher could be held liable for failure to report because the uncle was indeed a reportable custodian or
person legally responsible for the child’s care—as a person in whose care the child had been entrusted—during the
child’s extended visits with him because it was clearly unreasonable for the teacher to fail to report the uncle given the
facts she knew, as such facts created a “reasonable suspicion” that child abuse had occurred. Therefore, mandatory
reporters should report reasonable suspicions of child abuse, even if they are uncertain whether or not the situation fits
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Child Abuse Reporting Q&A, March 2009
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the legal definition thereof. Of course, if a mandatory reporter is certain that the situation does not fit the legal definition
of child abuse, a report would not be in good faith and could be considered willful misconduct, thereby not immunizing
the mandatory reporter from criminal and civil liability.
30 N.Y. SOC. SERV. LAW § 419 (McKinney 2008).
31 N.Y. PENAL LAW § 240.50(4) (McKinney 2009). Paragraph (a) of the law covers individuals who make false reports
directly to Statewide Central Register. Recent legislation added paragraph (b) to the section to cover the individual who
makes a false report indirectly by giving the false report to someone they know is obligated to make the report to the
statewide central register and with the intent that the report reach there. L. 2008, c. 400 § 1, eff. Feb. 1, 2009.
32 When the provision was initially passed, the accompanying legislative memorandum indicated that the purpose of the
law was to address the problem of individuals misusing the hotline by making “child abuse reports for harassment
purposes, especially during the course of matrimonial proceedings and child custody disputes.” See Donnino, Practice
Commentaries, McKinney’s Cons. Law of N.Y., Book 39, Penal Law § 240.50, at 169.
33 N.Y. SOC. SERV. LAW § 420 (McKinney 2008). See Bowes v. Noone, 748 N.Y.S.2d 440, 444 (4th Dept. 2002) (finding no
grounds for civil liability when the failure to report was not willful even where there was reasonable cause to suspect
child abuse); Page, 488 F.Supp.2d at 219 (noting that a showing of a reasonable cause to suspect child abuse is
insufficient as a matter of law to establish civil liability if the evidence does not support a finding that the failure to
report was knowing and willful).

Please note that the provider managing a sexual assault case, should
Request that the survivor sign an insurance waiver form (attached and
extras available in the evidence collection kit and the colpo closet) so
that the hospital gets reimbursed for the service. Form goes with the
chart. Thanks so much.

Barbara Richardson, MD
Medical Director, SAFE

Sexual Assault Checklist

The new camera and photo policy has been deployed in the clinical environment. The Policy can be found with the other department policies on line. The necessary sheets (Photo consent, Photo ID sheet) are located in copies. In summary….

Obtain the camera from the Peds ED Pyxis (if SAFE is not involved), print out the consent and the ID sheet. Get consent (not necessary for child abuse cases). Ensure the memory card is in the camera. Take your first picture of Patient label, take your photos of the patient, document after each photo on the photo ID sheet what the photos are of (ie left arm bruise), take your last picture of the patient label. Remove the memory card. Place card in envelope with the signed Photo ID page (envelopes located behind the storage box), place the sealed envelope in the photo storage lock box located in the attending office. Document in the chart that the photos were taken. SW will download the images the next day. Let Dr. Cohen, Dr. Richardson or Sara Mendes know if there are any questions.

TIPS

1) For close ups use the flower Icon on the camera (macro setting)
2) Spare battery located in the charger in the locked attending cabinet in peds
3) Extra memory cards are located in the pyxis

Policy for all Digital photography taken in the Emergency Department must be managed according to this procedure for the following protocol cases:

A. Sexual Assault (Code 11) see policy # 26.4
B. Domestic Violence see policy #26.3
C. Child Abuse/Sexual Abuse/Neglect- see policy #26.1
D. Educational Purposes

Photographs to be taken by SAFE Examiner and/or ED physician.

Consent for the taking of photos must be obtained from the patient except in cases of child abuse! Photo consent form is in Copies.

How to take photographs:
1. Obtain digital camera and Memory Card from Pediatric PYXIS/Safe Cabinet.
2. Ensure that memory card is loaded into camera and empty.
3. Ensure battery is charged. (Spare located in attending cabinet in peds ED.)
4. Ensure that appropriate date and quality setting is correct.
5. Obtain three (3) patient labels from IBEX.
6. Obtain Photo Documentation Page from Copies, affix patient label, fill in your name, document subject of each photo i.e. body part or injury.
7. First and last picture in sequence must be of patient’s IBEX label.
8. For all close up pictures, ensure that ‘macro’ setting (flower icon) is enabled.
9. Include in each picture, patient label and reference marker (paper ruler) if possible.
10. Review all pictures taken to ensure clarity and identification. Delete unusable pictures.
11. Remove memory card from camera.
12. Place memory card and Photo ID page into envelope (located behind lock box in attending office), label envelope, and deposit in locked box located in attending office.
13. Document in Ibex that photos have been taken and by whom.

How to upload images to Onbase (social work):
1. Social work will check the locked box in Attending Office when contacted by on-call SW and weekly to ensure that all pictures have been downloaded.
2. Insert Card into Card reader
3. Select Onbase Program, enter user ID and Password.
4. Download pictures to appropriate secure drive (i.e. Sexual Abuse, etc…) inserting comments from the Photo Id Page.
5. Insure Photos are deleted from memory card.
6. Return empty card to Pediatric Pyxis/Safe cabinet.
7. Document in Ibex that pictures have been downloaded.
8. Give Photo ID Sheet to B.A. to scan into chart

Access to Onbase Program is restricted to:
1. ED Attendings
2. ED social workers
3. Child and Family Support Program
4. Medical Records

After all photographs are completed and uploaded ensure that appropriate documentation is completed in IBEX i.e. “photos taken by ____”. Insure that appropriate consents are scanned into the medical record.

Extra charged battery located in the Attending cabinet in Pediatric ED.

As you know, we are a Center of Excellence for sexual assault, one of several in the City.

Stable survivors may be brought here preferentially. When such a survivor is identified,

he/she should be brought into a private area (Urgent Care A, either GYN or Peds GYN), immediate needs assessed

and SAVI, the SAFE, AND social work are called via AMAC 24/7. The SAVI is the patient advocate and provides emotional support and info on options post discharge; the social worker assesses for immediate social needs, safety, clothing, etc.

The SAFE on call will perform the evaluation and documentation on the Comprehensive SA Form and photos, evidence collection as per the patient’s wishes. The SAFE will make every effort to limit the nursing time involved with evidence collection.

SAFE will present their findings to the supervising Attending in the area. Unless the SAFE on call also is a MSH ED physician or PA,, the ED Attendings/residents or PAs would write med orders and lab orders using the order sets and complete the PICIS SA eval . If there is no SAFE on call (per AMAC and /or schedule posted in Urgent Care) then the ED MD/PA does the exam per protocol. Explicit instructions on collection of evidence are in the kit.

The check sheet (attached) can be used as a quick guide to timelines, chain of custody, post exposure

prophylaxis, referrals. This has been updated to include with option of Suprax or cefixime 400 mg oral for GC in lieu of

ceftriaxone IM. (now stocked in the ED and Urgent Care, thanks, Scot) and a reminder about the photo policy.(thanks, Ari)

Thanks for your attention to quality improvement for our survivors.

Barbara Richardson, MD

Medical Director, SAFE Program at Mount Sinai