Examining Mandatory Abuse Reporting Requirements for Physical Therapists

(This article will appear in the California Physical Therapy Association's March 2015 Newsletter, PT Interventions.)

Reporting abuse sounds like a simple and straightforward process. But due to the personal nature of the physical therapist-patient relationship, it can be difficult. Because such reporting is mandated by California law, this article examines who must report, what must be reported, and the serious consequences of a failure to report different injuries and abuse.

Laws Imposing Reporting Obligations

Three main areas of law require health care providers to make reports of abuse. These deal with child abuse and neglect, domestic violence, and elder abuse. The law addressing these issues includes:

• California Mandatory Reporting Law (Domestic and other Victims of Violent Crimes)[1]
• California Child Abuse and Neglect Reporting Act[2]
• Elder Abuse and Dependent Adult Civil Protection Act[3]

Under each of these statutory schemes, a physical therapist must report certain suspicious injuries or wounds observed when treating a patient.

California Mandatory Reporting Law

The California Mandatory Reporting Law (“MRL”) requires reports of certain types of abuse and injuries.

Who must report? Any health practitioner, including a physical therapist, employed in a clinic, health facility, physician’s office, local or state public health department, or clinic or other facility operated by a public health department must make a report under the MRL.

When does a physical therapist need to report? The physical therapist must report when he or she:

1. Provides medical services for a physical condition; and
2. Knows or reasonably suspects a person is:

    

    

   1. Suffering from any wound or other physical injury inflicted by his or her own act or inflicted by another where the injury is with a firearm; and/or
   2. Suffering from any wound or other physical injury inflicted upon the person where the injury results from assaultive or abusive conduct.[4]

The MRL broadly defines “assaultive or abusive conduct” against anyone as reportable and includes a list of 24 criminal offenses including murder, manslaughter, torture, battery, sexual battery, incest, rape, spousal rape, abuse of cohabitant, various types of assault including with a deadly weapon, and an attempt to commit any of these crimes.[5]

What must be reported? The MRL requires a physical therapist to contact local law enforcement to report the discovered abuse “immediately or as soon as practically possible” by telephone and to provide a written report within two working days.[6] The report shall include the name of the injured person if known, the injured person’s whereabouts, the character and extent of the person’s injuries, and the identity of the person the injured person alleges inflicted the injury.[7]

A reporting form developed by the Governor’s Office of Criminal Justice Planning entitled “Suspicious Injury Report” (From OCJP-920) is available on the Internet.[8]^,[9]

Medical records. The MRL specifically recommends that physicians who make a suspicious injury report enter into the medical records: 1) any comments by the injured person regarding past domestic violence; 2) a map of the injured person’s body identifying the injuries and bruises; and 3) a copy of the law enforcement reporting form. Further, the MRL recommends that a physician also refer the person to a local domestic violence services agency.[10] Physical therapists should also follow these guidelines to insure proper protocol in dealing with these issues.

Penalties for failure to report. While a physical therapist who makes a required report under the MRL is generally immune from civil and criminal liability,[11] anyone who fails to report is guilty of a misdemeanor punishable by up to six months in jail, a fine of $1000, or both.[12] Further, any misdemeanor substantially related to the practice of physical therapy can be grounds for license discipline based upon “unprofessional conduct.”[13]

Child Abuse and Neglect Reporting Act

Who must report? The Child Abuse and Neglect Reporting Act (“CANRA”) designates 45 groups of individuals and employees as “mandated reporters.”[14] Physical therapists are mandated reporters as defined under this Act.[15]

When does a physical therapist need to report? A physical therapist, who within his or her employment or professional capacity, must report if he or she knows, observes, or reasonably suspects the child has been the victim of any of the following:[1]

(1) sexual abuse;[2] (2) neglect;[3] (3) the willful harming or injuring of a child or the endangering of the person or health of a child;[4] (4) unlawful corporal punishment or injury;[5] (5) abuse or neglect in out-of-home care;[6] and/or (6) child abuse or neglect.[7]

A "child" means a person under the age of 18 years.[8]

Self-Inflicted Abuse. Although questions arise about reporting self-inflicted abuse, the reporting obligations are the same and the cause of the abuse does not alter a physical therapist’s reporting obligations. As children react differently to abuse and/or neglect, certain indicators may appear as self-inflicted abuse, but could, in reality, simply be the child’s reaction to neglect and/or abuse. Although the following indicators do not necessarily prove that a child is being abused, the Department of Education has noted them as warning signs to look further:[9]

• Frequent injuries or unexplained bruises, welts, or cuts;
• Untreated illnesses and physical injuries; and
• Depression, self-mutilation, suicidal gestures/attempts.

It is best to error on the side of caution and report injuries a physical therapist  could believe to be self-inflicted because the underlying reason for the injuries may actually be physical abuse or neglect. The reporter is not required to discern the cause of the injuries. The reporter is required to report their existence which will lead to an investigation.

What must be reported? CANRA requires the health care provider to report to a child protective agency of discovered abuse “immediately or as soon as is practically possible” by telephone and to provide a written report within 36 hours.[10] If known, the report must include:

• The mandated reporter’s name, business address, and telephone number;
• The information that gave rise to the reasonable suspicion of child abuse or neglect and the source or sources of that information;
• The child's name, the child's address, present location, and, if applicable, school, grade, and class;
• The names, addresses, and telephone numbers of the child's parents or guardians; and
• The name, address, telephone number, and other relevant personal information about the person or persons who might have abused or neglected the child.[11]

The reporting form entitled “Suspected Child Abuse Report” (Form SS-8572) is available online.[12]

Employment Verification. CANRA requires any mandated reporter entering employment after January 1, 1985, to sign a statement acknowledging the reporting obligations of Penal Code section 11166.[13] The California Department of Social Services has created a form for this purpose, which should be retained in the employee’s file.[14]

Immunity and Confidentiality. Persons legally mandated to report suspected child abuse have immunity from criminal or civil liability for reporting as required or authorized by law.[15] The identity of a mandated reporter is confidential and disclosed only among agencies receiving or investigating reports and other designated agencies.[16] Reports are confidential and may be disclosed only to specified persons and agencies. Any violation of confidentiality is a misdemeanor punishable by imprisonment, fine, or both.[17]

Penalties for failure to report. A mandated reporter who fails to make a required report is guilty of a misdemeanor punishable by up to six months in jail, a fine of $1,000, or both.[18] Further, any misdemeanor substantially related to the practice of physical therapy can be grounds for license discipline based upon “unprofessional conduct.”^[19]

Elder Abuse and Dependent Adult Civil Protection Act

Who must report? The Elder Abuse and Dependent Adult Civil Protection Act (“EADACP”) requires health practitioners,[20] care custodians, clergy members, and employees of county adult protective services agencies and local law enforcement agencies to report known or suspected cases of abuse of elders and dependent adults and to encourage community members to do so.[21]

Elder means any California resident, 65 years or older.[22] Dependent adult means any California resident, ages 18 through 64, who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, including, but not limited, to persons who have physical or developmental disabilities or whose physical or mental abilities have diminished because of age.[23]

When does a physical therapist need to report? Any physical therapist who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult[24] must make a report if he or she “in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of an incident that reasonably appears”[25] including:

• Physical abuse,[26] neglect,[27] financial abuse,[28] abandonment,[29] isolation,[30] abduction,[31] or other treatment with resulting physical harm or pain or mental suffering.[32]

• The deprivation by a care custodian of goods or services that is necessary to avoid physical harm or mental suffering.^[33]

What must be reported? EADACP requires the health care provider to report to local law enforcement discovered abuse “immediately or as soon as practically possible” by telephone or through a confidential Internet reporting tool and to provide a written report within two working days.[34] The report shall include, if known:

• The name, address, telephone number, and occupation of the person reporting.
• The name and address of the victim.
• The date, time, and place of the incident.
• Other details, including the reporter's observations and beliefs concerning the incident.
• Any statement relating to the incident made by the victim.
• The name of any individuals believed to have knowledge of the incident.
• The name of the individuals believed to be responsible for the incident and their connection to the victim.^[35]

The Department of Social Services has created a reporting form entitled “Report of Suspected Dependent Adult/ Elder Abuse.” (Form SOC-341) available online.^[36]

Immunity and Confidentiality. No person making the report shall be subject to any sanction for making the report.[37] Reports are confidential and may be disclosed only to specified persons and agencies. Any violation of confidentiality is a misdemeanor punishable by imprisonment, fine, or both.[38]

Employment Verification. The EADACP requires a mandated reporter who enters employment after January 1, 1995, to sign a statement acknowledging the obligations of the EADACP.[39] The Department of Social Services has created a form for this, which is available online.[40]

Where to report. If the abuse occurred in a long-term care facility or residential facility serving adults or elders or an adult day program, the provider must report to either local law enforcement or the local long-term care ombudsman.[41]^,[42] otherwise, the employee must report to local law enforcement or county adult protective services.[43]

Penalties for failure to report. A mandated reporter who fails to make a required report is guilty of a misdemeanor punishable by up to six months in jail, a fine of $1,000, or both.^[44] Further, any misdemeanor substantially related to the practice of physical therapy can be grounds for license discipline based upon “unprofessional conduct.”^[45]

CONCLUSION

Physical therapists must consider these mandatory reporting requirements and their obligations under these different statutory schemes in their day-to-day practice. One never knows when a reportable issue will present itself and the reporting requirements do not allow much time to comply. Physical therapists are encouraged to consult legal counsel with any questions regarding these issues.