Mary is the CEO of a chain of primary care clinics (PrimaryFirst) that serve both adult and pediatric patients in the Savannah, Georgia, area. The system has a clinic in Pembroke, which has a family practice physician one day each week, Dr. Seldom, and is staffed by a nurse practitioner the other days that the clinic is open. Mary have been made aware by the risk manager that the clinic in Penbroke discharged a 3-year-old boy yesterday who had a splinter fracture of his left radius (one of the two bones in the forearm). The child was assessed by Dr. Seldom. He took an x-ray to confirm the break and placed a soft cast. He contacted an orthopedic physician in Savannah for the child to see in two days for that physician to determine whether surgical intervention or other further care and treatment are necessary. Dr. Seldom noted in his record of this child's visit that the behavior of the child and his parents seemed suspicious, and he noted that this was the second broken bone for this child in the last six months. No other action was taken.

The risk manager informs Mary that she visited with Dr. Seldom and questioned why he didn't report the child's broken arm as suspected child abuse. She states that the physician's response was that he wasn't there enough to get involved in "social issues" and that he didn't want to risk a lawsuit for defamation against the parents of the child.

Based on the information provided in the Pozgar text and Georgia Law (see the link above) provide the assessment of the following questions:

1. What action should Dr. Seldom have taken?
2. If reporting was appropriate, to what agency should this have been reported and what information should have been communicated to the reporting agency?
3. Was Dr. Seldom correct in is concern of a lawsuit for defamation if he was incorrect by report? Why or why not?
4. Did Dr. Seldom subject himself to potential criminal liability by not reporting? Why or why not?
5. Fortunately the child in this case did not die. If he had been admitted to a hospital following this incident and subsequently died, would the child's death be required to be reported to the medical examiner? Why or why not?
6. Had the events of this case occurred in a children's hospital rather than a primary care clinic, would a root cause analysis be recommended? Why or why not?

State of Georgia

Disclosure of Confidential Child Abuse and Neglect Records

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Current Through June 2017

Confidentiality of Records

Citation: Ann. Code 49-5-40; 49-5-186Each and every record concerning reports of child abuse and child controlled substance or marijuana abuse that is in the custody of the Department of Human Services, other state or local agency, or child advocacy center is declared to be confidential, and access thereto is prohibited except as provided in 49-5-41.

Information in the abuse registry shall be confidential and access thereto is prohibited except as provided in this article.

Persons or Entities Allowed Access to Records

Citation: Ann. Code 49-5-41; 49-5-185The following persons or agencies shall have reasonable access to records concerning reports of child abuse:

• Any federal, state, or local government agency or tribal entity that has a need for the information in order to carry out its legal responsibilities to protect children from abuse and neglect
• A grand jury when it is necessary for determination of an issue before it
• A prosecuting attorney in connection with any official duty
• Any adult who has made a report of suspected child abuse regarding the child who was the subject of the report about whether the investigation is ongoing or completed and, if completed, whether child abuse was confirmed or unconfirmed
• Any entity that receives a report of suspected child abuse from a school employee
• The State Personnel Board for determination of an issue involving departmental personnel
• A child advocacy center investigating known or suspected child abuse
• Police or any other law enforcement agency of this state or any other state or any medical examiner or coroner investigating a report of abuse
• Any child abuse protocol committee
• The governor, attorney general, lieutenant governor, or speaker of the house of representatives in order to determine whether the laws of this state are being complied with
• A court seeking records for an in camera inspection of such records
• Individuals who are engaged in legitimate research
• A physician who reasonably suspects a child may be abused
• A licensed child-placing agency or child-caring institution that is locating or providing foster or adoptive homes for children in the custody of the department or an investigator appointed to investigate a pending petition for adoption
• A person authorized to place a child in protective custody when such person requires the information in the record in order to determine whether to place the child in protective custody
• An agency or person that has the responsibility to care for, treat, or supervise the child who is the subject of a report
• Members of citizen review panels
• Guardians ad litem or court-appointed special advocates
• A public child protective agency or law enforcement agency of another state bound by similar confidentiality requirements when, during or following the department's investigation of a report of child abuse, the alleged abuser has left the state
• A child welfare agency or a school where the department has investigated allegations of child abuse made against any employee and any child remains at risk from exposure to that employee
• An employee of a school or a child welfare agency against whom allegations of child abuse have been made
• Any person who has an ongoing relationship with the child named in the record of child abuse, but only if that person is required to report
• Any school principal, guidance counselor, social worker, or psychologist who is counseling a student
• The Department of Early Care and Learning
• Any child-caring agency, child-placing agency, or identified foster parent with respect to any child who has been placed in their care or custody

Access to information in the abuse registry is limited to:

• An abuse investigator; medical examiner; coroner; any federal, tribal, state, or local governmental entity; or out-of-state abuse investigator that is investigating a case of possible child abuse
• The governor's office, general assembly, district attorneys, and law enforcement agencies that shall receive a statistical analysis of reported cases from the abuse registry at the end of each calendar year
• A district attorney for use in any court proceeding if such information is otherwise admissible

When Public Disclosure of Records is Allowed

Citation: Ann. Code 49-5-41; 49-5-186Child abuse and dependency records shall not be confidential and shall be subject to public inspection if the records are applicable to a child who at the time of his or her fatality or near fatality was in the custody of a state department or agency or in the care of a foster parent; was receiving protective services; or was the subject of an investigation, report, referral, or complaint.

The following may be redacted from the records:

• Confidential medical and mental health records
• Privileged communications of an attorney
• Identifying information of a person who reported the suspected child abuse
• The name of a child who suffered a near fatality
• The name of any sibling of the child
• Any record of law enforcement or prosecution agencies in any pending investigation or prosecution of criminal activity contained within the child abuse, neglect, or dependency records

Upon the release of documents pursuant to this subsection, the department may comment publicly on the case.

Information in the abuse registry applicable to a child who at the time of his or her death was in the custody of a state department or agency or foster parent, as it relates to the child while in state custody, shall not be confidential.

Use of Records for Employment Screening

Citation: Ann. Code 49-5-40(c); 49-5-41; 49-5-185Each and every record concerning child abuse or neglect that is received by the department from the child abuse and neglect registry of any other state shall not be disclosed or used outside of the department for any other purpose other than conducting background checks to be used in foster care and adoptive placements.

The department may permit access to information from child abuse records to:

• A licensed child-placing agency that is assisting the department by locating or providing foster or adoptive homes for children in the custody of the department
• A licensed adoption agency of this or any other state that is placing a child for adoption
• A court-appointed investigator who is investigating a pending petition for adoption

Persons or entities that may access information from the child abuse registry include:

• State or other government agencies of this state or any other state that license entities that have interactions with children or are responsible for providing care for children
• A licensing entity, to the extent that such information is required in a proceeding arising from an adverse action taken against a licensed entity or individual as a result of information found in the registry
• A court-appointed special advocate program for the purpose of screening and selecting employees and volunteers of the program
• Any federal, tribal, state, or local governmental entity of this or any other state for the purpose of conducting background hecks of prospective foster or adoptive parents
• Any licensed child-placing agency of this state for the purpose of conducting background checks of foster parents or adoptive parents
• Any entity licensed by any other state to place children for adoption for the purpose of conducting background checks on adoptive parents or prospective adoptive parents

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Making and Screening Reports of Child Abuse and Neglect

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Current Through January 2017

Individual Responsibility to Report

Citation: Ann. Code 19-7-5;16-12-100A mandated reporter who has reasonable cause to believe that a child has been abused shall report or cause reports of that abuse to be made as provided in this section. An oral report shall be made immediately by telephone or otherwise and followed by a report in writing, if requested, and in no case later than 24 hours from the time there is reasonable cause to believe a child has been abused.

A person who, in the course of processing or producing visual or printed matter either privately or commercially, has reasonable cause to believe that the visual or printed matter submitted for processing or producing depicts a minor engaged in sexually explicit conduct shall immediately report such incident, or cause a report to be made, to the Georgia Bureau of Investigation or the law enforcement agency for the county in which such matter is submitted.

Content of Reports

Citation: Ann. Code 19-7-5The report shall contain, if possible:

• The names and addresses of the child and the child's parents or caregivers
• The child's age, if known
• The nature and extent of the child's injuries, including any evidence of previous injuries
• Any other information that might be helpful in establishing the cause of the injuries and the identity of the perpetrator

Reporting Suspicious Deaths

Citation:This issue is not addressed in the statutes reviewed.

Reporting Substance-Exposed Infants

Citation:This issue is not addressed in the statutes reviewed.

Agency Receiving the Reports

Citation: Ann. Code 19-7-5The report shall be made to a child welfare agency providing protective services, as designated by the Department of Human Services, or, in the absence of such agency, to an appropriate police authority or district attorney.

If a report of child abuse is made to the child welfare agency or independently discovered by the agency, and the agency has reasonable cause to believe the report is true or the report contains any allegation or evidence of child abuse, then the agency shall notify immediately the appropriate police authority or the district attorney.

Initial Screening Decisions

Citation: DHS CW Man. Ch. 2, 2.2A case manager will evaluate the intake report to determine if the three components of child maltreatment reports are met. These components include:

• An alleged perpetrator:
• Who is a known or unknown individual
• Whose relationship to the victim is classified as being that of a parent, guardian, foster parent, stepparent, or adoptive parent; an employee of a public/private residential home, care facility, or daycare facility; a custodian (a person standing in loco parentis); other caregiver; or school personnel
• A child from birth up to their 18th birthday
• An allegation that meets the definition of child abuse, neglect, sexual abuse, or emotional abuse

Intake reports containing the required components must be approved for assessment (investigation) and submitted to a social service supervisor for approval and transfer to a case manager for completion of an abuse/neglect assessment.

Agency Conducting the Assessment/Investigation

Citation: Ann. Code 49-5-180; DHS CW Man, 5; 5.1The investigation may be conducted by an abuse investigator, which includes the department, any local Department of Family and Children Services (DFCS), or a designee thereof.

In regulation:As the designated child welfare agency in Georgia, the Division of Family and Children Services (DFCS) is legally mandated to investigate reports of known or suspected instances of child abuse and neglect, including physical or mental injury, sexual abuse or exploitation, or negligent treatment or maltreatment under circumstances that indicate that the childs health or welfare is threatened.

Law enforcement is the criminal investigative agency in the community and is often investigating the same allegation as DFCS. When this is the case, CPS and law enforcement must work as a team to coordinate investigative activities.

Assessment/Investigation Procedures

Citation: DHS CW Man, 2104.1The local county department will conduct the investigation to determine whether an incident of maltreatment occurred and, if maltreatment is substantiated, to determine the level of risk for future maltreatment to the child and to plan for the child's safety and protection.

Investigation is a process to determine the validity of a complaint by interviewing, observing, and gathering information. This process leads to decisions about the level of risk for future maltreatment to the child, the degree of safety, and the need for the continued involvement of the agency until protection of the child is ensured.

Components of the investigation include:

• Reviewing the report to determine the best approach
• Coordinating, as necessary, with law enforcement
• Making the initial contact with the child and parent
• Planning additional contacts with the child and parent, as needed
• Gathering all available evidence
• Making collateral contacts
• Determining the degree of protection and safety of the child and the level of risk
• Continuing to coordinate, as needed, with law enforcement regarding possible criminal prosecution
• Making a case determination and sending required notifications of decisions

Timeframes for Completing Investigations

Citation: DHS CW Man. Ch. 2, 2.5; 2104.1DFCS will begin response time calculation at the conclusion of the intake call. DFCS response time categories include:

• Immediate: The child is in imminent danger. The case manager must leave to initiate the assessment (make face-to-face contact with each child victim) immediately following the assignment of the response time.
• Up to 24 hours: The child is not in present danger but it is likely that the child's safety will be compromised in the immediate future. The case manager must initiate the investigation within 24 hours or by the specified period of time assigned to the case by the supervisor.
• Five work days: There is no present safety concern. The assessment (investigation) must be initiated within 5 work days (excluding weekends but including all holidays).

The investigation is completed within 30 calendar days of the date the report is received.

Classification of Reports

Citation: Ann. Code 49-5-180The term 'substantiated case' is used when an investigation of a child abuse report by an abuse investigator has confirmed, based upon a preponderance of evidence, that child abuse has occurred.

Reports are classified as follows:

• 'Confirmed' means that the investigation has revealed that there is equal or greater credible evidence that child abuse occurred than the credible evidence that child abuse did not occur.
• 'Unconfirmed' means that the investigation has revealed that there is some credible evidence that child abuse occurred, but there is not sufficient credible evidence to classify that child abuse as confirmed.
• 'Unfounded' means that the investigation has determined that there is no credible evidence that child abuse occurred.

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Penalties for Failure to Report and False Reporting of Child Abuse and Neglect

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Current Through February 2019

Failure to Report

Citation: Ann. Code 19-7-5(h)Any person or official required by law to report a suspected case of child abuse who knowingly and willfully fails to do so shall be guilty of a misdemeanor.