As primary eye care providers, optometrists can detect non-accidental trauma in ways that other providers can’t. But signs of child abuse aren’t always clear — and for many optometrists, neither are the steps to take when abuse is suspected.

OPTOMETRISTS ARE MANDATORY REPORTERS

All 50 states, plus the District of Columbia, have some kind of mandatory reporting law for child abuse. Further, HIPAA allows health care providers and other covered entities to report suspected child abuse or neglect to “a public health authority or other appropriate government authority, authorized by law to receive reports of child abuse or neglect,” according to 45 C.F.R. 160.203.

GOOD FAITH REPORTING

Optometrists may worry about the consequences of reporting suspected child abuse that turns out to be unsubstantiated. All states are required by Federal law to provide immunity from prosecution and liability for individuals who make reports “in good faith.”

State immunity laws vary, but in general, reporting child abuse “in good faith” means that to the best of your knowledge, you have reason to believe that a child is subject to abuse or neglect. When reporting, you typically must explain the circumstances surrounding your suspicion or knowledge, but you are not required to provide actual proof of abuse or neglect. Whether you are required to provide your name also varies by state, although in most states, your identity is protected and would not be disclosed.

DEFINED POLICY

A defined policy on when and how to report suspected child abuse is essential. First, it can be very nerve-wracking for physicians or staff members if they aren’t trained ahead of time on what to do in these situations. Secondly, without a policy, you could be subjected to claims of bias, prejudice or just acting emotionally or in the heat of the moment.

You’ll want to base your policy off of the specific laws in your state and/or jurisdiction, but in general, you’ll want to include instructions for reporting to the proper entity, as well as what steps to take in situations where you’re suspicious of certain behaviors vs. when you’re suspicious due to ocular findings.

FOLLOWING UP ON REFERRALS

Retinal hemorrhaging and detachments can be signs of abuse, and it’s possible that an optometrist will want to refer the patient to a retinal specialist. Once that referral is made, the O.D. should always follow up, and that means calling the other doctor and having a conversation — not just getting a report and sticking it in the patient’s chart. Even when you refer a patient out, you are still responsible for them, and you still have a legal obligation to them. OM

Disclaimer: The information in this article is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. The information contained in this article is not legal advice, and it is not intended to be a substitute for legal counsel on any subject matter. No reader of this article should act or refrain from acting on the basis of any information included in, or accessible through, this article without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

DR. GILBERT-SPEAR is the founder and director of The Visual Performance Center and is a consultant and speaker with various eye care companies. She is also a partner at Pacific Apex Law Group, LLP, where she focuses her practice on Health Care and Life Sciences.