Doctors hesitant to report neglect

DSS can't keep up with needs

by Anna B. Mitchell

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Five minutes of neglect can land a mother in jail if her baby drowns unattended in a bathtub.

But what about the parent who fails to give his child asthma medication regularly or refuses to sign the child up for physical therapy?

Medical professionals, legally bound to report neglect of any kind to the state Department of Social Services, are hesitant to do so for many reasons, experts say. Time constraints, incomplete information about their clients and a moral balancing act that begs whether they could do any better in a parent's place are some of the reasons why.

According to a recent report in the journal Pediatrics, doctors fail to report obvious cases of child abuse 27 percent of the time and possible cases of child abuse 76 percent of the time. The report did not address neglect – cases where a child isn't fed or nurtured properly – but it did offer some explanation for why doctors tend to stay out of the lives of their patients.

"The doctor who makes reports to child welfare, maybe people don't go to that practice anymore," said Dr. Cindy Christian, a national expert on pediatric neglect. "Maybe they are afraid of lawyers. It's costly to shut down your practice for a day to testify. Sometimes you are afraid of the family, of retribution.”

Local experts say one of the biggest challenges to better disclosure and investigations of neglect is manpower. The Department of Social Services, they say, is chronically underfunded and cannot handle the caseload it has now: 5,000 children need foster homes and 3,500 homes are available.

"We would overwhelm the system if we called every time we saw a child not getting what he needs," Christian said.

Tiffany Thompson, director of The Parenting Place in Pickens County, said she works with the agency regularly as she works to prevent child abuse in her community.

“Until taxpayers open their eyes to fund the Department of Social Services and things like that, they don’t have the resources to investigate every phone call,” Thompson said. “How can you blame them?”

Last year, more than a third of 27,652 cases of suspected abuse reported to DSS were not accepted for investigation, according to data acquired by the Journal through a Freedom of Information request.

Thousands of cases reported by a parent or relative outside the home were found to be unsubstantiated. But among seemingly unbiased professionals outside the home – medical personnel, cops, educators – a fifth to a third of cases were still judged to be unsubstantiated. Physicians as a group reported abuse 260 times, about a quarter of which were not investigated.

The agency keeps track of who made the reports, but the identities of those calling DSS is confidential, though case workers ask for names to help with follow-up calls.

Dr. Kent Jones, South Carolina chairman of the American Academy of Pediatrics, has been in practice for 25 years.

“I think there is some frustration with the agency, which is horribly underfunded,” Jones said. “I can’t think of an agency I’d less like to be head of.”

Jones said those professionals required by law to report abuse – anyone in the medical field, coroners, clergy, educators, social workers and cops, among others – have to use judgment before picking up the phone. He said he sees cases all the time where the parent isn’t putting the child first or getting fewer services than he or she should.

“Even when a parent has good intentions, sometimes they just aren’t capable,” he said. “I had a case where a mother heard nothing but bad news. So she circled the wagons and kept the child at home. She would have periods where she would see what the system could do but then give up again. There’s a psychology to what’s going on. Should you call DSS on these people? Would I truly do better in her shoes?”

Medically, Jones said, it’s much easier to make a case for physical abuse than neglect, even though state records from last year show confirmed cases of neglect occurring twice as often as physical abuse.

Jo Ann Brink, a former social worker who handles cases of medically fragile children for Palmetto Health, said reporting a parent who is neglecting the medical needs of a child is tough because the best scenario is to keep families intact.

“We try to understand and ask questions to help the family,” Brink said. “Sometimes children are removed and it’s much better for them. By the time a doctor makes a report, it’s very serious.”

For her, she said, the tipping point for reporting neglect is when parents completely refuse to cooperate with doctors, nurses and caseworkers.

“When I’m working harder than the client – harder than the mother – then that’s it,” Brink said. “I need to make a report to DSS at that point.”

Every call about potential child abuse or neglect is answered within 24 hours, said Wilbert Lewis, the state’s director of child welfare. His 176 child protective services assessment workers investigated 17,616 cases last year. That’s 100 cases each.

During that time, the agency – which also handles child support and care for the elderly – absorbed more than $42 million in cuts because of state shortfalls in revenue. Open positions aren’t getting filled, employees have been furloughed and millions of dollars in contracts, including those for group homes, have been dropped.

The agency recently got a “D” rating in a preliminary federal review of its services – primarily because of the long waiting periods children face in receiving services.

Still, Lewis said, case workers are trying to stay within that 24 hours in following up on initial calls.

“We encourage everyone to report,” Lewis said. “We don’t want a professional not to call us because of a bad experience in the past.”

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