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The
Connecticut Supreme Court weighed in on the important issue of a
physician's immunity from liability when determining whether reasonable
cause exists to suspect child abuse under Conn. Gen. Stat. § 17a-101e.
After enduring what can only be described as a Kafkaesque experience,
a family whose medically complex children were removed from the
home by the Department of Children and Families ("Department") for
suspected child abuse brought a damages action for negligence, medical
malpractice and negligent emotional distress. The trial court granted
the physician's motion for summary judgment and the Supreme Court
grabbed the appeal (pursuant to Conn. Gen. Stat. § 51-999(c)) to
interpret the breadth of a physician's immunity when examining a
child in the abuse and neglect determination process.
The
disturbing scenario emanates from an April 23, 2001 report to the
Department from a pediatrician's office indicating that the plaintiffs'
two children, Kaylee and Matthew, presented with bruises and a rash
during a Birth-to-Three program visit. Unable to access an examination
by the children's pediatrician, the Department social worker transported
the two children to Backus Hospital, where Dr. Robert Cruetz, a
staff physician, conducted an examination. Based on his examination,
which indicated an inordinate amount and extremely suspicious quality
of bruising, Cruetz recommended further investigation of the injuries'
source. Cruetz did not order blood tests to determine whether a
blood disorder contributed to the bruising. The Department proceeded
to invoke a 96 hour hold on the children, placed them into custody,
and applied for and obtained orders of temporary custody.
On April
25, another pediatrician (in concert with the foster family and
the Department) examined the children and ordered blood tests for
Matthew, the results of which showed some abnormalities, including
a very low blood platelet count. Seeking further clarification,
the pediatrician referred Matthew to Yale-New Haven Hospital, where
he was admitted and underwent a further evaluation. The following
day, the Yale specialists diagnosed Matthew with idiopathic thrombocytopenic
purpura ("IPP"), a blood disorder. On April 26, Matthew was discharged
from the hospital, the Department moved to vacate the orders of
temporary custody, and the Department returned the children to the
parents' custody later that day.
The
parents subsequently filed their action against Cruetz (and his
employers) for medical malpractice for failing to order a blood
test which resulted in a misdiagnosis of child abuse rather than
a blood disorder. The family also brought counts against the Department
for negligence, recklessness, acts of malice and negligent infliction
of emotional distress. [1]
The Supreme Court thoroughly addresses the issue of whether Cruetz'
failure to order the blood test falls outside of the scope of immunity
provided to mandatory reporters under Conn. Gen. Stat. § 17a-101e(b)
because his actions did not constitute the "first person reporting"
of child abuse.
In tackling
this interesting issue, the court noted that the immunity statute
is silent regarding physicians who the Department retain to perform
medical evaluations to determine whether abuse or neglect has occurred.
Citing the public policy behind protecting children enumerated in
Conn. Gen. Stat. § 17a-101, and the mandatory reporting system enacted
by the legislature, the physician's reporting of his examination
results, followed by a written confirmation of that report, 'clearly
falls within the common usage of the term "report,"' thus requiring
protection under the immunity statute. None of the reporting statutes,
including the immunity provision, limit their application to the
initial reporters of child abuse, or relieve reporting obligations
because the Department already knows or has received reports of
abuse or neglect. Citing the broad stoke of Conn. Gen. Stat. § 17a-101e(b),
which extends immunity to "any" good faith reporter, the court reasonably
concluded that physicians who perform evaluations at the Department's
behest are entitled to immunity.
The
court engages in a thorough discussion of the policy implications
of extending the immunity to "secondary" reporters, and spends a
good deal of time analogizing Zamstein v. Marvasti, 240 Conn. 549
(1997) to support its contention that the child protection system
relies on the highly sensitive, discretionary nature of the reporting
process. They went on to rebuke the plaintiffs' claim that granting
immunity here would have a deleterious effect because it will create
a loophole for medical malpractice committed against the state's
children. Distinguishing the child abuse evaluation from misdiagnosis
of underlying injuries, the court easily allayed the plaintiffs'
concerns and indicated that the immunity extension does not give
evaluating physician's "carte blanche" to commit malpractice with
respect to the diagnosis and treatment of any underlying medical
conditions. The court refused to consider the plaintiffs' argument
that Cruetz' medical malpractice constituted or was evidence of
"bad faith," a necessary prerogative to hurdle the immunity statute,
because the argument was first raised in the reply brief.
This
case may be accessed by going to the Judicial Branch website at
www.jud.state.ct.us/external/supapp/Cases/AROcr/CR272/272CR18.pdf
(JES)
[1]
The sole issue before the state Supreme Court was the plaintiffs'
claim regarding Cruetz and his immunity from liability. The trial
court denied the Departments' motion for summary judgment and the
Department's appeal is presently pending before the appellate court.
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