Manifold v. Ragaglia, et al

Connecticut Supreme Court

272 Conn. 410 (2004)

December 28, 2004

 

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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