Recently, a 16-year-old patient hospitalized with complications of anorexia nervosa told me privately that her father has been sexually abusing her for years. I couldn't see any physical signs of abuse; if she hadn't said something, I wouldn't have suspected a problem. Especially troubling is her manner when she was telling me her story. She appeared more watchful than anything else, almost as if to see how I'd react.
I've encountered many abused children in my career, and something about this situation rings false. I know it's my duty to report abuse, but what if this girl is lying? If her father is wrongly accused, the legal ramifications could be devastating. I'd hate to ruin a man's life because of a false story, but of course he should be brought to justice if it's true. What should I do?—C.R., CALIF.
Your duty is to report what the patient told you, not to decide whether it's truthful. In most states, not reporting known or suspected child abuse is a crime.
You also have an ethical obligation to your patient. If you don't follow facility policy and your state's reporting laws, you may be contributing to the ongoing sexual abuse of a young person.
Your intuition can play a valuable role in nursing, but relying on it in this case is inappropriate. The patient might have seemed “watchful” for various reasons. Perhaps she hadn't had the courage or the opportunity to tell anyone about her abuse and wanted to see if you'd believe her.
The law is very clear: When a patient confides a story of abuse to you, you must report it. Child Protective Services will investigate your patient's reasons for sharing this information. Once an investigation is under way, the matter is out of your hands. If the patient's father is innocent and the investigation exonerates him, you're protected by law from liability in most states provided you made your report in good faith.
Penny Simpson Brooke is a professor at the University of Utah College of Nursing in Salt Lake City and a member of The American Association of Nurse Attorneys.