Department for Community Based Services

Standards of Practice Online Manual

2.23 Pediatric Forensic Medicine Consult

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 2-Child Protective Services (CPS) Intake and Investigation
Effective:
4/1/2016
Section:
2.23 Pediatric Forensic Medicine Consult
Version:
4

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Legal Authority/Introduction

LEGAL AUTHORITY:

  • N/A

To determine if an injury appears non-accidental (inflicted) vs. accidental, the SSW may require timely consultation with a qualified medical professional for the assessment of possible abusive injuries.  When a determination cannot be made by medical personnel at the local level, the SSW may request a consultation with the Division of Forensic Medicine (DFM). 

Procedure

The SSW:

  1. Reserves consultations for cases in which an expert opinion is required beyond what local medical resources can provide; 
  2. Complies with the following referral guidelines to ensure that this limited resource is used most effectively:
    1. Active physical abuse or neglect investigations, involving a child with a physical injury or physical exam finding that is suspicious for injury may be appropriate for referral if local medical resources are either not available or are unable to determine if the injury/finding is likely to have been the result of maltreatment;
    2. Active investigations involving a reported method of injury that may not be consistent with the noted physical injury may be appropriate for referral (For example, a child with a fracture that is reported to have fallen off the couch); 
    3. Priority should be given to the very youngest, non-verbal children in which it is difficult to determine by interview how the injury occurred;
    4. DFM will not be able see Munchausen’s by Proxy cases; however, limited consultation may be provided by the medical support section;
    5. Consultation on child fatality cases is not available through DFM;
    6. DFM may not be utilized merely for the purpose of obtaining evidence for criminal prosecution of non-caretaker abuse; and
    7. It is important to avoid the subpoena of medical professionals from the DFM to court proceedings when at all possible.   If testimony for custody petitions or dispositional reviews is required, deposition or phone testimony should be utilized;
  3. Discusses the appropriateness of the DFM referral with the FSOS; 1  
  4. Contacts their regional office designee to discuss the referral;
  5. Contacts DFM at (502) 629-3099 during normal business hours to request a consultation, if after consultation with their regional office designee, it is agreed that a referral to DFM is warranted; 
  6. Provides an email, upon DFM’s request, to briefly summarize the discussion and impressions and honors any requests from DFM:
    1. To review current medical records, x-rays and/or photographs in order to accurately assess the situation.  A written report based upon the review will then follow and may be available prior to initial placement decisions, provided the records and photos are received by DFM promptly;
    2. That the child be brought to the DFM clinic or Kosair Children’s Hospital in Louisville for examination and possible additional medical testing.  Reasonable efforts will be made to avoid the necessity of transporting children long distances, including the use of photographs obtained by DCBS staff;
  7. Completes and faxes the Pediatric Forensic Medicine Consult Request to (502)629-3096 within twenty-four (24) hours; 
  8. Provides DFM all needed background and medical records as expeditiously as possible once a referral is made.

Practice Guidance

  • In case of an emergency after normal business hours, a DFM clinician may be contacted at (502)629-6000. 
  • After contact is made with DFM, the appropriateness and type of consultation will be decided. 
  • DFM typically provides a written report within thirty (30) days of receiving all necessary requested information from the SSW. 
 

Footnotes

  1. If it is agreed that consultation regarding a physical injury is warranted, options for local or regional medical consultation should be first considered. 

Communicate

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