To report or not to report–that is the question. Or is it? In light of the fallout surrounding the Sandusky scandal at Pennsylvania State University and the perjury and failure-to-report charges against two university officials, many EMS providers are now asking about their reporting obligations for suspected victims of abuse.
This sparked an internal debate in our office regarding the Pennsylvania EMS reporting obligations for child, elderly and domestic abuse. The laws in Pennsylvania and other states are, frankly, less than clear. And the laws in every state are different. State law governs your legal obligations. In many cases, the role of EMS agencies has been completely overlooked, except for a few states. But is there really a need to debate what our legal reporting obligations are in each of these three types of abuse scenarios?
Perhaps the problem as to why Sandusky was allegedly allowed to continue to have contact with children is that people were more concerned with not ruining his career and reputation than reporting something they suspected but didn’t know with complete certainty. The thought of the unthinkable may have paralyzed much of the decision-making. Perhaps the problem was not reporting to the right people or that it wasn’t clear what was happening when the alleged observations were made.
In any case, the bottom line is that few cases of real abuse are actually reported for these and many other reasons. The vast majority of EMS providers entered this field because we desire to help people. Certainly we would report it if we actually knew for a fact that someone was being abused. But another problem is that the “signs and symptoms” of patient abuse may be subtle and difficult to assess. Perpetrators are often good at disguising the truth, and victims and their relatives can’t bring themselves to believe a loved one would commit such acts. And false accusations can ruin reputations.
Reporting It
The fact that we’ve received so many questions about reporting responsibilities seems to indicate that perhaps the focus in the past has been too much on what EMS organizations are legally required to do, rather than what they should do in the best interest of the patient. Mark this one down: How often have you had an attorney tell you to focus less on your legal obligations and more on your moral obligations? But that’s precisely what EMS providers need to do, and that is the mark of a true EMS professional.
All EMS organizations should have a policy on reporting abuse. The policy should give examples of the various types of abuse and set forth a procedure for reporting suspected abuse. Each emergency service organization should also have a “designated individual” to whom any suspected or witnessed patient abuse should be reported. There should be education involving the appropriate social service agencies to help EMS providers better identify suspected abuse.
Organizations, such as area agencies on aging and coalitions against domestic violence, are a great resource with trained professionals who deal with these difficult issues every day. We can learn a lot from them. The importance of staying objective and not letting our own emotions and personal bias take control when dealing with suspected patient abuse should be emphasized to help avoid erroneous reports.
EMS providers who think they may have witnessed or been given credible information that indicates patient abuse has or is occurring should immediately report their suspicions to their supervisor or designated individual. Preferably, the report should be in writing, but verbal reports should not be ignored. Once the designated individual reviews the report and confirms that there may be patient abuse, the designated individual should file a report with the appropriate agency in accordance with the laws of that particular state. When in doubt, report your concerns. Use common sense and good professional judgment.
It really is that simple. Focus less on what the law actually requires you to do and more on doing what you honestly and objectively believe is right–even in the absence of a legal requirement to take action.
As President Abraham Lincoln said, “Right makes might!” Actions based on integrity and doing what’s right while others are silent can have a profound effect. That’s how slavery was abolished more than 150 years ago. In the context of EMS, doing what’s right when reporting suspected abuse could save a life.
No matter where you live, if you, in good faith, think a patient is being abused, tell someone–the right person. If you aren’t sure, talk to your supervisor. Don’t over-analyze, and don’t be hesitant. Most states have immunity provisions for reporting cases of suspected abuse that are made in good faith.
It’s much better to be proactive than inactive or reactive like those Pennsylvania State officials and end up in the public eye for failing to report suspected abuse. It’s best that you know at the end of the day you did the right thing in the best interest of your patient? After all, that person being abused is someone else’s child, sibling, parent or grandparent. Wouldn’t you want them to do the same for you?
