What happens when a child arrives in an emergency room with a serious injury?

Ideally, medical providers evaluate the injury for suspicious circumstances, said Dr. Lawrence Ricci, co-director of the Spurwink Child Abuse Program, based in Portland.

Anyone in health care is considered a mandated reporter, he said. In other words, if health care workers suspect abuse, they’re required by law to notify child protective services.

Ricci said certain injuries trigger automatic reporting, while others are at the provider’s discretion.

“Certainly, when someone comes in with concerns about sexual abuse, that’s a mandated report,” he said. “And, certainly, if someone brings a child in and raises a specific concern that the child was abused, that typically indicates a mandated report.”

Any life-threatening injuries that are not the result of an obvious accident, such as a car accident, are also automatically reported.

Bone fractures are less clear, he said.

“Once children start (walking), there’s a number of fractures that they can get that are pretty accidental,” he said. “That falls more into the category of judgment. But what we ask medical providers to do is to at least think of abuse, and if there are any questions about whether to report a case, to give us a call so we can help them make that decision.”

Ideally, reports are made while the family is with the health care provider, he said.

“If you’re going to make a report of an injury, make it before the family leaves, so you, in concert with child protective services, can make a decision about the safety of the child going home. It’s a really dangerous practice to send a child home and then make a report, because then you no longer have any control over what happens to that child.”

After a health professional reports suspected abuse, case workers from the state get involved, said Therese Cahill-Low, director of the Office of Child and Family Services in Augusta.

Cahill-Low said caseworkers are required to respond to a report of abuse within 72 hours.

“But in the case of an emergency room (report), we usually try to make it happen within the same day or within the 24-hour period,” she said.

If abuse is confirmed, case workers would decide whether circumstances require an immediate protection from abuse order or a range of other options like placing the child with relatives or a foster parent.

The department is required by law to reach a resolution within 35 days of the initial report, she said.

Medical providers aren’t the only mandated reporters, Cahill-Low said. Anyone who works in a school of child care setting is considered a mandated reporter, as well as firemen, psychologists, clergy, counselors, social workers and others.

“One thing that I like to get out there is, while these people are specifically identified as mandated reporters, the law allows anybody to make a report,” she said. “It’s a community effort as far as people referring and keeping kids safe.”

Despite the safety nets, some instances of abuse get through the medical system, Ricci said. Statistics don’t exist for Maine, he said, but Ricci cited a study in Colorado in 1999 that looked at 173 children younger than 3 years old with abusive head injuries.

“They found that 30 percent of those children had prior injuries, things that should have led to a diagnosis of abuse, but were missed,” he said.

Cahill-Low said consequences for not reporting can be serious.

“They could be prosecuted,” she said. “In the case of someone who has a professional license, they could lose their license.”

Ben McCanna — 861-9239

bmccanna@centralmaine.com