Suspicious injuries, comment

As far as the consent to take the pictures and maintain them in his medical record is concerned, on first entry into the ER the mother was given forms to fill out along with a consent for treatment which she would have had to sign in order for the ER to get to this point in the examination. But I understand that there is a separate consent form specifically for pictures and if this form is not signed by the parents then the pictures cannot be made part of the medical record. Now the issue of the father coming to the ER and the police being called is another problem that needs addressing. As mandated reporters the ER staff should have notified the social worker or social services not expect the police to take care of it the next day. Since one of the parents is suspected of having caused the injuries, the child should not have been released to them until cleared by Social Services.

Original Post:
November 5, 2008
Suspicious injuries
I want to discuss an interesting forensic case that came through the ER this weekend. An 11-year-old male came in with L wrist pain. He denied any injury and gave an elaborate account of a dream he had the night before where he injured his wrist and woke up with his wrist hurting. There was obvious bruising to the dorsal aspect of his hand and wrist with petechiae inside the bruising. It looked to me like someone had stepped on him or applied a lot of pressure. I asked him what he did before he went to bed. He said he was playing a game with his friend (gamecube). Again denied any injury occurring, couldn’t remember any type of pain before bed. The patient was in the ER with his mother only. On XR his radius and ulna were both broke. We called the sheriff department immediately. We looked up the mothers medical records which also showed multiple hand and arm injuries. The mother was in complete denial and refused to believe he got the injury from something else than a bad dream (she wasn’t an individual with a high IQ). She got upset and called the father who came to the hospital and was also upset. The father has a history of head trauma and is known to have rage outbursts. Anyways, the police came and interviewed all and said he would contact social services the next day. My question is-we took pictures of the child’s injury and bruising noted. We usually need a consent form signed to take and maintain pictures in a medical record. But since the injuries are suspicious and abuse may be suspected by one of the parents, do we still need consent or is it implied since it is a mandatory report to law enforcement?

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