Health Professional Exams of Suspected Child Victims

Two recently published studies provide data regarding the prevalence of non-physicians in the examination, diagnosis, and treatment of child abuse cases. Giardino, Montoya, Richardson & Leventhal (1999) designed a 16 item questionnaire regarding the staffing, service, and financial characteristics of a sample of medically-oriented child protection programs in the United States. They distributed 118 questionnaires to child protection programs identified by the Executive Committee on Child Abuse and Neglect of the American Academy of Pediatrics under the sponsorship of the Special Interest Group on Child Abuse of the Ambulatory Pediatric Association.

There were 73 returned surveys from 31 different states. The respondents were required to have either a physician or a nurse practitioner on staff in order to qualify as a medically-oriented child protection team. Forty-nine percent (49%) of the respondents had nurses on the teams. The article did not specify further qualifications such as physician assistant, nurse practitioner, registered nurse, etc. The inclusion of nurses in their survey, the requirement that either an MD or NP staff a "medically-oriented" child protection team, and the response that approximately half of these teams use nurses, demonstrates acceptance of non-physician practice by the Academy of Pediatrics.

Kelley and Yorker (1997) conducted a survey of 221 non-physician health care providers (nurse practitioners, physician assistants, and registered nurses) who provided child abuse examinations. Out of the 104 respondents, 95.2% performed examinations in cases of sexual abuse and 70% in cases of physical abuse. In order of frequency, the practice settings of the respondents were clinics (70%), emergency departments (41.4%), child abuse programs (27.9%), and child advocacy centers (23.4%).

The respondents had an average of six years of experience working in the field of child abuse and 76.9% provided colposcopic examinations. Almost 80% reported being supervised by an M.D.

The data from this study regarding court experiences of non-physicians who work in the field of child abuse are particularly relevant to the current study. Seventy-eight percent of the respondents had qualified as an expert witness and testified in court, only twelve percent ever had a judge refuse to qualify them as an expert, and the average number of times each had testified in court was 25.6 with a range from 0 to 360 times.

We specifically asked respondents if they perceived that their credibility was an issue with other disciplines involved in child maltreatment. Respondents believed they had credibility problems with the following professionals: defense attorneys (35.6%), physicians (16.7%), prosecutors (11.5%), judges (10.6%), police (6.8%), and child protective services (3.9%).