Mandatory Reporting, Patient Rights, And When Law Enforcement Should Intervene

March 31, 2019

The national news recently picked up a story that is close to home for me. Several weeks ago in Chandler, Arizona, children were removed from their home after a mother refused to take her unvaccinated child with a 105 degree fever to the hospital. Law enforcement was at the home for 3 hours trying to conduct a wellness check on the child, and the family refused to cooperate. The police obtained a court order on the basis that the child needed immediate medical attention, and then entered the home. This morning I was a guest on Fox & Friends to share my insight into this case as a pediatric medical provider.

Like I said in the opening of the interview, no one wants to see police officers using force to enter a home and remove children. It is a scary situation and a reality that no parent would ever want to face. At the same time, we can also all agree that we don’t want children to die.

When cases like this come into the public spotlight, people are quick to panic. Some sites prone to conspiracy refer to it as “medical kidnapping,” and after this story broke, there was a post going viral about unvaccinated children being stolen.

There is so much misinformation and fear-mongering online.

Mandatory Reporting, Patient Rights, And When Law Enforcement Should Intervene

I’m thankful Fox & Friends had me on their show to share a few thoughts. News segments are always short, so I want to dive deeper into the story here, and shed some light on what parents should know about this case as well as some of the medical considerations that come into play in these difficult situations.

KidNurse on Fox & Friends

The public never sees the entire story in these cases.

This makes it easier for healthcare providers and law enforcement to be wrongfully maligned. Because of HIPPA confidentiality laws, the naturopathic physician that saw this child can’t share all of the medical details that made her make this decision.

We now know that this toddler had a 105° temperature and was not vaccinated. Because this child wasn’t vaccinated, the provider was rightfully concerned about the toddler possibly having meningitis. The risk of meningitis is much higher in children that are unvaccinated. Meningitis can kill children in less than 12 hours. Time was absolutely of the essence. Furthermore, when the child was taken to the clinic, he had “other symptoms,” as well. Was he lethargic? Was he dehydrated? In addition to his fever, he could have had other serious symptoms – we don’t know.

What we do know is that when this child was examined, it was a severe enough medical situation that the naturopath urgently recommended that the child be taken to a pediatric hospital, where life-saving care could be given, if needed. We also know that the naturopath even consulted a pediatric hospital before sending the family over.

DCS can’t comment about this case because they are also trying to protect the confidentially of this child and family.

This may not have been the family’s first interaction with DCS, but again, we just don’t know. Because we fiercely defend a patient’s right to privacy, the initial media coverage of stories like this are often extremely one-sided and generally only cover the reaction from the parents.

Healthcare providers are mandatory reporters.

Any time a child is in danger, we don’t have a choice – healthcare providers legally have to report it to the authorities. With the thousands of children I have cared for in practice, I’ve only had to make a handful of reports to DCS. We take these cases very, very seriously.

The naturopathic doctor that saw this child had to have been seriously concerned for this toddler’s wellbeing to have reported it. It is truly the intention of healthcare providers to do everything we can to keep children safe, not to tear families apart.

Law enforcement didn’t show up and immediately enter the home.

Many of the initial videos made it look like the Chandler police officers came to the house and immediately broke down the door. What actually happened is the family refused to cooperate with law enforcement for over 3 hours. What had started as a wellness check escalated to law enforcement entering the home because the family refused to work with the police after they had made multiple attempts to work with the parents.

The police obtained a court order on the basis that the child needed immediate medical attention, and then entered the home. When the police finally did get to the children, they had vomit in their beds and had stains around their mouths. The police report also said that the house was messy enough that it was difficult to walk and the parents had an unlocked shotgun next to their bed.

The naturopath’s concerns were not unfounded – two of the three children were sent to the hospital in an ambulance and the child with the very high fever was admitted.

Parents don’t always recognize when their children are critically ill.

This is hard for many parents to understand, but I’ve seen it over and over again in practice. I don’t know if this was a factor in this case, but it is a common factor to consider in pediatric emergencies.

The reality of your child being critically ill is often too much for parents to wrap their minds around. Mentally minimizing the severity of your child’s illness is actually a form of self-preservation. This is the same reason that it’s not advised that medical providers take care of family members – your judgement can be clouded when it comes to caring for the people you love. I’ve taken care of children that come into my office literally gasping for air and the parent is confused and then guilt-ridden because they just didn’t understand the level of medical emergency their child was experiencing.

A foundational aspect of practicing medicine is analyzing the risk for worst-case medical scenarios.

When this story initially broke a month ago, I was hesitant about forming an opinion until more of the circumstances involving the case came to light. There is almost always more to these stories than what is initially reported.

The worst case in this scenario was that the child could actually have vaccine-preventable meningitis and could die within a few hours without medical intervention. This reality could have been ruled out with further testing that could be performed at a pediatric hospital. I was just speaking with a pediatric nurse practitioner colleague who recently cared for an unvaccinated infant that contracted vaccine-preventable meningitis. Thankfully, this patient did receive medical care. They had to drill Burr holes into her skull to drain the infection. While this child lived, the brain damage was catastrophic and they anticipate she will be disabled for the rest of her life.

The general public doesn’t necessarily consider that a feverish child could result in lifelong disabilities or death from meningitis, but we do. That’s part of our job. As healthcare providers, we are trained to consider all the causes of a child’s illness. In children that aren’t vaccinated, there are considerably more diseases that a child is at risk for.

The mother in this case confided to the naturopathic physician that she wanted to lie to the hospital and say that her child was vaccinated. She was afraid that DCS would remove the children for not being vaccinated. This is ridiculous. The naturopathic physician even confirmed with the hospital that they would not do that. Your child’s vaccination status is needed, so we can know what we might be dealing with and give your child the best care.

America was founded on fighting for freedom – it’s dear to all of our hearts. At the same time, medical neglect is a real child safety issue which can lead to tragic outcomes if appropriate action isn’t taken. We must have an investigative process in place when we are concerned that children might be in potentially deadly situations – and we do. That’s why we have mandatory reporting and DCS.

The salt in the wound with this case was the parents’ refusal to work with law enforcement. Had they done so, I believe this case could have easily had a different outcome. Currently, both parents are facing a child abuse charge from the Chandler Police Department.

Author: Dani Stringer, MSN, CPNP, PMHS – founder of KidNurse and MomNurse Academy