Shelley Eskridge, RN, BSN, CEN, was elated when Florida Gov. Rick Scott recently signed into law a bill that gives Florida the toughest mandatory child abuse reporting requirements in the nation.
“I cant believe this has finally gone through,” said Eskridge, who has seen dozens of cases of severe child abuse during her nursing career. She spent five years working with the Broward County Child Protection Team — a group of nurses, physicians and social workers trained to look for medical evidence of abuse or neglect. “This new law is critical because I think it is too easy to abuse a child and get away with it,” she said. “We might finally be able to put some of the perpetrators behind bars who we could not prosecute in the past.”
A previous Florida law required mandatory reporting of child abuse only when the suspect was a parent, legal guardian or caregiver, and this narrow definition did not include many perpetrators, said Eskridge, who is an ED nurse at Gulf Coast Medical Center in Fort Myers, Fla. “Jerry Sandusky of the recent Penn State abuse scandal was volunteering with children in a leadership role, so under the previous law this type of person could fall through the cracks,” she said.Shelley Eskridge, RN
The Protection of Vulnerable Persons law which takes effect Oct. 1, also imposes a stiffer penalty for failing to report child abuse, making it a third degree felony as opposed to a first degree misdemeanor. The new law also imposes steep financial penalties for colleges or universities where administrators, staff or faculty fail to report child abuse on school property or during a school-sponsored event. The institution will be fined up to $1 million for each failure to report.
With stiffer penalties possible, nurses may start seeing more patients who have been abused, said Terri Augspurger, RN, MSN, CFN, CPEN, SANE-A/P, a clinical forensic nurse examiner for St. Johns County, Fla. “I think we will be seeing an increase in suspected abuse reports to authorities as well as an increase in visits to the ED because the law will make parties feel it is their responsibility to report,” Augspurger said.
Possible signs of sexual abuse in girls include recurring urinary tract infections, bruising of the hymen and the absense of hymenal tissue, Augspurger said. In boys, the signs include bleeding in the genital area, anal scarring or a dilated rectum and injuries to the penis or scrotum, Augspurger said. These injuries can be present for legitimate reasons, but they also can warrant further investigation, especially absent a logical explanation. Other signs in children include sexualized behavior toward adults or other children and sexual knowledge beyond the developmental level.Terri Augspurger, RN
Likewise, a suspicious explanation for a physical injury can signal physical abuse, Augspurger said. For example, a parent may claim a baby was injured after rolling off a bed, yet developmentally the infant is too young to be capable of rolling over. Multiple injuries at different stages of healing may indicate the a child has been hurt at different times, and “patterned injuries” — such as hair dryer marks, belt marks, cigarette burns — also can be a red flag, as can injuries in hard to reach areas, such as the back of the body.
Eskridge said the new law highlights the important role nurses play in documenting evidence of abuse. “I hope to see more people reporting abuse to their providers, and our medical documentation of these cases might be used to help prosecute someone,” she said.
Although cases such as Sanduskys revealed the need for laws like the one passed in Florida, Eskridge suggests the legislation was long overdue. Her experience working for the Broward County Child Protection Team cemented her belief that changes were needed in the legal system. “It seemed like we had death after death after death with no prosecution,” Eskridge said. “Florida nurses should be proud that our governor is taking such as stand. Not many people want to stand up against child abuse because there are a lot of politics at play, but this will help us to take our kids seriously.”