Introduction
The hypothetical case introduces the complex ethical and legal implications of physicians as mandatory reporters when treating patients with mental illness. When a patient with reality challenges (e.g., psychosis, mania, or delirium) endorses having sexual contact with minors, how rooted in reality are these statements? Some providers may prefer erring on the side of caution by automatically reporting these statements to child protective services. However, reporting the patient on the basis of statements that may not be true may cause significant harm by violating the patient’s autonomy and damaging the physician-patient relationship. Further complicating this situation are laws that punish providers who fail to report child abuse. Here, we summarize mandatory reporting laws and provide considerations to help health care providers make informed decisions of whether to report. Finally, we offer policy proposals to address this complex issue.
Mandatory Reporting Laws
All states have mandatory reporting laws, which typically include professions such as physicians. In 45 states, “reasonable” belief of abuse is the standard required to trigger mandatory reporting. State-specific examples are cited below, chosen because we identified pertinent case law from those jurisdictions.
California, for example, defines “reasonable suspicion” as “objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on the person’s training and experience, to suspect child abuse or neglect”. This “does not require certainty,” and there does not need to be a specific medical sign of abuse.
Failure to report child abuse can be punishable under criminal law. In Illinois, violations of the mandatory reporting statute can be punished as a class A misdemeanor, which can include incarceration of up to a year, probation up to 2 years, and a fine up to $2,500.
On top of criminal liability, there can also be civil liability in the form of a lawsuit. Moreover, failure to report child abuse can have consequences such as suspension of a professional license.
Between the ambiguous language defining reasonable belief and the consequences of failing to report (civil and criminal liability and professional licensure), reporters such as physicians may have a low threshold for reporting to err on the side of safety to protect the investment in their careers.