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Johannesburg - The reporting of suspected child abuse by medical aids is either non-existent or needs to increase significantly, child welfare organisations say.
An employee of a medical aid told The Star that when he had asked his managers what he should do about potential child abuse cases he was coming across, he was told to do nothing.
The employee, speaking on condition of anonymity, said medical aids were in the best position to pick up cases of possible child abuse.
This was because the abuser was likely to take a child who was regularly hurt to different doctors and hospitals to avoid discovery.
“There was one family that put repeated claims for their daughter who was being admitted to different doctors for burn wounds,” the employee said.
“Another case saw a child being admitted for concussion three times in two weeks at different hospitals.”
He was picking up at least one or two cases a week that worried him, the employee said.
“One injury probably won’t get the doctor too concerned. It is sometimes the medical aid that is in the best position to pick up patterns, but they are doing nothing,” he said.
Professionals who work on child abuse cases agree with him. Not one of several help organisations The Star contacted could remember receiving child abuse referrals from a medical aid.
Professor Ann Skelton from the Centre for Child Law said there might be a gap in the law regarding medical aids reporting child abuse, while all citizens were legally compelled to report suspected child abuse voluntarily.
The list of professionals who have to report suspected child abuse under section 110 of the Children’s Act includes teachers, doctors, nurses and lawyers.
Medical aids, however, are not part of the list.
Nomvuyo Shabangu from Johannesburg Child Welfare said many of the child abuse cases their case workers followed up on were reported by doctors and hospitals.
Shabangu said they often expected the doctor to make the call because even if they see the child only once, that one incident might raise suspicions that something isn’t right.
“It could just be something about the story that doesn’t make sense,” Shabangu said.
“But anyone who comes across child abuse is mandated to report it, otherwise children will die.”
Shabangu said she could not recall even one case where a medical aid had reported suspected child abuse.
Most of the referrals Child Welfare received came from doctors at state hospitals, where children were often kept overnight if health workers suspected a possible problem in the home, she said.
When a case was referred to them, it would be investigated to determine whether abuse was taking place.
“At that point we don’t know what is going on. It is our job to check the story. Sometimes it isn’t child abuse. For instance, the child might have a medical condition. You don’t know until you investigate,” Shabangu said.
Professor Lorna Jacklin from the Teddy Bear Clinic said the issue of medical aids being obligated to report suspected child abuse cases was one that needed to be debated in public.
She too had never come across a child abuse referral from a medical aid.
Nicolette Myburgh, director of the Christian Social Council, which deals with child abuse cases across the country, said most of the cases that were referred to them came from the community, particularly schools and nurses.
“We have had absolutely nothing from the medical aids,” she said. “And they would be the only ones that could pick up a pattern if parents take their children to different doctors every time.”
Myburgh said the reporting of child abuse was a big problem, and they believed that doctors were not coming forward and reporting abuse enough. “We believe doctors are seeing a lot more abuse than they report,” she said.
A child homicide study by Shanaaz Mathews from the Children’s Institute at the University of Cape Town showed that ongoing abuse can lead to the death of children.
The study, which looked at child homicides in 2009, found that South Africa’s child homicide rate was more than twice the global figure. The study found that there may be an underestimate in the number of child deaths linked to child abuse because police investigations and inquests are not always done when a child died.
“Fatal child abuse remains hidden, and the perpetrators literally get away with murder,” Mathews wrote in one report.
Medical aid groups contacted about the issue shared their opinions:
Momentum Health said “the information provided with the submission of a claim is, on its own, not sufficient to determine if child abuse is definitely taking place.
“Re-occurring hospital admissions of the same nature could potentially alert the scheme to a trend that is cause for concern. The scheme can, however, not act on suspicion alone.
“If suspicion exists, the scheme would address its concern with the treating provider, as the service provider has had direct contact with the patient…
“Should it occur that we identify a confirmed case of child abuse via information provided by the treating service provider, the scheme would follow up with the doctor to confirm if the case was reported.
“Due to member confidentiality, the scheme would legally be unable to share information without the express consent of the member in question.
”Where appropriate, the scheme’s case managers would make contact with a family and assist with the provision of social- work services.”
Fedhealth’s Peter Jordan said: “Unfortunately, medical aids are generally the last stop in terms of picking up potential abuse cases. The attending doctors who see and treat these children are obliged to report all suspected abuse cases.
“Medical aids… do not actively run reports on suspected abuse cases. This said, where cases are identified or suspected, these will definitely be referred and reported for further investigation.
“Fedhealth has dedicated high-risk-beneficiary case managers and social workers who would become involved where suspected cases are identified.”
Some specific examples they have dealt with:
* A mother did not give the child the required diabetes care and the child ended up in hospital repeatedly. The case was categorised as abuse/neglect and referred by a care co-ordinator.
* A grandmother reported the emotional and physical neglect of her grandchildren.
Discovery Health said: “Definitively detecting suspected child abuse cases on our system is impossible, as Discovery Health receives claims containing relatively limited clinical information.
“For example, we would receive a claim stating ‘broken ribs’, but the codes on the claim would not provide us with any definitive information on the cause of the broken ribs. These could have been an accident, a fall, or abuse.
“Only the treating health professionals are aware of the real situation, not medical schemes.
“Of course, if such health professionals ever request supporting information or other assistance from us, we would not hesitate to provide this, subject only to the regulations concerning patient confidentiality.
“Discovery Health was recently informed (by the treating doctor) of a case of suspected abuse of a seven-month-old baby. The doctor was determined not to allow the child to be returned to the parents. So while the hospital social worker was investigating a safe/foster home for the baby, Discovery Health authorised the child to remain in hospital until the baby could be delivered to a safe house.”