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Pediatric ophthalmologists likely to testify in abusive head trauma case at least once
On average, a pediatric ophthalmologist sees 2.5 cases of probable abusive head trauma per year and will likely be subpoenaed in such a case 1.25 times in his or her career, according to a survey.
A nationwide survey looking for trends in abusive head trauma cases was sent to 875 members of the American Association for Pediatric Ophthalmology and Strabismus. One hundred thirty-two pediatric ophthalmologists responded for a response rate of 15%.
Results showed that pediatric ophthalmologists evaluated abusive head trauma a median of 10 times per year and could expect to testify in a case at least once in their career.
Fifty-four percent of respondents (71 of 132) were in academic practice and 92% of those in academic practice (65 of 71) had residents who were evaluating patients for abusive head trauma. Twenty percent of those residents were asked to testify in a case.
Furthermore, the average pediatric ophthalmologist would be expected to see two cases of ocular signs of child abuse not related to abusive head trauma in his or her career, according to the survey. Such signs included optic neuropathy, corneal laceration, toxic conjunctivitis from bleach in the eye, third cranial nerve palsy and homonymous hemianopia.
Where the practice was located, whether retinal images were obtained and whether an inter-office child abuse team was in place did not influence whether a pediatric ophthalmologist was subpoenaed or testified in court, according to the study. – by Kate Sherrer
Disclosure: The authors report no relevant financial disclosures.
Perspective
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This article summarizes a survey sent to members of AAPOS regarding their experience with examinations of children with presumed abusive head trauma and legal consequences. It confirms on one hand the apathy of practitioners’ involvement in this topic with a 15% response rate to the survey, and at the same time the reality of the low incidence of actual need to take time out for court appearances with an average of one incident in the practice time of a physician.
The reality is that we are all faced with the need to examine these children and our participation is fundamental in the subsequent management of the child, the family and protection of other children in the future. There is no question that these exams, particularly when fundus photography is included, take time, and the subsequent subpoenas, depositions and possible blocked time for court appearances affect a physician’s practice. However, the study confirms my own experience that the actual time involved in the medicolegal aspect of these cases considered in a lifetime of practice is not significant. Maybe more physicians will be willing to participate in the management of these cases when they realize the benefit to society has a low personal cost sacrifice. We are here for the children and we should all be encouraged to participate more in the future.
At the same time our Association should try to lobby for and advocate more consideration from state and county courthouses with respect to the physician’s time when being subpoenaed to testify. Our time out of the workplace affects taking care of multiple children with serious vision problems, while court dates are often rescheduled.
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Sussenbach EC, et al. J Pediatr Ophthalmol Strabismus. 2016;doi:10.3928/01913913-20160113-08.