State law, ER policy led to questioning of family
KXAN (AUSTIN) - Like a lot of toddlers, Kenzie Williams is still getting used to her own two feet.
“She’s a typical 1-year-old,” said her mother, Alison. “She toddles around and falls.”
That is exactly what happened in May when Kenzie accidentally fell off the couch while playing with her 13-year-old sister. Not long after the fall, her parents decided to take her to the emergency room.
“We noticed a bruise about 30 minutes later and we took her to Dell Children’s Medical Center to make sure nothing was wrong,” said her father, Jason.
After an X-ray in the ER, doctors informed Jason and Alison that Kenzie had suffered a hairline fracture of her clavicle, or collarbone. Due to the nature of the injury and Kenzie’s young age, there was very little treatment that could be performed and doctors advised that it would just need time to heal.
Jason and Allison answered multiple questions about how Kenzie injured herself before doctors said additional testing would be needed.
Not just for her clavicle.
“I asked ‘why?’," Jason said. "And they said to ensure there has not been past injuries.”
Jason said it felt like he was being investigated for child abuse. He would also have to pay for the extra testing out of pocket, but initially allowed the skeletal survey to begin.
But after a short amount of time, he could not let it finish.
“There were two grown men holding her down to do the scan and it was pretty aggressive,” said Jason.
“After 10 minutes of them holding her down and her crying, I could not take it anymore so I picked her up and took her out.”
Before walking out, Jason was warned.
“They said that if we didn’t finish the tests, Child Protective Services will get involved,” he said.
Sure enough, a CPS caseworker showed up at their home later that night and asked to conduct an interview with Jason and Alison whom are parents of three daughters.
After answering questions about their household and their parenting techniques, the Williams family said they waited while the case worker went outside to talk to her supervisor.
“When she came back in, she said if we didn’t go back to the hospital, they would legally take (Kenzie) away.”
Policy and the law
Young children provide Dr. Pat Crocker with some of the more difficult cases he sees as chief of Emergency Medicine at Dell Children’s Medical Center.
“It is very difficult to diagnose a fracture in kids under one year or two,” said Crocker.
Because of this challenge, Dell CMC has a policy to conduct automatic skeletal surveys for all children under 12 months that enter their ER with a fracture.
Crocker says the additional surveys find other fractures more than 10 percent of the time. It also helps them stay vigilant in reporting potential cases of child abuse as required by Texas law.
“The law not only obligates us to report, but empowers health care providers to obtain the test necessary regardless of parental concern,” said Crocker, who recalled very few instances of family objections in the nearly 30 years he has been working in emergency rooms.
“We need to investigate to protect the child,” he said.
If parents object to the additional testing, doctors will not require it. However, they will contact Child Protective Services.
“When we see families that are resistant to (testing), we usually do not insist on the test, but we will report to CPS because it needs to be investigated.”
Child Protective Services spokeswoman Julie Moody says teachers and healthcare professionals are the leading professions that report cases of suspected child abuse.
From the CPS website:
- Child Protective Services caseworkers investigate reports of child abuse or neglect to determine whether any child in the reported family has been abused or neglected. Caseworkers decide if there are any threats to the safety of all children in the home. If so, they determine whether the parents are willing and able to adequately manage those threats to keep children safe. If CPS concludes that children aren't safe, the caseworker starts protective services.
And doctors can provide additional information to case workers.
“We really rely on their professional opinion because CPS workers are not medically trained,” said Moody.
Crocker says even if CPS is contacted, the cases rarely result in anything more than an interview. And removal orders must be signed by a judge before a child is ultimately taken from the home.
He also believes any notions that the law and policy should deter parents from taking their child to the ER are very ill-advised and misplaced.
“Fear about the state law that requires a report should play a role in that decision because it is an uncommon occurrence.”
Aftermath
Presented with the notion of having their daughter taken from them, the Williams family returned to Dell CMC and completed the skeletal survey.
The tests were negative. A CPS case file was never opened.
“She is healing fine,” said Alison, while holding a smiling Kenzie a little more than five weeks after the accident.
“We took her to her regular doctor and they say she is healing fine.”
The bills from that day reached nearly $1,800, according to the Williams family. But since the interview with KXAN, they said they have been in conversations with the hospital management about a possible refund and the bills are currently being reviewed.
Still the experience is one they do not believe they should have been put through after an accidental fall.
“My wife and I were interrogated for over an hour,” said Jason.
“It was very hard to hear that. There was no reason to believe it.”