Should the reporting of abuse be mandatory?

By JAN CORBETT

Ask Dr Patrick Kelly how to spell the Maori name of his child protection unit at Starship hospital and he will tell you to add "hau" to the surname of the victim of one of our most horrific abuse cases.

Whakaruruhau means a place of protection.

Dr Kelly asks how much protection James Whakaruru enjoyed in a life that ended before he turned 5 when he was beaten to death by his mother's boyfriend.

Among the recommendations in Children's Commissioner Roger McClay's subsequent report was examining the idea of mandatory reporting of child abuse - requiring doctors, lawyers, teachers and any other professionals involved in the care and protection of youngsters to tell the Department of Child, Youth and Family Services (CYFS) every time they suspect abuse.

Reporting abuse now is voluntary.

But paediatricians such as Dr Kelly, tired of the gruesome frequency with which the bruised, maimed and violated bodies of abused children turn up in hospital wards, mortuaries and newspaper headlines, want it made compulsory so the telltale signs of cigarette burns, healed fractures with no record of treatment, and sexual abuse are not ignored.

But what may sound like an easy answer has reignited a debate that has raged in child protection agencies and Parliament for more than 20 years.



Ask Dr Kelly why we should have mandatory reporting and he turns the question around: "Why not?"

Since 1995, hospital policy has required hospital doctors to report suspected child abuse cases to CYFS, and he sees the benefit of this.

He says that when doctors think a child's injuries are not consistent with the type of accident described, it is easier to tell the family they are required by law to report their suspicions.

"It takes the heat off the doctor. You're not seen to be picking on them and they can't bargain with you."

Dr Kelly believes mandatory reporting would make it easier for GPs working in isolation to overcome pressure from the family not to report.

"We're all at risk of getting sucked into colluding with families. In nine out of 10 cases, it's erroneous to think you can deal with this by yourself."

But he admits reporting child abuse does not necessarily mean CYFS steps in immediately. Its response rate is hampered by scarce resources.

And that is one of the practical arguments against mandatory reporting - CYFS can barely deal with the cases it has now.

Chief social worker Mike Doolan says mandatory reporting "would swamp us."

"There's no way it could be introduced without a significant input of resources."

But Dr Kelly says CYFS' inability to deal with the extra workload is no reason not to measure the extent of child abuse.

To him, it is like saying we have this terrible disease but we cannot treat everyone so we would rather not know how many people have it.

Mandatory reporting would at least give a more accurate picture of the extent of child abuse, he believes.

At the same time, CYFS is conscious that only 1 per cent of child abuse reports come from GPs - one of the lowest rates in the western world.

But since 1994, when Parliament last voted against mandatory reporting, CYFS has concentrated on teaching professionals how to recognise child abuse and developing ways of encouraging them to report it.

Previously, 45 per cent of reports came from the professionals, the rest coming from the public. Now the percentages have reversed.

But Mr Doolan says mandatory reporting does not necessarily create a safer world for children.

Victims Craig Manukau and James Whakaruru were already known to CYFS when they were beaten to death. In the year to July 1999, five children known by the service to be at risk died violently.

Under the current philosophy of including family in care and protection solutions rather than automatically taking a child away, Mr Doolan sees mandatory reporting as an unnecessarily blunt instrument.

Parentline manager Maxine Hodgson wants mandatory reporting obligations to include everyone - friends, neighbours and family.

She is in the middle of an 18-month campaign to push that message and the need for everyone to be trained to recognise and report abuse.

She thinks those who oppose mandatory reporting are those who have not been trained how to do it effectively.

Dr Ian Hassell, a former Children's Commissioner and now chairman of the lobby group Children's Agenda, describes himself as lukewarm on the idea of mandatory reporting.

" I've taken the view that reporting by doctors is much more dependent on their confidence in the outcome than it is on requirement of the law."



Dr Hassell believes doctors will voluntarily report suspected abuse if they know the response will be timely and appropriate.

His view is shared by Medical Association chairwoman Dr Pippa MacKay.

"It is a disincentive to reporting when nothing happens or the wrong thing happens," she says.

Dr Ralph Wiles, chairman of the Royal College of General Practitioners, thinks mandatory reporting is a blind alley. GPs are already obliged to report genuine cases, but he worries that if the threshold is lowered, families could be torn apart by trivial allegations.

He would rather see money being spent on interdisciplinary education and community discussion on recognising genuine abuse and dealing with it.

Although the Medical Association has no policy on mandatory reporting, Dr MacKay points out some of the difficulties facing GPs who treat injured children.

One is the fear that the child will not be taken to the doctor at all because it would lead to the inevitable visit from the social worker or police.

Another is the damage inflicted on a family by a false accusation.



But as Dr Hassell points out, a recurring theme in each report on a child battered to death is the lack of coordination or information-sharing among agencies. Even medical files are not centralised, so a child such as James Whakaruru could see more than six doctors at 30 different times without any of them having the full picture.



Mr McClay, who voted against mandatory reporting when he was a National MP, and says he is still calling for debate on the issue, appears to have changed his mind in his role as Children's Commissioner.

"We ask a lot of our doctors," he says, "but if they don't report it, I know the children won't. They can't.

"So what do we do? Do we carry on and say it's too difficult so let the children die?"