In a ruling eagerly awaited by the medical community, the New Jersey Supreme Court ruled Wednesday that an emergency room physician was not negligent for failing to contact child welfare authorities after treating a 2-year-old girl who had ingested cologne.
The court overturned an appeals court finding that a reasonable jury could determine that the child’s condition was the result of “reckless” or “grossly or wantonly negligent” conduct or inaction by the parent or guardian.
The court said there must be a “reasonably objective” belief based on circumstances known at the time that child abuse may have occurred before the statutory requirement that the state be notified comes into play.
Any lessening of the standard, or a heightened requirement of reporting based on inference, could lead to over-reporting of suspected abuse or neglect cases, which runs against public policy, the court said in a unanimous ruling.
On Jan. 13, 2001, relatives brought the child, known as S.A., to the emergency room at Jersey Shore University Medical Center in Neptune. She was vomiting and walking with an unsteady gait and was observed as lethargic and weak with an unusual odor on her breath.
The emergency room doctor, Daniel Yu, conducted an extensive examination, ran tests for blood-sugar levels and carbon monoxide poisoning, and ordered blood work, a chest X-ray and urinalysis. The child had a blood-alcohol concentration of .035 percent.
Based on the test results, the cologne odor and accounts by the child’s relatives, Yu concluded that S.A. had ingested cologne. Three hours after she arrived, S.A. was alert and able to walk normally, and was discharged.
S.A., who had been abandoned by her mother soon after birth, had been living with her father by order of the Division of Youth and Family Services.
In March 2001, DYFS received reports that S.A. had been burned and beaten. It removed her from her father’s care the next month after she was found with chemical burns on her vagina, foot, leg and buttocks, along with bruises and belt marks.
An individual identified as L.A. adopted S.A. in April 2006 and a year later sued DYFS, state officials, Jersey Shore and Yu on behalf of the child. The lawsuit alleged Yu and the hospital were negligent in that they failed to report a suspected case of abuse as required by N.J.S.A. 9:6-8.10.
Mercer County Superior Court Judge Paul Innes dismissed the claims against Yu and the hospital on summary judgment, saying the mere fact that a child ingested a foreign substance was not enough evidence to support a reasonable belief of child abuse. The Appellate Division reversed on appeal.
After a trial, a jury assessed $3.25 million in damages against DYFS. Facing a claim for attorney fees because of a civil rights allegation, and a separate trial on punitive damages, the state settled for $5 million that day.
The Appellate Division held that Yu fell short of his obligations by failing to report the matter to DYFS, now the Division of Child Protection and Permanency.
Yu and the hospital appealed.
Justice Jaynee LaVecchia, writing for the court, said it was not the intent of the Legislature, when it enacted the reporting requirement, that physicians report based on probable inference.
“[W]e agree with the trial court that, objectively viewed, the circumstances surrounding S.A.’s presentation at the hospital were insufficient to give rise to a finding that Dr. Yu behaved unreasonably in failing to report an incident of suspected child abuse,” LaVecchia said.
The situation was not as though the child had been put into close proximity with acid, poison or a gun, which no reasonable adult would allow to occur, she said.
“While child-proofing of homes is not a new or revolutionary precaution in modern life, the idea that a toddler might find a way to get her hands on a common cosmetic or toiletry item is not equivalent to grossly negligent or reckless behavior on the part of a parent,” LaVecchia said. “Were that to be so, every accidental ingestion case presenting at a hospital emergency room would risk becoming a mandatory child abuse reporting incident. We do not believe that the reporting obligation was meant to operate in such fashion. Indeed, it would foster over-reporting.”
The attorneys representing Yu and the hospital reacted positively to the ruling.
“It maintains a balance between the public’s responsibility to report child abuse when there is a reasonable belief that it has occurred against over-reporting based on mere suspicion that intrudes on the sanctity of the family,” says Yu’s attorney, Hugh Francis of Morristown’s Francis & Berry. “It also clarifies the statute so that it applies to all individuals” and not just physicians.
The hospital’s lawyer, Richard Amdur, of Amdur, Maggs & Shor in Eatontown, says, “The ruling is carefully reasoned, and reflects what the average person would think is proper law.”
David Mazie, representing an individual who eventually adopted S.A., says he doesn’t disagree with the overall interpretation of a doctor’s duties but believes the court misread the facts underlying his claim against Yu.
There was, he says, a “significant amount” of evidence available to Yu at the time for him to have a reasonable belief that the child had been the victim of child abuse. “I was entitled to have a jury determination on that issue,” says Mazie, of Roseland’s Mazie Slater Katz & Freeman. ■
Contact the reporter at email@example.com.