mssmem.com

Hello,
Gordon has brought to my attention that not all of the adult docs are aware of the asthma follow up clinic. For patients followed in the general peds clinic there is a follow up asthma clinic in the gen peds clinic. The book for follow up is on the desk and labelled Asthma Clinic. Please schedule follow up for all known clinic pts who present with asthma for the following day.

—
Adam Vella, MD

Please be aware of the following recommendations for Pediatric pain control, in particular for our sickle cell patients, discussed at the most recent pain meeting:

Anesthesia pain team can now be called at any time to begin management of a pediatric sickle cell patient who is in pain. This team may begin a PCA pump for the patient.
If the physician covering the anesthesia consult service (resident) is resistant to the addition of a basal rate, and the patient has a history of requiring one, the physician requesting the consult may ask to speak to the fellow.
Once the patient is admitted to P4, the team managing the PCA/analgesia will be decided on a case by case basis (heme/onc vs pediatrics vs anesthesia)

As per Jeff Glassberg ,who attended:
The Chief of Anesthesia expects that the response to our consultation request be immediate and that the fellow or resident actually appear in person in our ED within 15 minutes of being called. Consultation recommendations over the phone are to be discouraged.

Please note that the goal is adequate pain control not only for those pts that are being admitted but also for those who are in the ED in pain, so that they may have the possibility of being discharged to home.

Thanks

Sylvia

As you both know, I am back at Mount Sinai part-time heading up the Child Protection Program. Our Child Protection Committee meets weekly at 12 noon on Wednesdays, followed by a follow-up/evaluation clinic. We are really pleased to have the PER SW Amanda Ferguson work with us and I have received some calls from the PER for advice. I just want you to know that we want to be available as much as possible and assist in any way you feel is appropriate. My cell phone is 917-751-4066. Dr. Rebecca Farnham and Liz Koskinen LCSW are part of the team and very available. Please let me know if there are any other ways we can be of assistance. Thank you. Sincerely yours,

Katherine Grimm, M.D

So we now have Sweet Ease for calming our cranky babies or babies before procedures and Pain Ease spray for use over intact skin to help with procedures, access, etc ! Both these items are stored in our Pediatric med / store room in our ED: the Sweet ease on the shelf near diapers and the Pain Ease immediately to the R, on the lower metal shelf. We are waiting for our baby pacifiers to arrive. Sweet ease and the pacifiers are great to help our little patients deal with painful procedures ( LP, etc.; can also be helpful when obtaining a BP on infants, hint, hint); please use them.

Also, please take time to review the location of items in the resuscitation room and on our isolette (located in room 3T) so you are also prepared to find things if an emergency occurs. There are 2 neonatal resuscitation boxes, one located on the code cart in the resuscitation room and one on the isolette cart, top shelf.

We also have shorter needles for use in accessing our younger infants.
If there are any concerns or questions about any operations related issues,please let me know.
Thanks
Sylvia
Sylvia E Garcia, MD
Assistant Professor, Pediatric Emergency Medicine
Operations Director, Pediatric Emergency Medicine
PALS Director, Emergency Medicine Residency

Hello,
Please be aware that if appropriately shielded, parents are allowed in room with their child while they are undergoing CT scans. Occasionally techs mention some policy, which does not exist, that parents are not allowed in. According to the email below from Dr. Rosenberg, this is not true. Today I was able to complete a non contrast Head CT on a 21 month old male without sedation. This clearly would not have been possible with the mother out of the room. Be aware that there is no policy against this.
thanks,
Adam

———- Forwarded message ———-
From: Rosenberg, Henrietta
Date: Tue, Apr 3, 2012 at 9:24 PM
Subject: RE: CT
To: Adam Vella

Adam,

If the parent is appropriately shielded, there is no reason why they cannot be in the room. However, having a parent present does not ensure patient cooperation when the patient is of an age when their behavior is likely unpredictable. What age and what type of CT study are you alluding to?

Henrietta

From: Adam Vella
Sent: Tuesday, April 03, 2012 4:53 PM
To: Rosenberg, Henrietta
Subject: CT

Hello Henrietta,

I have a quick question regarding radiology policy. Frequently having a parent in the room with the patient will allow us to complete a study without sedation. If the parent is wearing lead is there some problem with this? I have had multiple radiology techs say that their policy is that parent’s can’t be in the room. Clearly this is not family centered if it is the case. Can we address this from the pediatric perspective?

Adam

nyclu_pub_child_abuse_reporting

The New York Affiliate of the American Civil Liberties Union ? Tom Frey, President ? Donna Lieberman, Executive Director
125 Broad Street, 19th Fl.
New York, NY 10004
212.607.3300
212.607.3318
www.nyclu.org
Reproductive Rights Project
CHILD ABUSE REPORTING AND TEEN SEXUAL ACTIVITY:
CLARIFYING SOME COMMON MISUNDERSTANDINGS
(Updated March 2009)
New York laws about “statutory rape” and child abuse reporting are confusing. This list of
frequently asked questions (FAQ) describes when to make a report to the Statewide Central Register of
Child Abuse and Maltreatment (the reporting hotline for child abuse and neglect) based on a minor’s
sexual activity.
This FAQ explains that according to New York courts and guidance from the Office of Child &
Family Services (“OCFS”), parental knowledge of a minor’s voluntary sexual activity does not
necessarily give rise to reasonable suspicion of abuse or neglect and should not be reported to
the Statewide Central Register, absent other indications of abuse or neglect.
This memorandum is not intended to provide individualized legal advice. A mandated reporter or
young person who faces a specific legal problem should consult with an attorney.
1. What is reportable as child abuse?
New York’s child abuse reporting law mandates certain professionals to file a report when
they either have reasonable cause to suspect or become aware of abuse or maltreatment (neglect)
committed by a “parent, guardian, custodian or other person legally responsible” (hereinafter
referred to as “parent or caregiver”) for a child’s care.1 Abuse or maltreatment means that the
parent or caregiver directly harms the child or acts in a way that allows the child to be physically or
emotionally harmed or sexually abused.2
Under New York law, a child abuse report is only required if the abuse is committed by a
parent or caregiver, because they are the only ones that can be ‘the subject of a report.”3 Therefore,
the Statewide Central Register should only commence an investigation in a case involving suspected
child abuse or maltreatment against a parent or caregiver, and not in a case involving a person who
is clearly not considered a person legally responsible for the child’s care,4 even if that person harmed
a child.5
Harms committed by strangers or peers are therefore not mandated reports, unless a parent
has allowed a third party to harm the child. The word “allow” means that a child’s parent or
caregiver knew or “should have known about” abuse to the child by a third party and “did nothing
to prevent or stop it.”6 To determine whether abuse or neglect has occurred, New York courts
require a showing that a parent or guardian failed to exercise a minimum degree of care and
therefore generally consider “whether a reasonable and prudent parent would have so acted (or
failed to act) under [the] circumstances” that existed at the time.7
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
2
2. Who must report cases of child abuse?
Mandatory reporters are health and educational professionals who are legally required to report
suspected cases of child abuse or neglect to the Statewide Central Register when they have a reasonable
suspicion that a child whom they see in their professional capacity is an abused or neglected child.8
Mandatory reporters are:
? physicians (including residents and interns), physician assistants, and registered nurses;
? mental health professionals (including social workers, psychologists, substance abuse
counselors, alcoholism counselors, and licensed creative arts therapists);
? other health professionals (including dentists and dental hygienists, podiatrists, emergency
medical technicians, osteopaths, optometrists, chiropractors and Christian Science
practitioners);
? hospital personnel involved in patient admissions, examinations, care or treatment;
? school officials (including teachers, coaches, guidance counselors and principals);
? social services workers;
? employees or volunteers in certain residential care facilities;
? child care and foster care workers; and
? law enforcement officials (including police officers, peace officers, district attorneys,
assistant district attorneys and investigators employed by the district attorney’s office).9
Note: A provision added in 2007 now requires the mandated reporter to personally report
suspected child abuse to the Statewide Central Register and inform the director of his or her agency or
institution. This is a change from previous law, which called for a medical staff member to first report to
a designated agent for the agency or institution, who then was responsible for making the report.10
3. When must a mandatory reporter make a child abuse report?
Mandatory reporters must report a reasonable suspicion of child abuse or neglect immediately to
the Statewide Central Register.11 A reasonable suspicion must be based upon “articulable facts
which, when examined objectively, would lead others to the same conclusion” that a child whom
they see in their professional capacity has been abused or neglected.12 Therefore, a proper report is
based upon a reasonable suspicion that a parent or caregiver harmed – or allowed a third party to
harm – the child.
Social service workers who are either employed by or have contracts with local social service
districts are under an additional obligation to report child abuse or maltreatment if a third party
comes to them in their official capacity and provides the social worker with information that, if true,
would render a child abused or maltreated.13
4. Should a mandatory reporter file a child abuse report if he or she learns that a minor
is engaged in a sexual relationship with a parent, guardian or person legally
responsible —even if the minor says that it is consensual?
Yes. A minor engaging in a sexual relationship with a parent, guardian or person legally
responsible for their care —even if the minor considers the relationship consensual—is a proper
basis for a child abuse report.14
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
3
5. Can a child abuse or neglect report be made against the parent or caregiver solely
on the grounds that a teen in their care is sexually active?
No, absent other allegations of abuse or neglect, a minor is not an abused or neglected child
merely because she or he is sexually active.15 Without other evidence of abuse, mandatory
reporters should not report sexually active or pregnant minors to the Statewide Central
Register.
Situation #1: The parent is unaware of his or her child’s sexual activity.
Generally, there is no abuse or neglect if a parent or guardian is unaware of a teen’s sexual
activity. In Matter of Toni D, the court concluded that a parent must know that his or her teen is
engaging in sexual activity in order to consider a charge of child abuse or neglect.16 In that case, an
appellate court affirmed the lower court’s dismissal of charges against the parents of a 13-year-old
girl whose boyfriend was 23, because no evidence had been presented to suggest the parents knew
of the sexual relationship.
Additionally, recent guidance from OCFS further affirms that “no report will be registered
by the Statewide Central Register where the caller fails to provide a reasonable cause to suspect that
a parent was aware of sexual activity or should have reasonably been aware of the activity, absent
other indications of child abuse or maltreatment.”17
Situation #2: The parent or caregiver is aware of his or her teen’s sexual activity.
The phrasing of the child abuse reporting law has confused some mandatory reporters about
their duty to file a report in cases where the parent is aware of a minor’s voluntary sexual activity.
Under the child abuse reporting law, caregivers who allow a sexual offense to be committed against
a child may be considered abusive or neglectful. New York Penal Law broadly prohibits sexual
activity with a minor under the age of seventeen, commonly known as “statutory rape,” even when
the activity is voluntary and even when the minor engages in sexual activity with a peer who is also
under 17, because a person under 17 is deemed incapable of consent as a matter of law.18
Recent guidance from OCFS makes clear that a mandated reporter should make a case by
case determination that considers not only the parent’s awareness but also whether the parent or
caregiver’s response was appropriate under the circumstances. OCFS further clarifies two points: (a)
the mere reoccurrence of the sexual activity “does not in and of itself,” mean that the parent’s
response is inappropriate or that a report is required and (b) a parent’s support of or involvement in
the teen’s accessing sexual or reproductive health care services may be a reasonable response, and
therefore does not by itself give to a reasonable suspicion of child abuse or neglect.
New York courts that have considered the question of whether a parent’s knowledge of a
teen’s sexual activity constitutes child abuse have found that it is not child abuse for a parent to
know that a minor child is sexually active if they have responded appropriately under the
circumstances.19
For example, in In re Leslie C., a mother was charged with abuse and neglect because her
daughter was sexually active with, and became pregnant at the age of 14 by, a 20-year-old boyfriend.
The court dismissed the charges and concluded that Leslie’s sexual activity and pregnancy did not
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
4
support a child abuse finding against her mother. The court found that while statutory rape laws
serve a strong social policy purpose, child abuse liability cannot reasonably be extended to the
parents of all sexually active minors.20 The court extensively discussed the policy reasons against
imposing particular moral or religious values under the pretext of child protection, and the practical
problems involved in convicting thousands of parents—including responsible and involved
parents—of child abuse because of their children’s sexual activity.21 The court concluded that any
abuse or neglect charges should be “limited to those parents who fail to intervene in forced sexual
relationships of which they have personal knowledge.”22
In summary, parents of sexually active or pregnant minors should not automatically be
reported for suspected child abuse or neglect, even if they know of such activity.
6. Should a mandatory reporter file a child abuse report against the parents of a
sexually active minor solely on the basis of the child’s sexual activity with an older
partner?
No. In order to report a possible case of child abuse or neglect, a mandatory reporter must
have a reasonable suspicion that such abuse or neglect is occurring.23 Because courts have found
that failure to prevent a child’s voluntary sexual activity does not constitute abuse under New York
law, this situation in and of itself cannot give rise to a reasonable suspicion of child abuse.
While the age of the minor may be taken into account in determining whether sex was
voluntary, a conclusion should not be based solely upon the age difference between the partners. In
Leslie C., the court concluded that the six-year age difference between the 14-year-old minor and her
20-year-old partner did not itself warrant finding the parents guilty of child abuse. The court left
open the question of “whether, on different facts, an abuse finding should be made.”24 A court
might reach a different finding in a case involving, for example, a 12-year-old in a sexual relationship
with a 25-year-old, despite claims that it was voluntary and consensual.
Therefore, health care, educational and other facilities should not impose policies requiring
blanket reporting of all sexually active or pregnant teens to the Statewide Central Register because a
determination of reasonable suspicion of child abuse should be made on a case by case basis
depending on the specific circumstances of a situation.
7. How does a health provider’s duty of confidentiality affect the reporting obligation?
Most health care providers are prohibited from disclosing information about a patient
learned in their professional capacity without the patient’s permission, unless otherwise required by
law.25 Providers who disclose such information without patient authorization or other legal
permission commit professional misconduct and can be sued, fined, and have their licenses
revoked.26 However, as discussed above, one of the legal exceptions to this duty of confidentiality is
the requirement to report information to the Statewide Central Register when that information is the
basis for a reasonable suspicion of child abuse or neglect.
As described above, New York courts have held that most cases of voluntary teen sexual
activity do not give rise to reasonable suspicion of child abuse or neglect. When a health provider
does not have a reasonable suspicion of child abuse or neglect, there is no legal basis to breach a
patient’s confidentiality to file a report. A health care provider or other professional with
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
5
confidentiality obligations who makes a child abuse report without reasonable suspicion of abuse or
neglect commits professional misconduct. This can subject such providers to professional sanctions
for breaching patient confidentiality, in addition to potential liability for committing the crime of
false reporting (see Question # 9, below).
8. Should a mandatory reporter report teen sexual activity to law enforcement or the
police as statutory rape without the patient’s permission?
No. Even though the minor may be the victim of a statutory sex offense, there is no
blanket requirement that all crimes be reported to the police.27 Furthermore, a health care
provider who reports a minor’s sexual activity to the police without the patient’s permission (or the
parent’s permission if the minor is unable to consent to the health service) has breached patient
confidentiality, committed professional misconduct and made herself vulnerable to lawsuit by her
patient and to professional licensing sanctions. Hospital policies that mandate or permit reporting
of “statutory rape” to the police (or to child protective services without further evidence of abuse)
also make the hospital vulnerable to a lawsuit.
9. Can a mandatory reporter be sued or charged with a crime for making or failing to make
a child abuse report?
Maybe.
Situation #1: Penalties for mandatory reporters who make good faith, false or
negligent reports.
A mandatory reporter who makes a child abuse report in good faith cannot be sued by a
parent for injury to his or her reputation.28 Good faith is presumed unless a mandatory reporter acts
with willful misconduct (makes a report knowing that it is false) or gross negligence (makes a report
without exercising even slight care or diligence to determine its validity).29
Although good faith mandatory reporters cannot be sued, it is unclear whether a good faith
mandatory reporter who incorrectly reports suspected abuse can be charged with a crime for making a false
report. New York Social Services Law immunizes good faith mandatory reporters from being charged
with a crime.30 However, a conflicting New York Penal Law makes it a misdemeanor if a personmakes a
false report of “an alleged occurrence or condition of child abuse or maltreatment which did not in fact
occur or exist” to the Statewide Central Register either directly or indirectly.31 While this statute seems to
state that it can be a misdemeanor to file a false report regardless of situations where the suspicion of
abuse was reasonable and the report was made in good faith, no court has addressed this contradiction
and it appears that the law was not originally intended to apply to mandated reporters.32 Therefore, it is
unlikely that a good faith mandatory reporter would be prosecuted, even if the report turned out to be
unfounded. A cautious mandatory reporter may wish to consult an attorney before making a report.
Situation #2: The mandatory reporter fails to make a report.
On the other hand, a mandatory reporter who suspects abuse or neglect and deliberately fails
to report it may be guilty of a class A misdemeanor and can be sued for damages resulting from the
failure to report (for example, the continued abuse of the child).33
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
6
Endnotes
1 N.Y. SOC. SERV. LAW § 413 (McKinney 2006). “Persons legally responsible” for a child’s care include a child’s
guardian, custodian (any person regularly found in the child’s household) or other person responsible for the child’s care
at the relevant time. FAM. CT. ACT § 1012(g) (McKinney 2006). See also Matter of Case, 120 Misc. 2d 100, 102 (Oneida
Co. 1983) (finding a 19 year old brother with whom minor lived with was not a person legal responsible for her within
the meaning of the statute noting that “the mere fact that two persons are residing in the same household at the relevant
time does not create a presumption that the older is exercising any type of parental control over the younger”).
2 A caregiver commits child abuse if he or she: (1) inflicts or allows the infliction of a non-accidental, physical injury that
causes substantial risk of serious physical or emotional harm; or (2) creates or allows the creation of substantial risk of
non-accidental physical injury that is likely to cause serious physical or emotional harm; or (3) commits or allows to be
committed a sexual offense against the minor. N.Y. SOC. SERV. LAW § 412(1) (McKinney 2006); FAM. CT. ACT §
1012(e). A caregiver is guilty of child neglect when he or she fails to exercise substantial care, and thus causes or creates a
substantial risk of physical harm to the child or causes a substantial reduction in the child’s psychological or intellectual
functioning. N.Y. SOC. SERV. LAW § 412(2); FAM. CT. ACT §§ 1012(f), (g).
3 N.Y. SOC. SERV. LAW § 412(4) (McKinney 2008). See In re Catherine G., 3 N.Y.3d 175 (2004) (dismissing claim for
failure to report abuse of child by 14-year-old boy because boy was not a parent, caregiver, or person legally responsible
for the child’s welfare and therefore could not be the subject of the report pursuant to the law); see also Page v. Monroe, 488
F. Supp. 2d 219, 221 (N.D.N.Y. 2007) (finding that a report against a half-brother was not legally justified as a report of
child abuse or maltreatment because the half brother “could not be the subject of a report”) affirmed in part, reversed in part
by 300 Fed. Appx. 71 (2d Cir. 2008) (affirming the holding that there was no showing of a statutory duty to report under
the mandatory reporter law but reversing the grant of summary judgment for the medical malpractice claim because
there existed genuine issues of material fact as to whether the pediatrician otherwise breached her duty of care).
4 Teachers and other school employees are not considered persons “legally responsible” under New York child abuse
laws. However, abuse committed by a school employee against a student in a school setting is governed by another set
of laws. School employees must report any allegations of such abuse to school authorities, but not to the Central
Register. N.Y. EDUC. LAW, Art. 23-B (McKinney 2006).
5 See supra n.3.
6 In re Katherine C., 122 Misc. 2d 276, 278-279 (N.Y. Fam. Ct. Richmond Co. 1984) (finding a mother guilty of neglect
because she should have known that her daughter was being sexually abused by the stepfather and failed to act to
protect her). See also Besharov, Practice Commentaries, McKinney’s Cons. Laws of N.Y., Book 29A, Family Ct. Act §
1012 at 314 (1999) (“‘Allowing’ a child to be abused includes taking no appropriate protective (or preventive) action
after being warned of the danger to a child”).
7 See Katherine C., 122 Misc.2d at 278. See also, Page, 488 F. Supp. 2d at 221 (finding no statutory duty to report an
instance of abuse against a child committed by someone who could not be the subject of a report when there is no
showing that the mother was incapable or unwilling to protect the child from further potential abuse); In re Katrina W.,
171 A.D.2d 250 (2d Dept. 1991) (finding that daughter was an abused child because her mother was unwilling or unable
to protect her from being sexually abused by her older brother).
8 N.Y. SOC. SERV. LAW § 413(1) (McKinney 2006).
9 Id.
10 N.Y. SOC. SERV. LAW § 413(1)(a) (McKinney 2008).
11 N.Y. SOC. SERV. LAW §§ 413(1); 415 (McKinney 2008).
12 Vacchio v. St. Paul’s United Methodist Nursery Sch., NYLJ, July 21, 1995, p. 32, col. 2 (Sup. Ct. Nassau Co.) (Alpert, J.),
citing People v. Brooks, 88 A.D.2d 451, 454 (2d Dept. 1982).
13 N.Y. SOC. SERV. LAW § 413(1)(b) (McKinney 2008). “Social service worker” is defined by OCFS as professional or
paraprofessional staff either employed by, or who have contracts with, local social service districts to provide services to
children and/or families. New York Office of Children and Family Services, Administrative Directive, 07-OCFS-ADM-
15 (Dec. 13, 2007). The information that is provided to the social service worker should be accepted at face value, and
should be reported to the State Central Register so long as it would constitute child abuse assuming it were true. Id.
14 See supra n.2.
15 For example, in In re Philip M., a state appellate court affirmed a lower court’s decision noting that a 15-year-old with a
sexually transmitted infection could not be presumed to be the victim of child abuse because the minor’s age indicated
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
7
that he could have been engaged in “consensual sexual activity.” 589 N.Y.S.2d 31, 32 (1st Dept. 1992) aff’d on other
grounds, 82 N.Y.2d 238 (1993)
16 In re Toni D., 179 A.D.2d 910 (3d Dept. 1992).
17 Letter from Charles Carson, Assistant Deputy Counsel, NYS Office of Children & Family Services to Galen Sherwin,
Director, NYCLU Reproductive Rights Project, dated January 16, 2009, available at http://www.nyclu.org/node/2294.
18 Article 130 of the New York Penal law identifies sexual offenses including sexual misconduct, rape,
sodomy, and sexual abuse. The categories of offenses are based on the ages of the participants and the type of sexual
activity involved. Because New York law provides that persons 16 years old and younger generally do not have the
capacity to consent to sexual activity, anyone under the age of seventeen who engages in vaginal, anal or oral sex is the
victim of at least the misdemeanor crime of sexual misconduct, and may be the victim of a felony sexual crime
depending on the age of his or her partner. N.Y. PENAL LAW § 130.00 (McKinney 2006). However, it is important to
remember that this penal law scheme does not automatically implicate mandatory reporting obligations. Courts have
found that a statutory sex offense based on a minor’s voluntary activity does not in and of itself constitute abuse or
neglect by the parent or caregiver. See cases cited infra note 20.
19 Comm’r of Social Serv. ex rel Leslie C., 161 Misc. 2d 600, 609-610 (Kings Co. 1994); Page, 488 F.Supp.2d at 221 (finding
that in order to establish that a parent ‘allowed’ abuse to occur to their child, the appropriate standard is to determine if
“the parent or guardian failed to exercise a minimum degree of care, such as failing to take any appropriate action to
protect their child” and noting that “if the parent is responding appropriately and acting to prevent harm to their child,
then there is no grounds for a report and no justification for state involvement”).
20 Leslie C., 161 Misc. 2d at 608.
21 Id. at 607-608.
22 Id. at 610 n.15 (emphasis added).
23 N.Y. SOC. SERV. LAW § 413(1) (McKinney 2006).
24 Id. at 610.
25 Professionals who are licensed or certified by the State, including nurses, doctors, physician assistants, nurse
practitioners, pharmacists, social workers and psychologists, are bound by confidentiality obligations. 8 N.Y.C.R.R.§
29.2 (2006). See also N.Y. C.P.L.R. §§ 4504 (privileging doctor-patient communications); 4507 (psychologist) 4508 (social
worker); 4510 (rape crisis counselor).
26 Revealing personal information obtained in a professional capacity without the prior consent of the patient constitutes
professional misconduct and is punishable by fine, reprimand or license revocation. 8 N.Y.C.R.R. § 29.1 (2006); N.Y.
EDUC. LAW §§ 6509(9), 6511 (McKinney 2006). Providers who breach confidentiality without patient authorization may
be sued by their patients for resulting damages. See, e.g., MacDonald v. Clinger, 84 A.D.2d 482 (4th Dept. 1982).
27 There are a few narrow exceptions where a report may be required. For example, New York law mandates that
hospital workers report to the police injuries involving firearm discharge or life-threatening stab wounds. N.Y. PENAL
LAW § 265.25 (McKinney 2008).
28 N.Y. SOC. SERV. LAW § 419 (McKinney 2008) (immunizing good faith mandatory reporters from civil liability).
29 Id.; Gentile v. Garden City Alarm Co., Inc., 147 A.D.2d 124 (2d Dept. 1989). Courts have also defined “gross negligence”
as involving egregious conduct. Gandianco v. Sobol, 171 A.D.2d 965 (3d Dept. 1991); Spero v. Board of Regents of University of
State, 158 A.D.2d 763 (3d Dept. 1990). For example, in Vacchio, the court held that a teacher was not necessarily
immune from liability because her immediate reporting of a student’s black eye without first inquiring as to the cause of
the black eye could support a finding of gross negligence, and thus was made without “reasonable suspicion” that child
abuse had occurred. However, “reasonable suspicion” is a far lower standard than certainty. In Kimberly S.M. v. Bradford
Cent. Sch., 226 A.D.2d 85 (4th Dept. 1996), a sixth-grade student told her teacher (a mandatory reporter) that an uncle
sexually abused her while she was living with him during school vacations over the course of two years. On the
mistaken theory that the uncle was not reportable as a “person legally responsible” for the child, the teacher did not
report the allegation, and the student continued to spend her school vacations at her uncle’s house. The appellate court
ruled that the teacher could be held liable for failure to report because the uncle was indeed a reportable custodian or
person legally responsible for the child’s care—as a person in whose care the child had been entrusted—during the
child’s extended visits with him because it was clearly unreasonable for the teacher to fail to report the uncle given the
facts she knew, as such facts created a “reasonable suspicion” that child abuse had occurred. Therefore, mandatory
reporters should report reasonable suspicions of child abuse, even if they are uncertain whether or not the situation fits
NYCLU Reproductive Rights Project
Child Abuse Reporting Q&A, March 2009
8
the legal definition thereof. Of course, if a mandatory reporter is certain that the situation does not fit the legal definition
of child abuse, a report would not be in good faith and could be considered willful misconduct, thereby not immunizing
the mandatory reporter from criminal and civil liability.
30 N.Y. SOC. SERV. LAW § 419 (McKinney 2008).
31 N.Y. PENAL LAW § 240.50(4) (McKinney 2009). Paragraph (a) of the law covers individuals who make false reports
directly to Statewide Central Register. Recent legislation added paragraph (b) to the section to cover the individual who
makes a false report indirectly by giving the false report to someone they know is obligated to make the report to the
statewide central register and with the intent that the report reach there. L. 2008, c. 400 § 1, eff. Feb. 1, 2009.
32 When the provision was initially passed, the accompanying legislative memorandum indicated that the purpose of the
law was to address the problem of individuals misusing the hotline by making “child abuse reports for harassment
purposes, especially during the course of matrimonial proceedings and child custody disputes.” See Donnino, Practice
Commentaries, McKinney’s Cons. Law of N.Y., Book 39, Penal Law § 240.50, at 169.
33 N.Y. SOC. SERV. LAW § 420 (McKinney 2008). See Bowes v. Noone, 748 N.Y.S.2d 440, 444 (4th Dept. 2002) (finding no
grounds for civil liability when the failure to report was not willful even where there was reasonable cause to suspect
child abuse); Page, 488 F.Supp.2d at 219 (noting that a showing of a reasonable cause to suspect child abuse is
insufficient as a matter of law to establish civil liability if the evidence does not support a finding that the failure to
report was knowing and willful).

Hello Group,
We have battled in the past to get in touch with this service. I am told by the chair of peds to contact this person directly:
Tamiesha Frempong

212-241-0939

I have sent this information to AMAC so that when you call them they will reach out to Dr. Frempong directly, but I just wanted you to have it as well…
thanks,
adam

—
Adam Vella, MD

Hi All:
Rapid strep results must all be documented in the chart as POCT.
Nursing has an easier way of doing this on their template, and the
EPIC team is working on giving us the same easy way to document any
point of care testing (POCT) we do in the ED. In the meantime, please
make sure the residents are ordering the rapid strep test ( easily
found in peds common orders ) . To record the result, click on ‘more
activities’ located on the bottom of the left sided menu that has
‘snapshot’, ‘chart’ , etc . This will open a menu where you should
choose ‘enter / edit results’ . The page that will open for you will
have the ordered POCT at the top. You have to highlight the test for
which you are recording the results , and the place your ‘neg’ or
‘pos’ in the result box that will open at the bottom of the page.
Remember to also record the date.
This should all be less painful once we have the somewhat easier
version the nurses have. But, please record these results. We are at
risk for losing all POCT in the ED if we do not comply with some
changes.
Thanks

Sylvia

GUIDELINES FOR PEDIATRIC MANAGEMENT OF DIABETIC KETOACIDOSIS

This is not intended as a rigid protocol, but is offered as a guideline. Discuss each case promptly with the Pediatric Endocrine Fellow or Attending on call. Each case needs individual assessment and frequent reassessment with the diabetes team during the course of treatment.

*** 24-hour Pediatric Endocrine/Diabetes Contact via 212-241-6936. ***

EMERGENCY ASSESSMENT
First confirm the diagnosis of DKA (exclude other conditions i.e. ASA overdose). Then assess the severity of metabolic abnormality and plan gradual correction of dehydration, acidosis, hyperglycemia and hyperosmolality.

History: Duration of illness, symptoms (polydipsia, polyphagia), assessment of fluid loss (polyuria, nocturia, vomiting), weight loss (previous known weight), abdominal pain, nausea and fatigue. Medications (i.e. steroids). If established diabetes – Usual diabetes management: insulin regimen and time of last insulin injection/omission.

Physical Examination: Weight (kg); Vital signs (BP, HR, RR, T); Dehydration (dry mucous membranes, skin turgor, capillary perfusion, peripheral pulses); Level of consciousness; Fundoscopic exam; Fruity odor breath; Kussmaul respirations; Focus of infection. (NB: signs of shock include ¯ BP, ­ pulse, cap. refill >3 sec, skin – cool, pale).

INITIAL ASSESSMENT and MONITORING
Do – Fingerstick glucose and urine dipstick. Start 2 large bore IV lines. Send – VBG (STAT), SMA-10, amylase, preserved glucose, serum osmolality, CBC with differential, HbA1C and urine analysis. Calculate serum osmolality: (Na + K mEq/L) x 2 + glucose mg/dl
18

If newly diagnosed diabetes obtain before starting insulin treatment: Total insulin, C-peptide, DM related autoantibodies (anti Insulin Ab, anti GAD Ab, anti Islet cell Ab) and send to lab. Save 5 –10 cc in speckled top tube to give to Endocrine fellow.
ECG to check T-waves. If clinically indicated – Urine pregnancy, Urine toxicology screen, Cultures, CXR.
Establish Severity of Ketoacidosis:
Mild Venous pH < 7.3 and/or serum bicarbonate <15 mmol/L

Moderate Venous pH < 7.2 and/or serum bicarbonate <10 mmol/L

Severe Venous pH < 7.1 and/or serum bicarbonate < 5 mmol/L

E. Monitoring: Q 1 hr – VBG, Fingerstick glucose and vital signs; Q 2 hr – SMA-6; Dip all urine. Record fluids - strict INS/OUTS – starting in ER. Admit patient to ICU as soon as possible.

TREATMENT OF DKA
Objectives: Fluid therapy to restore circulating volume; replace deficits of water, Na and K; and restore GFR to enhance clearance of ketones and glucose. Insulin therapy to suppress lipolysis with ketogenesis, decrease gluconeogenesis and increase glucose uptake.

INITIAL MANAGEMENT:
Hydration: If the patient’s hemodynamic status appears compromised (shock), a NS (0.9% saline) bolus (10-20 cc/kg) may be given rapidly. If without shock, depending on state of hydration, may give 5-10 cc/kg NS over 1 hr.

Acidosis: Use of bicarbonate only considered if pH < 6.90. Discuss with Pediatric Endocrine Attending (Possible dose: 1-2 mEq/kg over 1-2 hr). Do NOT use IV bolus.

B. FLUIDS:

Calculate specific requirements (See Additional Considerations sections for more detail).

Volume: Calculate Deficit + Maintenance and replace evenly over remainder of 48 hrs. Total fluid rate should not exceed 1 1/2 – 2 x maintenance.

*** Record Ongoing Losses (i.e. polyuria, vomitus) for subsequent consideration.

Eg: Severely ill 30 kg child with DKA and 10% dehydration. Overall deficit 3000cc plus maintenance 70 cc/hr. Received 10 cc/kg/hr X 1 in ER. Deficit 3000cc minus ER 300cc plus maintenance = 4380cc to be given over 47 hr = 93cc/hr. 93 cc/hr minus insulin drip of 30 cc/hr = 63 cc/hr of IVF.

Fluid: In practical terms the following sequence of fluids is generally used. This results in a moderate excess of sodium, but is acceptable if the patient does not have cardiac or renal disease or other limitations.

Start with NS (0.9% saline).
Add Potassium when serum K <5.0 or1-2hrs after fluids and insulin started and recent urination.
When K is added may use NS (0.9% saline), ¾ NS (0.67% saline) or ½ NS (0.45% saline). Do not use fluids with osm. less then .45%NS !
When serum glucose < 250-300 mg/dl, add dextrose to ½ NS (0.45% saline) plus K.
C. INSULIN TREATMENT:

Start IV insulin as soon as diagnosis confirmed and fluid hydration established. IV insulin infusion allows flexibility to change the dose rapidly but needs close supervision.

Insulin IV Infusion: Insulin infusion, 0.1 U/kg/hr (50 units of Regular insulin in 500 cc NS (0.9% saline) = 0.1 U/cc. Initial dose 1 cc/kg/hr). Run 50 cc through the IV tubing first. Insulin infusion must be regulated with a pump. Make up fresh solution every 8-12 hrs. Aim to decrease blood sugar by 100 mg/dl/hr.

4. ADDITIONAL CONSIDERATIONS

Fluids.
NPO except ice chips.
Assess fluid INS/OUTS by adding up totals every 4 hours. Inadequate hydration contributes to persistent acidosis; over-hydration may contribute to cerebral edema.
Consider replacing deficit more slowly if child < 5 years of age and/or newly diagnosed or severe hyperosmolality.
Initial hypernatremia indicates severe dehydration. Rehydrate with extreme caution using NS (0.9% saline).
Consider adjusting fluid volume if excessive onging losses (vomiting, polyuria) leading to fluid OUTS > INS.
Potassium.
There is a marked depletion of body K+ in DKA. Add K+ sooner rather than later. Correction of acidosis and treatment with insulin + glucose will cause hypokalemia. If serum K+ < 5.0, and there is history of recent urination and/or ECG without peaked T waves, IV potassium can be started. Generally 30 – 40 mEq K+/L is used in hydrating fluid. A few patients need considerable more K+ as indicated by falling serum K+; increase to 50 or 60 mEq/L.

Phosphate.
Total body P is depleted in DKA. Benefit of P replacement is unclear. Consider half of potassium given as KCl and half as K phosphate. If P is given, monitor serum calcium levels because risk of hypocalcemia.

Bicarbonate.
Bicarbonate is not given in DKA treatment except for severe acidosis (pH < 6.9)

Sudden correction of serum pH can paradoxically lower CSF pH.
Endogenous production of HCO3 occurs with metabolism of ketones.
Insulin/Glucose.
Consider using lower insulin dose in special situations: infants, new onset diabetes, recent big SC dose of insulin or marked hyperglycemia (>1200).
If no clinical improvement on 0.1 U/kg/hr – reassess insulin infusion flow and constitution and hydrating fluids. Consider increasing cautiously to 0.15-0.20 U/kg/h (e.g. insulin resistance, ongoing infection).
Avoid stopping insulin infusion. Hypoglycemia may be managed with increased IV glucose and temporary decreasing insulin.
Insulin infusion should be continued until pH > 7.3 and/or serum bicarb > 18.
In order to maintain blood glucose at target range of 100-200 mg/dl may need to increase dextrose concentration to 7.5, 10 or 12.5% (limit of peripheral IV). If hydration rate is decreased may need to increase dextrose concentration or decrease insulin infusion.

5. MONITORING AND OBSERVATION.

*** VERY CLOSE OBSERVATION. KEEP FLOW SHEET. STRICT INS/OUTS ***

Over-vigorous management can produce too rapid changes in glucose, osmolality and pH and may contribute to development of complications: hypoglycemia, hypokalemia, hypocalcemia, hypernatremia, fluid overload and hyperchloremic acidosis.

Monitor at least Q 1 hr: vital signs, neurological check, fingerstick glucose. Monitor Q 2 hr: SMA-6 and pH for first 4-8 hours. When improving trend established, decrease frequency to Q 3-4 hrs. Do fingerstick glucose Q 1 hr while on insulin infusion and after any change in rate of IV glucose or insulin. Test all urine for glucose and ketones.
Cerebral edema: *** Cerebral edema occurs in up to 1% of children with DKA and accounts for more then half of the mortality rate. At highest risk are patients who are newly diagnosed and age < 5 years. Monitor sensorium carefully. If any indication of severe headache, increased drowsiness, deepening coma, dilated pupils, ? HR, ? BP, cranial nerve palsy — do complete neurological examination, check for papilledema and reach rapid decision for change in management with attendings. (Consider: Mannitol 0.25-1.0 gm/kg IV over 15-30min, decrease IVF by 50%, elevate head of bed)
6. PROGRESS TO SUBCUTANEOUS INSULIN.

When child is stable, alert, ready to eat and biochemical parameters improved (pH > 7.3, serum bicarb > 18) may change from IV to SC insulin. At time of change of insulin -First SC dose of rapid acting insulin should be given 10-45 min before stopping the IV insulin infusion. Insulin doses are individualized for each patient and must be discussed with the Pediatric Endocrinology/Diabetes Team.

When child has eaten, change IV fluid to dextrose free (i.e. 0.45% NS)
Decrease IV fluid rate to adjust for PO fluids. Allow patient to self regulate fluid intake

(Pediatric Diabetes Team/FG 7/03)

Hi everyone,

We wanted to clarify the admission and hospitalization process for patients with croup.

Racemic epinephrine can be given on the floors and does not need to be given in a monitored setting (i.e. the PICU). However, when administered on the floors, the floor team (residents and nurses) should be aware that the patient requires close observation, i.e. frequent checks, after the medicine has been given. These observations need to be documented in the medical record. Any patient who has a declining respiratory status, low oxygen saturation, or worsening hemodynamic status may require closer monitoring. The need for closer monitoring has less to do with the medication administered and more to do with the underlying disease process. A PICU attending may be consulted to assist in this decision.

Also, the amount of racemic epinephrine given in the Emergency Room does not dictate where the patient should be admitted to. The clinical status of the patient is what should determine if the patient goes to the PICU or to the floors. For instance, a patient may receive 2 doses of racemic epinephrine in the Emergency Room, and if they have an appropriate respiratory status for the floor, then they should be admitted to the floor.
If you have any questions or comments, please email me.

Thanks,

Beth Goodman, MD
Pediatric Chief Resident
The Mount Sinai Kravis Children’s Hospital
elizabeth.goodman@mssm.edu

Bottom Line:

For non-emergent dental patients without insurance accepted by our clinic: refer them up (not a consult) and they would have to pay up front to be seen, or they could go to someone who accepts their insurance.

For emergent dental patients: consult dental and they will come down or have you send the patient up.

Email from Carla Kellner:

The patients are to be sent to dental, and they are to be seen.

I think that there is confusion at the front desk with regard to a consult (needing emergency treatment) vs. a patient that has been discharged (without treatment) to follow up with a dentist. When patients are discharged and sent to us for follow up, we inform patients that we can see them, but that they will have a financial responsibility if they have an insurance that we do not accept, or if they are uninsured. We also provide information for them to complete Medicaid applications, particularly since children are all eligible for insurance. We do not turn away patients, however many patients choose to leave because they do not want the responsibility of a bill.

Thank you,

Carla Kellner
Administrative Director
Department of Dentistry
Mount Sinai Medical Center
(212) 241-5275

by Inna Elikashvili

Consent for Treatment
• Consent should be obtained from all patients seen in the ED.
• If Minors = <18yo ? obtain consent from legal guardian unless:
• emergency situation and consent would delay treatment
• minor is pregnant, married, a parent or emancipated
• minor seeking care for medical services they may consent to

Minors in NYS can consent to:
* Contraceptive Services * Adoptive Services
* Prenatal Care * STI Services
* Medical Care for Minor’s Child * No law regarding abortion

For info on other states:

http://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf

AMA

• Parents can sign children out AMA
• If MD feels it is not safe, may stop from doing so
• Protect yourself: call 911, Risk Management, ACS, Social Work
• DOCUMENT !!!

Mandated Reporter

• MUST REPORT when acting in professional role & presented with reasonable cause to suspect child abuse where a child, parent or other person legally responsible for the child is before the mandated reporter
• When not acting in professional duty, not required to report
• Cannot be penalized for reporting
• If fail to report:
o Could be charged with class A misdemeanor
o Can be subject to criminal penalties
o May be sued in civil court for monetary damages
• Parental knowledge of a minor's voluntary sexual activity with a peer is not child abuse and should not be reported to the State Central Register
• Statutory rape (minor + person > 18yo) is a crime, but not reportable to ACS

Mandated Reporter (800) 635-1522
Public Hotline (800) 342-3720

http://www.nyc.gov/html/acs

How to send nasopharyngeal specimens.

Peds asthma protocol is here

Hello,
Attached please find the pager numbers for our current PICU attendings. If you feel that communication is not going well with the resident in the PICU then ask which attending is on and ask to speak with them or page them directly. thanks,
Adam

PEDIATRIC CRITICAL CARE UNIT

MD Ext. Beeper Short Range

Joanne Hojsak 46529 (917)706-0765 7897

Margaret Satchell 44277 (917)729-9205 6183

Steven Yung 40011 (917) 205-1460

Sheemon Zackai 47696 (917)252-0529 0289

Christine Zawistowski 43732 (917)641-0235 0550

EXTENSIONS
PICU 3rd floor 48132
PICU 6th floor 42086
PCICU 43467
Nurse Manager 41855

FAX
(212)876-3255(Ped Pulmonary)
(212)534-5207(NICU)

Under 12 without a known MD goes to Peds Associates.

Under 12 followed by peds assoc, med/peds, known voluntary is assigned as such.

12 and over not followed already by peds assoc, med/peds, known voluntary or already followed by adolescent should be admitted to adolescent.

Subspecialty pts should be assigned to the appropriate team after discussion with them, if not then the rules above apply.

Hi Adam,

Just a quick e-mail to make things run smoother:

1. Regarding transfers from other facilities: if something is
being transferred that is thought / known to be operative, please call
the ortho resident first to ensure that we can accommodate them when
they get here. Calling will also help in the opposite way: it may not
need to be transferred if it is something that can be scheduled
electively. This will save the patient an ER visit and we can likely
just give them a clinic visit. (I’m writing this now secondary to the
fact that a type III supracondylar was transferred over here tonight,
but now the OR can not accommodate us and we can’t do the case in the
relatively timely fashion it should be done…. I am also trying to fix
this separate OR problem as well… but that is a much harder problem to
fix at the present time.)
2. Regarding peds ortho clinic: just wanted to reiterate that this
is not a walk-in clinic. Every patient seen in peds ortho clinic needs
to be run by the ortho resident in order to get there. The only time
they don’t need an official appointment is if they come during weekend
hours, but it still needs to be approved by the resident. This helps
because the resident may be able to delineate which clinic would be the
best clinic for them to go to (example: it may not just be the next
Monday … but it may be 3 Mondays away that is the better date for them
based on their injury) or they may be better off being seen by their
primary care doctor first and then they can refer them if there is still
a problem.

Thanks for your help, Adam!

Abby

Abigail Allen, MD

Director, Pediatric Orthopaedic Clinic

If anybody expresses interest in donating to the PED please give them this form.

Adam

If there are any unneccessary delays in sign out to the floor or issues with admissions to the floor, be it transfer or bed pending cleaning for a long period of time, please call the nurse managers from 8 a – 5p. For P4, Stacey: 646-385-1935. For P5, Richard 917-509-5894. Thay are eager to help, so use them…

Thanks
Sylvia

After recent discussion as to where to admit RSV positive infants please see the final decision:

The following are guidelines regarding admissions for infants with RSV. They are based on evidence that an infant <6wks of age with RSV has the highest risk of apnea during their first 2days of illness.

*RSV+ infants <6wks of age should be admitted to a monitored bed if they are in their 1st or 2nd day of illness

*RSV+ infants of any age that are in their 3rd day of illness (or more) do NOT need to be admitted to a monitored bed (unless they require PICU support for another reason – respiratory support, etc)

Since these are only guidelines, and NOT a formal policy, we encourage everyone to continue to assess patients on an individual basis – and to make a decision based on the clinical status of each patient.

Beth Goodman, MD

Pediatric Chief Resident

The Mount Sinai Kravis Children’s Hospital

Introduction:

The following describes the process by which The Mount Sinai Hospital’s Emergency Department will handle non-emergent pediatric patients during the hours of 8:30am -3:30pm Monday – Friday and 10am – 2:30pm on Saturdays.

Policy:

All patients that present to the Mount Sinai Emergency Department will receive a medical screening exam to determine level of acuity by a health care provider.   In the event the exam indicates that the visit is non-emergent, then the ED staff will refer the patient to the Pediatric Clinic if they are an established Pediatric Clinic patient in the past 12 months and participate in an insurance plan accepted by the Pediatric Clinic.

Procedure:

When a patient presents to the Mount Sinai Emergency Department, the ED-BA located at the Greet Desk will validate the patient’s name and date of birth.  During the look-up of the patient in the Cerner ADT system (between the hours of 8:30am to 3:30pm  Monday –Friday and 10am-2:30pm Saturday) the ED-BA will determine if the patient is an established patient in the Pediatric Clinic (seen within the past 12 months and participates in an insurance plan accepted by the Pediatric Clinic).  If the ED-BA determines that the pediatric patient has met the criteria as a Pediatric Clinic patient then the ED- BA will process the patient in the ADT system (Cerner) as a “Quick Registration.”  The Quick Registration will include the national patient identifiers (Name & DOB), referring source, PC (PEDS Clinic)/the reason for visit along with the onset date.

Once the patient’s Quick Registration has been completed with required data elements, then the patient’s information will be sent from the ADT system to the Emergency department’s electronic medical record system (IBEX).  The patient’s information will be viewed in the triage nurse’s queue and the patient will be called for triage.

The triage nurse will expedite all pediatric patients with the PC designation in the reason for visit field.    Once the triage nurse has assessed the acuity level of the pediatric patient (emergent vs. non-emergent), he/she will call the Attending/Fellow to validate the assessment.

Once the Attending/Fellow assesses the patient and validates the decision that the patient is non-emergent patient, the Attending/Fellow will suggest to the patient/parent that they can go to the PEDS Clinic as a walk-in patient.  If parent agrees, the Attending/Fellow will write a note in IBEX and disposition the patient as “sent to clinic”. If parent disagrees, they are sent to the ED waiting area to wait as triaged.

The BA will then: 1) identify the patient under “sent to clinic” disposition, 2) discharge the patient from IBEX, and 3) cancel the patient visit from Cerner.

The adolescent health center is now seeing patients from age 10-24 and are looking to expand their volume by 150%. They offer free services to their pts through grant support including dental/ophtho care. Please refer as many pts as you are able to them. Rather than med/peds in the 20/21 year old pts please refer everybody to AHC.
Thanks,

Adam Vella, MD

FYI, the PED resident schedule is on www.amion.com, but under the peds login “mshpeds” then click on “ER”.

Lori

NYU-Tisch/Bellevue PICU Transport Pager – 917 616 1111 (gets you NYU Peds Chief)

Cornell PICU – 212 746 0308 (direct to PICU Charge Nurse for bed availability)

Cornell Transfer Center (PICU/Floor/Burn Unit) 212 746 4703

Columbia PICU 212-305-6591 (direct to PICU Nursing Station for bed availability)

ColumbiaTransport Number 1 800 697 7828  (NYP STAT)

Children’s Hospital at Montefiore PICU – 718-741-2000 (Direct to PICU)

The official MS Word Document is available here.

Introduction:

The following describes the process by which The Mount Sinai Hospital’s Emergency Department will handle non-emergent pediatric patients during the hours of 8:30am -3:30pm Monday – Friday and 10am – 2:30pm on Saturdays.

Policy:

All patients that present to the Mount Sinai Emergency Department will receive a medical screening exam to determine level of acuity by a health care provider.   In the event the exam indicates that the visit is non-emergent, then the ED staff will refer the patient to the Pediatric Clinic if they are an established Pediatric Clinic patient in the past 12 months and participate in an insurance plan accepted by the Pediatric Clinic.

Procedure:

When a patient presents to the Mount Sinai Emergency Department, the ED-BA located at the Greet Desk will validate the patient’s name and date of birth.  During the look-up of the patient in the Cerner ADT system (between the hours of 8:30am to 3:30pm  Monday –Friday and 10am-2:30pm Saturday) the ED-BA will determine if the patient is an established patient in the Pediatric Clinic (seen within the past 12 months and participates in an insurance plan accepted by the Pediatric Clinic).  If the ED-BA determines that the pediatric patient has met the criteria as a Pediatric Clinic patient then the ED- BA will process the patient in the ADT system (Cerner) as a “Quick Registration.”  The Quick Registration will include the national patient identifiers (Name & DOB), referring source, PC (PEDS Clinic)/the reason for visit along with the onset date.

Once the patient’s Quick Registration has been completed with required data elements, then the patient’s information will be sent from the ADT system to the Emergency department’s electronic medical record system (IBEX).  The patient’s information will be viewed in the triage nurse’s queue and the patient will be called for triage.

The triage nurse will expedite all pediatric patients with the PC designation in the reason for visit field.    Once the triage nurse has assessed the acuity level of the pediatric patient (emergent vs. non-emergent), he/she will call the Attending/Fellow to validate the assessment.

Once the Attending/Fellow assesses the patient and validates the decision that the patient is non-emergent patient, the Attending/Fellow will suggest to the patient/parent that they can go to the PEDS Clinic as a walk-in patient.  If parent agrees, the Attending/Fellow will write a note in IBEX and disposition the patient as “sent to clinic”.  If parent disagrees, they are sent to the ED waiting area to wait as triaged.

The BA will then: 1) identify the patient under “sent to clinic” disposition, 2) discharge the patient from IBEX, and 3) cancel the patient visit from Cerner.

This is just a reminder about the operation of the Peds Assoc Asthma Follow Up Clinic. We go on hiatus over the summer months (June, July, and August) so there are no specific slots starting June 1, 2009.

However, the program should continue in spirit over the summer. ANY Peds Assoc patient who is seen in the ER or has been admitted to the hospital with asthma should receive a 24-48 hour follow up on discharge. Appointments need to be made through the general number (659-8559) and the patient should be given an urgent appointment. If a patient presents to the ER in the middle of the night, the family should be told to call the following morning for an urgent appointment.

The clinic will restart this coming September.
Carolyn Rosen, MD

Dear Colleagues,

The Mount Sinai School of Medicine’s Department of Psychiatry and Department of Pediatrics are collaborating on a study involving two interventions for overweight or obese adolescents.  The purpose of this federally funded trial is to compare a new family-based intervention to nutritional education counseling in addressing overweight status in boys and girls ages 13-17.  Study evaluations and interventions are offered at no cost as part of this two-year study.  The study is part of a multi-site collaboration with the University of Chicago, and is approved by the Mount Sinai School of Medicine Institutional Review Board (Protocol 07-0216; PI: K.L. Loeb).

Inclusion criteria include:
•       Ages 13-17
•       Male or female
•       Living with at least one parent or guardian who is willing to participate in the study intervention
•       A BMI percentile >85% for gender and age (e.g., overweight or obese)

Exclusion criteria include:
•       Current psychotic illness
•       Current alcohol/drug dependence
•       Active suicidality

•       Eating disorders (e.g., binge eating disorder)

•       History of bariatric surgery

•       Medication associated with significant weight changes (e.g., antipsychotics)

•       Serious medical or physical conditions resulting in significant weight changes

(e.g., pregnancy, genetic disorders).

•       Complications of obesity that contraindicate moderate physical activity

Please feel free to discuss this study with qualifying patients to gauge their interest. If they would like more information, they may contact Lauren Alfano, 212-659-8724 or Dr. Terri Bacow at terri.bacow@mssm.edu.  Please don’t hesitate to contact me (or the study coordinators) directly if you have any questions about the study.  Thank you.

Terri L. Bacow, Ph.D.

Instructor, Department of Psychiatry

Eating and Weight Disorders Program

Mount Sinai School of Medicine

1 Gustave L. Levy Place, Box 1230

New York, NY 10029

Ph: (212) 659-8891

Fax: (212) 859-1469

Email: terri.bacow@mssm.edu

Whoever is on for peds surgery is on call all the time, 6 days a week.  The exception due to 405 rules is Saturday (their one calendar day off per week).  From Friday midnight through Saturday overnight the general surgery resident on consult (the same person the adult side calls) is on for pediatric E.D. consults as well.  There is a designated person up to midnight friday, at 12:01AM its the general surgery consult resident.

Monday 2-12

Tuesday 2-12

Wednesday 4-12

Thursday 4-12

Friday 2-8

Sat 2-8

Sun 2-10

From: “Cohen, Ari” <Ari.Cohen@mountsinai.org>
Date: August 22, 2008 1:48:22 PM EDT

Please if you are taking pics for educational purposes use the flash card in the attending cabinet. Please take picture of patient label before and after your pictures. Please have patient consent scanned into chart. Please put the Photo ID page in the loose leaf labeled “photo book” so we can have a catalog of the pictures we have in stock ( I am putting this looseleaf over the PACS)