I forget…what did that email say? oh yeah, its at

Archive for March, 2012

Sign Language Interpreter Service

We have a requirement under the Americans with Disability Act to provide effective communication with patients who are hearing impaired. Lip reading is specifically discouraged and it is noted that written communication is often limited.

Youmust document effective communication with the patient. If you cannot communicate effectively, you must obtain a SL interpreter promptly. I have attached the algorithm for reaching a SL interpreter.

***If more than two hours go by without an interpreter coming to the ED, please escalate to RN leadership and document in the chart. If this is not effective, escalate to MD leadership. ***


A3-105 5 Sign Language Interpreter Service_0611 copy

Written by reuben

March 23rd, 2012 at 11:16 pm

Posted in Translator

Code Radiology to ED

After conversation with our rads colleagues, should you find yourself needing immediate radiology sonographic expertise the following is the workflow they would like us to follow.

1. Indicate “portable” on the request.

2. Since these studies should occur infrequently, attending to attending or attending to on-call resident should occur as this will ensure that the exam is expedited.

These are the numbers you can use:

Ultrasound reading room (8a-5p M-F): x45750

Body reading room (5p-11p M-F, 9a-5p S-S): x47928

Radiology resident on call (all other times): pager 1490

Godspeed and goodluck,


Written by reuben

March 23rd, 2012 at 10:40 pm

Posted in Radiology

Severe Alcohol Withdrawal Protocol, Modified for Benzodiazepine Shortage

Written by reuben

March 18th, 2012 at 8:33 pm

Posted in Toxicology

Joint Commission Preparation Focus on Safety Resource Guide

Written by reuben

March 18th, 2012 at 8:26 pm

Posted in JCAHO

Storage of Laryngoscope Blades

March 13, 2012

Nursing Practice

Storage of Laryngoscope Blades

? New Joint Commission Requirement: After sterilization, the laryngoscope blades must be placed in a sterile dated labeled package and maintained in that package until use.

? Laryngoscope blades: cannot be stored outside of sterile packaging (e.g., peel wrap). Examples of incorrect storage include unwrapped blades on top of a code cart or unwrapped blades in an intubation cart/box/drawer.

? All laryngoscope blades must be processed in the Sterile Processing Department.

? Laryngoscope handles: considered contaminated after use and must be wiped down with hospital approved disinfectant.

Written by reuben

March 18th, 2012 at 8:22 pm

Posted in Airway

ABO Confirmatory Specimen & Blood Product Transfusion Check

March 13, 2012
Nursing Practice Alert

ABO Confirmatory Specimen

The 2nd ABO specimen practice is a patient safety measure to help prevent ABO hemolytic transfusion reactions and patient identification errors.

When this is needed, the Mount Sinai Blood Bank notifies the patient care area.

When a 2nd ABO confirmation specimen is requested,
it is important that a different person draw the sample at a different time than the first sample.

In the event of an emergency transfusion, the Blood Bank will provide type O red blood cells until the ABO blood type can be confirmed.

For any questions about this process, call the Blood Bank, x 46101.

Blood Product Transfusion Check
Requires 2-clinician independent check, each person verifying each element of the process on his/her own. Then, both must agree that all of the following are correct before proceeding.

> Check consent

> Check the blood product label against the patient’s order.

> Perform patient identification and check that patient’s name, date of birth and medical record number on the patient’s identification bracelet are identical with the Blood Product Flowsheet form #MR-151 and the Blood Product Label on the bag.

> Compare the Blood Product Flow Sheet Label with the
Label on the Blood Product. All elements must be
identical: patient name, date of birth, medical record
number, blood type, Rh and the Donation Identification
Number (DIN).

> If all elements confirmed as correct, both clinicians Sign the Blood Product Flowsheet and the blood product is administered. If not confirmed, STOP and do not administer the blood.

Nursing Education/Professional Practice x 57240

Nursing Education/Professional Practice x 57240

Written by reuben

March 18th, 2012 at 8:18 pm

Posted in Blood Bank

Elmhurst Tonopen

I believe most of us have, at one time or another, noticed that we cannot get the Tonopen to work. Well, apparently it does.

The Biomed rep went through the calibration process with me, to be done each time you turn it on:

1. Press the main button and hold it down for 15 seconds, you will hear a beeping sound.

2. Keep holding down the button, the screen will then say “Dn” which means orient the Tono-Pen downwards, for approximately 15 seconds while continuing to hold down the button.

3. You will then see the screen say “Up”, which means orient the Tono-Pen upwards for 15 more seconds while continuing to hold down the button.

Essentially, you will be holding down the button throughout the entire process and will be prompted by instructions on the digital screen.

After this process is complete, the Tono-Pen should work. If not, call Biomed.

The Tono-Pen is kept in Dr. Kessler’s office, in the cabinet above his desk.

You can ask Security to get access to it at night in cases of emergency.


Written by reuben

March 15th, 2012 at 10:58 pm

Cath Lab Handoff

Attached is a copy of our handoff procedure to Cath Lab. This came about as a result of an RCA. It is brief and easy to read; please familiarize yourself with it. The part that physicians and PAs should especially know about is:

The Cardiac Cath Lab’s designated provider will locate the ED provider at the time the patient is ‘consented ‘for a catheterization. At this time provider to provider hand-off will take place.

Thank you all



• The Emergency Department RN will call the Cardiac Catheterization Lab to speak to a RN or provider in order to give hand-off information regarding the patient they will be receiving.

• The Emergency Department RN will document the hand-off in the EPIC/ SBAR dedicated area only.

• The Cardiac Cath Lab’s BA will call the Emergency Department’s charge nurse prior to picking up the patient in order to confirm identification of the patient using the patient’s name and DOB.

• The Cardiac Cath Lab’s designated provider will locate the ED provider at the time the patient is ‘consented ‘for a catheterization. At this time provider to provider hand-off will take place.

• The Cath Lab provider will document the hand-off in the pre-cath note only.

March 2012

Written by reuben

March 10th, 2012 at 12:29 am

Posted in Cardiology

Benzo Shortage

So for at least the foreseeable future, there is a shortage of IV ativan, please consider these alternatives

Sedation for Violent Behavior/Elopement Prevention
Please use droperidol/ versed (5/2) or either agent individually. This is a preferred choice over haldol/ativan even without the shortage. Get an ekg at some point in the patients course to document no prolonged QTc (this doesn’t need to precede the drugs)

Mild ETOH Withdrawal
Ativan 2mg PO Q6 or LIbrium 50 mg PO Q6

Severe ETOH Withdrawal/DTs
We may or may not have IV valium, if we do start with that just like always

If we run out, choose one of these course
Place patient on midazolam drip using standard drip sheet dosages, Patients may need a bolus of 2 mgs; repeated Q5 minutes until sedation achieved prior to the drip. Unintubated patients on midazolam drips must go to an ICU bed
Intubate the patient and place on midazolam, intubated pts on midazolam may go to A4/CCA
Intubate and place on a propofol drip. intubated patients on propofol may go to A4/CCA

Status Epilepticus
Hospital is conserving ativan specifically for these patients, so it should be available, if not:

use midazolam 2-4 mg (max 8mg) just as you would use ativan

Hospital is also adding IV Kepra and IV Valproate, consult neuro for dosing, timing, and usage

If and when we lose IV midazolam, furhter recs will follow

please write with questions


Scott Weingart, MD

Written by reuben

March 9th, 2012 at 3:12 am

Posted in Pharmacy,Shortage

New BBFE Flowsheet

As of today, the multiple old needlestick / blood & body fluid exposure forms have replaced by a single document that was re-written from scratch collaboratively with ID, nursing admin, and employee health. This new flowsheet is designed to successfully guide your psychiatry intern through the process at 3am without any input from you.

You can find it in the Documents section of Epic, see attached.

It can also be viewed (and printed) using this link:

Let me know if you have any questions.


Written by reuben

March 8th, 2012 at 2:54 am

Posted in Needlestick

Child abuse vs. Statutory Rape


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
Reproductive Rights Project
(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. 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
? 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
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
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
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
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
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
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?
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
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
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
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
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).

Written by reuben

March 7th, 2012 at 4:16 pm

Posted in Peds,Sexual Assault

Medical Board Update: Pre-procedure consent, HIV testing

To: All Medical Staff, Housestaff, and Credentialed Providers

From: David Reich, MD
President, Medical Board
The Mount Sinai Hospital
1. HIV Testing Policy: As required by NY State, all patients 13-64 years of age and those at risk must be offered HIV testing at hospital admission, or in primary care outpatient/office and Emergency Department settings. Nursing has incorporated the assessment in workflows, but a physician or a credentialed provider (NP/PA) must counsel and consent the patient prior to testing. The seven counseling elements are as follows (abridged version):
i. HIV is the virus that causes AIDS and can be transmitted through unprotected sex, contact with blood, sharing needles, and by HIV-infected pregnant women to their infants during pregnancy/delivery/breast feeding.
ii. There are treatments for HIV/AIDS that can help an individual stay healthy.
iii. Individuals with HIV/AIDS can adopt safe practices to protect uninfected and infected people in their lives.
iv. Testing is voluntary and can be done anonymously at a public testing center (outside of Mount Sinai).
v. The law protects the confidentiality of HIV test results and other related information.
vi. The law prohibits discrimination based on an individual’s HIV status.
vii. Consent for HIV related testing remains in effect until it is withdrawn verbally or in writing.

The full policy and the DOH consent form are attached to this announcement. The DOH consent form may also be downloaded at:, and may be used until a Mount Sinai form is created.

2. Preoperative Testing Form: The new standardized form for ordering preoperative and pre-procedure testing is attached to this announcement. Requirements for laboratory testing, ECG, and chest X-ray are markedly reduced, and the pre-admission testing staff have been instructed to question any non-standard testing. Adhering to the guidelines in this template will help to minimize delays/postponement of surgery/procedures due to abnormal results and reduce costs. All perioperative nurses and anesthesiologists will consider the testing specified in the policy as sufficient to proceed with surgery.

3. Consent to Surgery/Procedure/Treatment and Anesthesia Form: The existing surgical/procedural consent form has been amended to expand “tissues” to “tissues, organs, and body fluids” so as to be more understandable for patients.

4. Prescription Pad Security: Prescription pads must always be secured in Pyxis or other locations with a high level of protection against theft or unauthorized access. This must occur in all settings, include office and outpatient areas.

5. Epic Physician Documentation: The next round of training is scheduled to be completed prior to the physician documentation go-live date of June 10th. Training will be available via e-learning and classroom modules and will take approximately four hours. Interim Chief Medical Information Officer Dr. Darrow is investigating opportunities for department-specific training.

6. Medical Student Documentation in the Medical Record: The Bylaws and the Hospital Staff Rules and Regulations will be amended to indicate that all medical student notes must be reviewed and signed by a member of the housestaff or an attending physician. Attending physicians may utilize any portion of a medical student note as part of their documentation, but may not make linking statements to notes written by medical students.

doh consent-2556
HIV Testing and Counseling Policy (A4-120)
Preop Testing Form MR1829

Written by reuben

March 5th, 2012 at 4:34 pm