1. The Shy Patient Marcia Espinoza and Reina Ligeralde DEH 24 5.30.08

2. The Situation Teresa Bishop, a new shy, reserved, well- mannered 8-year old patient came in for a dental prophylaxis with RDH, Maria Gomez Maxillary central incisors were fractured due to Teresa falling off her bike while not wearing a helmet

3. The Situation (continued) Recall appointment 6 months later – incisors are restored but now Teresa has bruising around both eyes due to falling down the stairs at home Teresa’s mother is holding her hand but offers no further explanation. Record reveals she has previously been seen by 3 different general dentists in the same city prior to her transfer to Maria’s office

4. Ethical Decision Making Steps 1.Identify the ethical dilemma. –Should Maria wait to find more evidence before further action? –Should Maria immediately report child abuse to the local Child Protective Services (CPS) agency? –Should Maria do nothing at all so she can keep Teresa as a patient from leaving the practice?

5. Ethical Decision Making Steps 2. Collect information. 3. State the options. –Try to get more information out of Teresa alone. –Question Teresa’s mother. –Call the other dental offices for documentation of suspicious child abuse. –Maria can tell the dentist of her suspicions. –Report the situation to the child protective services. “All that is necessary for evil to triumph is for good people to do nothing.” – Edmund Burke

6. Ethical Decision Making Steps 4. Apply the ethical principles to the options. –Try to get more information out of Teresa alone. Confidentiality Veracity Societal trust Justice Autonomy Nonmaleficence Beneficence

7. Ethical Decision Making Steps 4. Apply the ethical principles to the options. –Question Teresa’s mother. Confidentiality Veracity Societal trust Justice Autonomy

8. Ethical Decision Making Steps 4. Apply the ethical principles to the options. –Call the other dental offices for documentation of suspicious child abuse. Confidentiality Nonmaleficence Beneficence Veracity Justice

9. Ethical Decision Making Steps 4. Apply the ethical principles to the options. –Maria can tell the dentist of her suspicions. Confidentiality Nonmaleficence Beneficence Veracity Justice Autonomy

10. Ethical Decision Making Steps 4. Apply the ethical principles to the options. –Report the situation to the child protective services. Confidentiality Veracity Societal trust Justice Autonomy Nonmaleficence Beneficence

11. Ethical Decision Making Steps 5. State your decision. –Finish dental treatment. –Check if Teresa says the same story without her mother present. –Find out what the other dental offices have on record. –Document suspicions and findings. –To be courteous to the dentist, let him or her know of the situation. –Call the local CPS agency: 1-800-442-4918.

12. Ethical Decision Making Steps 6. Implement your decision. –The steps will be carried out that day while Teresa’s mother is in the waiting room.

13. Case History Questions 1.Should Maria suspect child abuse? 2.What professional obligations does Maria have to her patient? 3.How should Maria document her observations? 4.How should Maria proceed?

14. Case History Answers 1.Yes, Maria should suspect child abuse so she is safe rather than sorry. 2. As a healthcare provider, Maria has the professional obligation and is mandated to report any suspicious child abuse.

15. Case History Answers “Reports must be made when there is a reasonable cause to suspect child abuse or neglect in order –to make state investigative and social services available in a wider range of cases at an earlier point in time, –to make sure that investigations regarding child abuse and neglect are conducted by trained investigators, –and to avoid subjecting a child to multiple interviews about the abuse or neglect.” Beemsterboer, P. L. (2002). Ethics and Law in Dental Hygiene. Philadelphia, PA: Saunders.

16. Case History Answers 3. Maria should document her observations including all steps of action in the SOAP notes as well as a copy of the report filed with the CPS agency. 4. Please see Step 5 in the ethical decision making steps to find out how Maria should proceed.

17. Questions?