The Bruise and the Boyfriend
Dr. Elena Ramos, a licensed psychologist in Montgomery County, has seen 9-year-old Eli six times for separation anxiety. Eli’s parents are divorced; his mother has primary custody, and his father has alternating weekends. During a session, Eli says his mother’s boyfriend “hit me with a belt” last night and shows Dr. Ramos a purple bruise on his thigh. He says, “Please don’t tell my mom-she’ll get mad at me.” The boyfriend lives in the home. Eli’s mother is in the waiting room and has signed the treatment consent. Dr. Ramos has no other evidence of abuse, but the disclosure is specific and recent. She wonders whether she must report, whether she may tell the mother, how to handle the father’s access to records, and whether she can continue treatment. The practice has a policy of calling the county child protective services hotline for consultation.
1. Does Dr. Ramos have a mandatory reporting duty, and what must she do and when?
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Maryland’s child abuse reporting statute, Family Law Article §5-704, makes health practitioners mandatory reporters when they have reason to suspect abuse or neglect. Eli’s specific, recent disclosure and visible bruise are enough; Dr. Ramos does not need proof and must not investigate. She must make an oral report immediately to the local department of social services or law enforcement, and follow with a written report within 48 hours if required. The report should identify Eli, his age and address, the mother and boyfriend, the exact words used, the location and appearance of the bruise, and the time of disclosure. She should not call the mother first to ask whether abuse occurred, and she should not delegate the report to the mother. The duty is personal and cannot be discharged by a practice consultation call. If the child is in immediate danger, call 911.
2. What may Dr. Ramos tell Eli, his mother, and his father about the report and the records?
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Dr. Ramos should not promise Eli secrecy. She can explain, in child-appropriate terms, that she must tell people whose job is to keep children safe. She may tell the mother that a report was made if doing so does not increase risk to Eli; the statute does not require parental consent or pre-notification. She should avoid sharing unnecessary details. The father’s access to records depends on the custody order and applicable law; both parents may have rights, but disclosure must not compromise the investigation or Eli’s safety. She should verify the custody order, release only what is authorized, and consult the Board or an attorney if the parents’ requests conflict. She should not tell the boyfriend.
3. How should Dr. Ramos document the disclosure and proceed with treatment?
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Document the exact disclosure in quotation marks, the bruise’s size, color, and location on a body diagram, the time, who was present, the call to the hotline, the agency and person contacted, and any instructions. Document the rationale for notifying or not notifying the mother. Continue treatment if clinically appropriate; the report does not automatically require termination. Develop a safety plan, assess Eli’s anxiety, and coordinate with the agency. Do not alter records after a report; late entries should be dated and identified as additions. Consult a supervisor or attorney about record requests and keep the child’s clinical needs central.