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ital impairments and infants or children with specialneeds." 103 This was rejected by the medical groupson the ground that it would lead to undue intrusion.Instead, the American Academy of Pediatrics madea counterproposal giving enforcement authority toState child protective services agencies, the frameworkthat was eventually adopted. 104 Under thestatute as enacted, within 1 year after the act becamelaw, such agencies desiring to receive Federal fundswould have to:have in place for the purpose of responding to thereporting of medical neglect (including instances of withholdingof medically indicated treatment from disabledinfants with life-threatening conditions), procedures orprograms, or both (within the State child protectiveservices system), to provide for (i) coordination andconsultation with individuals designated by and withinappropriate health-care facilities, (ii) prompt notificationby individuals designated by and within appropriatehealth-care facilities of cases of suspected medical neglect(including instances of withholding of medically indicatedtreatment from disabled infants with life-threatening conditions),and (iii) authority, under State law, for the Statechild protective service system to pursue any legalremedies, including the authority to initiate legal proceedingsin a court of competent jurisdiction, as may benecessary to prevent the withholding of medically indicatedtreatment from disabled infants with life-threateningconditions. 105The Principal Sponsors' Statement of the Senatesponsors adopted by the conference committeenoted that preexisting law required recipient Stateagencies "to provide certain mechanisms for thereporting of abuse or neglect cases. The samereporting mechanisms and standards set forth in theAct and existing regulations would be applicable tothe reporting of cases of medical neglect. . . ." 106Those preexisting regulations establish a Stateduty to create classes of individuals legally requiredto report both known and suspected cases of childabuse and neglect, a State duty to permit all otherpersons to submit such reports, 107 and a State dutyto investigate promptly to substantiate the accuracyof all such reports. 108The HHS Final Rule implementing the ChildAbuse Amendments is largely built on these require-103Gerry & Nimz, supra note 66, at 344.104Id.10542 U.S.C.A. §51O3(b)(2)(K) (West Supp. 1988).1M H.R. Conf. Rep. No. 1038, 98th Cong., 2d Sess. 41, reprintedin 1984 U.S. Code Cong. & Admin. News 2947, 2970. It madespecial mention of the requirement that a guardian ad litem beappointed for children in the course of all judicial proceedingsrelating to abuse or neglect. Id.ments. To ensure that health care facilities takeseriously their obligation to designate individualswith the specific responsibility to report known orsuspected withholding of medically indicated treatmentand to serve as a point of contact andcoordination during investigations, it mandates thatState agencies contact each health care facilityannually to identify the names, titles, and telephonenumbers of the designated individuals. 109 It requiresthat States demonstrate, through statute, regulation,or the opinion of the State attorney general, thattheir State laws give adequate authority to enablethem to prevent violations of the federally definedstandard of care. 110Perhaps the most important feature of the FinalRule pertaining to enforcement was its emphasis onproviding the mechanisms necessary to ensure anindependent medical evaluation of circumstancesthat give rise to a report of suspected medicalneglect. As the American Bar Association's ModelProcedures point out: "The judgment of physician(s)who specialize in the medical problems and disablingconditions of newborn infants is necessary to assesswhether reasonable medical judgment was employedin a decision to withhold medical treatmentor care from a disabled infant." 111 A social workeror other child protective services specialist is rarelyequipped to make an accurate judgment aboutwhether legally required treatment is being withheld.Short of outright admissions by medical staff,detection of such withholding normally requires aspecialist's knowledge of the appropriate level ofcare for the life-threatening condition, so as to judgewhether the treatment being accorded by the healthcare facility falls short of it. Furthermore, a judgmentabout what care is appropriate necessarilydepends on an accurate diagnosis of the child'scondition. Without the assistance of a consultantqualified to make an independent evaluation of thatcondition, a child protective services worker wouldin most cases be reduced to relying solely upon theunconfirmed representations of the very physicianswhose conduct is the subject of investigation. 1120745 C.F.R. §1340.14(c) (1987).08Id. §1340.14(d).45 C.F.R. §1340.15(c)(3) (1987).Id. §1340.15(d)(2)(ii) (1987).Model Procedures, supra note 46, at 229.The analogy in a more "traditional" child abuse case, one inwhich someone reports that a neighboring child has been severelybeaten by her parents, would be a child protective services91