PDF1 - University of Maryland School of Law

More documents

Recommendations

Info

BABY DOE COMPARED WITH REGULAR CPS INVESTIGATIONSWe asked CPS respondents how their baby doe procedures differfrom those used when investigating other reports of childabuse or neglect. Three major differences were citedconsistently: immediate response, use of medical consultantsand State level involvement.1. Immediate ResponseStates report that due to the urgency and potentiallylife-threatening nature of baby doe situations, thesereports are considered emergencies and are investigatedimmediately* In general, States require that theinvestigation begin with an immediate call to thehospital liaison where the infant is located to ascertainthe basic facts in the case. In some States, apreliminary report is required within as little as 2hours.2. Use of Medical ConsultantsAll States report they have access to medical consultantsto make medical determinations in baby doe cases, statesuse a variety of arrangements to insure immediate accessto and availability of qualified medical consultants.Those mentioned most frequently were State levelcontracts with medical schools, children's hospitals orprivate pediatricians; and agreements with medicalprofessionals employed by the state (frequently in statehealth or social services departments).182In a few States, local CPS offices are responsible forobtaining medical consultants. Several States haveestablished multidisciplinary teams to investigate babydoe reports. These teams typically consist of apediatrician or neonatologist, a social worker and a CPSworker, and could also include other medical specialistsand legal expertise.3. State Level InvolvementAbuse or neglect reports are routinely investigated atthe local level. State CPS offices set policies, provideguidance and monitor the performance of local offices,but rarely conduct investigations. Because of thesensitivity of potential baby doe situations, many Stateshave elevated the level at which these cases are handled.Nine States reported that the initial baby doeinvestigation would actually be conducted by State CPSstaff. Several others require that the State office benotified immediately when a baby doe report is received;while the initial investigation would be handled locally,the State office would be kept informed and could step into lead or participate in the case if needed.- 6 -
ESTABLISHMENT OF HOSPITAL INFANT CARE REVIEW COMMITTEESAs required by the baby doe amendments, HHS published modelguidelines to encourage hospitals with acute infant careresponsibilities to establish infant care review committees(ICRCs). ICRCs are intended to educate hospital staff andfamilies about baby doe situations, develop hospital policiesand review potential baby doe cases.We asked CFS units how many hospitals in their States haveestablished ethics committees or ICRCs. State responses areshown below*HOSPITALS WITH INFANT CARE REVIEW COMMITTEESRESPONSEAll hospitals with OBs/NICUsMore than half of hospitals with OBs/NICUsHalf or fewer hospitals with OBs/NICUsAll large hospitals with OBs/NICUsUnknown/No responseSTATESNUMBER PERCENT13 25%2 422 434 810 20Thirteen States (25 percent) reported that all hospitals withOBs or NICUs have ethics committees or ICRCs. The CPSrespondents in 22 other States (43 percent) estimated thatcommittees have been established in half or fewer suchhospitals. Ten States (20 percent) did not provide anyestimate. Additional detail on the number of hospitals withICRCs established is provided at Appendix B.State estimates are generally consistent with the findings ofa national survey recently completed by the American Academyof Pediatrics (AAP). The AAP survey found that as of August1986, about 52 percent of hospitals with over 1,500 birthsannually or an NICU were using committees to address ethicalquestions related to the care of severely disabled infants.An additional 8 percent were considering forming such acommittee. [National Collaborative survey of Infant CareReview Committees, AAP, March 1987].- 7 -183
Page 1 and 2:
MedicalDiscriminationAgainstChildre
Page 3 and 4:
idments • Section 504 • Medical
Page 5:
LETTER OF TRANSMITTALThe PresidentT
Page 9 and 10:
CONTENTSExecutive Summary 11. Funda
Page 11:
12. The Performance of the Federal
Page 14 and 15:
• The role of economic considerat
Page 16 and 17:
disabilities at the time that the c
Page 19 and 20:
generated by health care personnel
Page 21:
ing how they would obtain medical r
Page 24 and 25:
The Commission sees several advanta
Page 26 and 27:
acquiescence in the death or elimin
Page 28 and 29:
Services of the Department of Healt
Page 30 and 31:
Chapter 1Fundamental Rights: An Int
Page 32 and 33:
Carlton Johnson was evaluated by a
Page 34 and 35:
"that Mr. and Mrs. Doe, after havin
Page 36 and 37:
American Coalition of Citizens with
Page 38 and 39:
Chapter 2The Physician-Parent Relat
Page 40 and 41:
In all but a few cases, the parents
Page 42 and 43:
the family, and the family went alo
Page 44 and 45:
Chapter 3The Role of Quality of Lif
Page 47:
transition from education to employ
Page 50 and 51:
tion programs can become productive
Page 52 and 53:
unsuccessful efforts of a private a
Page 54 and 55:
[S]ince I have been at Children's M
Page 56 and 57:
Another survey by Siperstein, Wolra
Page 58 and 59:
of life with a child who is disable
Page 60 and 61:
Chapter 4The Role of Economic Consi
Page 62 and 63:
©TABLE 4.1Pediatricians' Responses
Page 64 and 65:
• The differences in average cost
Page 66 and 67:
FIGURE 4.1Comparative Costs of Inst
Page 68 and 69:
Chapter 5State LawWhat is the law g
Page 70 and 71:
Like all authority. . .parental aut
Page 72 and 73:
This decision, however, was promptl
Page 74 and 75:
No otherwise qualified handicapped
Page 76 and 77:
Bloomington's Infant Doe in April 1
Page 78 and 79:
ONONTABLE 6.1Physician's assessment
Page 80 and 81:
Essentially, HHS interpreted the su
Page 82 and 83:
Final 504 RuleHHS received nearly 1
Page 84 and 85:
lifesaving operations to close her
Page 86 and 87:
any further implementation of the F
Page 88 and 89:
handicapped infants might violate S
Page 90 and 91:
the provision does cover discrimina
Page 92 and 93:
of the infants. The review mechanis
Page 94 and 95:
Under the law, the Department of He
Page 96 and 97:
that "the phrase 'or holds the reas
Page 98 and 99:
allows an infant to be denied nutri
Page 100 and 101:
avoid the explicit standards set fo
Page 102 and 103:
(as opposed to the far) future, the
Page 104 and 105:
It was recognized, therefore, that
Page 106 and 107:
als with the particular disability
Page 108 and 109:
cared for. They are thus different,
Page 110 and 111:
medical advice. Given the magnitude
Page 112 and 113:
tions at all regarding the subject
Page 114 and 115:
strates that there is a grave dange
Page 116 and 117:
Disincentives to Whistle BlowingDen
Page 118 and 119:
Using a cumulative scaling procedur
Page 120 and 121:
Of that 300 we targeted, approximat
Page 122 and 123:
Conclusionphysicians set forth in t
Page 124 and 125:
taking place when a report of suspe
Page 126 and 127:
where the parents say "the child fe
Page 128 and 129:
Nevertheless, the organization oppo
Page 130 and 131:
Chapter 11The Role and Performance
Page 132 and 133:
a member of the American Academy of
Page 134 and 135:
possibilities that "will be most li
Page 136 and 137:
clearly indicate that the committee
Page 138 and 139:
Reviewing the first 30 months of th
Page 140 and 141:
Webster's defines "suspected" as "t
Page 142 and 143:
Chapter 12The Performance of the Fe
Page 144 and 145: The baby's doctor, E. Laurence Hode
Page 146 and 147: to achieve a reasonable life". . .w
Page 148 and 149: an unmarried mother receiving welfa
Page 150 and 151: can be sure all appropriate actions
Page 152 and 153: inquiries to determine whether they
Page 154 and 155: Chapter 13The Protection and Advoca
Page 156 and 157: authority to conduct retrospective
Page 158 and 159: facility that uses such a committee
Page 160 and 161: Chapter 14Findings and Recommendati
Page 162 and 163: as the coordination and development
Page 164 and 165: in the advisory process who is conc
Page 166 and 167: A Dissenting View on the Report Med
Page 168 and 169: arts) to depend upon knowledge of h
Page 170 and 171: Attachments to Statement of William
Page 172 and 173: medical facility. Considerations su
Page 174 and 175: Fund for the Improvement of Postsec
Page 176 and 177: eports such as Kopelman et al. demo
Page 178 and 179: Appendix 1EXPOSING OUR CHILDREN, EX
Page 180 and 181: abilities or functions, they are de
Page 182 and 183: My principal reason for objecting t
Page 184 and 185: I derive this hint from the many co
Page 186 and 187: moral distinction. A girl is a huma
Page 188 and 189: Appendix 2SURVEY OFSTATE BABY DOE P
Page 190 and 191: insure the immediate referral of po
Page 192 and 193: Hospital Liaisons Designated in Mos
Page 196 and 197: We also asked state CPS offices wha
Page 198 and 199: Limited information was available o
Page 200 and 201: one-quarter felt that baby doe case
Page 202 and 203: Appendix 3INFANT CARE REVIEW COMMIT
Page 204 and 205: and guidelines concerning the withh
Page 206 and 207: treated to assure the prompt ^repor
Page 208 and 209: 3. Educating Staff and FamiliesThre
Page 210 and 211: One of the 10 ethics committees vis
Page 212 and 213: asphyxiation during the birth proce
Page 214 and 215: Prospective Review -- Each committe
Page 216 and 217: OBSERVATIONSThe inspection found th
Page 218 and 219: May 1, 1989Page 2The Commission adv
Page 220 and 221: Doe 1 admitted on the record of the
Page 222 and 223: tion is the basis for failure to tr
Page 224: her (much appreciated) vote for thi
show all

PDF1 - University of Maryland School of Law

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?