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Ethics in Child Abuse

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The following incident occurred in NJ.

Dr. Valerie Adun is examining Alexa James, age fifteen months, who was brought into the urgent care center by her mother, Sheila Washington, and her live-in boyfriend, Lewis Murphy. X-ray results show a fracture of her right tibia (lower leg) and a one to two-week old fracture of her right femur (upper leg). When asked by the doctor, neither Ms. Washington nor Mr. Murphy could explain Alexa's injuries. They claim to be the child's only caretakers.

Dr. Adun performs a complete physical examination of Alexa, including a series of x-rays. The x-rays reveal a healing rib fracture in addition to the two leg fractures. Alexa's medical records do indicate that Alexa has brittle bone disease and has suffered past breaks, including the rib fracture. However, the doctor is concerned that the caregivers cannot provide an explanation as to how these newest breaks occurred.

In another child, the various ages, types, severities, and locations of the injuries without explanations about their occurrence would indicate the injuries were non-accidental. However, with Alexa's condition, breaks can occur by her merely falling down or hitting an object with one of her limbs.

I need help with this paper. I also need to provide support for your reasoning, including references to state regulations (see the ABA link to the state law summaries) and any best practice principles involved.

What, if anything, could the provider do to prevent future issues or mitigate any future harm/damage to the patient or the provider (or his/her organization)?

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Solution Summary

A review of a case study regarding a child that has sustained significant injuries that are suspicious of child abuse.

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The child has arrived in the urgent care long after needing care. This child has already sustained significant injury not appropriate for a child that is fifteen months old. The physician is taking a conservative approach to the examination of the child by taking into account all of the events that could have caused these broken bones. The child does not have a medical problem that causes bones to break easily. The doctor has finally concluded that the patient has been harmed in the care of the people who brought her into the clinic. Significant injuries of the long bones and to the ribs are not normal breaks for a child of this age. Also, the fact the child has also sustained a fracture that was not treated is a red flag indicator of severe child abuse.

Children are subject to child abuse and neglect in many ways. Abuse can take place in the form of beatings, sexual behavior and rape, emotional abuse and neglect. Neglect on the other hand may be more insidious. Children may be left at home unattended in an unsafe environment. Mothers or fathers may think they can go to work and leave the child and all they have to do is make a call to another person. Neglect can be calling the child a name that is abusive or degrading. Lack of meals and poor nutrition take on another form of abuse. The signs of a neglected child may be underweight, falls asleep in school and has a poor attention span. They may appear to be dirty or unbathed and often have an appearance of being on illegal drugs (Beddoe, Schub, & Pravikoff, 2012).

In a 2009 report by the Government Accountability Office (GAO), child maltreatment resulted in the death of a reported 1,343 deaths in 44 states. Unfortunately, this is probably only the tip of the iceberg. The types of abuse that lead to death were neglect (35.5 8%), physical abuse (23.2%), and multiple maltreatment ...

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