HOSPITALS CLINICS HOSPITAL AUTHORITY by alicejenny

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									                                     CHAPTER 20

                             HOSPITALS / CLINICS
                           (HOSPITAL AUTHORITY)


20.1   Medical Officers (MOs), nurses and para-medical staff of hospital / clinic of
       the Hospital Authority should familiarize themselves with the procedures of
       handling suspected child abuse. They should be alert to the signs of child
       abuse by making reference to the Indicator of Possible Child Abuse & Guide
       to Risk Assessment in Chapter 2. If a child has symptoms or signs which
       indicate that sexual abuse may have taken place, the MOs, nurses and
       para-medical staff should follow the Guide to People Working with Children
       Who Disclose Sexual Abuse at Appendix IV and Guidance for Paediatric
       Wards, A&E and Staff involved with Child Abuse at Appendix XVI.


GOVERNING PRINCIPLES

20.2   The primary objectives in managing victim of suspected child abuse or neglect
       are :

       (a)   to protect the child;

       (b)   to plan and provide a healthier environment for the child; and

       (c)   to facilitate criminal investigation and subsequent prosecution.

20.3   Principles :

       (a)   The child must not be further traumatized by the investigative process.

       (b)   The best interest of the child must be accorded top priority. The
             emotional well-being of the child must be protected and all those
             involved must be sensitive to the social and psychological needs of the
             child and the family. The clinical interview should be conducted in
             private to minimize further distress to the child.

       (c)   History is the keystone in establishing a diagnosis of child abuse. A
             detailed medical history from the child, as far as possible, and from the
             carer should follow the format of a thorough paediatric health
             assessment with special attention to the injuries and to factors that may
             determine any continuing risk. However, the clinical interview can be
             very distressing for the child and should be carefully planned. At the
             initial contact, it is probably the best to keep the number of
             interview to a minimum.

       (d)   The number of investigative / assessment interview on the suspected
             abuse incident(s) should be kept to a minimum, say one interview. The

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             interviewer may be the responsible caseworker, the professional to
             whom the child has established trust for disclosure, the representative
             from the Police, or jointly by these professionals. For video-recorded
             interview to be used in court proceedings, the interview should be
             conducted by police officer, social worker or clinical psychologist
             employed by the Government. The information collected with regard
             to the suspected abuse incident(s) shall be shared with relevant parties
             concerned as soon as possible.

       (e)   Advanced training and experience are needed for the proper recognition
             and examination of child sexual abuse cases. The initial assessment
             should be limited to a general examination with visual inspection of the
             genital area depending on the history, and the age and level of distress of
             the child. A careful and comprehensive record should be made.
             Normal physical findings do not exclude the diagnosis of child sexual
             abuse.

       (f)   For child sexual abuse cases in need of full medical / forensic
             examination, the child should be examined by medical professionals
             with expertise in child abuse examination. Should the child indicates
             the preference for a female medical officer, this should be entertained if
             a female expertise is available.

       (g)   The number of examination must be kept to a minimum.


ROLE OF MEDICAL CO-ORDINATOR ON CHILD ABUSE (MCCA)

20.4   Medical Co-ordinators on Child Abuse (MCCA) are designated in the
       Paediatric Departments within the Hospital Authority Hospitals (List of
       MCCA at Appendix XI) for handling child abuse cases. Working closely
       with medical social workers (MSW), nurses, clinical psychologists,
       psychiatrists and other related personnel through their expertise in child
       protection, the MCCA provide support to the suspected child victims by
       making their physical, emotional and developmental needs understood.

20.5   The duties of a MCCA include :

       (a)   acting as a source of referral and providing medical service to child
             abuse cases;

       (b)   assisting to arrange direct admission for the child to Paediatric Ward
             upon receiving a referral as appropriate;

       (c)   providing expert medical advice to colleagues and other professionals;

       (d)   co-ordinating and facilitating intra-agency and inter-agency
             communication, investigation and planning for further handling of the
             case, through the assistance of MSW.
INTAKE PROCEDURES

20.6   For child sexual abuse cases, the handling procedures for medical officer are
       outlined at Appendix XVII. Such cases will be managed according to the
       index of suspicion at Appendix XVIII and the need for urgent medical
       treatment. When handling these cases, all medical officers are advised to read
       the following procedures together with Appendix XVII & XVIII.

Referral received by Accident & Emergency Department (AED) and Specialist
Outpatient Clinic (SOPC)

20.7   (a)   If child sexual abuse or serious physical abuse is suspected, the
             doctor should :

             (i)    inform the Consultant / Senior Medical Officer (SMO) in charge
                    of the case who may in turn consult the MCCA of the hospital or
                    nearby hospital or the Social Work Officer of Family and Child
                    Protective Services Unit (SWO/FCPSU) at Appendix VII or
                    seeking advice from Child Abuse Investigation Unit
                    (Police/CAIU) on crime-related issues at Appendix VIII; or

             (ii)   admit or refer the child to a paediatric in-patient unit.

       (b)   If other form(s) of child abuse is/are suspected, the doctor should
             inform:

             (i)    the Consultant / SMO in charge of the case who may in turn
                    consult the MCCA of the hospital or nearby hospital; and

             (ii)   the MSW who would initiate the child protection mechanism
                    including checking with Child Protection Registry (CPR) via
                    his/her supervisor (reference on CPR at Appendix VI), contacting
                    the respective SWD / NGO staff if the case is known to the SWD
                    / NGO unit, or consult / refer the case to FCPSU as appropriate if
                    the case is not known to other SWD / NGO unit.

       (c)   For cases in need of urgent intervention / investigation, the doctor
             should inform the Police (the nearest Hospital Police Post or Police
             Station) or social worker (SWD hotline / FCPSU or Hospital MSW) as
             appropriate, and keep the Consultant / SMO in charge of the case and
             MSW informed of the case for assistance as soon as possible.

       (d)   For cases where child abuse is suspected and the child concerned is
             not going to be warded in hospital before the child leaves the AED or
             SOPC, the doctor or MSW concerned who has first-hand information on
             the suspected abuse incident(s) should make a report to the Hospital
             Police Post if police investigation and management is considered helpful.
             The concerned police unit will then contact the doctor or MSW
             concerned for further enquiries as soon as possible. The MSW should
      make sure that the case is reported to the Police as soon as possible.
      For known cases of SWD / NGO unit, the MSW will keep the SWD /
      NGO staff informed of the case for follow-up. For new cases, the
      MSW will refer the case to FCPSU for follow-up actions.

(e)   For suspected child abuse cases where hospitalization for
      observation or treatment is necessary, the child can be admitted to the
      Department of Paediatrics or other appropriate Department of the
      Hospital or nearby Hospital.

      (i).    The MCCA and other relevant staff will as far as possible ensure
              that appropriate assessment to the child be completed. These
              will include both physical and mental aspects.

      (ii)    If parent(s) / guardian(s) resist hospital admission, the
              doctor-in-charge should try to persuade the parent(s) / guardian(s)
              to stay whilst contact is made with the responsible social worker
              of known case or SWO/FCPSU or IFSC / SWD for assistance or
              consideration who is relevant for invoking powers under Section
              34F(2) / Section 35(1)(a) of the Protection of Children and
              Juveniles Ordinance, Cap 213. The MSW in hospital should
              assist whenever situation warrants in office hours. Assistance
              could also be obtained through the SWD hotline (Tel. no.: 2343
              2255).

      (iii)   If the child’s life and safety is endangered and/or the parent is in
              breach of peace, police officers may intervene. Once an order
              for removal and detention under Section 34F(2) / Section 35(1)(a)
              is made by the relevant public officers, the Police will, as far as
              possible, assist to ensure enforcement of the order.

(f)   For doubtful cases where in-patient treatment is not required and
      the level of suspicion of child abuse is not high, Consultant / SMO in
      charge of the case or MCCA or FCPSU can be consulted. The child
      should be referred to the MCCA or relevant welfare organisation for
      follow-up, or be followed up by the MO in-charge of the AED for
      review as soon as possible.

(g)   For cases where in-patient treatment is not required and there is not
      enough evidence to substantiate the suspicion of child abuse but the
      child or the family has other welfare needs, the doctor of AED /
      SOPC is advised to ensure that the case is referred to the relevant
      welfare organisation for follow up e.g. MSW / IFSC / ISC.
Referral received by Paediatric Ward

20.8   (a)   If child abuse is suspected, the doctor should inform :

              (i)    the Consultant / SMO in charge of the case who may in turn
                     consult the MCCA of the hospital or nearby hospital or
                     SWO/FCPSU or seeking advice from Police / CAIU on
                     crime-related issues; or

              (ii)   the MSW who would initiate the child protection mechanism
                     including checking with Child Protection Registry (CPR) via
                     his/her supervisor (reference on CPR at Appendix VI), contacting
                     the respective SWD / NGO staff if the case is known to the SWD
                     / NGO unit, or consult / refer the case to the FCPSU as
                     appropriate if the case is not known to SWD / NGO unit.

Referral received by Orthopaedic / Gynaecological / Medical / Surgical Ward,
etc.

20.9   (a)   If child abuse is suspected, the doctor should :

              (i)    inform the Consultant / SMO in charge of the case who may in
                     turn consult the MCCA of the hospital or nearby hospital or
                     SWO/FCPSU or seeking advice from Police / CAIU on
                     crime-related issues; or

              (ii)   refer the child to a paediatric in-patient unit.


MEDICAL AND FORENSIC EXAMINATION

20.10 Reference can be made to Chapter 9 for the procedures for medical / forensic
      examination.


MULTI-DISCIPLINARY CASE CONFERENCE ON CHILD ABUSE

20.11 The MO attending the case would be invited to attend the Multi-disciplinary
      Case Conference to formulate the welfare planning of the child. A written
      report on the child’s condition should be prepared for reference of the
      Conference (paragraph K of Annex I to Chapter 11).


COLLABORATION WITH OTHER PARTIES

20.12 All parties concerned should maintain communication about the case progress
      as appropriate for the protection of the child and provision of welfare service to
      the family.

								
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