Many questions arise in our ED concerning sexual abuse, reporting of STDs,
release of information related to a minor and STDs etc. I would be most
interested in responses from Florida, where our statutes prevail.
1. If sexual abuse of a minor, according to statute, is the penetration of a
vagina, anus etc by a penis,etc... is there any logic in reporting positive
STDs [not necessarily the test results but the fact that sexual activity
meeting the definition took place] to the state abuse registry hot line. To
date, the registry accepts these calls as "reportable" not "investigateable",
unless a true abusive situation exists. I realize this is not the intent of
the law to report sexual activity between consenting teenagers, but in the
strictest interpretation, it meets the description laid forth. Also, if you
feel it shouldn't be reported because it is consensual, at what age do you
feel it is not in the best interest of the child to be having sexual relations
[and therefore should be reported for follow up]?
2. Do you question a minor about their sexual activity in front of the
parent/guardian? If no, how do handle the GYN exam [tell parent or not]? If
the minor requests that you don't release information to their parent, how do
you handle a positive UCG [in the ED]? In our ED, we give the results to the
minor strongly encouraging them to tell their parent, but I am interested in
what discussion you have with the parent, who certainly has questions. Also,
if the minor truly will not give permission to release information, how do you
handle billing as our statutes do not allow for billing of the test etc?
Lastly, how do you give follow-up to the minor, with a positive STD, who
refuses release of information totheir parent? If on teh phone, how do you
guarantee identity? Is it reported to the Health Dept? Can the minor truly be
responsible enough to notify sexual partner/s? Handling of angry parents who
want to know why you are calling?
Hope my questions are clear. It is my intent to err on the side of caution.
In my experience with children [25 yrs] I have found that in these situations,
children do not often disclose what is truly going on. So how do we know and
can we accept that the if a minor tells us the sexual partner is a boyfriend,
it is really not abuse by the father etc? I've just realized that these
questions are all addressing the issue assuming the "victim" is female, the
reverse certainly could be true.
One final question, what is the age range of patients seen in yur Peds ED?
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Children's Emergency Center
Wolfson Children's Hospital
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