How I Broke the Law for 90 seconds

I generally stay out of politics for the same reason I don’t fly airplanes: I will not mess around with things I don’t fully understand where someone may get hurt.  Laws, as they apply to medicine, tend to run with a steamroller over problems best attacked with a scalpel, and the fewer of those we have, the fewer patients will suffer the consequences.  I have a story of a little girl who got better in spite of laws to the contrary.

It was 10 minutes to seven PM.  The mother ran in, scattering tears, clutching her little 2-year-old daughter, upset beyond words.  She had just picked her up from day care, and as she started to change her diaper –

she could talk no more.  Crying, she undressed her child, revealing a huge buttock bruise and bleeding in the diaper area.

Let’s stop for a second.  The law dictated for me to call the police at that point.  It is very specific that where a suspicion of child abuse exists, it must be immediately reported.  That’s not what I did.  Instead I ordered a CBC, a complete blood count, to be done.

Let’s stop again.  I have a CBC machine in the office.  It takes 90 seconds to return a result.  There is another law, called CLIA, designed to make it very difficult to operate a lab in the office.  This is actually a law we have been able to follow, at great expense and with considerable difficulty.  Most pediatricians do not have a lab, and must wait overnight for results from their patients.

90 seconds later I knew I was not going to be calling the police or Child Protective Services.  The platelet count was extremely low, 10 times less than normal.  Platelets are the blood cells that stop small bleeds.  The little girl had ITP, and less than an hour later was in the emergency room getting appropriate treatment (I called ahead and had them ready the immunoglobulin before she even got there, wasting no time on testing).  She went home to recover completely without further adventures.

Did my brief encounter with illegality save her?  Maybe.  I know I saved the day care center people, and I don’t even know who they are.

What brought this back (from ’93 or ’94, quite a while ago) is an entire issue of a respected pediatric journal devoted to “advocacy for children”.  That means, getting the legislatures to pass laws to help children.  I just hope they do a better job with these laws than with some of the others…

RE: Mr Chavez comment:

There was nothing to report.  ITP was responsible for all the bruising and bleeding — without platelets, the force of just sitting down on the floor is enough to produce hemorrhaging.


8 thoughts on “How I Broke the Law for 90 seconds

  1. I believe what you did was professional in nature, you had to do what your profession asked you to do : Save the child’s life. What got the better of me in this article was why the childcare workers did that to a poor 2-year old toddler and why you did not report as soon as the life-saving procedure was done. I’m sure the judiciary system would be inclined to side with you regarding your breech of the laws in this case. And that whatever evidence could be corroborated by witnesses (the mother for one, you for another, and the medical staff that you worked with, not to mention the other workers in the childcare center).

  2. Pingback: Pediatric Center News » Blog Archive » Y’all ain’t gonna believe this…

  3. how did you get around that? if it costs money to take a complete blood count (which i suspect it does) how did you get around the insurance problems? did you just not file it or did they pay by themselves?

  4. @Enrique Chavez:

    Having low blood platelet counts means someone is VERY susceptible to bruising and so on. I imagine sitting down a bit hard could have done it. Remember it’s a day care, kids are in a day care. Kids can and will do things that get them hurt. (I jumped off the swing set at the highest point I could, that ended well.)

    Point is, I think it’s not a good idea to just /assume/ the day care did this by negligence or something. Kids will be kids.

  5. I do question why you had immunoglobulin waiting for her, rather than platelet transfusion. There must be something I’m just not getting here.

  6. ITP is a disease of rapid platelet destruction. Immunoglobulin slows that down; a platelet transfusion would last a few hours at best.

  7. I suffered two different injuries as a child: once falling very hard backwards, straddling a wheelbarrel handle…and on another occasion, dismounted a boy’s bike without remembering the center bar! Both caused me great pain and a bit of bleeding. Had I told my mother, and/or had medical care been given (and it were today!)…well, you know the story. In actuality…both were simple childhood accidents…nothing more.

  8. you followed the socratic oath, to the best of my understanding. thats a higher law in my book than anything politicians can come up with.

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