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Ethics in Child Abuse

The following incident occurred in NJ.

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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.


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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