Guest guest Posted June 13, 2006 Report Posted June 13, 2006 Howdy folks, A little input would be appreciated. Several days ago, an ND in our office asked for an opinion on follow up for a case she had seen. Patient was a 6 yo boy, 2 weeks s/p a fall on the playground. Kid struck the side of his head hard. He had nausea and vomiting for 2 days. He is also the son of a DC in Washington, and mom brought the son in against dad's wishes. Kid now has diplopia, is walking around with one eye closed, because the pupil in the eye is 2mm dilated relative to the other. Worried about damage to the middle meningeal artery and possible subdural hematoma, I heartily encouraged the ND to contact the family immediately to get CT. ND says that dad refuses to get imaging or seek consult. My question, given the very real possibility that the child could become comatose and/or die from this condition, what are the reporting duties of both the ND and myself? Does this fall under the heading of abuse via neglect? If anyone has Dave McTeague's e-mail and could forward this to him it would be much appreciated. Take care. W. Snell, D.C. Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.com Quote
Guest guest Posted June 13, 2006 Report Posted June 13, 2006 I would say alot depends on what your relationship to caregiver (mom) is in this case. Did you just verbally consult with ND at ND's request? If so, then you really have no better choice than to give your opinion to ND. You have got to respect the ND doc's primacy..the ND is at bat here. Or did mom bring boy to you for exam seperately and/or in conjunction with ND? If so, then you now have a direct relationship with mom. And if so, then you make your Rx. And it is up to her to say yes or no...if she says no and you want to know why...you ask ...I am assuming you did and she said that the father refuses...then you ask...why in Sam Hill woulld he refuse such advice ...if you do not get a satisfactory answer ...then you tell mom that would like to contact DC dad and you get his number from mom (or you look it up because he is co-guardian) ( I am assuming these parents are seperated/divorced?) and you politely and collegially ask him his paternal/clinical reasoning behind his decisions...is it financial...is it other? maybe he has a semi-decent reason....But, if he is a dufus who is using his kid as some sort of pawn in relationship wars then you read him the freakin riot act and you ask him what his kid did to ever be treated so badly. At that point i would let it go, myself. Document of course and follow kid along to whatever degree you can. Good luck. > > Howdy folks, > A little input would be appreciated. Several days ago, an ND in our office > asked for an opinion on follow up for a case she had seen. Patient was a 6 > yo boy, 2 weeks s/p a fall on the playground. Kid struck the side of his > head hard. He had nausea and vomiting for 2 days. He is also the son of a > DC in Washington, and mom brought the son in against dad's wishes. Kid now > has diplopia, is walking around with one eye closed, because the pupil in > the eye is 2mm dilated relative to the other. Worried about damage to the > middle meningeal artery and possible subdural hematoma, I heartily > encouraged the ND to contact the family immediately to get CT. ND says that > dad refuses to get imaging or seek consult. > > My question, given the very real possibility that the child could become > comatose and/or die from this condition, what are the reporting duties of > both the ND and myself? Does this fall under the heading of abuse via > neglect? If anyone has Dave McTeague's e-mail and could forward this to him > it would be much appreciated. Take care. > > W. Snell, D.C. > Hawthorne Wellness Center > 3942 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > drpsnell.chiroweb.com > Quote
Guest guest Posted June 13, 2006 Report Posted June 13, 2006 Great question Don, and definitely a preferred route to deal with the situation personally and congenially rather than in a confrontational, bureaurocratic manner. Complicated issue that I think has ultimately been handled appropriately by the ND. She spoke directly with the father after phone consultation with a peds neurologist @ OHSU who said the child should be out of the woods by this time with respect to a chronic subdural hematoma. As this is still contrary to what I have read re: such things, I hope to follow up with neurologist tomorrow. Thanks for the concern and help to all. W. Snell, D.C. Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.com >From: MekaAbou@... >drpsnell@... >Subject: Re: mandatory reporting >Date: Tue, 13 Jun 2006 21:49:23 EDT > >Phil, > >Could you talk to the father??? Without pointing fingers > >Don WHite Quote
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