Honorable Robert Bunda

President of the Senate

Twenty-First State Legislature

Regular Session of 2002

State of Hawaii

Sir:

Your Committees on Health and Human Services and Judiciary, to which was referred S.B. No. 2150 entitled:

beg leave to report as follows:

The purpose of this measure is to require medical referrals to a qualified medical facility for an opinion on whether child abuse or neglect has occurred.

Testimony in support of this measure was received from Department of Human Services (DHS) and Kapiolani Child Protection Center.

Your Committees find that the DHS could use help in determining whether or not child abuse or neglect has occurred in reported cases. The signs and symptoms of abuse or neglect are often subtle and at times not visible. A trained expert physician is oftentimes necessary to assist in making a diagnosis of child abuse or neglect.

There are medical specialists and facilities specializing in diagnosing and treating child abuse and neglect. Your Committees believe that these medical resources should be used by the DHS in these cases. The intent of your Committees is that most suspected cases should be referred for an opinion, in the interests of protecting the safety of the child. Your Committees have every confidence in the treating physicians, particularly pediatricians, to recognize these cases. However, there is everything to gain and nothing to lose in seeking a second medical opinion. In this regard, your Committees view this measure as good medicine. More particularly, a second expert opinion could assess the severity and length of time of abuse and recommend treatment modalities, both medical and psychological for the child.

Your Committees request the DHS to implement a system review procedure that starts with a case file review followed by an interview with the reporting person, and if necessary, with the parent or custodian of the child. If from there, the DHS is still not completely satisfied that an abuse or neglect has not occurred, your Committees believe that a referral should be made for a second opinion. The DHS should bear in mind that time is of the essence. For the sake of the file review, your Committees suggest that the medical referral expert could assist in making a preliminary review in appropriate cases without examining the child.

Your Committees have amended this measure to require the DHS to review every report of child abuse or neglect to determine if a medical referral is necessary to obtain a definitive medical opinion, and to make an immediate referral accordingly. Your Committees have dispensed with informed consent for purposes of this referral, in recognition of the gravity and urgency of the matter and the probable non-cooperation of the parent or guardian.

As affirmed by the records of votes of the members of your Committees on Health and Human Services and Judiciary that are attached to this report, your Committees are in accord with the intent and purpose of S.B. No. 2150, as amended herein, and recommend that it pass Second Reading in the form attached hereto as S.B. No. 2150, S.D. 1, and be referred to the Committee on Ways and Means.