Doctors could not figure out why a 4-month-old infant was vomiting and not gaining weight. But Olga Rosa saw something more sinister than tummy troubles.
The child was starving and had a “downward gaze,” said Rosa, a child abuse pediatrician. The child also had increased pressure in the skull, caused by an abusive head trauma, commonly called shaken baby syndrome.
For children suffering from abuse and neglect, a medical diagnosis by a pediatrician who specializes in detecting child abuse can be a lifesaver.
But last year, roughly 4 in 5 S.C. children who could have benefited from a medical evaluation by a child abuse pediatrician went without one, said Rosa, medical director of the S.C. Children’s Advocacy Medical Response System and a University of South Carolina clinical pediatrics professor.
Housed within the forensic pediatrics division of the University of South Carolina School of Medicine, the Response System is asking legislators to almost double its funding to $1.4 million.
For years, the program has been underfunded, advocates say, and the extra money would help the network train more doctors to perform more medical evaluations.
More doctors and evaluations will be needed as the state’s child welfare agency this year expands statewide a call-in system for reporting abuse and neglect, they add. That expansion is expected to uncover more abuse cases.
Need is increasing
S.C. lawmakers made the Response System part of state law in 2014, when the state’s child welfare agency was under fire for children dying from abuse and neglect while under its watch.
The law directed the Response System’s network of child abuse pediatricians to create guidelines for professionals who interact with children about when they should seek a medical evaluation.
But the new state mandate came with no added state money.
Now, the program’s leaders want lawmakers to restore its state funding to $1.4 million, its 2008 level. State money dropped to $690,082 in 2009 as the Great Recession forced cuts, and has ticked up only slightly since then. Last year, the state gave the program $750,000.
The Response System’s network of two dozen doctors statewide performed exams on 4,032 children last year. In 55 percent of cases, those exams indicated abuse.
But the need for exams was likely five times higher, Rosa said, citing her own research.
Child welfare advocates say more money is especially important now as the state prepares for a spike in child abuse investigations and the resulting need for more medical evaluations.
By the end of the year, the S.C. Department of Social Services plans to expand statewide a call-in system to report suspected abuse and neglect.
When that happens, Social Services and child welfare advocates expect a spike in child abuse cases. Two years ago, when the call-in centers were launched, Social Services saw a 25 percent spike in calls, leading to a 41 percent increase in suspected child abuse and neglect cases.
To cope with that expected spike, Social Services Director Susan Alford has requested more than $18 million in added state money for her agency’s child welfare operations, including money to hire more than 250 workers. Many of those workers will handle the added child abuse cases the agency anticipates.
The Response System’s network of child abuse pediatricians also needs more personnel statewide, especially in the Upstate, Midlands and Pee Dee regions, Rosa said.
Providers not compensated fully
Advocates say legislators should find the money.
State Rep. Gilda Cobb-Hunter, D-Orangeburg, said there is a shortage of child abuse pediatricians, especially in rural communities. As a result, abused children sometimes have to be driven long distances or wait weeks to be evaluated.
More money also would help attract doctors to join the network, said Cobb-Hunter, the director of CASA Family Systems, a nonprofit that runs a child advocacy center where child abuse pediatricians sometimes conduct exams. (CASA does not get any money from the Response System, Cobb-Hunter said.)
Like most physicians, child abuse pediatricians bill for the medical services they provide.
But many of those services cannot be billed to insurers. For example, the network’s medical providers often spend several hours – and sometimes days – in court or meeting with authorities.
Rosa said 95 percent of the state money that comes through her program goes to the network’s pediatricians for the time they spend working beyond their billable medical services.
That money does not come close to paying the doctors fairly, added Rosa, who recalled being paid $135 for a child abuse case that took her seven days to investigate.
Children’s hospitals also more money put into the Response System’s child abuse pediatricians so more abused children get medical evaluations, said Maggie Michael with the S.C. Children’s Hospital Collaborative.
Seeing a need in the Midlands, the Palmetto Health Foundation raised $800,000 to expand a child abuse assessment program at Palmetto Health Children’s Hospital. The money paid for three child abuse pediatricians.
Those pediatricians “can save a child’s life,” Michael said.
Finding abuse has “got to be done with a lot of skill, and it’s got to be done quickly to get these kids into the best situation possible,” she said.
SC child abuse pediatricians
Who are they? The S.C. Children’s Advocacy Medical Response System
What do they do? The 22 medical providers in the network are trained to determine whether children are the victims of physical or sexual abuse, medical child abuse or neglect, or whether children are at substantial risk for abuse.
What do they want? The program’s state funding almost doubled, to $1.4 million from $750,000