The procuratorate issues letters of appointment to doctors, and it is mandatory to report these things

Protecting children’s physical and mental health is as important as treating disease.

WrittenText | Wan Shunshun

Source | “Medical Community” Public Account

On August 15th, Dr. Song Zhijun, Deputy Director of the Medical Department of Shanghai Children’s Hospital, received a new letter of appointment “Compulsory Reporting Liaison”.

This letter of appointment was jointly issued by the Shanghai Putuo District Procuratorate and the Putuo District Health and Health Commission, and issued to Song Zhijun and other 24 medical practitioners from various general hospitals, specialized hospitals, community health centers in Putuo District, etc. Institutional doctor.

“Compulsory reporting liaison officer” appointment letter distribution site (4th left in the picture is Dr. Song Zhijun) / Photo courtesy of the interviewee

Physicians are no strangers to mandatory reporting, and it was brought up several times this year:

An outpatient doctor in Donggang City, Liaoning Province performed abortion on a girl under 14 years old. The girl was raped by netizens for two times and had two miscarriages. The attending physician was suspended from practicing for six months for failing to make a mandatory report.

In July, the medical blogger “Dr. Xu Chao” received a photo of a 2-year-old girl with condyloma acuminatum around the anus. “If there is any sexual assault, call the police.” Dr. Xu Chao The police report is also a requirement of the mandatory reporting system.

The above incident also reflects the many shortcomings since the implementation of mandatory reporting. How should the doctor report? Who to report to? In particular, how to protect personal safety and prevent retaliation after mandatory reporting?

Shanghai first set up a “mandatory reporting liaison officer”, can it solve the doctor’s doubts?

Doctor reported having a contact

Song Zhijun said that the mandatory reporting liaison is generally held by medical management staff. On the one hand, he will check the content of the report, and on the other hand, he will not disclose which doctor or department reported it.

“After the clinician finds that the minor has been violated, the relevant information will be summarized to me first, and after the preliminary judgment confirms that it is a compulsory reporting matter, then report the case to the public security organ, and write a written Report to the District Supervisory Committee for the record.” Song Zhijun said.

According to him, the work of the liaison officer is mainly in three aspects: setting up a reporting network for cases of violations against minors, so that doctors can report when they encounter suspected situations; Propaganda and training to allow more doctors to participate in the work of protecting minors; be responsible for sorting out, reporting and keeping files of mandatory reporting incidents of this institution.

Letter of Appointment/Photo courtesy of the interviewee

From 2021 to the present, Shanghai Children’s Hospital has reported 5 cases of violations against minors, including cases involving the death of children. Song Zhijun found that the mandatory report has many details: sometimes it is necessary to obtain more information and time through some skills, so that the subsequent public security organs can intervene.

After taking office as the liaison officer for mandatory reporting, he is undergoing systematic training. “In the training, it was emphasized many times that the doctor should not be directly involved in the confrontation with the parents.”

“This is also the case when our hospital is dealing with such incidents. During the investigation phase, the doctor does not need to contact the suspect directly, but the liaison officer cooperates with the public security organ to collect evidence.”

Shanghai Children’s Hospital once treated a child with vomiting symptoms. The parents lied that the child had a bad stomach from the small intestine. During the actual diagnosis process, the doctor found that it did not match what the parents said. In addition, the child had obvious scars on the head and body, and the doctor chose to call the police that day.

Behind the scenes, Song Zhijun had been in contact with the police and parents. The child was pronounced dead due to serious injuries, and the forensic doctor was present to conduct preliminary evidence collection.

Setting up liaisons is a requirement in the “Work Tips for Medical Institutions to Strengthen the Compulsory Reporting of Cases Against Minors” jointly issued by the Putuo District Procuratorate and the District Health and Health Commission. Key reminders are given in five aspects, including reporting matters, reporting procedures, precautions, reporting responsibilities, and liaison personnel settings.

Three points for physicians and medical institutions to take note of:

1. Relevant medical record materials should be written, recorded and kept in accordance with regulations, and the materials should be submitted to the public security organs when reporting the case.

2. Care should be taken to protect the privacy of minors and keep information related to minors confidential.

3. Pay attention to the protection of the reporter and keep the reporter’s information confidential.

What situations require mandatory reporting?

In Song Zhijun’s view, protecting children’s physical and mental health is as important as treating diseases.

Opinions on Establishing a Compulsory Reporting System for Cases of Violation against Minors (for Trial Implementation) After the introduction of the system, doctors will be given a basis for protecting children. “In the past, doctors may think that this is someone else’s housework and intervene by themselves. It may not be suitable, I don’t know if I should participate. After the introduction of the system, it will give us a legal basis, and these reporting work can be done with confidence. said Song Zhijun.

The newly revised “Physician Law of the People’s Republic of China” also has relevant basis. Article 33 stipulates: There are two types of relevant situations that doctors should report to their medical and health institutions or relevant departments and institutions. : It is found that the patient is suspected of injury or abnormal death, and other circumstances stipulated by laws and regulations.

Putuo District Procuratorate printed a reminder card for mandatory reporting work and sent it to medical institutions, “The reminder card is a small plastic-sealed card, which can be placed in the front-line doctor’s office or consultation room, and can also be carried around. Song Zhijun said that doctors in the emergency department, various surgical departments, neonatal departments and intensive care units are all key departments for mandatory reporting.

The reminder card details 4 major categories of children and minors who have suffered or are suspected of being abused or at risk of being abused:

Abandoned minors are also a major concern for hospitals. Since 2018, Shanghai Children’s Hospital has handled 4 stranded children with the assistance of the Putuo District People’s Procuratorate.

“With regard to stranded children, our hospital and the Putuo District People’s Procuratorate have formed a good cooperation mechanism. Parents refuse to come to the hospital to learn about the child’s condition, or deliberately cut off phone, email, etc. contact for more than 6 months If the above, and affects the normal diagnosis and treatment and discharge of the child, we will report it to the procuratorate for further investigation. If the procuratorate collects evidence and does meet the crime of abandonment, the parents will be arrested and transferred to the court for trial and sentencing.”

Song Zhijun stated that after the parents were tried and sentenced, whether the child finally returned to the parents, or the child was handed over to the civil affairs agency for raising because the parents were unsuitable to continue raising. “In the end, children can grow up in a better environment than staying in the hospital, which is more beneficial to the children and the hospital.”

From accountability to entry

How to avoid minor abuse cases as much as possible? Song Zhijun said, “First, let the doctor report as much as possible, because the doctor may not understand every rule very clearly, and we have received more training.”

The mandatory reporting system for cases of violations against minors is involved in the Law of the People’s Republic of China on the Protection of Minors, which was revised and implemented in June 2021. Reporting violations is no longer an ethical choice but a legal obligation.

This means that doctors may be penalized for not reporting as required.

In May 2021, the Supreme People’s Procuratorate came up with a measure, the procuratorial organs and relevant departments to implement a “report or not” mandatory inspection mechanism for each case of violations against minors – as long as it is found during the handling of the case Where the units and personnel responsible for compulsory reporting fail to implement compulsory reporting responsibilities as required, resulting in serious consequences, sanctions shall be imposed on the persons directly responsible, and if a crime is constituted, criminal responsibility shall be investigated.

How to let doctors take the initiative to participate in mandatory reporting, establishing a contact person is one of the measures. Huzhou City, Zhejiang Province piloted a digital management method, and the mandatory report prompts directly enter the doctor’s diagnosis and treatment system.

In April 2022, Huzhou Maternal and Child Health Hospital made an attempt. When the doctor fills in the medical records of minors, the system will automatically pop up a window, and an automatic warning unit for compulsory reporting will appear, prompting abnormal medical treatment. elements.

“In front of the parents, it is inconvenient to call the police. Now you can fill in the information directly in the system.” said the doctor of Huzhou Maternal and Child Health Hospital.

Furthermore, digital management avoids delays in police reporting after a doctor’s report. According to the “Zhejiang Legal News”, when the front-end filling of the doctor’s admission is completed, the abnormal diagnosis and treatment records will automatically enter the data distribution platform, and the report information will be pushed to the public security organs online at the first time, and will be simultaneously pushed to the supervision of the procuratorial organs and the record of the health and health department. .

Source: Medicine

Proofreading: Zang Hengjia

Editor in charge: Tian Dongliang

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