Suspected physical abuse

• The MRT has a responsibility to respond to suspected physical abuse when identified, and where possible, prevent further abuse¹.
• CAMRT documentation consistently refers to the welfare of patients as a focus and the requirement for the MRT to act as an advocate for patient welfare and rights^2,3.
• Once signs of possible physical abuse are recognized, it is the duty of the MRT as patient advocate to pursue the matter through the appropriate channels.

Legal obligations

• For child abuse, the MRT has a legal duty to report, which overrides any duty of confidentiality.
  • In every Canadian province and territory except the Yukon, there is legislation that creates a duty to report cases of suspected abuse or neglect of children⁴
  • Failure to report abuse can carry legal penalties (e.g., fines of up to $10,000 for failure to report child abuse)⁵
  • The reporter does not need to know that abuse or neglect has occurred; it is sufficient for there to be “reasonable and probable grounds to believe”⁶
• Reporting of elder, spousal, and other abuse is not mandatory in any province or territory in Canada at this time, but there have been arguments made in its favour (particularly elder abuse in nursing homes)⁷.
• MRTs should be aware of the reporting obligations under any legislation applicable in their province and facility policy regarding the reporting of physical and sexual abuse of patients.

• Working in healthcare, MRTs have the potential to come into contact with people who have suffered physical abuse.
  • Diagnostic imaging is often a mechanism by which physical abuse is discovered
  • MRTs should be familiar with institutional policies and procedures relating to suspected abuse
• Abuse should be considered in cases where bruises, welts, cuts, burns (or other injuries) are found on the patient’s body⁸.
  • Fractures or injuries at varying stages of repair and repetitive injuries are also suggestive of abuse^8,9
  • Bruises on the buttocks are in the primary target zone for non-accidental injury in children
• When an MRT suspects abuse, it should be reported and referred to the appropriate authorities so that follow-up investigation and management is carried out, including⁸:
  • Patient interview
  • Physical examination
  • Further imaging/testing
• The extent to which the MRT is involved in the follow-up of abuse depends on facility/local protocols and procedures.
• If the patient is in a position to help him/herself, the opportunity is taken to provide information to the patient about support mechanisms and resources¹.

• If the MRT is involved in uncovering suspected abuse, he/she will be involved in documenting the relevant details.
• Patients are advised that although the information remains confidential, it will be documented in the medical record¹.
• Speed is important in ensuring the safety of abuse victims, so reports are made to the appropriate authorities immediately:
  • In cases of abuse against women, it is the woman’s right to choose if she wishes to involve the police
• The MRT documents any visible signs of physical signs of injury/abuse on the patient’s medical record or on the requisition.
• The MRT also notes other aspects of the patient encounter that could be relevant to investigation¹:
  • Emotional, psychological and behavioural responses
  • Responses to questions
  • Treatment or care provided
  • Follow up