Julie, a 38 year-old mother of two children and a long standing patient, presents to you for a follow-up appointment. Julie seems more anxious than usual and at the end of the appointment she discloses for the first time that she was sexually abused by Mr P from the ages of 12 to 14, but was too frightened at the time to tell anyone. She felt that she should say something now as she has heard that Mr P has returned to the area and is working as a gardener at the local school. She is very worried that he may do the same thing to other young girls.*
As a doctor you are aware of your obligation to report concerns about children at risk of harm. However you wonder what you should do as Julie suffered the abuse as a child and many years have passed. Should you report Mr P to the police?
Doctors uncertain on how to deal with past child abuse reports
Doctors’ obligations around mandatory reporting of child sexual abuse can be unclear and often confusing given that there are differences in the requirements across states and territories. It was also recently found, as part of the Royal Commission into Institutional Responses to Child Sexual Abuse ‘Report of Case Study 27’, that doctors are particularly uncertain about how to deal with reports by adults of abuse they suffered as children. The Royal Commission deemed that doctors need further education and training about their mandatory reporting obligations, particularly when considering historical child sexual abuse.
Royal Commission findings
As a result of public hearings conducted during May 2015, a number of systemic issues were identified, including the ways healthcare services and the regulators receive and respond to reports of child sexual abuse and in particular historical claims of this type of abuse.
It was recognised in the subsequent Royal Commission report that medical practitioners will often be a key person in the early identification and reporting of incidents of child sexual abuse.
Mandatory reporting obligations in your state
While each state and territory has slightly different legislation, they all require doctors to report suspected child sexual abuse. This generally applies to anyone up to the age of 18, except in NSW where reports for 16 and 17 year old patients are voluntary and in Victoria where it is mandatory only up to the age of 17. In the Northern Territory a child can include someone who appears to be under 18 years old and in Western Australia can include someone whose age cannot be proven.
When should you report past child sexual abuse?
In situations like the case example above where an adult patient has informed their doctor of past sexual abuse, doctors’ mandatory reporting obligations vary depending on the state or territory.
In NSW, doctors must make a mandatory report if there is an identifiable class of children at risk of significant harm, such as when an adult patient reports that they know an alleged offender continues to have contact with children, for example through their occupation. This means that the doctor must report the suspected or reported abuse, even if there appear to be barriers such as the length of time between the adult patient’s own reported abuse (meaning they are no longer a child under the legislation) and the time of the report.
The legislation in the other states and territories differs in that they do not contain equivalent provisions to those in NSW regarding reporting classes of children at risk. However, evidence given by witnesses in the Royal Commission highlighted a common theme. One of the first questions asked by survivor victims when reporting their own abuse was whether the people that abused them were still practising in healthcare or otherwise had contact with children. This can often be the tipping point prompting a victim to talk about their historical sexual abuse, as they are concerned about protecting other children.
Therefore, the obligation to report child sexual abuse may arise from a reasonable belief or suspicion that sexual abuse may continue to be perpetrated against other children in close contact with the alleged offender. If these legal obligations are not triggered in particular circumstances, information may still be disclosed to police if the exceptions to disclosure without patient consent are met under the privacy legislation. Read our article on disclosure of information to the police.
Key lessons
In view of the Royal Commission’s recommendations, the Australian Institute of Family Studies published resources clarifying doctors’ mandatory reporting obligations in each state and territory and outlining how to make a report. Of course, each situation will be different, inherently complex and sometimes uncertain. Essentially, doctors’ obligations are as follows:
- Suspected child sexual abuse must be reported in all states and territories to the Child Protection Unit at the State or Territory Department of Health.
- A report of historical sexual abuse by an adult patient may still warrant reporting to the Child Protection Unit, where the offender continues to have contact with children, particularly if through their occupation and there is a risk of harm to the children.
- If the law does not mandate reporting of historical sexual abuse, information may be able to be disclosed to police under the privacy provisions. However, it is necessary to ensure these provisions apply to a particular situation.
*This case has been created based on our experience. All names have been created and any relation to actual people is purely coincidental.
Need advice?
If you need advice on your mandatory reporting obligations around suspected child sexual abuse or historical accounts of abuse, call Avant’s Medico-legal Advisory Service on 1800 128 268.
Visit the Avant Learning Centre for resources including case studies, articles, eLearning courses, fact sheets, checklists and webinars.
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