Suspected Non-accidental Trauma: Femoral Shaft Fractures

Imagine the following:

You are the parent of two boys, ages 12 and 2.  Your children get along well – the 12-year-old recently helped you wean the little one off of bottles and takes pride in teaching his brother new things.  “Follow the Leader” has been one of the pair’s favorite games since the youngest learned to walk, and your five-acre property in Peoria provides ample space for the boys to play.  Bumps and bruises are common occurrences, and you keep the medicine cabinet well-stocked with bandages and antibiotic ointment.

Emergency Room (Woodnick)One day, during a particularly intrepid session, the 12-year-old guides the younger boy through the grass, over the lawn tractor, and into the part of the yard where your horse trailer is stored when not in use.  Because of your own recent injury – a car accident has left you unable to work for two years and the children are insured through KidsCare as a result of your low income – the yard is not as well-kept as it once was, leaving a lot of undergrowth around the trailer.  Because of the tall weeds, neither boy notices that a rattlesnake has taken up post in the weeds looking for a meal.  The younger boy notices the snake first and screams.  The snake, startled, coils up and begins its telltale warning rattle.

The 12-year-old immediately runs back to rescue his brother and scoops him up before the snake strikes.  Unfortunately, as the older boy is running away with the younger in his arms, he trips and drops his brother.  The younger boy lands on the tongue of the trailer, before falling to the ground, just as you arrive to see what the commotion is all about.

You check on your sons and discover that a large bruise has already formed on the leg of the 2-year-old, who is clearly in tremendous pain.  Like any parent would, you retrieve an ice pack from the freezer, instruct the older boy to keep it on his brother’s leg while in the car, and drive to the hospital as fast as the speed limit allows.

When you arrive, everything goes as expected: registration, triage, and a relatively short wait before your injured child sees a doctor and is taken for x-rays.  While you wait, a hospital social worker asks you and your older son some questions and fills out a form on a clipboard.  The radiologist eventually reads the x-rays and determines that your young son has sustained a femoral shaft fracture.

X-Ray (Woodnick)Little known to you, the doctor tipped off the social worker when you arrived because she found the injury suspicious.  Now that the femoral shaft fracture has been confirmed by scans, the doctor’s suspicion is even greater – so much so that she believes her duty to report abuse under A.R.S. § 13-3620 has been triggered.

As a result, the social worker calls Child Protective Services (“CPS”) and begins investigation of suspected non-accidental trauma (“SNAT”).  You are prevented from leaving the hospital and you and your sons are separated while CPS officials perform a preliminary investigation.  The younger boy is highly impressionable and, although advanced in speech for his age, will still respond with a “yes” to most questions, particularly when they are asked of him by adults.  His interviewer coaxes the boy to admit that he gets hurt often.  When the 12-year-old is asked about suspected abuse, he promptly denies any wrongdoing.

One CPS worker discovers several bruises and cuts on both boys – you know them to be the result of having two rambunctious boys who like to play outdoors – and records them in the report.  As a result of the femoral fracture, the boys’ testimony, the presence of bruising and abrasions on both children, and the fanciful nature of the rattlesnake story, CPS determines that the children may be at risk and removes them from your custody until a formal investigation can be performed.

Just like that, your son’s unfortunate accident turns into a formal accusation of child abuse because the doctor and CPS officials are trained to identify femoral shaft fractures as suspected non-accidental trauma (SNAT) – a strong indication of abuse even if the injury is explained by the parent.

What do you do?

First, know that CPS will attempt to place the children with a family member, usually grandparents, while the investigation proceeds.  Next, call an experienced Arizona child abuse and neglect defense attorney.

Girl in Cast (Woodnick)The presumption that a femoral shaft fracture is more frequently caused by abuse than by accident is not insurmountable, but it carries significant weight in CPS proceedings.  In order to prove that no wrongdoing has occurred, you may need to hire an expert to review the x-rays and compare them to the scene of the accident in order to refute the claim of abuse.  Because the eyes of judges and jurors tend to glaze over when they hear complex medical testimony, your attorney will need to understand not only the law, but also the medicine and how to synthesize the two in a way that non-experts can understand.

In 2011, the Phoenix Children’s Hospital published a study about CPS SNAT investigations and femoral fractures at their institution (you can access the study here: http://www.ncbi.nlm.nih.gov/pubmed/21598897).  Doctors within the Division of Pediatric Orthopedic Surgery there observed that, over a five-year period, 31% of children with femoral shaft fractures were referred to CPS due to suspicion of non-accidental trauma.  Among children younger than 1 year, 90% of those children were referred to CPS.  Children whose parents used Medicaid or who had no insurance were also statistically more likely to be suspected.

These observations – that younger children and children of low-income families are more likely to be referred to CPS due to suspected non-accidental trauma – are just a few of the dangerous assumptions that we have seen lead to CPS action against fit parents.  Femoral shaft fractures are not the only common SNAT injuries, either: spiral fractures, circular burn marks, oddly shaped bruises, and cervical spine injuries are just a few of numerous alarm-triggering issues that many physicians feel obligated to report.

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One thought on “Suspected Non-accidental Trauma: Femoral Shaft Fractures

  1. Mel

    I was left speechless while reading this article and it made me sick to my stomach. Is there any recourse for the families affected by these medical claims to abuse?

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