There are times when a child, young person, parent, guardian or caregiver may need a physical, psychological or psychiatric medical examination. It is important that these examinations are carried out by a practitioner who is qualified and appropriate to do that; that necessary consent is obtained and, in the case of a child or young person, that caring support and reassurance is given through the process.
During the course of Oranga Tamariki involvement, a child or young person may require a medical examination.
This key information outlines the three provisions of the Oranga Tamariki Act 1989 s53 medical examinations of a child or young person at the request of a social worker, s49 Court ordered medical examination and s178 medical, psychiatric or psychological reports) whereby a medical examination can be arranged for a child or young person.
Section 53 of the Oranga Tamariki Act 1989 enables a social worker, with the consent of any parent or guardian, to arrange a medical examination in respect of any child or young person for whom a warrant has been issued under s39 or who has been placed in the custody of the chief executive under s40 or 42 of the Act (s53(1)).
When arranging these medical examinations, you should obtain the parent or guardian’s consent where possible. Sometimes, even after unsuccessfully making reasonable efforts to obtain the consent of the parent or guardian, you may still wish for an examination to proceed. In situations where you have not been able to get consent you should seek advice from your supervisor.
It is important you arrange for a medical practitioner experienced in child abuse work to undertake the examination. Doctors for Sexual Abuse Care (DSAC) are specially trained in determining sexual abuse. Each office should have a list of these doctors.
Speak to the medical practitioner about the reasons for the examination and the need for a written report. The examination may be used to support proceedings in Court and the medical practitioner may also be called to give evidence.
It’s important to remember that this may be a difficult process for the child or young person. Make sure they have someone with them that can provide support and reassurance. They are entitled to this so discuss with them whether they want someone with them and if so, who this might be.
There are special provisions governing internal examinations of the genitals or anus. They can only be carried out if the medical practitioner believes the child or young person may have been subject to recent physical or sexual abuse involving those parts of the body, and the child or young person consents to such an examination. No medical procedure that involves the administration of a general anaesthetic can be used.
Social worker’s report to the chief executive
If the medical examination is completed without parental or guardian consent, you must prepare a report to your regional director (on delegated authority from the chief executive) within three days of the examination being carried out. This report should outline the circumstances that required the medical examination to be carried out. Also provide information about what actions to obtain consent were taken. The regional director will let you know they have received your report, so if you don’t hear from them follow this up.
Under s49 of the Oranga Tamariki Act 1989 a social worker can apply for a Court ordered medical examination before or after making an application for declaration that the child or young person is in need of care and protection. To make this order, the Court must be satisfied that there are reasonable grounds for suspecting a child or young person is suffering ill-treatment, abuse, neglect, deprivation or serious harm, and that a medical examination needs to be carried out as soon as possible to find out whether the suspicion is well founded. The Court can impose restrictions on the nature of the medical examination and the procedures to be used and the medical examiner must provide a report to the Court.
The Court may, upon application by any party to the proceedings or of its own motion, order a child or young person or a parent/guardian/caregiver to have a medical, psychiatric or psychological report at any stage of the care and protection proceedings (s178). Before such an order is made for a parent or guardian or caregiver, that person’s consent is required.
Whenever you may think a medical examination is needed it’s always useful to talk to your team about what you think and how you might go about it. Using team members whenever you have complex practice decisions to make is a good idea.