FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`NYSCEF DOC. NO. 140
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`INDEX NO. 20-46602
`INDEX NO. 20-46602
`RECEIVED NYSCEF: 10/25/2023
`RECEIVED NYSCEF: 10/25/2023
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`EXHIBIT C
`EXHIBIT C
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`INDEX NO. 20-46602
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`RECEIVED NYSCEF: 10/25/2023
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`The problem of abused children has recently been recognized as a significant
`health concern. Nevertheless, many incidents in older children probably
`go unnoticed. In Syracuse, N. Y., a program was started on the premise
`that the school system would be valuable in detecting cases. The
`program and the results of the first four years of operation
`are presented.
`
`THE ABUSED CHILD AND THE SCHOOL SYSTEM
`
`C. George Murdock, M.D.
`
`chil-
`SINCE the dawn of civilization,
`dren have been abused or maltreated
`by adults. Many cultures for centuries
`used infanticide to appease their deities,
`eliminate defective offspring, and control
`early form of
`(an
`population
`their
`planned parenthood). Examples have
`been provided for us through the writ-
`other
`Dickens and
`Charles
`of
`ings
`authors. Who can ever forget the trials
`and sufferings of Oliver Twist told in
`such lurid detail by Dickens? The cruel
`indifference to the employment of chil-
`dren in the mines of Great Britain dur-
`ing this period was vividly described by
`the Earl of Shaftesbury in his speech to
`the House of Commons in 1842.1
`"In Oldham the mountain seams are wrought
`in a very rude manner. The ways are so low
`that only little boys can work in them, which
`they do naked, and often in mud and water,
`dragging sledge-tubs by girdle and chain. The
`child is obliged to pass on all fours-through
`avenues not so good as the common sewer,
`quite as wet, and often times more contracted.
`This kind of labour they have to continue
`several hours in a temperature described as
`perfectly intolerable."
`More recently, many of us can recail
`the horrible tales and vivid pictures of
`child labor in this country around the
`
`turn of the century in factories, sweat
`shops, and coal mines. These conditions
`were corrected by the Child Labor Laws
`and the general enlightenment of the
`public.
`However, despite the efforts of many
`governmental and private agencies, cases
`of child beating and maltreatment con-
`tinued to occur. The American Humane
`Association estimates that there are at
`least 10,000 cases of child abuse an-
`nually in the United States.2 Obviously
`only a small fraction of these cases are
`currently being reported.
`It is sometimes difficult to sharply de-
`marcate the difference between abuse
`and discipline. The attention of the med-
`ical profession was again drawn to this
`problem in 1946 by Caffey's report8
`which described the relationship between
`multiple fractures of the long bones in
`subdural hema-
`infants and chronic
`tomas. Other reports in the medical lit-
`children
`describing
`followed,
`erature
`with multiple injuries indicating new or
`recent trauma superimposed on old inju-
`ries. Increased public attention was ex-
`pressed by many magazine and news-
`paper articles as well as radio and tele-
`vision programs. A variety of profes-
`
`JANUARY, 19970
`
`-105
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`INDEX NO. 20-46602
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`RECEIVED NYSCEF: 10/25/2023
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`sional disciplines-medical, governmen-
`tal,
`social, and welfare-joined in at-
`tempting to meet the problem.
`
`Guidelines for Legislation
`In 1962, the Children's Bureau as-
`sembled a group of experts in this field.
`They agreed that these children must
`first be found and identified before the
`community could protect them, and rec-
`ommended the passage of state laws which
`would require physicians to report these
`cases with immunity from legal counter-
`suit. As a result, in 1963, the Children's
`Bureau published "The Abused Child-
`Principles and Suggested Language for
`Legislation on Reporting of the Phys-
`ically Abused Child," to serve as guide-
`lines.4
`State legislatures started to pass child
`abuse reporting laws in 1963 and, by
`1968, all 50 states had statutes. Since
`each state enacted legislation to meet its
`own circumstances, there was consider-
`able variation in the laws. Some states
`have already amended their
`original
`statute, while others are likely to do so
`in the future. A comprehensive review
`of the current state laws was published
`by the Children's Bureau in 1966: "The
`Child Abuse Reporting Laws-A Tabu-
`lar View."5 The variations
`in
`these
`statutes are too numerous to report in
`detail in this presentation.
`The New York State Law, which be-
`came effective July 1, 1964, makes the
`reporting of any suspected case of child
`abuse mandatory for physicians, den-
`tists, osteopaths or the superintendent,
`manager, or person in charge of any
`hospital, sanitarium, or other institution
`where such a child is being treated.
`Legal immunity is granted for such re-
`porting.
`Upon a personal request, the phrase
`"other institution" was interpreted by
`local and state legal counsel to include
`schools, since these children were com-
`ing to the Health Service rooms for ad-
`
`vice and treatment. Because of this legal
`decision, the school authorities in Syra-
`cuse were apprised by the health direc-
`tor of the new law, and its mandatory
`regulation for reporting suspected cases
`of child abuse, in September, 1964. The
`Syracuse School District was the first in
`New York State and one of the first in
`the nation to participate in this pro-
`gram. Subsequently, many other school
`districts in the state and throughout the
`country have adopted similar
`proce-
`dures.
`
`School Program in Syracuse
`Since its inception, the school pro-
`gram has been the greatest single source
`of uncovering these problems in Syra-
`cuse. This may be due to inadequate re-
`porting of these cases by physicians and
`hospitals in this community, since it has
`been found in other surveys that school-
`age children account for only 20-30 per
`cent of the total cases. On the other
`hand, these other surveys may not have
`used the schools as an identifying agent
`for older children. The program has
`been invaluable in the identification of
`abused children of school age because,
`in most cases, the injuries are not of
`sufficient severity to necessitate care by
`a physician.
`A simple reporting form (Figure 1)
`was prepared and copies were issued to
`all schools in the district. These were
`completed and returned to the office of
`the director of Health Service, where
`duplicate copies were made for filing,
`and the original report was then for-
`warded to the Children's Division of
`the County Department of Social Wel-
`fare. Two full-time social workers from
`that office were assigned to investigate
`suspected cases of child abuse, and they
`subsequently referred them to the local
`Family Court if any punitive action was
`deemed necessary.
`A central registry was established by
`the Children's Division which provided
`
`106
`
`VOL. 60. NO. 1. A.J.P.H.
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`INDEX NO. 20-46602
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`RECEIVED NYSCEF: 10/25/2023
`THE ABUSED CHILD
`
`for other reports from different sources
`such as physicians and hospitals. This
`accumulative file often revealed repeated
`abuse of the same child, or other sib-
`lings in the same family, and strength-
`ened the position of the division when
`action was deemed necessary.
`court
`of
`extreme mobility
`the
`Because of
`many of the families invelh ed, many
`authorities working on this problem have
`stressed the importance of central regis-
`at the local
`for these children,
`ters6
`level and, hopefully in the future, at
`state and national levels. Several states
`have already or are in the process of
`establishing such registers.
`
`Results
`The Syracuse school system has just
`completed its fourth year of reporting
`suspected cases of child abuse. In the
`school year of 1964-1965, 18 cases were
`in
`reported; in 1965-1966, 20 cases;
`1966-1967, 24 cases; and in 1967-1968,
`18 cases.
`An early reluctance on the part of
`school personnel to report these cases
`was overcome after they were informed
`that they would be given legal immunity
`
`and that reporting was mandatory. The
`total registration for the school district
`at about 30,000,
`has remained static
`and the general socioeconomic status of
`the community has remained relatively
`unchanged during the past four years.
`The ages of the children involved
`varied from 5 to 14 years, but were pre-
`dominantly in the younger age groups
`(Table 1). This is probably accounted
`for by the predilection of younger chil-
`dren to become involved in provoca-
`tive situations.
`The types of injuries sustained con-
`sisted mainly of ecchymosis and welts
`with
`sticks,
`whippings
`incurred
`by
`broom handles, ropes, belts, and elec-
`tric cords-with a scattering of lacera-
`tions caused by knives or other sharp
`objects. Upon investigation, the perpe-
`trators of the abuse were frequently
`found to be emotionally disturbed, men-
`tally handicapped or chronic alcoholics.
`When stepparents were involved, their
`relationship was often by common law
`only and impermanent. Almost all of
`our cases came from the lower socioeco-
`nomic group, which is contrary to the
`findings of other investigators.
`Case reporting was usually done by
`
`Figure I-City School District, Syracuse, N. Y., Report form for abused child (please
`type or print)
`
`Name
`Address
`
`_
`Birth Date
`Mother_
`_
`
`_
`
`Father_
`
`Description of injuries (location, degree, and extent) -
`
`Statement from child regarding injuries.
`
`Statement from witnesses, if any, or other pertinent information.
`
`uate
`
`JlSlnigatur
`Title
`
`Return to: Director, Health Service, 409 West Genesee Street, Syracuse, N. Y. 13202
`
`JANUARY. 1970
`
`107
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`INDEX NO. 20-46602
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`RECEIVED NYSCEF: 10/25/2023
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`Table 1-Case reports by year and age
`
`Age
`
`1964-
`1965
`
`1965-
`1966
`
`1966-
`1967
`
`1967-
`1968
`
`Total
`
`5
`6
`7
`8
`9
`10
`11
`12
`13
`14
`
`3
`5
`2
`2
`0
`0
`0
`0
`2
`4
`
`1
`1
`8
`2
`4
`1
`3
`0
`0
`0
`
`3
`4
`4
`2
`4
`3
`1
`2
`2
`0
`
`1
`2
`4
`2
`2
`2
`1
`2
`0
`2
`
`Total
`
`18
`
`20
`
`25
`
`18
`
`8
`12
`18
`8
`10
`6
`5
`4
`4
`6
`
`81
`
`the school nurse-teacher after referral
`to her office, but other school person-
`nel were also involved (Table 2). Prior
`to the submission of the report, the
`school
`physician examined any sus-
`pected cases whenever he was available.
`Reports
`periodically
`obtained
`are
`from the Children's Division concerning
`the findings of their investigation and
`the disposition of each case. Two social
`workers have been relieved
`of other
`duties by the division so that they might
`devote their full attention to the solu-
`tion of these problems. The disposition
`of cases is shown in Table 3. A copy of
`each report from the division is returned
`to the individual who made the initial
`referral. This maintains their interest in
`the program and gives them a sense of
`accomplishment.
`
`Difficulties and Recommendations
`The following difficulties encountered
`in initiating our program might serve
`as guidelines for other school systems
`contemplating similar projects.
`i. The reluctance of school personnel to re-
`port suspected cases, for fear of legal involve-
`ment and court appearances, can be overcome
`proper presentation
`by a
`the" problem,
`of
`
`especially in those states where reporting is
`mandatory.
`2. Maximum cooperation between the school
`system and the investigating agency is of ex-
`treme importance. A frequent exchange of in-
`formation between the two organizations should
`be encouraged, not only in the initial reporting
`but also in the continued observation of these
`cases.
`The following recommendations of
`the Committee on Infant and Pre-School
`Child
`of the American Academy of
`Pediatrics regarding child abuse are ex-
`cellent.6 It is suggested that school per-
`sonnel and school systems be added to
`physicians and hospitals in these state-
`ments.
`1. Physicians should be required to report
`suspected cases of child abuse immediately to
`the agency legally charged with the respon-
`sibility of investigating child abuse-preferably
`the county or state department of welfare or
`health or their local representatives, or to the
`nearest law enforcement agency.
`
`Table 2-Reporters
`
`1964-
`1965
`
`1965-
`1966
`
`1966-
`1967
`
`1967-
`1968
`
`Total
`
`Nurse-
`teacher
`Principal
`Visiting
`teacher
`Teacher
`Guidance
`counselor
`School
`physician
`
`6
`6
`
`1
`3
`
`1
`
`1
`
`8
`6
`
`0-
`3
`
`0
`
`3
`
`16
`4
`
`4
`1
`
`0
`
`0
`
`11
`0
`
`2
`1
`
`1
`
`4
`
`41
`16
`
`7
`8
`
`2
`
`8
`
`Table 3-Disposition
`
`Year
`
`Closed
`
`Open
`
`1964-1965
`1965-1966
`1966-1967
`1967-1968
`
`Total
`
`10
`15
`8
`3
`
`36
`
`0
`1
`10
`11
`
`22
`
`Place-
`Un-
`ment known
`2
`2
`1
`3
`2
`2
`3
`1
`
`8
`
`8
`
`X08
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`VOL. 60. NO. 1
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`A.J.P.H.
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`INDEX NO. 20-46602
`FILED: ORLEANS COUNTY CLERK 10/25/2023 02:56 PM
`NYSCEF DOC. NO. 140
`RECEIVED NYSCEF: 10/25/2023
`THE ABUSED CHILD
`
`2. The agency should have ample personnel
`and resources to take action immediately upon
`receipt of the report.
`3. Reported cases should be investigated
`promptly and appropriate service provided for
`the child and family.
`4. The child should be protected by the
`agency either by continued
`hospitalization,
`supervision at home, or removal from home
`through family or juvenile court action when
`indicated.
`5. The agency should keep a central register
`of all such cases. Provision should be made for
`the removal of case records from the register
`when it is found that abuse did not, in fact,
`occur.
`6. The reporting physician or hospital should
`be granted immunity from suit.
`A program following these principles
`should
`be
`successful
`in
`identifying
`abused children and in protecting them
`from further abuse, in restoring those
`families that are capable of rehabilita-
`tion, in allowing the physician to per-
`form responsibly within the bounds of
`medical knowledge and ethics, and in al-
`lowing the community to meet its ob-
`ligations to its children.
`
`Summary
`The problem of abused children has
`recently been brought into sharper focus
`by the enactment of laws by state legis-
`latures for the protection of these indi-
`viduals.
`Although physicians and hos-
`
`pitals are the primary sources for iden-
`tifying these cases, especially in infants
`and preschool children, it was felt that
`many incidents in older children went
`unnoticed.
`With the supposition that a school
`system might be valuable in revealing
`suspected cases in older children, a pro-
`gram was initiated
`the Syracuse
`in
`(N.Y.)
`School District. This program
`is described in detail and the results
`of the four years since its inception are
`outlined.
`
`3.
`
`REFERENCES
`1. Pediatrics 41,4:749 (Apr.), 1968.
`2. De Francis, V. Child Abuse-Preview of a
`Nationwide Survey. Denver, Colo.:
`Chil-
`dren's Division, American Humane Asso-
`ciation, 1963.
`Caffey, J. Multiple Fractures in the Long
`Bones of Infants Suffering from Chronic
`Subdural Hematoma. Am. J. Roentgenol.
`56:163, 1946.
`4. Children's Bureau, United States Depart-
`ment of Health, Education, and Welfare. The
`Abused Child-Principles and Suggested
`Language for Legislation on Reporting of
`the Physically Abused Child. Washington,
`D. C.: Gov. Ptg. Office, 1963.
`. The Child Abuse Reporting
`Laws-A Tabular View. Washington, D. C.:
`Gov. Ptg. Office, 1966.
`6. Report of Committee on Infant and Pre-
`School Child: Maltreatment of Children.
`Pediatrics 37,2:377 (Feb.), 1966.
`
`5.
`
`-
`
`Doctor Murdock is Director, Health Services, Syracuse City School District
`(409 West Genesee Street), Syracuse, N. Y. 13202, and Clinical Professor,
`Emeritus, of the Department of Pediatrics, New York State University Upstate
`Medical College, Syracuse.
`This paper was presented before a Joint Session of the American School Health
`Association and the School Health Section of the American Public Health
`Association at the Ninety-Sixth Annual Meeting in Detroit, Mich., November
`12, 1968.
`
`JANUARY. 1970
`
`1109
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`