WASHINGTON – Janice A. Kispert called a dozen doctors last summer looking for one to work a few hours a week at the Frederick County Child Advocacy Center, examining young victims of chronic sexual abuse.
When they all turned her down, Kispert wrote to the local pediatric association, begging for someone who could do forensic tests and testify in court so the state could take her most vulnerable clients out of dangerous homes.
When that failed, she stood up in her night marketing class at Johns Hopkins University, hoping her classmates might know a doctor who would take on the task.
“I asked everybody and anybody I saw,” Kispert said. “I went to them and said, `Please, dear Lord, help me, I cannot find a doctor.'”
Her struggle is common to advocates across the state, who say caps on public funding and a lack of doctor training make it all but impossible for local health centers to find physicians willing to give their time to help young victims of sexual and physical abuse.
Dr. Scott Krugman, head of pediatrics at Baltimore’s Franklin Square Hospital, said a study he did in 1999 showed that fewer than half of all Maryland kids who were suspected victims of abuse were examined by doctors trained to deal with child trauma and to collect forensic evidence.
Some kids — like those who reported molestation years after the event — did not need an exam, Krugman said. But for those who said they had been abused days or weeks earlier, the state did not have enough physicians to deal with their cases, especially in rural areas.
In Maryland, each county determines how to provide medical attention to abused children, which leads to a disjointed system, Krugman said. In Baltimore, for instance, a full-time physician handles all cases. But in Somerset County, abused kids are sent to emergency rooms, and Howard County contracts with a University of Maryland pediatrician.
“There are a lot of kids who slip through the cracks, who are blown off,” Krugman said. “The fact that a lot of these kids aren’t seeing any doctor is concerning to us.”
Many doctors are unwilling to take time off from their private practices because they get little or no compensation for their work, which could last days if a doctor has to go to court for the child, said Bobbi Seabolt, public policy director of the American Association of Pediatrics’ Maryland chapter.
“When a child goes to the ER and has a broken arm, insurance will pay to set that arm,” Seabolt said. “But when the child then says, `My daddy did this to me,’ everything beyond that is not covered.
“All the forms, the interviews, the depositions, all the time in court is all time that the physician is out of his practice,” she said. “In the case of a private physician, he will never be able to recoup those hours.”
Kispert, who eventually got a University of Maryland doctor to work five hours a week at her center, said several physicians laughed at her when she told them she only could pay $50 per hour because of a local health department cap on contract service fees.
“One woman almost hung up on me,” she said.
Teresa Thorn, program manager at the Washington County Child Advocacy Center, said she tried for 18 months to find a physician. When she called other centers around the state hoping one would share its doctor, she found they were in the same situation.
For Thorn, a doctor or nurse was the last critical need in her center, which already had staff to provide mental health care, law enforcement services and legal advocacy to child abuse victims.
“We want to be a place where our community knows they can come for a whole range of services, including medical services,” she said, adding that a local doctor recently volunteered to work four hours a week.
Krugman said the current patchwork system not only denies many kids necessary medical attention, but also lessens the chance of preserving physical evidence of abuse. In court, that could mean the difference between sending molesters to jail and returning kids to abusive situations.
Advocates have asked the legislature three times — including once this year — to give roughly $500,000 for a statewide system that would provide financial incentives and continuing education for doctors to cater to young abuse victims. Each time, they have been denied.
Krugman believes it is because lawmakers do not understand how crucial medical treatment is to making sure abused children are not returned to dangerous households.
“I don’t think anyone really understands it,” he said. “I know that there’s no money in a time of tight state resources, but it’s this lack of foresight that pretty much makes it so that kids go back into abusive situations and then wind up back in the system all over again.”