Many states impose penalties, either a fine and/or imprisonment, for failure to report child maltreatment. A mandated reporter, such as a physician, may also be sued for negligence for failing to protect a child from harm. The landmark California case Landeros v. Flood et al. (17 Cal. 3d 399, 551 P.2d 389, 1976) illustrates such a case. Eleven-month-old Gita Landeros was brought by her mother to the San Jose Hospital in California for treatment of injuries. Besides a fractured lower leg, the girl had bruises on her back and abrasions on other parts of her body. She also

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appeared scared when anyone approached her. At the time Gita was also suffering from a fractured skull, but this was never diagnosed by the attending physician, Dr. A. J. Flood.

Gita returned home with her mother and subsequently suffered further serious abuse at the hands of her mother and the mother's boyfriend. Three months later Gita was brought to another hospital for medical treatment, where the doctor diagnosed "battered child syndrome" and reported the abuse to the proper authorities. ("Battered child syndrome" refers to the collection of injuries sustained by a child as a result of repeated mistreatment or beatings. The term was coined in 1961 by Dr. C. Henry Kempe and his colleagues and includes not only

physical assault but other forms of abuse, such as malnourishment, failure to thrive, medical neglect, and sexual and emotional abuse. The term now used is child maltreatment.)

After surgery the child was placed with foster parents. The mother and boyfriend were eventually convicted of the crime of child abuse. The guardian ad litem (a court-appointed special advocate) for Gita Landeros filed a malpractice suit against Dr. Flood and the hospital, citing painful permanent physical injury to the plaintiff as a result of the defendants' negligence.

The trial court of Santa Clara County dismissed the Landeros complaint, and the case was appealed to the California Supreme Court. The California Supreme Court agreed that the "battered child syndrome" was a recognized medical condition that Dr. Flood should have been aware of and diagnosed. The court ruled that the doctor's failure to do so contributed to the child's continued suffering, and Dr. Flood and the hospital were liable for this. While this case applied specifically to a medical doctor, the principles reached by the court are applicable to other professionals. Most professionals are familiar with the court's decision in Landeros.

Although all states have enacted legislation requiring, among other things, the mandatory reporting of child maltreatment by certain professionals, states vary in the standard for reporting. The standard to report child maltreatment varies from, "have reasonable cause to suspect," to "have reason to believe," to "have observed conditions which would reasonably result," to "know or suspect."

EMERGENCY NURSE CHARGED WITH FAILURE TO REPORT. On August 10, 2002, two-year-old Dominic James was brought to Cox South Hospital in Springfield, Missouri. Paramedics told emergency nurse Leslie Ann Brown that the boy, who was having seizure-like symptoms, had bruises on his back and to report this to the attending physician. Told by Dominic's foster parents that the child got bruised by leaning back on a booster seat, Brown did not report the bruises to the physician. Neither did she include the presence of bruises on her medical reports. Dominic was rehospitalized a week later and died soon after.

In February 2003 the state of Missouri charged Brown with failure to report child abuse. In September 2003 Green County Judge Calvin Holden dismissed the

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criminal charges, stating that the Missouri statute with the "reasonable cause to suspect" standard for reporting child abuse was unconstitutionally vague in violation of the U.S. and Missouri Constitutions. The state appealed the case in May 2004. In August 2004 the Missouri Supreme Court reversed Judge Holden's ruling, allowing the case to proceed to trial.