Dr. Konstantinos Gus Agoritsas

Sometimes digging a little deeper can save a child' s life, says Dr. Konstantinos Gus Agoritsas, Director of Pediatric Emergency Medicine at Kings County Hospital. The doctor recalls the 9-month old baby who was brought into the ER with a bruised cheek. On the surface, the doctor remembers, the baby boy's cheek looked like a typical black-and-blue mark.

The parent said the baby was hit when he crawled into a door that was opened suddenly, recalled Dr. Agoritsas. That could have been the true story, and perhaps in another time or in another emergency room, the baby would have been given an ice pack and sent home. But in this case, a thorough medical evaluation revealed that the bruised cheek was only the tip of the iceberg.

“When I removed the baby's clothes, I found his right leg was swollen,” the 37-year-old physician recalled. “Then we ordered X-rays and these showed that the baby's leg was fractured and that several of the baby's ribs had been broken as well.” The doctor and his team provided the medical care the baby needed and alerted law enforcement authorities.

“I like to think that we intervened and saved the baby's life,” the doctor said.

It's this kind of intervention that Dr Agoritsas and his team find rewarding amid the difficult and often painful work they do on a daily basis as part of the Comprehensive Evaluation and Treatment of Child Abuse and Neglect program (CETCAN) at Kings County Hospital. HHC established CETCAN programs in all city-run hospital emergency rooms in 2007 following the death of Nixmary Brown, a 6-year old Brooklyn girl who had been chronically abused.

Medical providers are on the front lines of identifying, treating and reporting child abuse and neglect. As part of CETCAN, a Child Abuse Response Team (CART) -- made up of a medical doctor, social worker, mental health professional and a child protection coordinator -- is available in the emergency department or on call 24 hours a day, seven days a week.

Children who are brought in are examined and treated promptly by the team. After the examination, team members decide if child abuse or neglect is suspected and if so, report it to local law enforcement authorities and child welfare workers. The team agrees on a treatment plan for the child and refers him or her to the hospital's Child Advocacy Center, where a similar team follows up with additional medical care and social work needs.

What is most important about CETCAN, Dr. Agoritsas said, is that it organized all the processes in one place, improved communication among the entire professional group and child welfare agencies and most importantly, improved the follow through. Every month a multi-disciplinary team made up of pediatric emergency medicine physicians and nurses, a child protection coordinator, child abuse experts and psychiatrists meet to further discuss cases that they feel stand out and need follow up.

In 2008, the Kings County CETCAN team evaluated 233 cases. Of those, 41 percent were found to be maltreatment or neglect, 35 percent were physical abuse, 21 percent were sexual abuse and 3 percent were other or unclassified.

In 2009, the team evaluated 241 cases. Of those, 43 percent were maltreatment or neglect, 38 percent were physical abuse and 19 percent were sexual abuse.

“It's a place where children can be seen immediately and it allows us to intervene early and follow through,” he said. “The CETCAN program ensures access to care and provides for the safety and well-being of all children in New York City.”

November 2010