Caught In The Middle

A mother named Jane Peel brought in her 4 year old daughter Jane Peel for evaluation of possible sexual assault.

Mother Jane Peel stated that daughter Jane Peel told her that mother Jane’s live-in boyfriend John Peel (no relation) touched daughter Jane Peel in her “boo-boo.” When I went into the room and started to get a history, mother began prompting daughter to describe what happened to her.

“Did John touch you in your boo-boo?”
“Yes.”
“Show him where John touched you.” The child looked at her and then pointed to her genital region.
“When did he touch you there?”
“When mommy went to work.”
Every time I tried to ask daughter a question, mother interjected. After several rounds of this, I asked the mother to leave the room. She seemed upset about being asked to leave. As she was walking out, she told her daughter to “remember what we talked about.”

I started off by asking her what she and her mother had talked about.
“John”
“Who is John?”
“He’s a pig!”
“You have a pet pig named John?”
“Yup.”
“Do you have any friends?”
“Yup.”
“Who’s your best friend?”
“Anna.”
“Does your mommy have a boyfriend?”
“Yup.”
“Has your mommy’s boyfriend ever hurt you?”
“He spanked me on my butt when I was crying because my mommy went to work.”
“Did your mommy’s boyfriend ever touch you anywhere else?”
“No.”
“Did he ever touch you in your ‘boo-boo’?”
“Yes.”
“You mean down there (pointing to genital region)?”
“Ummm … no.”
“Did Anna ever touch you on your butt?”
“(Laughing) Nooooo.”

From this interaction, I got the impression that the child could generally identify people, but that she did not necessarily understand what her “boo boo” was or whether the boyfriend actually touched her genitals.

The nurse and I also performed an examination of her genitals and there were no signs of abuse. In fact, there was a small amount of lint along her upper genital region, leading me to believe that if she had been touched there, it wasn’t very much.

We let the mother back in the room and told her about our discussions with daughter Jane and the normal physical examination. Immediately mother Jane started in with the interrogations.
“Did John touch you in your boo-boo?”
Daughter Jane said “Yes.”
I asked Daughter Jane “Who’s John?”
Again, she replied “He’s a pig!”
Mother Jane shot me a scowl.
Then I asked her if Anna ever touched her in her “boo-boo.”
She looked at her mom who shot me another scowl and then said “Yes.”
Then I asked her if her mommy ever touched her in her “boo-boo.”
Without batting an eye, she said “Yup.”

Mother Jane told us “You’re just confusing her now.”

I charted the questions I asked, the answers daughter Jane gave me, mother Jane’s demeanor, and the normal physical examination. We also notified the police and gave them a copy of the chart.
Needless to say, mother Jane Peel left the ED unhappy.

Being accused of the sexual assault of a child is a major deal. It has been my experience that when a child is brought for an evaluation of possible sexual assault, often people tend to assume that the accused is guilty until proven innocent. In this case, the boyfriend was already in jail.

Here lies yet another problem emergency departments frequently encounter.

We are here to protect the patients, but how do we decide what is in the patient’s best interests? Is the boyfriend abusing the child or does the mother just have some ulterior motive for getting the boyfriend in trouble?

If he is charged, I may end up having to testify at the boyfriend’s trial. If there are no physical signs of injury, how are you supposed to prove that you didn’t touch someone?

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