Opinion ID: 766396
Heading Depth: 2
Heading Rank: 2

Heading: Physical Examination of Sarah

Text: 123 The majority is on stronger precedential ground in sections I.B. and III.B., which address the physical examination of Sarah. It concludes that the examination was investigative in the police sense, rather than medically indicated, and therefore inappropriate without parental consent or judicial preauthorization. 124 The principal authority in this Circuit on the question of medical examinations during the course of child abuse investigations is van Emrik v. Chemung County Department of Social Services, 911 F.2d 863 (2d Cir. 1990). In that case, two parents took their small child to the hospital, where a leg fracture was diagnosed. See id. at 864. Suspicious that the baby-sitter had caused the injury, the parents agreed with hospital personnel that the case should be reported to the state's child abuse hot line. See id. at 864-65. 125 When the child was about to be discharged, the assigned case worker asked the attending physician to perform long-bone x-rays. Id. at 865. The doctor demurred because of the radiation risk, and so advised the case worker. See id. The case worker prevailed on the doctor, however, insisting that she needed to know if there were other fractures that had gone undetected and had healed. Id. 126 In a fact-specific opinion, the van Emrik court emphasized that the x-rays in that case were not medically indicated and that the doctor had initially opposed them. Id. at 867. The x-rays were not sought to facilitate diagnosis or treatment.... but to provide investigative assistance to the caseworker. Id. The court concluded that parents' liberty interest in the care, custody, and management of their child was especially significant when an examination serve[s] primarily an investigative function. Id. In such cases, the Court held, it is improper to perform the examination without a judicial finding of justification and reasonableness. 127 The district court here found that the gynecological examination of Sarah--like the examination of the child in van Emrik--was not conducted 'to provide medical treatment to the child, but to provide investigative assistance to the caseworker.' Tenenbaum v. Williams, 907 F.Supp. 606, 618 (E.D.N.Y. 1995) (quoting van Emrik, 911 F.2d at 867). The sole evidence on this point is the testimony of defendant Nat Williams to the effect that Sarah was examined to detect sexual abuse. The district court construed this testimony (which is set out in the margin 5 ) as a concession that the examination was purely investigatory, as van Emrik used that term. The district court thus read the word investigatory as a term of art suggesting (to lawyers) a police or criminal investigation. However, the district court (as well as the majority opinion) fail to appreciate that medical diagnostics is also investigatory--in the sense that the physician investigates whether the patient would benefit from treatment. 128 In van Emrick, there was no question that the examination was conducted exclusively to further the forensic investigation: the case worker was seeking evidence of healed fractures, and the procedure was medically harmful (in the doctor's view). The holding of van Emrik therefore extends no further than instances in which medical justification is lacking. The case should not be read to bar physical examinations that serve a medical purpose, even if a law enforcement purpose is served as well. 129 No doubt, the physical examination of Sarah Tenenbaum had its forensic uses. But it was also investigatory in the additional sense that signs of sexual abuse would have served important diagnostic purposes: a five-year-old girl who has been sexually abused by an adult male (a) may need immediate medical care; and (b) may need to be kept out of an environment in which she would be exposed to further medical and psychological injury. 130 These cases being necessarily quite fact-specific I believe that, notwithstanding the holding in this case, the door stands open for the City to prove in other cases, or after adoption of new guidelines, that the investigatory purpose of the Tenenbaum-style examination is chiefly diagnostic, and designed to ascertain whether the child is in need of medical treatment and protection from further injury. 131 The majority notes that if Sarah had ever been in imminent danger, she was no longer in danger while in the custody of the child welfare workers. They therefore had time to seek judicial authorization for the examination. See Majority Opinion at 37-38, 54. Of course, in another portion of the opinion (in which I concur), we affirm dismissal of the plaintiffs' substantive due process claim on the ground that the temporary separation of Sarah and her parents was not severe enough to constitute a violation of substantive due process. See Majority Opinion at 42. These two rulings will create a dilemma for the child welfare worker who has removed a child and sees a need for a medical examination. She might await judicial authorization, which may require overnight detention, with concomitant delays sufficient to support a substantive due process claim. Or she might go ahead with the examination, in order to return the child home as soon as possible, and run the risk of procedural due process and Fourth Amendment liability. 132    133 The influence of this opinion is potentially far-reaching. The Court creates a new procedural requirement that burdens, punishes, and thereby marginally inhibits decisive action to protect children from people in their households. Notes: 1 The majority quotes testimony of caseworker James that Williams told her on Monday that she would have to take [Sarah] to the hospital, and deduces from that testimony that Williams made the decision on Monday. But James' categorical testimony on this point establishes that she did not act on Monday because the decision could only be made by Williams, i.e., the decision and order to act had not happened. 2 Although the CWA maintains an emergency children's services unit that is on call nights and weekends, no one contacted it about the Tenenbaum situation. Majority Opinion at 11. 3 Some of these cases addressed qualified immunity, rather than the underlying constitutional claim. As we have recently noted, however, the cases in this area typically collapse the two inquiries, so the qualified immunity cases are directly relevant to this discussion. See Wilkinson, 182 F.2d at 107 & n.10. 4 Another passage in the majority opinion also has this unintended effect of increasing the risks of child abuse. The majority opinion strongly implies that the defendants in this case should have complied with New York's statute governing preliminary removal orders. See Majority Opinion at 13-14 & n.6 (citing N.Y. Fam. Ct. Act 1022). Although such an order can be obtained ex parte, the officer seeking it must make a notice showing, i.e., either that the parent or other person legally responsible for the child is absent or that the parent refused to consent to the child's temporary removal. See N.Y. Fam. Ct. Act 1022(a); see also id. 1023; In re Adrian J., 119 Misc.2d 900, 464 N.Y.S.2d 631, 633 (Fam. Ct. 1983) (finding 1022 order jurisdictionally defective and therefore a nullity when child protection workers failed to ask [parents] to consent to a temporary removal of the child). The majority opinion thus has the effect of imposing a constitutional requirement of parental notice. It is worth pointing out that while the child welfare worker is seeking the order, the child will presumably remain in the custody of the alleged abuser, who is thereby alerted to the accusation and has time to coach the child, or take other measures. I cannot agree that the Constitution requires resort to the New York statute even when a child is in objective danger of harm. Cf. Robison, 821 F.2d at 923 (Federal constitutional standards rather than state statutes define the requirements of procedural due process.). 5  [M]y decision was that [Sarah] should be removed from the school and taken to Coney Island Hospital, specifically to be examined to rule out sexual abuse. Q: [Y]ou removed or had Sarah removed because you wanted to have a medical examination done to determine whether or not she had been sexually abused; is that correct? A: That is correct. I was doing [the exam] to determine whether or not the child had been sexually abused.