6.1 Reporting Suspected Child Abuse and Neglect (CANRA)
Key Takeaways
California Penal Code § 11165.7 names dentists, dental hygienists, and every other person licensed under B&P Division 2 as mandated child abuse reporters.
A mandated reporter must phone a report immediately or as soon as practicably possible and send a written follow-up within 36 hours (Penal Code § 11166(a)).
Failing to report suspected child abuse is a misdemeanor punishable by up to six months in jail, a $1,000 fine, or both (Penal Code § 11166(c)).
California Penal Code § 11171.2 lets a dentist take skeletal X-rays of a child without parental consent to diagnose possible abuse.
Under California Penal Code § 11165.2, general neglect does not include a parent's economic disadvantage.
Who must report
Penal Code § 11165.7(a)(21) lists a "dentist," a "dental hygienist," and "any other person who is currently licensed under Division 2" of the Business and Professions Code as mandated reporters. That includes RDAs, RDAEFs, RDHAPs, and anyone holding a Board license. An unlicensed dental assistant is not named in that paragraph but may still report voluntarily, and the office should include every team member in its reporting procedure.
The duty is individual. Under § 11166(i), no supervisor may impede a report, internal policy cannot require a supervisor to file it instead of the employee, and the reporter cannot be punished for reporting. Telling the dentist-owner does not satisfy an RDA's own duty. When several reporters share the same knowledge, they may agree that one of them makes a single report. Anyone who learns that the designated person did not report must then report (§ 11166(h)).
What must be reported
A "child" is anyone under 18 (§ 11165). "Child abuse or neglect" (§ 11165.6) includes:
- Physical injury inflicted by other than accidental means.
- Sexual abuse, including assault and exploitation.
- Neglect: severe neglect, such as intentionally failing to provide adequate medical care, and general neglect, a negligent failure to provide adequate food, clothing, shelter, medical care, or supervision that puts the child at substantial risk of serious harm. General neglect does not include a parent's economic disadvantage (§ 11165.2).
- Willful harming or endangering of a child.
- Unlawful corporal punishment or injury.
The reasonable-suspicion standard
You must report when, in your professional capacity, you know or reasonably suspect abuse or neglect. Reasonable suspicion means it is "objectively reasonable" to suspect abuse based on facts that would cause a reasonable person in your position, drawing on your training and experience, to suspect it. It does not require certainty or a specific medical finding (§ 11166(a)(1)). A minor's pregnancy alone is not reasonable suspicion of sexual abuse.
Oral and facial warning signs
| Category | Findings that should raise suspicion |
|---|---|
| Physical abuse | Bruises in different stages of healing; bruising on the cheeks, ears, or neck; torn labial frenum in a pre-walking infant; fractured or avulsed teeth with an inconsistent history; bite marks; patterned burns |
| Sexual abuse | Unexplained palatal petechiae or erythema; oral lesions of sexually transmitted infections such as condylomata or gonorrhea in a young child |
| Neglect | Rampant untreated caries, pain, or infection after the caregiver was told about the need for care and help with access, and nothing is done; missed follow-up for an acute infection |
| History | A story that changes, an injury that does not match the child's development, a delay in seeking care, or a child who seems afraid of the caregiver |
Dental neglect requires more than finding cavities. The concern is a caregiver's failure to seek or follow through with necessary care that leaves the child in pain or with infection, especially after the problem and resources were explained. Poverty alone is not neglect.
How and where to report
- Telephone report immediately, or as soon as practicably possible, to a police or sheriff's department (not school police), the county probation department if the county designates it, or the county welfare department (child protective services) (§ 11165.9).
- Written follow-up within 36 hours of receiving the information, sent by mail, fax, or electronically on the Department of Justice form (SS 8572) (§ 11166(a)).
- You may attach nonprivileged documentary evidence, such as photographs and chart excerpts. Civil Code § 56.10(c)(14) allows disclosing this information with the report.
Recording evidence (K1122)
- Chart objectively. Record the location, size, shape, and color of each injury; the exact words of the child and caregiver in quotation marks; who was present; and your findings. Avoid conclusions such as "abused child."
- Photographs: a mandated reporter, and anyone taking photos at the reporter's direction, is immune from liability for photographing a suspected victim without parental consent and sending the photos with the report (§ 11172(a)). Include a scale and the date.
- Radiographs: § 11171.2 lets a physician or dentist take skeletal X-rays of the child without parental consent, but only to diagnose possible abuse or neglect and determine its extent.
- The CDA Code, Advisory Opinion 1.D.2, agrees: when abuse is suspected, a dentist does not need informed consent before taking photographs, impressions, or X-rays of a minor or dependent adult.
Protection for reporters, and penalties for failing to report
- Immunity: a mandated reporter is not civilly or criminally liable for any required or authorized report (§ 11172(a)).
- Confidentiality: the reporter's identity is confidential and shared only with the agencies and courts listed in § 11167(d).
- Privilege: the physician-patient privilege does not apply to information reported under the Act in court or administrative hearings (§ 11171.2(b)).
- Penalty: failing to report is a misdemeanor: up to six months in county jail, a $1,000 fine, or both. Intentionally concealing a failure to report makes it a continuing offense (§ 11166(c)).
- Licensure: a criminal conviction for failing to report can also support Board discipline, and the Board's mandatory Dental Practice Act CE course must teach these reporting duties (16 CCR § 1016(b)(1)(B)). The ADA Code (Section 3.E) makes identifying and reporting abuse an ethical duty "consistent with state laws."
Warning
Do not investigate, confront the caregiver, or wait for proof. Your job is to report a reasonable suspicion. Investigating is the agency's job.
A 4-year-old has bruises on both ears and a torn upper labial frenum. The parent says the child "fell off a chair." Which action does California law require of the treating dentist?
Report only after an X-ray confirms a fracture
Discuss the concern with the parent first and report if the explanation is unsatisfactory
Ask the office manager to decide whether a report is warranted
Telephone a report to law enforcement or child protective services immediately and send a written report within 36 hours
An RDA suspects child abuse and tells the dentist, who says, "I'll handle it." Two days later the RDA learns no report was made. What is the RDA's legal position?
The RDA must make the report personally, because the reporting duty is individual and a designated reporter failed to act
The RDA has no further duty because she informed her supervisor
The RDA may report only with the dentist's written permission
The RDA's duty ended after 36 hours, so it is too late to report
During an exam for suspected abuse, a dentist wants to photograph facial bruises, but the caregiver refuses consent. What does California law provide?
The dentist may take and send photographs with the report without parental consent and is immune from liability for doing so
The dentist must obtain a court order before taking any photograph
The dentist may photograph only with a law enforcement officer present
The dentist may describe the bruises but may not photograph them without consent
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