Child sexual abuse: The significance of the history and testifying on non-confirmatory findings.

Johanna M Kotzé,Hanneke Brits

doi:10.4102/phcfm.v11i1.1954

Johanna M Kotzé, Hanneke Brits

Open Access

https://doi.org/10.4102/phcfm.v11i1.1954

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Abstract

BackgroundDespite numerous studies and publications, there is still a common expectation that a medical assessment can confirm or rule out child sexual abuse (CSA). The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds.AimThe objective of this article was to suggest which aspects to consider when the expert medical witness in a CSA case needs to explain why CSA can seldom be confirmed and can never be ruled out. The importance of a sound medical and medico-legal history was discussed because the history was generally the only positive ‘finding’ of the assessment of children who have possibly been abused.MethodAuthoritative sources were used to support the explanation of reasons for an absence of corroborative clinical findings in CSA, as defined by the World Health Organization. The authors structured the individual sections by providing a background on which to base the testimony. They then summarised the clinical forensic significance of the information which should be offered in the courts and which should reflect on the court records, to be taken into account in the eventual decision, which will be made by the court.ResultsA guideline was provided for answering questions frequently posed to the expert witness in child abuse cases where there were no positive findings.ConclusionA structure for the explanation of reasons for a normal clinical examination when evaluating children who may have been sexually abused may reduce the discomfort of medical witnesses and improve the quality of expert medical testimony.

Highlights

The courts, parents and caregivers, laypersons and inexperienced healthcare providers commonly expect that a clinical examination will confirm or rule out child sexual abuse (CSA)
Healthcare providers may be under the impression that it is their medical responsibility to make a conclusive decision on whether CSA took place
The erroneous perception that healthcare providers have a responsibility to prove whether CSA has happened may cause a sense of loss of control

Summary

Introduction

The courts, parents and caregivers, laypersons and inexperienced healthcare providers commonly expect that a clinical examination will confirm or rule out child sexual abuse (CSA). Healthcare providers may be under the impression that it is their medical responsibility to make a conclusive decision on whether CSA took place. The courts rely on healthcare providers for the interpretation of medical theory to put a reliable medical examination and opinion on record to interpret the legal significance. This opinion should eventually add value to the comprehensive information that should be taken into account when the courts make the ultimate decision. The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds

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