“Did you know we have to take all our kids to UNC or Duke for abuse evaluations?” Rosemary Zimmerman, Cumberland County DSS Child Protective Supervisor, said to me in 1994. Frankly, I didn’t. All the Pediatricians in the community had agreed to see any child who needed to be seen when we were “on call for the ED” and I assumed that was all that was needed.
I had recently left a private pediatric practice to be a faculty member at FAHEC (now the Southern Regional Area Health Education Center or SR-AHEC). I had available clinical time and agreed to see if I could help – having “no clue” what was involved! The Child Medical Evaluation Clinic (CMEC) at FAHEC saw its first patient in November 1994. It didn’t take long before consults for child abuse evaluations were also being received from the ER and Pediatric ward at Cape Fear Valley Medical Center.
The CMEC was held in the Specialty Clinic using an old, borrowed colposcope and staffed by Monica Ford, RN (a gifted nurse with great passion for children) and me (Howard Loughlin), an experienced general Pediatrician who was launched on a very steep learning curve on the developing medical field of evaluating children when there were concerns that a child might have been abused.
“If you build it, they will come” proved true for the CMEC. Social workers and detectives from Cumberland and the surrounding counties requested CMEC appointments. Unlike some other child abuse clinics, we were “old school” with the physician, rather than a forensic interviewer, taking the very detailed history from the investigators, child and family as well as doing a complete physical exam. The capacity of the CMEC to see the number of children needing evaluations was quickly overwhelmed. Thankfully, experienced and superb child abuse examiners - Drs. Sharon Cooper, Laura Gutman and Molly Berkoff – were also able to hold clinics at SR-AHEC. This allowed medical evaluations to be offered for children from throughout the region.
A major milestone in the evolution of child abuse evaluations at SR-AHEC was the arrival in 2012 of Dr. Danielle Thomas-Taylor, a second full-time, board certified Child Abuse Pediatrician (CAP). Child Abuse Pediatrics had become a Pediatric subspecialty in 2009; Danielle and I were among the first group to be board certified.
I retired in 2016 but the CMEC at SR-AHEC, under Danielle’s leadership, continues to serve the children of Cumberland and the surrounding counties.
As I reflect on the CMEC at SR-AHEC, several important points need to be made –
- The CMEC could not have been started and would not have survived without the support of SR-AHEC leadership, especially CEOs Strand, Teasley and Kapoor. Child Abuse evaluations are never “money makers” and only by institutional commitment to the importance of the program (and piecing together many funding streams) could the CMEC have survived.
- Medical evaluations are only one component of the very complicated process of determining whether abuse has occurred and what actions are necessary to safeguard the child(ren) and hold perpetrator(s) accountable. The Child Advocacy Center (CAC), among other services, provides 1st rate forensic interviews and hosts in-depth case reviews by the Cumberland County multidisciplinary team. This collaboration by all the investigating professionals, including a medical provider from SR-AHEC, is the best hope to “get it right” in making abuse determinations.
