For nearly two decades, staff members at the KIDS Center in Bend have evaluated cases of suspected child abuse. The overwhelming majority of those cases, up to 90 percent, involved sexual abuse. But that proportion is likely to shift significantly, as the local nonprofit is seeing an in- flux of suspected physical child abuse cases due in large part to a new state law.

The law, referred to as Karly’s Law, came about after 3-year-old Karly Sheehan died from physical abuse in Corvallis in 2005.

The law, which was passed unanimously by the Oregon Legislature in 2007 and took effect immediately, requires that children with suspicious physical injuries be seen by a designated medical professional within 48 hours of the start of an investigation.

In Deschutes and Crook counties, all of those cases are being funneled to the KIDS Center. Until Karly’s Law took effect, doctors at the KIDS Center saw few urgent child physical abuse cases. Children with suspicious injuries may have been taken to an emergency room or a pediatrician or may not have been seen by any medical professional.

Because of their expertise in evaluating child abuse injuries, staff members at the KIDS Center believe the law will ultimately result in more physical abuse cases getting noticed.

“I know everywhere around the state is inundated with Karly’s Law cases,” said Dr. Janey Purvis, a child abuse examiner for the KIDS Center. “The numbers really have increased significantly.”

So far this year, the center has seen 31 cases referred because of Karly’s Law, but staff members believe that figure will continue to grow as awareness builds.

Purvis believes the law will help prevent cases from falling through the cracks, as Karly’s did. “It’s very valuable; it might save some kids’ lives,” she said.

The law

State Rep. Sara Gelser, of Corvallis, believes Karly might still be alive if the protections outlined in the new law had been in place in 2005.

“It was a failure of the system to protect Karly,” she said.

The Department of Human Services received two reports about suspected abuse against Karly and investigated the allegations, but determined they were unfounded. During the trial that followed Karly’s death, it became clear to Gelser that there were big holes in the investigation, even though, technically, all of the policies had been followed. Two key points she noted: The obvious injuries Karly suffered were not evaluated by a child abuse specialist, and the photos taken by child protective service workers were lost.

Karly’s Law requires the following:

•Suspicious physical injuries must be photographed. Injuries include burns, multiple fractures, bruises on a child’s neck or face, substantial cuts and more.

•If evaluators (typically law enforcement or child protective service workers) have a reasonable belief the injuries could have been caused by abuse, then the child must be evaluated by a designated medical provider who has training in child abuse evaluation.

Gelser believes this rightly shifts the responsibility of making medical assessments away from child protective service workers and law enforcement, because it is “really not safe and not fair” to ask them to make those judgments, she said.

By the end of October, the Oregon Department of Justice is slated to release data about the number of evaluations statewide since Karly’s Law was enacted.

“We’ve definitely seen evidence that this law is leading to a substantial increase in medical assessment of potential cases of child abuse,” said Jake Weigler, spokesman for the department.

Specialists

Purvis, who spent many years as a general practitioner, believes being trained in detecting child abuse makes a huge difference in a doctor’s ability to evaluate a case. She thinks she is more likely to be suspicious of child abuse and more likely to make a diagnosis of child abuse than a physician who does not specialize in this area.

At St. Charles Bend, Susan Yokoyama, a sexual assault nurse examiner in the emergency room, says medical staff members do not conduct extensive interviews with children suspected of having been abused.

“It takes some special training to be able to gain the confidence of a child,” Yokoyama said.

A Karly’s Law physical examination typically takes about 90 minutes, and most of the cases involve children from toddler age to about 10 or 11. The physician takes down a brief medical and social history of the child and asks how the injury occurred. Purvis says she tries to get as many sources as possible on what happened.

She looks at the injury to see if it is consistent with the story. She looks at factors like the developmental level of a child (for instance, a 15-month-old would be unlikely to turn on the hot water and scald himself). Bruises on infants are another warning sign, because young babies aren’t mobile.

Other warning signs are bruises behind the ears, on the neck or on the buttocks. Purvis also looks for older injuries. For instance, one little girl came in with a recent arm fracture, but an exam showed she also had old rib fractures.

Some physical abuse cases are easy to detect, such as those where injuries were caused by belts, cigarettes, spoons or cords. Purvis, who splits her time between the KIDS Center and a similar facility in Klamath Falls, believes more physical abuse cases are being diagnosed now.

“I think before, it was missed,” she said.

Missing cases?

KIDS Center staff members aren’t certain where Karly’s Law cases went before the legislation was passed.

“A lot were taken to the ER; maybe some of it just wasn’t dealt with,” said Vickie Pesterfield, medical intake coordinator for the KIDS Center.

She believes that sometimes child protective services or law enforcement workers might believe an explanation offered by parents about a child’s injury. Now, those children must be seen by medical professionals anyway.

“Let the experts in the field get one last look at the child,” Pesterfield said. “It wasn’t necessarily happening before. Things get missed that way.”

Law enforcement officers through the Deschutes County Sheriff’s Office were recently trained on the details of Karly’s Law and given pocketsize cards that outline the new regulations. Since the training, KIDS Center staff say they’ve seen an increase in suspected abuse cases. But Lt. Kevin Dizney says officers were already aware of child abuse and that he is “very, very proud of the way we have been doing business.”

What this law has done is “add one more rung on the ladder” of the process, according to Dizney, who says he supports Karly’s Law.

Dizney does not see that the new law has changed much in terms of what law enforcement does or how they investigate a case. The biggest difference is that cases that previously ended with the Sheriff’s Office, the Department of Human Services or a doctor now end with the KIDS Center.

“We let KIDS Center double-check, if you will, our findings,” Dizney said.

So far, he does not believe any of the cases they have brought to the KIDS Center has changed in terms of being founded or unfounded. KIDS Center staff determined that about 30 percent of the Karly’s Law cases brought in were conclusively the result of child abuse. Pesterfield says another large proportion of the cases included many factors that caused concern, but medical staff could not determine with certainty that they were cases of abuse.

Sheriff’s Office Detective Mike Quick calls the law a win-win and thinks having cases seen by doctors trained in child abuse is helpful. “Nothing will ever slip (by),” he said.

Yokoyama says Karly’s Law has helped raise awareness among the nursing staff about physical child abuse. After attending training, Yokoyama created a poster outlining warning signs of child abuse and posted it in the emergency room. Since then, she has gotten more questions from the nursing staff about child abuse.

Challenges

Because the law went into effect immediately after it was passed, agencies have scrambled to meet the requirements.

“Big changes always come with big challenges,” Gelser said.

The KIDS Center wasn’t set up to handle emergency cases. Most sexual abuse evaluations are scheduled well in advance, because often the abuse has been going on for a long time and does not typically result in physical evidence. The Karly’s Law cases, however, involve suspicious injuries that need to be seen before the evidence fades.

“It created a panic because of the immediacy of it,” said Elaine Knobbs, KIDS Center director of prevention and education.

Another big challenge is that Karly’s Law did not come with any funding attached. The KIDS Center is funded through state money, grants and a lot of local donations. Knobbs said corporate donations are down, even as the center is serving more children.

The center is set up to see children only during regular business hours, so Karly’s Law cases that come up on the weekends are directed to doctors at St. Charles Bend or local pediatricians, who then pass on the case information to the center for further evaluation.

The passage of the law created “a lot of chaos,” according to Mike Wenndorf, child welfare supervisor for the Department of Human Services in Deschutes County. “It’s taken a while to get infrastructure and system in place.”

One of the remaining unanswered questions is which cases investigators refer to the KIDS Center, as the law leaves them some discretion.

“If we referred every single case of child injury, the system would be completely and thoroughly overwhelmed,” Wenndorf said.

He also worries about the workload for staff at the KIDS Center. He worries about the sexual abuse investigations getting pushed back because of the new Karly’s Law cases.

Wenndorf says that Karly’s Law has increased the workload for DHS staff, but he also thinks the law is a good thing. Now every child protective service worker has a digital camera to document suspected abuse. On average, the county department assigns about 70 suspected child abuse cases a month for investigation. Of those, about 20 percent turn out to be physical abuse cases. About 80 percent to 85 percent of the cases are determined to be unfounded, according to Wenndorf.

Most officials, however, agree the new law is a good move because it is designed to protect children.

“I, for one, am very glad,” said Beth Patterson, general manager for KIDS Center. “We may be filing a gap that was there.”

Gelser has a pragmatic view.

“It’s great to have a bill; it doesn’t bring Karly back.”

Background on Karly’s Law

What the new law requires

Karly Sheehan, of Corvallis, was 3 years old when she died in June 2005 from injuries inflicted by Shawn Field, her mother’s boyfriend. Field was convicted and sentenced to life in prison, with the possibility of parole. The law is an attempt to shore up some of the holes that Karly’s case exposed. The Department of Human Services received two reports about Karly being a suspected victim of abuse, but investigators determined the suspicions to be unfounded. Karly’s injuries were not evaluated by a medical professional specializing in child abuse, and the photographs of her injuries were lost.

Sarah Sheehan, Karly’s mother, is now working to start a nonprofit in Bend to honor her daughter’s memory. The organization, Karly’s Angels, is dedicated to assisting children of single parents. Via e-mail, Sheehan explained that plans for the nonprofit are currently on hold as she cares for her mother, who is ill. “By the new year, I expect that my time will be freed up considerably, so the plan is to take off again from that point. In the meantime, the nonprofit status is being filed, and Karly’s Angels is being more defined as far as goals, how funds are dispersed and marketing.” She did not comment about Karly’s Law.

David Sheehan, Karly’s father, lives in Corvallis and is suing the Department of Human Services for $2 million, saying the state agency contributed to his daughter’s death, according to reports in the Corvallis Gazette Times. The trial is set to begin in December.

• Each county is required to designate a medical professional to handle Karly’s Law cases. In most cases, these are doctors with training in identifying child abuse. In Deschutes and Crook counties, the KIDS Center medical staff is the designated medical provider; in Jefferson County, it is a physician at the hospital.

• If an investigation turns up suspicious physical injuries, such as burns, scalds, bruises on a child’s neck or face, or multiple fractures, the investigator must take photographs of the injuries and bring the child to the designated medical professional within 48 hours.