In Lebanon County, officials say the number of reported child abuse cases are up, but some medical professionals say knowing when to report is not as easy as spotting a bruise.
"There's a big cost," said Dr. Benjamin Levi. "Children are taken from homes, the investigation itself is very invasive, you're inviting the state into your home to decide whether you're a good parent, reporting has significant costs - not just financial, but psychological."
Professor Levi is also a pediatrician. By law, Levi is mandated to report abuse. He said the laws pertaining to reporting abuse are too vague and that the training they receive varies.
"The scope of people who qualify as mandated reporters is very large, and some people have very little clinical training and other people are experts," said Levi.
Six-month-old Zariyah Mitchell died a few weeks ago after investigators say she was abused for months in a Lebanon County home. Her parents were charged with homicide, and a Good Samaritan Health System pediatrician was charged with failing to report abuse.
"If you have reason to believe that the child may be a victim of abuse, you must report that. The reality is that's part of your job," said Lebanon County District Attorney David Arnold.
Lebanon County Children's Services says it responds aggressively to reports of abuse but the process can be taxing on the staff.
"It does certainly get to you - it's trying, it's stressful for the case workers, supervisor. I think that's some of the reason turnover rate is rather high," said Director Jim Holpry.
Lebanon County's District Attorney says it's simple: If you suspect something say something.
"If you're afraid to offend somebody in the case of trying to protect the child's life, maybe that person's in the wrong profession," said Arnold.
A Good Samaritan Hospital spokesperson said all hospital employees are trained in mandatory reporting laws and get periodic education. The hospital said it reports an average of three child abuse cases a month.
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