As physicians, if you suspect child abuse, you are mandated to report to the appropriate authorities, such as Child Protective Services (CPS). In Texas, where our vignette played out, professionals are beholden to the following law.

Section 261.101 of the Texas Family Code mandates that anyone who suspects child abuse or neglect must report it immediately. The report may be made to (1) any local or state law enforcement agency; or (2) the Department of Family and Protective Services.

All persons are required to make the report immediately, and individuals who are licensed or certified by the state or who work for an agency or facility licensed or certified by the state and have contact with children as a result of their normal duties, such as teachers, nurses, doctors, and day-care employees, must report the abuse or neglect within 48 hours.

Deric Cahill took his toddler to an urgent care center in Dallas. He alleged the doctor turned him into CPS for leaving a one-star Google review. In other words, the doctor weaponized the duty to report because of a nasty review.

The Cahill family is a content creator for Instagram and TikTok with 750,000 followers. What followed, predictably, did not go well for the physician.

To state the obvious, what follows are only allegations. As to whether the doctor believed, in good faith, she suspected abuse and HAD to report, is unknown.

And in Texas:

A person acting in good faith who reports or assists in the investigation of a report of child abuse or neglect is immune from civil or criminal liability. Failure to report suspected child abuse or neglect is a Class A Misdemeanor, punishable by imprisonment of up to one year and/or a fine of up to $4,000. Merely reporting the incident to a supervisor or manager is insufficient.  

The incentive TO report based on reasonable suspicion is high. The penalty for NOT reporting is steep.

Back to the urgent care center.

Cahill’s toddler had a fever for several days. He called a nurse’s hotline. He then took the child to pediatric urgent care center.

Cahill says the physician checked his ears, nose, and throat and listened to his breathing.  After a few minutes, Cahill says the doctor told them that his fever could have been caused by anything and recommended they visit the emergency room to get blood work, urinalysis, and other tests to rule everything out. Cahill says he and his wife sat in stunned silence after the doctor’s recommendation and were surprised the provider hadn’t asked them more questions. After the doctor repeated her recommendation, Cahill said he wasn’t happy with how the appointment went and left.

Miffed, Cahill wrote his online review in the parking lot.

“This is the most transactional experience I’ve ever had with a caregiver. We brought our son in with a fever, and after five minutes of normal tests: check ears, check throat. The doctor tells us to just go to the hospital to get urine, blood, and x-rays to figure out if it’s pneumonia, UTI, or some other infection. Bring your kid here if you just need antibiotics…anything else, it’s a waste of time and money.”

And, he emailed the corporate office for the urgent care center to express his displeasure. He wanted a refund for the perceived lack of service.

Within two hours of leaving the urgent care center, a report was filed to CPS about a severely dehydrated child. Within one hour of filing, a CPS officer showed up at the Cahill’s house.

Cahill says the case worker told him she expected to see a severely ill child but left after 30 minutes of sitting, talking with the family, and observing [the child].

Cahill went back to the urgent care center to speak with the physician about the CPS report. He received the records related to dehydration, but was instructed to wait outside. Meanwhile the staff called the police. All of this was documented in a TikTok video.

After speaking with the police and learning that the provider would not speak with him, he left with his child’s paperwork.

For Cahill, there is a clear connection between his critique of the care and the CPS report. “Why would she wait an hour and a half to call CPS if she was so concerned? Why wouldn’t she follow up with us to ask if we followed the guidance?” Cahill says. “It feels malicious.”

After the CPS visit, the family took the toddler to their usual urgent care, where Cahill says the provider spent 30 minutes with the family and asked more questions. The record of the appointment describes a very different toddler. Rather than “sick looking, weak cry” in the first visit, the second report describes a child that is “alert, pleasant, well-nourished and in no acute distress.” The provider told them to monitor their son, and his fever broke for good that night.

“Based on everything we experienced that day, the only thing I am led to believe is that this doctor was offended that I called her out in her office, that I left a Google review, that I emailed her senior leadership team, and she retaliated against us by weaponizing her position and calling CPS,” he said in a video post.

Cahill filed complaints with the Texas Medical Board and Texas Attorney General Consumer Services Division. In Texas, falsely reporting child abuse with the intent to deceive is a felony. Still, given the incentives to report and penalties for not reporting, I doubt criminal penalties will be imposed.

CPS cases move slowly.

The CPS case isn’t closed yet, but Cahill says the case manager told them she has no concerns and is working on character references to end the investigation. In a conversation with [the] Urgent Care management, Cahill reported that the organization said it would explore ways to improve its policies and that providers are bound by mandatory reporting standards. 

Cahill is a man on a mission.

“Money is not my motive. My motive is to hang this doctor’s license in my bedroom because she will no longer be able to practice medicine. That’s the mission.”

What are the evolving lessons?

1. 1. 1. Physicians need to understand what their obligations are for reporting suspected child abuse.
      2. The protections from civil and criminal liability apply if the report to authorities is made in good faith and without malice (at least in Texas).
      3. As to whether good faith and without malice apply, reviewers will look to the totality of the circumstances – the facts of the case, the timing of the report, and any extraneous circumstances.
      4. Doctors should be cautious about reporting someone to CPS FOR a one-star Google review. They should report FOR suspected child abuse.
      5. If the timeline suggests the father wrote the online review, and then Google sent an email to the physician about the one-star review, and then this email was opened and read, and then the report to CPS was filed, well, you can draw your own conclusions.

What do you think?

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Jeffrey Segal, MD, JD

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Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.