DANVILLE — Dr. Pat Bruno did not start off as an expert on child abuse, but it was the career he was called to.
“This was not something I chose, it was something that chose me,” said the Geisinger Medical Center pediatrician.
Earlier this year, Bruno earned his pediatric child abuse board certification from the American Board of Pediatrics. This makes him one of just eight Pennsylvania doctors and 275 nationally to earn this recognition for their expertise in child abuse.
And while Pennsylvania has come a long way in successfully identifying abuse, the state still has a long way to go, according to Bruno.
“I was the only pediatrician”
Bruno began his practice in Sunbury in 1979. As the only doctor of his type in the county, he would often be referred to for child abuse cases. “I started seeing more and more of these cases. I was the only pediatrician, so children and youth services were referring them to me,” he recalled.
During the late 1980s, Northumberland County led the state by a wide margin in the number of reported cases and actual cases of child abuse per capita.
While being used as a referral for the county, Bruno realized he needed additional education to better identify child abuse. He sought further training at the San Diego Children’s Hospital, and what he saw there impressed him.
“I essentially cloned their unit, brought it back to central Pennsylvania” and brought it before the board of Sunbury Community Hospital, he said. They allowed him to do exams at their hospital until the early 2000s. In 2004, Bruno joined Geisinger Medical Center as a general pediatrician. That same year, Geisinger founded the Northumberland-based Child Advocacy Center, where Bruno now examines children reported to have been abused.
Pennsylvania is “at the bottom of the list”
When it comes to child abuse, Pennsylvania needs a lot of improvement. “We’re at the bottom of the list” nationally, when it comes to investigations of child abuse, Bruno said. “There aren’t any other states that are lower than us” even in the wake of the conviction of Jerry Sandusky.
Across America, the number of children investigated for the possibility of child abuse is 40 out of 1,000. In Pennsylvania, that number is 10 per 1,000. Likewise, the number of documented cases of child abuse nationally is 10 per 1,000 incidents reported, whereas in Pennsylvania it is 1 per 1,000.
In 2012, 750 documented cases of child abuse occurred in Delaware, compared to 3,000 in New Jersey and 9,000 in Ohio. In Pennsylvania, that number was only 375.
The difference in these numbers doesn’t come from lower incidents of abuse in Pennsylvania but from the insufficient way the commonwealth defines abuse.
“The problem with the state of Pennsylvania is that their definition of what abuse is has been so narrow that we’ve been missing cases,” Bruno said.
In Pennsylvania, if there is not an identifiable perpetrator for abuse then it is not considered to be abuse. This is true even if a child dies from his or her injuries, Bruno said. This keeps those numbers out of statistics which legislators use to determine how much funding to give to children and youth services.
States also vary in their definition of abuse, and in Pennsylvania there needs to be evidence of “severe” physical trauma for a case to be considered abuse. However, that definition is too open to interpretation from investigator to investigator, Bruno said.
Currently, there are bills working through state legislature to expand the definition of child abuse so that it can be classified without identifying a perpetrator, Bruno said. The revised laws won’t go into effect until the end of 2014.