Every working day, Dr. Russell Bain sees about 30 children at his private pediatric practice. Sometime during nearly every day, he makes room for one more _ a child who has been abused.
"It's very difficult," Bain said. "You have to be committed to helping these children."
Recently, Bain's commitment has started to wane. He said the examinations of abused children are easy compared to the aggravation he gets from a court system that leaves him waiting endlessly to testify. The frustrating red tape of depositions, subpoenaes and testimony has damaged his private practice and already persuaded the only other pediatrician who examines Pasco's child abuse victims to quit the job.
"I don't know how much longer I can go on," Bain said. "But not much longer."
It is a problem that has been present for as long as child protection teams have existed. The teams are non-profit agencies that contract through the state Department of Health and Rehabilitative Services to examine abused children. Doctors, who perform those examinations for a nominal fee, are reluctant to devote time away from private practice to testify in the multiple hearings that make up a criminal case.
Judy Griffiths, executive director of the 5-year-old Pasco Child Protection Team, said retaining qualified doctors willing to perform abuse examinations is the hardest part of her job.
"The primary reason is that the court system is jammed," Griffiths said. "It makes it very difficult to convince doctors to forego so much of their private practice to participate in the program."
For the past two years, Bain and his partner in private practice, Dr. Jay M. Harvey, have seen about 25 children per month. Each was referred by Pasco's Child Protection Team.
Pasco's team gets about 800 cases a year from HRS, law enforcement officials and private citizens. Of those cases, 300 children are referred to pediatricians for a full medical examination to confirm child abuse. About 63 percent of the cases involve sexual abuse of children, Griffiths said.
In the majority of cases, Griffiths said, doctors find some indication that abuse has occurred. But the cases, most of which involve a parent, babysitter or other custodian accused of sexual abuse, rarely end in criminal prosecution. Griffiths said it is just too difficult to meet the "reasonable doubt" burden in criminal court.
Instead, many cases are referred to family court where judges are asked to terminate the custodian's right to see the child.
Either way, Bain and _ until recently _ Harvey, have been forced to spend hours giving sworn statements to attorneys. When a case reaches court, they often are subpoenaed as many as five times. Four of the appearances will be canceled, but the doctor often ends up spending a morning waiting at the courthouse for a hearing that will never occur.
Since Bain sees about 30 children per day in his New Port Richey private practice, each morning spent waiting in court means he has to reschedule 15 appointments. He has to find another doctor willing to see patients with emergencies. If a hearing is postponed more than once, it begins to financially damage Bain's practice.
"If you're lucky, you can get the attorneys to tell you four days in advance what day you might be needed to testify," Bain said. "Then if you reschedule all your appointments for that day to the next day and your appearance is suddenly moved ahead by another day _ well, you can see how it damages our practice."
About a month ago, Harvey was threatened by a judge with contempt-of-court after he failed to appear for a hearing. Harvey didn't appear because he thought the hearing had been canceled.
After hearing his explanation, the judge chose not to find Harvey in contempt. But the aggravation of having to explain himself was enough to convince Harvey that the job wasn't worth the $50 to $65 he received for each case.
"Dr. Harvey just decided that he couldn't do it any longer," Bain said. "He may come back if the court system improves."
Two weeks ago, Griffiths and Bain met with prosecutors, public defenders and Pasco Administrative Judge W. Lowell Bray Jr. to discuss the problems with the court system. They came away from the meeting believing that Bray was committed to making court appearances easier and less time-consuming.
"We said, "Look, this problem has been going on for years. We've got to work something out,'
" Bain said. "I felt they were receptive."
The attorneys agreed that prosecutors and public defenders will begin scheduling depositions at times convenient to the doctors. Doctors also will be notified by telephone and told whether a hearing will actually occur. Currently, doctors are subpoenaed to attend scores of court hearings that are canceled at the last minute.
But even if the court system begins to operate more smoothly, Bain said the real problem won't be solved until one of three things happens:
More pediatricians agree to take referrals from the child protection team, allowing the cases to be spread more equally among all doctors.
"If every doctor would see one kid a month, it would reduce the caseload for everyone," Bain said. "But I don't think it will happen. Some doctors don't want to get involved. Some have been involved and know what a nightmare the court system is and other doctors have heard how bad it is and don't want to ruin their practices."
Griffiths and her staff receive a grant from the County Commission to significantly increase their $206,000 annual budget. That would allow the team to hire a full-time nurse practitioner who could screen many of the cases doctors see. With enough money, a full-time pediatrician could begin handling the cases.
"We've applied for $70,000 this year," Griffiths said. "But, money is tight and we're competing with a lot of other good organizations with needs."
The public in Pasco County gets involved and demands that more money be spent to prevent child abuse and treat children who are victims.
"But there is a tremendous amount of apathy in Pasco County," Griffiths said. "I don't know how that will change."
For 14 years, Dr. Anthony Gellady examined child abuse victims in Pinellas and Pasco counties. He helped start the Pasco Child Protection Team about five years ago.
But he's no longer involved. And he says the court system is the reason.
"I was found in contempt of court in Pinellas," Gellady said. "So there I was, a physician, standing in court with drug dealers and burglars and all kind of bad people. I thought, "This is ludicrous.'
That was about two years ago, when Gellady was the medical director in Pasco County. He stayed with the team until Bain took over. He no longer wishes to be involved.
"It's like if you stood and beat your head against a wall," Gellady said. "When you stop, it feels so good."
Though he doesn't want to get involved again with the court system, Gellady has sympathy for Bain. He experienced the same problems in getting help while he was medical director.
And he's concerned that more children will fall through the cracks and will not get the treatment they need.
"If Dr. Bain left, there is no question that kids would suffer _ even more than are suffering now," Gellady said. "If we can't start to care about the underprivileged children in Pasco County, we will just continue to have these problems."
Gellady says the only true solution is finding the money to hire a full-time pediatrician to treat children. And to fund programs that will help prevent child abuse.
He is not optimistic.
"I'm an optimistic person in general," Gellady said. "But I don't think the people in Pasco County care that much about children."