Mid-Atlantic Health Law TOPICS

When a health care provider has a reason to believe that a child has been abused or neglected, there are several legal and ethical issues to consider. This article provides an historical overview of the mandatory child abuse reporting requirements under Maryland law, and discusses recent changes from the 2026 Maryland Legislative Session that became law.

This article also provides context, and a closer look at how the reporting law interacts with the Maryland Psychologists Act and the psychologist’s code of ethics. While this article focuses on psychology, other behavioral health professionals face similar issues.

A. To Disclose

Maryland has required child abuse reporting since at least the mid-1960s. The “modern” version of the applicable statute reads as follows:

Notwithstanding any other provision of law, including any law on privileged communications, each health practitioner, police officer, educator, or human service worker, acting in a professional capacity in this State:

1. who has reason to believe that a child has been subjected to abuse or neglect, shall notify the local department or the appropriate law enforcement agency; and
    
2.  if acting as a staff member of a hospital, public health agency, child care institution, juvenile detention center, school, or similar institution, shall immediately notify and give all information required by this section to the head of the institution or the designee of the head.

In response to Maryland legislators seeking clarification on ambiguous terms such as the meaning of the word “child”, the Office of the Maryland Attorney General opined on this statute in 1993.

That Opinion explained that reporting is mandatory if the abuse occurred when the person was a child, regardless of current age; reporting is required even if the alleged abuser is deceased; and that any report made is generally kept confidential by the State agencies receiving the report.

The Opinion declined to weigh any public policy benefit of a health care provider’s ethical obligation to do no harm to patients against the Maryland General Assembly’s determination to compel disclosure. An Opinion of the Maryland Attorney General is not law, but it is generally given legal deference.

The laws on mandatory reporting continued to evolve. In 2019, the Maryland General Assembly made it a misdemeanor if a health practitioner, police officer, educator, or human service worker willfully failed to report suspected abuse or neglect if the victim is currently a child. Penalties under that law include up to three years in jail and a $10,000 fine per offense.

In this year’s Maryland Legislative Session, two different bills were advanced to address mandatory reporting. The first one, signed into law by Governor Moore, broadens the Department of Human Services’ ability to disclose the report of the abuse to childcare center administrators, youth sports program officials, and other custodial officials when necessary to determine if individuals seeking involvement with those organizations had been the subject of a child abuse report. 

The second bill, the Survivor Reporting Reform Act, will not become law, and if it had passed, would have required the Department of Health to create a mandatory form that health care professionals use for reporting allegations of child abuse.

B. To Disclose

In contrast to these disclosure laws, many health care professionals have a reflexive reaction not to disclose individual patient health information. This is, in part, because federal and state patient privacy laws, most notably the Health Insurance Portability and Accountability Act’s Privacy Rule (HIPAA) and the Maryland Confidentiality of Medical Records Act (MCMRA), prohibit disclosure in many circumstances. Mental health records and records of substance use disorder facilities are also awarded additional legal protection.

While these federal and State patient privacy laws generally prohibit mental health professionals from disclosing medical records/protected health information, those laws also permit any disclosure that is required by law. In short, if a law compels disclosure, HIPAA and the MCMRA, by themselves, would not prohibit disclosure.

Many Maryland professional acts, including the Maryland Psychologists Act, complicate the matter by providing that any of the following reasons are grounds for an action against a professional’s license: willfully failing to make a mandatory report, violating the Board’s Code of Ethics, the nebulous standard of “unprofessional conduct,” and acting in a manner that is inconsistent with generally accepted standards.

Further, embedded within the psychologist’s ethical code is a lengthy section on a psychologist’s duty neither to harm clients nor to exploit their trust. Accordingly, some professionals may be reticent to report out of a concern that the report might harm the client.

However, another section of the ethical code explicitly compels each psychologist to advise clients of the psychologist’s duty to inform authorities of any abuse or neglect of children. 

Other health care professionals also have similar ethical guidelines.

C. Recommendations

The sum of these obligations may appear to be a morass of shifting moral, legal and ethical quicksand. However, there are some things that might help you avoid sinking if you think you are ankles-deep in quicksand:

1. Review your informed consent document so that it includes clear language about mandatory reporting obligations. Consider talking with each patient to help them understand that you are a mandatory reporter.
    
2. Stay informed of any changes in law after each Session of the Maryland General Assembly.
    
3. Lastly, if you find yourself in shifting quicksand, your local professional Ethics Committee might be a good place to look for a lifeline. The Ethics Committee considers ethical, clinical, and legal considerations in response to ethics calls. Also, if you still find yourself wondering whether a course of action is or was compliant, either before or after the fact, you should seek legal advice.

Christopher P. Dean
410-576-4249 • cdean@gfrlaw.com