Carroll parents who suspect their children have been sexually assaulted usually must take them to Baltimore to be examined because most county doctors are not trained to gather evidence and are unwilling to testify in court.
In emergencies -- when sexual assault is suspected to have taken place in the last 72 hours -- doctors at Carroll County General Hospital perform examinations and report suspicions to police.
But if a child waits days or weeks before telling someone about the assault, Carroll prosecutors and social workers must comb the Baltimore area to get an appointment with one of the few experts in child sexual abuse.
"After doctors do the examinations a couple of times and then spend time in court, they don't want to do them any more,"said Assistant State's Attorney Kathi Hill, who has been working for several years to try to get a Carroll doctor to agree to do the exams on a routine basis.
Parents and social workers can take children to be examined by any pediatrician to make sure there is no physical damage or disease, she said.
But most doctors do not have the special training required to detect scar tissue or trauma that may have healed since the assault, and they don't want to spend the time testifying in court, she said.
Dr. Charles Ashburn, a county pediatrician, said examinations for sexual abuse have become a highly technical area.
"It's gotten to a point where its almost a specialty in pediatrics to itself," said Ashburn. "It's often really in the patient's best
interest to refer them to specialists who know how to collect the evidence properly."
Carroll County General, like many other community hospitals, refers abuse victims to the area's regional trauma unit for child sexual assault -- Mercy Medical Center in Baltimore.
But taking Carroll children there to be examined often causes a hardship for their parents, and social workers and children must wait weeks for an appointment, Hill said.
Dr. Janet Neslen, director of the county Department of Health and Mental Hygiene, tried to ease the situation in July by agreeing to have the department's pediatrician do the examinations one afternoon each week.
That agreement ended in October when the Health Department was forced to lay off 75 people, and Dr. Elizabeth Ruff was assigned to cover Carroll and Frederick counties.
But Neslen said that while Ruff's examinations would have helped, it wasn't a permanent solution to the problem.
"We agreed to do it until as a temporary measure, until they find someone todo it permanently," said Neslen.
In addition to the time spent intraining and court, Neslen said pediatricians often are daunted by the task of building credibility with judges.
Dr. Charles Shubin, a pediatrician at Mercy Medical Center and Francis Scott Key Medical Center in Baltimore, has examined children for signs of sexual abuse for 17 years.
Shubin said doctors without special training in childsexual abuse are justified in refusing to perform the exams.
"If I were in private practice in Carroll County, I wouldn't do it either," he said.
He says he does not blame doctors for not wanting to get involved with the legal system because the relationship between the doctors and prosecutors can be strained.
Shubin, who has examined more than 10,000 children for sexual abuse, said doctors get frustrated when they have to spend hours waiting to testify when they couldbe seeing patients in their private practices.
He said doctors insexual assault cases often do not get paid for their court time because they are considered factual witnesses who are subpoenaed, not expert witnesses who are paid for their time.
Hill said the Carroll State's Attorneys Office picks up the tab for children's examinations,and often pays for court time.
In Baltimore County, where they have a large, federal grant-funded Sexual Abuse Treatment Program, a county health department doctor spends one morning a week examining children suspected of being abused.
Kris Debye, coordinator of the program, said that since it began in 1989, the number of child sexual assault trials has decreased and the number of confessions and plea agreements has gone up.
"He (Dr. Mike Reichel) has gained a lot of credibility with judges, prosecutors and defense attorneys," Debye said.
Hill said she will keep searching for a county doctor who is willing to see the cases through.
"We need a doctor who is willing to get some additional training, is good with children and is willing to put in some time," Hill said.