The waiting room of the large family practice clinic was filled with patients, many of them children, but this didn’t faze Ms. N, a 28-year old pediatric nurse practitioner. She loved her job. She didn’t mind the long hours and high volume of patients. She’d found her niche in working with children.

Ms. N was on duty when Mr. and Mrs. Q came in with their shy four-year-old daughter Mary for a well-child visit. Ms. N chatted with the parents and tried to put Mary at ease as she checked her height and weight and examined her ears, eyes, and throat. The parents told Ms. N that they had noticed a bump on the side of the child’s rib cage, so she examined it and became concerned that Mary might have some broken bones. After consulting with her supervising physician Dr. J, Ms. N sent Mary to the radiology department. X-rays showed eight broken ribs and a possible distal fibular fracture, but the cause and origin of the injuries could not be determined.

Ms. N reported the results to Dr. J. Both clinicians returned to the examination room and questioned the parents at great length to determine what had happened. The parents appeared perplexed. Most of the talking was done by Mrs. Q. She said that her husband sometimes squeezed the little girl hard and played roughly with her. “He horses around with her,” said the mother. The two clinicians exchanged glances. During the discussion, the child’s mother also reported that there was a history of bone disease in her family but could not provide any details.

Ms. N and Dr. J stepped into the hall to confer. “I think you know what we need to do,” said the physician. “I’ll call child protective services to report a suspicion of child abuse,” replied Ms. N.

In the following weeks, Mary was put into foster care, a change that was both traumatic and disruptive to the child. Her father was arrested on criminal charges of child abuse. His arrest resulted in a suspension from his job as a school custodian. Court-ordered medical tests revealed that Mary suffered from the metabolic bone disease osteogenesis imperfecta (OI), a genetic disorder affecting the body’s ability to produce collagen, thereby creating brittle bones that break easily.

Based on this information, the criminal charges against Mary’s father were dismissed, and the child was returned to her parents. Feeling outraged with Ms. N and Dr. J, the parents sought the advice of an attorney. Mrs. Q described how her child had been taken away, crying and screaming for her mother. She told him about the heartache that she and her husband suffered from being separated from their child. Her husband explained how he had been arrested at his place of employment. How even now that he was absolved, his coworkers still looked at him differently. Then the parents talked about the harm to Mary—how she now cried whenever she was separated from them and had nightmares about being taken away from her parents. The attorney agreed to accept the case.

Ms. N and Dr. J were sued for negligently failing to properly diagnose Mary’s condition. The lawsuit also alleged that the clinicians’ negligence resulted in a criminal prosecution against Mr. Q and the removal of Mary from her parents’ home.