As a new medical graduate just beginning a pediatric residency at Seattle Children’s Hospital in 2006, James Metz, M.D.’06 (at left, with Tracey Wagner, R.N., MSCN, CPN, and Mary Ellen Rafuse, MSW), never imagined that 12 years later, he’d return to his alma mater and home state as one of only two board-certified child abuse pediatricians in Vermont.
Now a Larner assistant professor of pediatrics and the sole child abuse specialist at UVM Children’s Hospital, Metz, along with his team at the UVM Medical Center’s Child Safe Program, is making a positive impact on health care for mistreated children in the state. But Metz is quick to admit that, without a solid framework created by the medical professionals and mentors who came before him, that impact wouldn’t be possible.
A New Field of Medicine
Child maltreatment—including neglect and physical, sexual, and psychological abuse—is not new, nor is the need for trained medical professionals to treat these victims, says Metz’s mentor Joseph Hagan, M.D., a Vermont pediatrician, clinical professor of pediatrics and national pediatrics leader. Hagan notes that it wasn’t until C. Henry Kempe, M.D.’s article, “The Battered- Child Syndrome,” was published by the Journal of the American Medical Association in 1962, that the issue of child abuse was recognized by the medical community as one that needed to be clinically researched, diagnosed, and treated. At the time, this duty largely fell to primary care pediatricians.
It’s a duty that Hagan and Karyn Patno, M.D., Metz’s other role model, earnestly dove into early in their careers—Hagan in the early 80s and Patno in the early 90s. Over time, Hagan and Patno, who is Vermont’s only other board-certified child abuse pediatrician, became the “go-to” doctors for Vermont clinicians, caregivers, and social workers who were seeking guidance in complex cases of suspected child abuse and neglect. For years, the two covered all calls for child abuse clinical specialists in the state. Patno, in St. Johnsbury, covered the east side of the state and Hagan, in Burlington, covered the west. It was Patno who first created Vermont’s Child Safe Program in 2008. Until Metz’s recent arrival, Patno ran the Child Safe clinics first from St. Johnsbury. She subsequently expanded the program to UVM Children’s Hospital and later worked in tandem with Hagan in Burlington.
Over four decades following the publication of Kempe’s JAMA article, a small group of clinicians around the country— including Patno and Hagan—unofficially surfaced as specialists in evaluating abuse cases and assisting child protective agencies with their medical point of view. In many states, there were none. Finally, around the same time Metz was graduating from medical school, the field of child abuse pediatrics formally came into existence. In 2006, the American Board of Medical Specialties officially recognized child abuse pediatrics as a pediatric subspecialty. Three years later, the American Board of Pediatrics held the first board certification examination.