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Several large-scale institutional child sexual abuse cases have recently received increased attention in arenas of public commentary. Most of the dialogue surrounding these cases involves social commentary, newspaper accounts of the trial and any punitive aspects, and commissioned reports that detail the extent of the abuse and the cover-ups that ensued. Absent in this coverage are more in-depth examinations of the responses to allegations of child sexual abuse within institutional settings. This examination is a case study of the Earl Bradley (former pediatrician) case that unfolded in Lewes, Delaware throughout the mid-1990’s until Bradley’s conviction in 2011. Through in-depth interviews with institutional actors involved in the Bradley case, this study explores the institutional responses of various organizations, agencies, and/or professions (i.e. legal, medical, and/or victim advocate) to allegations of child sexual abuse against Bradley both before and after his arrest in 2009. Policy implications of various responses will be discussed.