Childrens-Mercy-SCAN-Clinic

The Division of Child Abuse and Neglect (SCAN) clinic at Children’s Mercy Hospital in Kansas City. Story involving SCAN.

Going to the Children’s Hospital? Bring Your Lawyer.

New Pediatric Sub-specialty Appears to Correlate with Recent Epidemic of Medical Kidnappings

by Monica Mears
Health Impact News

What do the Salem witch trials of 1692 have in common with the experiences of Keshia and Chris Turner and their son Brayden, or Max and Justine Gibbs and their little baby girl? How do those events over 300 years ago illuminate what has happened recently to Jessica Battiato and her son Cesar, or Rebecca and Anthony Wanosik’s little baby girl, or Brandon and Cynthia Ross and their son Ryder? Why does one of the most notorious events in American history seem to aptly apply to a new scientific sub-specialty in pediatric medicine?

Two words: “witch hunt.”

Keshia and Chris Turner from Tennessee sought medical help for their son Braden’s medical and developmental issues. But instead, after a child abuse pediatrician at Vanderbilt Children’s Hospital accused Keshia of abuse, the investigators and doctors allegedly stopped looking for any other explanation for Brayden’s condition. He is now nine months old, and his mother says he cannot even sit up by himself, but doctors at Vanderbilt tell her that there is no need for any testing.

Jessica Battiato from Pennsylvania has been blamed for child abuse by a doctor and a system that she says refuses to look for the medical cause of her baby’s condition. Since her son Cesar, now five months old, was taken by child protective services two months ago, her son has reportedly been diagnosed with rickets and hypotonia by a radiology expert. However, CPS took custody of Cesar in April, allegedly based on accusations by Penn State child abuse specialist, Dr. Kathryn Crowell, that Cesar’s injuries could only be caused by abuse.

Similarly, Max and Justine Gibbs from Maryland found their lives turned upside down after taking their 8-week old daughter to the hospital to check out a bruise. Max, a pastor with no previous troubles with the law, was arrested and put in jail on suspicions of abuse. He is now completely cut-off from BOTH of his children.

In yet another sad story reported on MedicalKidnap.com, Rebecca and Anthony Wanosik from Missouri had all 5 of their children removed from their home after Rebecca brought their 3-week old daughter to the doctor to check on a condition with her ribs, while her husband was on active military duty.

Brandon and Cynthia Ross from Maine had their son Ryder taken away after bringing him to the hospital because his leg was swollen. Brandon, the father, was later arrested on charges of child abuse, and Cynthia’s grandfather (the great-grandfather of the baby) became so upset that he committed suicide.

These are not isolated cases, but representative of what thousands of families around the U.S. are reporting is happening to them after taking their children to a doctor or hospital to check on broken bones, bruises, or other medical conditions.

A witch hunt is defined as “seeking and persecuting any perceived enemy, particularly when the search is conducted using extreme measures and with little regard to actual guilt or innocence.”

For many traumatized children and families, this defines their experiences with children’s hospitals and child abuse pediatricians, who seem intent on reaching a verdict, rather than evaluating all of the evidence.

New Pediatric Sub-specialty: the “Child Abuse Pediatrician”

Crowell

Child Abuse Specialist Kathryn Rausch Crowell, M.D. – Penn State Hershey Medical Group. Image source.

The rise in aggressive uses of CPS by doctors and hospitals in diagnosing “child abuse,” extensively documented by MedicalKidnap.com, appears to parallel several new developments in the world of pediatric medicine. In 2010, the American Academy of Pediatrics certified a new sub-specialty in child abuse pediatrics, which requires a fellowship with a teaching hospital’s child protection unit and a separate board exam.

The majority of the nation’s 324 Child Abuse Pediatricians are housed within children’s hospitals.

Children’s Hospitals Build Entire Teams focused on Child Abuse

Another related change is the focus by the National Association of Children’s Hospitals and Related Institutions (NACHRI) to emphasize and define the role of child abuse teams at children’s hospitals.

In 2006, the NACHRI provided a framework to aid understanding of the range of services offered, periodically updating, making benchmarks available and defining best practices. Thus, the child abuse specialists “frequently lead child protection teams that also include social workers, case managers and other clinical providers. These teams serve as a resource to children, families and communities by accurately diagnosing and treating abuse (as well as ruling out abuse); consulting with local child welfare agencies and law enforcement; testifying as experts in court; and directing child abuse and neglect prevention programs.” [1]

The 2012 Survey Findings of Child Abuse Services at Children’s Hospitals reports that:

“Children’s Advocacy Centers (CAC) represent a well-known model through which many communities respond to suspected child abuse. A quarter of hospitals (33 out of 131) house a CAC. 62% (80 of 130) provide medical services to one or more independent CACs. 38 respondents neither house nor provide services to a CAC.”

See:

Eight year old Jaxon Taken By Hospital When Parents Ask For Second Opinion

Child Abuse is Not A Medical Diagnosis, but a Legal Accusation

Dr. Deborah Lowen

Dr. Deborah Lowen is a Child Abuse Specialist, and the head of the Child Abuse team at Vanderbilt. Source.

Essentially, these new child abuse pediatricians and their accompanying teams at children’s hospitals are NOT specialists in orthopedics, neurology, psychology or numerous other subspecialties, but focus exclusively on determining a LEGAL allegation for a set of medical issues.

“Child abuse” is not a medical diagnosis, but due to its horrific nature, the allegation often seems to trigger a “witch hunt,” sometimes ripping a sick child out of his or her loving family to languish, undiagnosed and untreated. Though abusive parents exist, and children’s injuries can sometimes provide evidence of abuse, it is being frequently reported that more and more often a rush to judgment by doctors and CPS is destroying healthy families, and often damaging the very children that are meant to be “protected.”

Additionally, child abuse pediatricians and their hospital based teams struggle with exactly how and what their role should be. A recent study in the medical journal Pediatrics acknowledges, there is:

“no consensus on what makes child protection teams effective.”[2]

Since the easiest way to define “effectiveness” can often be sheer numbers, then teams who “identify” more abuse cases may be seen as more “successful” – increasing pressure to rush to judgment and quickly allege abuse.

Multiple Ethical Concerns for Child Abuse Specialists and Teams

diane-redleaf

More particularly, this new subspecialty of pediatrics has “generated questions regarding the investigatory or prosecutorial role assumed by child abuse pediatricians.”[3]

A paper published last year by George Barry and Diane Redleaf of the Family Defense Center in Chicago, titled, “Medical Ethics Concerns in Physical Child Abuse Investigations,”[4] reveals the extent of breeches of medical ethics by child abuse medical investigators:

Issues That Arise As to the Child Abuse Pediatrician’s Role

Most significantly, the structural issues that the child abuse pediatrics specialty gives rise to include:

  • the child abuse pediatrician not seeking out appropriate consultations with other specialists, in particular neurosurgeons and orthopedists;
  • the child abuse pediatrician working at the same institution from which the Hotline call, that triggered the investigation, was made and in the same institution in which the child’s treatment was provided, which can affect the objectivity of the child abuse pediatrician’s opinion;
  • the child abuse pediatrician failing to evaluate and weigh the information of colleagues who are treating physicians and who know the parents and family who brought the child in for treatment; and
  • the child’s treating physicians becoming passive observers, unwilling to question the opinions of the child abuse pediatrician.

The paper concludes:

After researching medical ethics principles and opinions as documented in this Paper, we believe that there is indeed something ethically problematic with the way the child protection community and the larger medical community, with the newly-adopted child abuse pediatrician specialty, has treated the field of child abuse investigations.

See:

Family Defense Center in Illinois Documents Medical Ethics Violations in Medical Kidnappings

 “Defensive Doctoring” Leading to Families Wrongly Accused?

Another, broader concern exhibited by child abuse pediatricians is described in social workers and judges, too:

“Defensive social work” refers to the tendency of CPS personnel, first identified in the early 1980s, to base removal decisions on fear – fear of job discipline, fear of civil (and even criminal) liability, and especially fear of adverse publicity resulting from the death of a child left with or returned to his biological parents.”

…the prevailing attitude – among the general public as well as many CPS insiders – that emergency removal is a magic bullet in the battle against child abuse and neglect, (is viewed as) a conservative, risk-free way of ‘erring on the side of safety.’[5]

Disturbingly, this attitude seems to extend to child abuse pediatricians. No part of the children’s hospitals’ child abuse processes appears to recognize, or even acknowledge, that a “defensive” rush to judgment, which some might call a “witch hunt,” creates real, lasting damage in families who are wrongly accused.

A real-life example of how this plays out can be found in a federal lawsuit filed this February by seven families in Ohio against Nationwide Children’s Hospital. It alleges the hospital violated a number of constitutional rights during its child abuse exams. Chad Burley, the father in one of the families, labeled it a “witch hunt.”[6]

Child Abuse Pediatricians a Self-fulfilling Prophecy?

While “defensive doctoring” can reasonably describe the function of many child abuse pediatricians, another perspective raises yet more serious concerns – a self-reinforcing bias.

“I would contend the very existence of the child abuse pediatrician specialty becomes something of a self-fulfilling prophecy,” notes Phil Locke of the Duke Law Wrongful Convictions Clinic. “I’m here to diagnose child abuse, so that’s what I’m going to do.”[7]

“When your tool is a hammer, the whole world is a nail,” said Diana Rugh Johnson, an attorney and child-welfare law specialist in Atlanta, noting this same phenomenon.[8]

The old joke used by Howard Stern, “Have you stopped beating your wife yet?” illustrates how wrong assumptions, even in a simple question, can color people’s (and doctors’) perception of a situation.

The CPS system itself is built around the premise that parents – accused by anyone of anything – are “guilty until proven innocent”…an approach not terribly different from the Salem witch trials 300 years ago. And when a doctor encounters a potentially suspicious situation, he or she can easily fall into a bias that, once labeled (rightly or wrongly), can snowball.

Video Surveillance Violates Privacy Rights, Heightens Antagonism

Security surveillance camera on wall in a hospital room

The necessity of covert video surveillance used as a tool in identifying instances of abuse also further erodes the ethical footing of the patient-doctor relationship.

“You’d be hard pressed to find any hospital in the nation that doesn’t already use some form of video surveillance,” notes a practicing emergency room physician. “In fact, in the next 5-10 years I predict that audio or even video recording of patient encounters will become commonplace – much like police encounters are recorded now.”[9]

Video surveillance has become an established tool for children’s hospitals in identifying some forms of child abuse, particularly Munchausen Syndrome by Proxy (MSBP), where a caregiver is accused of deliberately causing a child’s illness for personal attention.[10]

Not only is it legal, but covert video surveillance in children’s hospitals is considered “a justifiable assessment tool to establish a firm diagnosis or to help to exclude deliberate harm to the child.”[11]

In fact, some pediatric facilities have constructed “special inpatient rooms that are equipped with multiple cameras, all hidden and unknown to patients and family. When MSBP is suspected, the patient is transferred to that room under some pretense.”[12]

Pediatric child abuse specialists, and their teams of professionals, all focused on determining guilt, are faced with multiple ethical challenges. Many feel these challenges make it almost impossible to avoid an antagonistic approach and an unbiased, medical role.

Families Irreparably Damaged, Reputations and Jobs Lost, Children Emotionally Devastated

medically-kidnapped-children

A brief glance through MedicalKidnap.com’s many stories demonstrates the horrific impact a wrongful accusation of child abuse can wreak on an innocent family. No system, and no one human being, can be perfect. But the current system at children’s hospitals virtually ignores the severity of the damage that can be done when a child abuse pediatrician and the child protection team wrongly allege child abuse, creating a witch hunt with very little attention to doctors in other sub-specialties or those family pediatricians with first-hand knowledge of the subjects in question.

The new children’s hospitals’ child abuse pediatricians and processes cannot be excused from the damages they cause, when hurting children are torn from loving and competent parents; when parents’ reputations can be permanently damaged and jobs lost through state child abuse registries; and when every day a child spends in foster care represents another tick of the clock in a countdown toward termination of parental rights.

References

[1] https://www.childrenshospitals.org/issues-and-advocacy/child-health/child-abuse/fact-sheets/child-abuse-facts-and-trends   from the Children’s Hospital Association, March 20, 2015

[2] Study in Pediatrics, July, 2010 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596017/

[3] “Litigating Shaken Baby Syndrome Allegations in the Child Welfare Context,” by Melissa L. Staas, June 18, 2015 http://apps.americanbar.org/litigation/committees/childrights/content/articles/summer2015-0615-litigating-sbs-allegations-child-welfare-context.html

[4] “MEDICAL ETHICS CONCERNS IN PHYSICAL CHILD ABUSE INVESTIGATIONS:A CRITICAL PERSPECTIVE,” by George J. Barry and Diane L. Redleaf, The Family Defense Center, March 14, 2014 http://www.familydefensecenter.net/medical-ethics-concerns-in-child-abuse-investigations/

[5] “BURDEN OF PROOF BEGONE: THE PERNICIOUS EFFECT OF EMERGENCY REMOVAL IN CHILD PROTECTIVE PROCEEDINGS,” by Paul Chill, University of Connecticut School of Law, Family Court Review, October 2003 http://onlinelibrary.wiley.com/doi/10.1111/j.174-1617.2003.tb00907.x/abstract

[6] “Parents Claim Nationwide Children’s Hospital Violated Rights After Reporting Alleged Abuse,” By Kevin Landers, WBNS-10TV, February 24, 2015

[7] The Child Abuse Pediatrician (CAP) – Just Another Term for Medical “Cop,” by Phil Locke, The Wrongful Convictions Blog, March 20, 2014   http://wrongfulconvictionsblog.org/2014/03/20/the-child-abuse-pediatrician-cap-just-another-term-for-medical-cop/

[8] “Parents Wrongly Accused of Child Abuse Struggle to Get Kids Back,” by Rachel Blustain, The Daily Beast, April 13, 2012 http://www.thedailybeast.com/articles/2012/04/13/parents-wrongly-accused-of-child-abuse-struggle-to-get-kids-back.html

[9]“Hospital Video Surveillance,” February 27, 2014  http://drwhitecoat.com/hospital-video-surveillance/

[10]“Evaluation of covert video surveillance in the diagnosis of munchausen syndrome by proxy: lessons from 41 cases,” Journal of Pediatrics, June 2000 http://www.ncbi.nlm.nih.gov/pubmed/10835073

[11] “Covert video surveillance: an important investigative tool or a breach of trust?” Archives of Disease in Childhood (peer-reviewed journal) http://adc.bmj.com/content/81/4/291.full

[12] “Covert video surveillance can be useful in abuse cases, but some reason for caution,” Healthcare Risk Management, AHC Media, Feb. 2007  http://www.ahcmedia.com/articles/101003-covert-video-surveillance-can-be-useful-in-abuse-cases-but-some-reason-for-caution

About the Author

Monica Mears holds a Master’s in Journalism from Regent University and writes professionally in a broad variety of genres. She has worked as a senior manager in public relations and communications for major telecommunication companies, and is the former Deputy Director for Media Relations with the Christian Coalition.

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