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I am a pediatrician, and I didn't start out in the field of child abuse pediatrics. I started out in a different field. And in 1983, I took my first job in the field of child abuse, and I've been doing it ever since until I retired in 2022. And where were you working at that time when you retired? When I retired, I was a professor at the University of Washington, and I was...
on the child protection teams at Children's Hospital of Seattle and Harborview Medical Center in Seattle. Okay. And you are a child abuse pediatrician? I am. You got that designation. Yes. Okay. Can you explain what exactly that designation means? Child abuse pediatrics is a board-certified subspecialty of the American Academy of Pediatrics. So in 2008,
nine, we had the first board exams were given and the subspecialty of child abuse pediatrics was established. What happened was we started doing this in the 1980s, early 1980s, and really since then the amount of knowledge has just burgeoned. And in the same way that cardiology or hematology or orthopedics
oncology, all the other specialties became so technical and there was so much knowledge that had to be absorbed to do it well. The same thing happened in child abuse pediatrics. And we realized that there was so much that a generalist couldn't absorb. And so when I started doing this in 1983, there were
Three or four articles in the literature. And now there are thousands published every year. Specifically on child abuse. On child abuse. Okay. So in 1993, we went to the Board of Pediatrics and we asked to establish this as a – I'm sorry, 2008.
We were asked to establish this as a board-certified subspecialty. So you were part of the push to actually make this a subspecialty? Yeah, I wrote the first application for this, and I sat on the first board that defined what child abuse pediatrics should be, what the content should be, and I was part of writing the first exam. Wow.
And so that was the original child abuse pediatrics board exam. And now to be a child abuse pediatrician, you have to do a three-year fellowship after residency. So you do four years of medical school, three years of residency, three years of fellowship, and then you have to show competence in research and then in
in taking this very complex exam and then every 10 years you have to re-examine, get re-examined and show that you continue to have
competence in the field. So that's extremely robust process. Oh, yes. It's exhausting. Yeah. I would assume every pediatric hospital, every place that treats children medically would need to have some kind of staff there to handle abuse suspicions. Is there a child abuse pediatrician in every hospital or how common is this? There are about 350 nationally.
that are board certified. And there really are not enough board certified physicians to fill the need. So the National Association of Children's Hospitals has a level that they think that every children's hospital should do. Level one, you have a physician who is
has expertise and works hard and goes to meetings and learns more about it and is available to consult. Level two, you have a formal team that works on cases. Level three, which is what Children's Hospital in Seattle is, you have a team that does fellowship training, research. Extensive training has board-certified subspecialists involved.
and active social workers and a larger presence that is a subspecialty presence within the hospital. So most
sub-specialty children's hospitals do have the level three teams. So we're talking about, because that actually, you know, a lot of the, both of the cases that we're really focused on for the podcast have taken place mostly at Cook Children's in Fort Worth, which I'm sure you're probably familiar with. And we interviewed Dr. Jamie Kaufman, who is the head of the care team there and is also a child abuse pediatrician. So I would assume that when you're talking about these different levels, you're talking about really larger levels
children's hospitals in major areas as opposed to sort of like some of these other maybe more rural locations that have, you know, as you said, one doctor with extra expertise. Well, it's, you know, these cases are very complex and they take an enormous amount of time. And I mean, it may take
Particularly in a medical child abuse case, it may take hundreds of hours of physician time to go through thousands of pages of records. And most general pediatricians just don't have that kind of time. And who is that time compensated by? In a children's hospital with an active team, the hospital takes this on. I think of it as one of those quality assurance services.
the hospital has to do. They have to have an infection control team. They have to have a quality assessment team. They have to have nursing education. And those are things that don't get, that insurance companies don't reimburse. You know, I think of it as one of those things
that a hospital has to do to be, to make sure the community is safe. Right. Because the hospital is not just a business, obviously. Well, unfortunately, yeah, tell that to the hospital administrators. But it, it,
There are certain things you have to do to be responsible to the community. And one is that you have to make sure that you recognize these cases and that you handle them appropriately. Right around this same time period that child abuse pediatrics was coming into existence with your help,
You wrote a book called Medical Child Abuse Beyond Munchausen by Proxy. And you in that book, you and your co-author made the argument for a paradigm shift about Munchausen by Proxy and introduced this term of medical child abuse, which is
widely used now, but also Munchausen by proxy is still very much around. And, you know, what we've found is that and the reason we still use on this podcast is because if the general public has heard of this at all, that is probably the term that they're familiar with. But can you explain what is the paradigm shift that you were suggesting in that?
This came from an experience that my husband and I had. He's the first author on this book. His name is Tom Ressler, a child psychiatrist who at the time was running a program for
medically ill, psychologically ill children at National Jewish Hospital or Research Hospital in Denver. And I was running the child protection team at Denver Children's Hospital. And we both shared a case of a child who came in and had a very severe asthma that just got worse and worse and worse and worse. And finally, he started off on Tom's unit at National Jewish. And finally, he needed to have intensive care and was transferred to Denver Children's.
And we were both involved. And it turns out that
A very smart pulmonologist realized that the child would have these horrible episodes of respiratory failure only when his mother was with him and when the curtains were pulled around the bed in the intensive care unit. And eventually, the police got a confession that she was giving the little boy Coca-Cola and then putting a hand over his mouth so he would aspirate this alcohol.
acidic substance into his lungs and then go into respiratory failure and go onto a ventilator. And essentially, eventually he was going to be, he was going to die. You know, she was going to kill him. And so we met with the lawyer for the state and
and we're talking to her about this case, and we said, this is child abuse. This is a child who, this is attempted murder. This is a very serious case. And she said to us, oh, really? I thought it was Munchausen syndrome by proxy. And we kind of looked at each other and said, what? What's the difference here? And that's when we started to think of this as child abuse, because in fact, it is. And then that
And then, in the summer, he and I gave a joint talk at a medical meeting. I think it was at American Professional Society on Abuse of Children. And that was the first time we presented on this concept of medical child abuse, which is a child receiving unnecessary and harmful or potentially harmful medical care.
at the behest of their parents or their caretaker. And sometimes it's making up an illness, sometimes it's exaggerating an illness, and sometimes it's inducing an illness, which are the worst ones when you actually make the child sick.
So we started to think of this not as some strange mental illness of the mother or the caretaker, but as an actual act that is perpetrated upon the child that's abusive and that hurts the child. And that sort of changes the emphasis from the parent or the caretaker to the child and changes the emphasis from the need to diagnose the
the person who's hurting the child to the need to protect the child. So when you have a sexually abused child, you don't call it a child who's been around a person who likes to have sex with children. You call it sexual abuse of a child. So it changes the emphasis or the perspective from the perpetrator to the child. And of course, as pediatricians and child psychiatrists,
Our main focus is on protecting the child. Right. And of course, that should be the community's main focus as well. I think most people would agree. Why do we get so fixated on the perpetrator in these cases? I hope there has been an evolution since you first introduced this idea. And certainly I have heard the term medical child abuse quite a bit. But
there remains this fixation on why would a mother do this? People get very hung up on that in a way that they don't, as you mentioned, with other forms of child abuse, right? I think we can all agree that not all is well with someone who's abusing their child. That's not a thing a sort of healthy person would abuse their child in any way. So why is it with this form of abuse we get so fixated on what is going on with the perpetrator? Yeah.
Well, I think in physical abuse or sexual abuse, there's no question. That's just outrageous. Nobody would do that. But anybody who has children can't imagine why you would want your child to be sick or why you would want them to be in the hospital. I remember when my daughter was five and she went in to have her tonsils out. She was in a day surgery. And I said to my husband, oh, you don't have to come with me. I'll just take her in. Right.
And so I went into the – we went through the day and at the end of the day, she was in a lot of pain and was crying and upset. And I ended up just dissolved at the bedside in tears. And I never thought that I would be so affected. But it was my baby. And so nobody can imagine wanting your baby to be sick or to have –
or IVs or all these things happening to them. No parent could actually imagine wanting to have your child go through that. The other thing is that I think physicians and nurses and physical therapists and occupational therapists and other people who take care of kids have this horrible feeling that they've made a big mistake and they've been fooled.
And why did this happen to me? How is it that I've been fooled? They get their backs up, you know, and they get outraged that somebody fooled them
And so they want to know why this person would do this. And so it becomes very personal. I see. When I read that in your book, when you were talking about the role of guilt and shame and anger that physicians go through when they've realized they've been used as a tool to abuse a child, which is obviously just a horrific thing. And all of those feelings on behalf of the physician are completely understandable. That really hit me because...
I think that that expands to sort of
everyone involved in these cases in a way because I think dads go through a version of that where they think, how did I let this happen? Why did I choose a person to be with that would, you know, that would do this? Like Mike, Detective Mike's talked about that. And even from my own family's reaction, the first time, which was 12 years ago when my sister was investigated, you know, our reaction was very much like,
along the lines of how can we help her? Because that framework is easier to swallow. And I think especially for my parents, who this was their child that they're fearing is doing these things. How can we help her and focusing on what's going wrong that's happening and how can we fix it and how can we keep everyone together? Um,
Our perspective has changed since then, but that was very much initially how we looked at it. I just thought that was a great insight about doctors in particular. It's really tempting to grab for an explanation of
Not that necessarily lets the perpetrator off the hook, but a little bit, right? Well, and it takes the guilt away from the doctors. We are the stick that hits the child. The mother picks up the stick and hits the child, but it's not – the mother is doing it, but we're the stick. And so by focusing on the mother, that takes the guilt away from us.
But by focusing on the child, that's where I think the main focus should be. Now, that doesn't mean the mother gets away scot-free. That means that first you focus on the child. You make sure the child is safe. Once the child is safe, you make sure the child remains safe.
And then you start to say, okay, can this child go back to the family? And if not, then what other ways can we build a strong family around the child? And then finally, there comes a point where you say, well, if this is someone who has actually hurt a child and there is motive and there is evidence, then we should talk about
that person paying the price, you know, like any other person who abuses a child, that should be investigated and they should be held responsible. Obviously, you have come across many, many cases, given your subspecialty, given your focus in this area. And there is obviously a range of behaviors with this abuse, right? So as you mentioned, sometimes it's
more in the realm of making things up and exaggerating things. And then it goes all the way to inducing things like the horrific case you talked about in some of the cases that we've talked about this on the show where they are poisoning their kids, they are suffocating their kids, they are starving their kids. So where along this spectrum is
do we find that a perpetrator really cannot have continued contact with their children? And what cases, what are some maybe cases of this where, you know, we've talked a lot about sort of the family court system and CPS being very, you know, skewed toward reunification in most cases. So like when is that appropriate in these cases? Anytime a child is not safe, the child's safety should be the first priority.
goal. And if the child is not safe, in the same way you wouldn't send a child to have visitation with a pedophile that's fixated on abusing children, if they're not safe, you wouldn't have them do that. If the child is not safe, they should not be in contact with the perpetrator. The safety of the child should be the first goal.
It's not the safety or the mental health or the comfort of the parent or perpetrator. It's the safety of the child. And that's the goal. So as we're talking about, fixating on the mental health of the perpetrator is the wrong element. And yet you hear a lot of cases where they bring in a psychiatrist or psychologist to evaluate the suspected perpetrator. And in fact, that is what happened in the first case.
investigation into my sister. They brought in someone to evaluate her. We talked to that person as well and sort of we were honestly reassured by that conversation because he seemed to understand that something was amiss. But why is that the wrong way to approach an investigation? That's the wrong way because if a person is medically abusing the child, the only way you're going to find out about that is by doing a very thorough review of the medical records.
And if the psychologist sits down with the perpetrator, the perpetrator could be very charming, very convincing. The doctors don't understand. They're trying to cover up for their own mistakes. And a high percentage of the time they'll say, oh, this is a wonderful mother who really cares for her child. And so we always say save the psychological evaluation until after the child is safe.
And once the child is safe, that's the time to call in the psychologists because that will just muddy the waters. Right. Because a psychologist can't sit with someone and determine whether or not they've committed a crime. Well, and in fact, what we do is if CPS wants to call in a psychologist, we say, fine, but let us sit down first and describe what we know about what has happened to this child.
This is what the child's health status was before when the child was with the parent. We took the parent away and this is how the child is now. The child went from being almost dead to being a very healthy child. And so the only difference is they're not with their mother or they're not with their caretaker. And they have to know the difference. And we've actually had cases where when we do that,
The psychologist then can say, get the person in therapy and then get to why it is. And one of our cases, the mother went on to say, I was so afraid my boyfriend would leave me. I just had to make sure the baby stayed sick so that he wouldn't leave me. And they get to it. Then they come to a recognition that,
what reality is. But the point is, if they listen to the mother's side of the story and don't know what the facts of the case really are, they're not going to have the whole story. These moms can be very, very convincing. And so, you know, yes, they need psychological care. Yes, they need psychological evaluation. But only after the child is safe. When there is a suspicion of medical child abuse within the hospital system,
How does that investigation begin? How do you get to the bottom of that? If it's a hospital that has a functional child protection team, the child protection team gets involved first and starts the medical record review.
And since that can be a very lengthy procedure, the question is, how do you make sure the child's safe in the interim? And there's some ways that you can do that. You can ask the mother to leave. You can put somebody in the room to be monitoring to make sure that nobody hurts the child. You can report to social services and get them involved. The problem with CPS is these are such complex cases, and these are...
complex medical issues and how in the world can they know if the effects of the drug was from an illness or from an overdose? And so that's why you have to have medical expertise involved in the phase of evaluation. And so the question is, how much do you need to know before you get child protective services involved?
And, you know, can you coordinate with them? And, you know, at which point do you pull this team together? It's very complicated. And the other thing you do is you have to have the physicians agree. A lot of these kids have
13, 14 specialists involved. And if two of the doctors are absolutely convinced the child has a rare disease and 12 doctors say, nope, this is really basically a healthy child and there's no reason why she or he keeps having all of these awful events and needs all this intervention,
And then you report it to social services. It goes to court, and those two doctors then stand up and say, I know this child has such and such. And then what does the judge do? The judge has to send the child home. So you need to cure the doctors. You need to have consensus among the physicians. You need to have a strong, in these very complex cases, you need to have a very strong consensus
team that is working together to present this case to the outside world. Now, there's a whole range of cases. I mean, there's...
from very mild to very severe. And mostly what we see in the literature and on TV and whatever are the very severe cases. And many of the cases we can handle really within the doctor's office or between specialists or on the hospital ward. And if the parents are willing to cooperate, if
If we can get their cooperation and get them on board and say, you know what, your child's getting an awful lot of medical care. And medical care can kill kids. And if you keep getting this much medical care, your child's really at risk. Let's turn this around and let's take another approach. Now...
I sort of wonder what a case like that looks like because there's more than one reason that someone might be taking their kid to the doctor too much, right? It might be an anxiety thing. It might be, you know, that there's a big difference between a parent who is genuinely concerned that their child is ill and a parent who is concerned
doing it in an abusive manner and knows that they're doing it in an abusive manner, right? They know they're poisoning their child. They know they're suffocating their child. They know they're lying about what the past test results have said, et cetera. The cases where you're talking about being able to handle it within the system without getting child protective services involved, I mean, are those kind of more of the cases where
parents are over-medicalizing their kids for other reasons and that they genuinely are having some fears around their kids' health. Yes, in those cases, what you can do is just bring in more family, bring in the grandparents, the father, other relatives, and, you know, use the family, expand the circle and help change the attitude of
of that parent. You bring in the primary care doctor and say, okay, instead of having mom call a cardiologist or make an appointment for a neurointervention with a radiologist, everything should go through the primary care doctor. Have a primary care doctor who evaluates, is this really necessary? Have a gatekeeper.
and treat mom's anxiety, work on what her issues are, give her medication if she needs medication, but also bring in other people to help her
manage her fears and make sure that the whole family gets involved in protecting the child. And if you do that and you use kind of a family therapy approach, that can be very helpful and very powerful. Now, if it's somebody who wants to get attention and knows that they're poisoning their child. And wants their child to be sick. I mean, you talked about there is this sort of
sacred contract between doctors and their patients or doctors and the parents of patients in pediatrics where the doctor is going to try and get you healthy or your child healthy and you are going to do everything that you can. Like everyone is working towards a mutual goal of health. But if you have an abusive parent, they are not interested in working towards the goal of health. So the basic idea of medicine in general is that
The patient is ill, they go to the doctor, they ask the doctor for help, the doctor says, "Okay, I'll help you." They give them medicine, they say, "You'll get to stay home from work, you follow my directions, you'll get better, then you go back to full health." And that's the rules that the doctor's following. Well, if the patient's not following those rules,
And the patient is saying, "Well, I'm going to pretend like I'm getting better or I'm going to continue to make myself sick." That breaks the contract between the doctor and the patient. The other thing is in pediatrics you always assume the parent is working in the child's best interest. That's a given. That's what we've been taught from little on up as pediatricians. And pediatricians are such nice people.
They're in pediatrics because they love kids, they love families, and they've always been taught to trust parents and believe what mothers say. So it's really hard for a pediatrician to say, oh, this mother's lying to me. And so when the mother breaks the contract, doesn't tell the truth,
doesn't work in the child's best interest, it really makes the medical care system very rocky. Yeah. I liked that you mentioned in your book that some degree of dishonesty is
is to be expected from patients and to some degree from parents, right? Like there's a normal degree of it. Like everyone lies in life. That's sort of a general truth. And I like the example that you gave in the book, which was that doctors are basically taught that like if you're asking a person to report on how many alcoholic drinks they have and they say, I have one drink before dinner every night, you can just assume they have two, right? Which made me laugh. But there's sort of a spectrum here of like maybe you're telling your –
your child's pediatrician that they get like a little bit more vegetables in their diet than they do, right? Because you're like, I'm going to give them the aspirational answer or not. Right.
Or whatever, or like a little less screen time than they say, oh, are you sticking to one hour of screen time a day? And you're like, yeah, you're like, except for last weekend and the weekend before that. But that was an exception. You know, like there is some like level of like. I think of the example of a friend of our child who was two years old, very bright and went to his first dentist appointment. And all he would eat was candy and hot dogs. And that was that was his diet. That's all he would take.
And he gets in the dentist's chair and goes up and down and is answering all the questions. And the dentist says, and what's your favorite food? And he says, vegetables. So you've talked about this medical record review process, which you've done many times. And in fact, you did on my sister's case.
This is a matter of public record. And you've talked about, you know, that these records are voluminous. They're from multiple institutions. They can number in the tens of thousands of pages. So what does that actual process look like?
Like, how are you sort of documenting? What are you looking for? Because you're looking for essentially a pattern, correct? Right. You're looking for a pattern of dishonesty, lies, inconsistencies. And what I do is I make a chart, a huge chart that's the date, the institution, the chief complaint, and then, you know, the nature of the visit and what happens. And you do that for everything that happens. Right.
And then what you find is this is what happened at this doctor and then he goes to another doctor and tells the opposite story. Or the doctor says, "I want to admit your child because she's not growing." And then they change doctors. Then the next doctor says, "I want to admit your child because she's not growing." And then they change doctors.
And if that happens two or three times, you start to say, wait a minute, what's wrong with this picture? Or the doctor says, oh, you don't have that problem. We're going to start weaning that medication. Then the parent goes to another doctor and says, the doctor says she has this problem and needs to stay on this medication for life.
And they never seem to go back and look at the old records. And so they put her back on the medication. Well, and sometimes if they're in a different institution, a doctor doesn't necessarily have the ability to do that, right? Because a parent has to give...
I mean, is that right? It's unclear to me what the parameters are. But yeah, and I'm not sure sometimes. But I think some of the most horrible mistakes people make are because they just don't feel like they have to go back and look at the records. And, you know, I've done a case recently where a child was horribly, horribly abused and almost died. And it was because...
At age three, she was taken away from her parents. She became a normal child. At age eight, at another children's hospital, she almost died and suffered long-term consequences. And they never went back and got all the medical records where she went from being almost dead to being normal to being almost dead. And the point is— Why wasn't that child—
taken away the first time. Well, she was. She was taken away. And an expert witness from a very prestigious medical school came in and said, oh, she has a rare disease. These doctors that say that she was being abused are just ridiculous. And the judge sent the child home. And then the same thing happens again and again and again. And by the time she was eight, her parents had almost killed her a second time.
But the point is, why don't you go back and look at records? Part of this is on the doctor's right, but it's also, I mean, because it strikes me about, and you talk in your book about how sort of
doctors are trained to think in a really different way than lawyers and judges. It strikes me that you could always find differing opinions with doctors, right? If you were looking for it, if you just went to the ends of the earth to find, you know, and especially in some of these diseases, and I want to talk about sort of some of the things that are the most common conditions that come up in these cases. But in some of these things, I mean,
They are next to impossible to prove. And so, you know, Mike Weber has talked about how he never asks a doctor on the stand, is it possible? Because it's always possible. Right. Right. He says, in your 20 years as a gastroenterologist, have you ever seen, you know, X, Y, Z? And because you're mostly dealing with circumstantial evidence in these cases. And so, yeah.
There is obviously onus on the doctors, and I appreciate that that's a perspective you're coming from, but you're also talking about the family courts sending these children home, and there are so many examples in your book where you describe these absolutely horrific cases, and then the end is this child was returned to their parents against medical advice. So what is the disconnect that is happening here between...
medical experts and especially like understanding that this can't just be some subspecialist that's seen the child one time giving an opinion that outweighs someone who has gone through the tens of thousands of pages of medical records like how should the courts be sort of weighing these opinions because it seems like I know you talked about the importance of consensus but that seems like
an impossible bar when you have a mother who has been taking their child to every doctor at every institution they can find. The chances that they're not going to find one doctor that they can fool seems infinitesimal to me. And indeed, when I talk to survivors who have been able to access their own medical records and gone back and put together their life histories that way, they indeed talk about how
Their mother, and you kind of pointed to this pattern, their mother would keep trying and keep trying and keep trying until she could find someone credulous. Right. They doctor shop. Exactly. Until they find a believer. Right.
The fact that someone can convince one doctor shouldn't outweigh the fact that they have all these other doctors and someone who's reviewed all of the evidence and that the tiny possibility that they might have a disease should outweigh the evidence that this parent has been deceptive, has been, you know, has sort of done all of these things. And indeed, there might be something wrong with the child, right? That doesn't—the existence of some illness in the child does not disprove—
abuse. Is that right? That's right. And a lot of these kids do have some problem, a well-documented problem, and are treated for some well-documented problem. But it gets so blown out of proportion. And there are outlying doctors that just suck up these cases. You know, there are cowboys out there who just have odd beliefs about
that, oh yes, everybody they see has Pott's disease or everybody they see has chronic Lyme or whatever and they come up with these diagnoses and literally they do very well diagnosing these oddball diseases which probably exist in a small number of people
But everybody they see has that disease. And one would imagine that medical child abuse is overrepresented. Oh, yes. Oh, yes. They just flock to them. There's a problem in the medical care community, too. There's doctors who make the same diagnosis over and over and over. And the mothers get online and they say, oh, everybody that he sees has mesenteric artery syndrome. And that's...
that if you go there, you'll get surgery for that. Now, what happens most of the time is that doesn't cure the pain, strangely enough, but they still go and they still get their surgery. Well, and if the pain never existed to begin with. Exactly. Or the pain is totally unrelated. The other problem is that once these kids get to be a certain age, they're very much part of the problem. They're very much trained to be
in constant pain, in constant distress, unable to eat, whatever. And then it's a real hard problem because to turn that around is really an issue. Yeah, I've done some work with survivors and I'm close with a few of them and they've talked about that, that they have these memories of being, you know, once they got to be 10, 11, 12, of not understanding...
even their own bodies, just sort of really being so disconnected and understanding that like their mother was wanting them to say these things, to perform these things, to report these things to the doctor. And then also just not even sometimes just being, you know, being very convinced themselves that they were sick. And even once they've discovered that they were victims, being very afraid to try sports or, you know, do any number of things because they've just been so convinced that,
they're ill and the world is this incredibly dangerous place for them because they're so fragile. What would a healthy four-year-old's medical records look like? So normal medical records. Well, of course, in the first year of life, you have
five, six well-child visits and you may have two or three illness visits for gastroenteritis and URIs. Second and third year of life, you really don't have much. You have your school visits and then in grade school you have sports physicals and things and camp physicals. But normal kids just don't go to the doctor that much. Now, then you look at kids that have cancer and
Or cystic fibrosis. And kids with MCA generally have thicker, bigger, uglier records than kids who are very seriously ill. Oh, interesting. So we're sort of talking about these three levels, right? You're talking about like a healthy child with no chronic conditions. Right.
you know, has however many, you know, I don't know if there's sort of an estimate, if you could say like, oh, 200 pages by the time they're 10 or whatever. And then sort of that's like, that's one stack. And then the next stack up would be a child that has legitimate chronic condition cancer. And then,
Like twice that is a medical child abuse case? Kids with cystic fibrosis or cancer or a serious chronic disease don't go all over the country looking for care. You know, they find somebody who takes good care of them at Children's in Seattle or the hospital in Portland or Boston Children's or Mayo Clinic or somewhere, and they get their care. But they don't go to –
You know, Boston Children's, Cincinnati Children's, Pittsburgh Children's, Lurie in Chicago, Mayo. We get kids that have been to literally six, seven, eight hospitals. They get to Seattle and they're going to fall off the edge of the continent. And then they have to go south to San Francisco and Los Angeles. They've been to so many hospitals.
And at each of those places they get the same tests, they get the same workups, they get the same results. So it's not getting a second opinion the way we think of like... No, no. Oh, you know, yeah, I'm going to go... I'm going to get a report from my child's doctor and then I'm going to go say... I'm going to go truthfully report to the next doctor. This is what the first doctor said, like, do you agree? It's not that. It's very distinct from that. It's in multiple, multiple consultations with multiple doctors.
And if they don't get the answer they like, they move on. And I mean, I would think, you know, so I yes, I have I have a four and a half year old and I have I have a 10 month old and we've been to a total of three different institutions. We have been to.
We have been to see their regular pediatrician at the pediatrician's office. And as you said, you know, when they're new, they go in like every month and then just well child visits. We have been to Children's Hospital urgent care twice for fevers that were high that miraculously went down in the car on the way over there.
which I'm told happens all the time and it is embarrassing. You go in there and you go, here is my sick child who is now jumping all over the room. But yes, we've had two of those visits and then once my son, when he was a few months old, got hair wrapped around his fingers and had the hair turned to get. And fortunately, we live one block away from the emergency room at Swedish, so we took him there and they snipped it off and it was fine. But I can't imagine living in a place like the Seattle area
And needing to go to a bunch of different hospitals because Children's Hospital in Seattle, which is one of the best hospitals in the country. And sure enough, you know, we have so many good hospitals here. Just the idea that you would need to go to four of them or five of them, it pushes credulity to say the least. And again, it's if you're not getting the answer you want, you go to another institution.
And that's a problem. In looking at these two cases, we're looking at the Hope U Bar and the Brittany Phillips case.
They are very different. Their behaviors towards their child are very similar. They're very different kinds of women. As you mentioned, you know, some of these perpetrators can be extremely charming, extremely warm, extremely persuasive and are beloved in their communities. And then, you know, Brittany Phillips, who we're talking about in season two, was just a bully. Nobody thought she was a good parent. Everyone thought something was going on. And yet, even then, it took a long time for anything to actually happen within the legal system.
Do you find that there's any kind of sort of, quote, profile for this abuser or can it really be anyone? I think for years people said, oh, there's a profile.
They're all people with medical backgrounds or – well, the only profile is that they're mostly women. Right. And that's been I think pretty clearly shown. And the other quote profile is that many have had traumatic childhoods or something that's been traumatic. Not all but many. Right.
But generally, it's all over the map. And that's the case with all forms of abuse, right? That there's sort of a higher instance of someone having some kind of trauma. Yeah. But the point is there is no profile. That's one of the problems. The psych profiles are sending them to a psychiatrist where they say, oh, this patient does not fit the profile of –
a Munchausen's by proxy patient. Right, because again, we're fixating on the perpetrator rather than looking at the behavior in the child. There is no, so I would say there is no profile. You look at what happened to the child. You look at the evidence. You look at the evidence of the experience of the child and the medical care that the child has experienced. And then you worry about the perpetrator later. Mm-hmm.
And with that said, you know, as I've looked at a large number of these cases, I have noticed there are certain procedures and conditions that come up just all the time. Premature births, gastroenterological issues in the feeding tubes, polymicrobial sepsis you mentioned in your book.
I mean, what are some of the most common, and again, we always want to emphasize when we talk about these procedures that come up again and again in these things that it is not that parents who have these legitimate issues in their children should be looked at with suspicion. But what are some of the most common things that come up in these cases? Well, in our series, our case series that Tom and I did, we looked at a large number of cases.
And, you know, many have multiple subspecialties involved in their care. We found that the number one subspecialist who would see these kids would be gastroenterologists. More than anything else, these kids have gastroenterology problems. And is that related to that?
failure to thrive diagnosis that comes up all the time. Well, failure to thrive is part of it, but diarrhea, chronic vomiting, gastroenterologic problems. And one of the issues is if you go in and say, my child has chronic diarrhea or my child cannot have stools, they have a 15-minute visit.
And how can you possibly know if that's true? And so you rely very heavily on the parents' reports. And the second would be neurologic conditions, particularly seizures. Because again, you're with the kid for 20 or 30 minutes even, chances are you're not going to see a seizure. And if the mother is reporting four or five seizures a day, the chances are they're not going to have a seizure when they're in the office. And so here these kids come in, they have four and five seizures.
normal EEGs. They never have a seizure in the hospital. And the mother reports extensive seizures at home. And interestingly with seizures, because yes, I have noticed that seizures come up a lot, there can be a huge range of ways that seizures present, right? I think we have all of our idea of a seizure as someone on the floor shaking and having a grand mal seizure. But in fact-
It can be a child staring off into space. I mean, there are a lot of things that are way more subtle so that you could sort of get someone to say, oh, no, no, I've seen those symptoms. You know, a family member or something being like, oh, yes, she sometimes stares off into space. I mean, my daughter does that all the time. I don't think she's having a seizure. So and a lot of these kids get put on huge amounts of medication.
and that are really very toxic. These are not good for you. And even though they're on large amounts of these toxic medications, they still are having seizures and having more seizures. And the doctors keep raising the doses and raising the doses based on the mother's
report of all these seizures. They have another EEG and another EEG and they're negative and then the doctor says, I want to bring them in for a 72-hour EEG in the hospital and for some reason that just never happens. Allergy is big. My child has so much trouble with allergy and how do you know? Food allergies, I mean, how do you prove it? Interesting. So I wanted to ask about the
Right.
But you are arguing that this behavior exists. It's abuse. It should be treated like abuse. There is another argument that said this diagnosis doesn't exist and –
Anyone who's being accused of this essentially is being falsely accused because this form of abuse essentially doesn't exist. There's this book that you mentioned, Disordered Mother or Disordered Diagnosis, that essentially makes this argument. There's an organization called MAMA, which I believe stands for Mothers Against Munchausen Accusations, that essentially treats every case –
of medical child abuse as though it is a false accusation. And in fact, you know, this is a sort of thesis that's been pretty upheld in the media. Certainly the work of Mike Hicks and Bogg, which we have discussed in detail with regards to my sister's case, Mike Weber and I have discussed that, you know, essentially seems to be coming from that angle of if a person is accused of this and is not convicted, or even in some cases if they are convicted,
It means this is a false accusation. This is so vanishingly rare that it's not something we need to be watching out for, etc. And it seems that this is not a recent argument, right? That seems like this has been around since the inception. What do you say to people that are coming from that standpoint of,
Either this doesn't exist, period, or this is so rare that we don't really need to be worrying about it. Well, I think it's the old thing of man bites dog versus dog bites man. I mean what makes an interesting story? Not that – not that –
a woman, not that a doctor realizes that a mother is abusing her child. It's that a poor, innocent mother has to go through all this and loses her child and we feel so sorry for her. That's much more appealing in terms of the cell in the media. And we've gone through the same thing with head trauma. Nobody shakes their baby. All these babies just
fall over and die, you know, and their heads explode. I mean, we've gone through that for years. And in fact, babies' heads just don't explode. You know, something happens to them and it's a really bad thing that happens to them. And so I think the media wants to make things...
exciting and interesting. And it was very interesting with around the issue of shaken babies. We had a very famous journalist come to one of our conferences in New York City because he wanted to see what the, what the, you know, what the
what the controversy was. And he was going to write about this and present it on TV. And then nothing ever happened. And the woman who organized the conference called and said, hey, didn't you come to talk about this? And he said, well, clearly this is a real thing. And she said, well, why don't you write that? Because who cares? Nobody cares about that because it just doesn't sell. You know, it's just not interesting. And so I think that
It's just not as interesting to say that moms hurt their babies as to say that this poor, poor innocent mom has been falsely accused. We have thought a lot about how do you tell this story where people connect to it and care about it and see it for what it is. And maybe this is why we can't get away from the fixation on the perpetrators because people are fascinated by –
mothers who do this, right? If you look at something like the Dee Dee Blanchard case, and obviously that case was wild for many other reasons that, you know, had to do with other things than just the abuse. But I have found, you know, being a person that's been talking about this publicly for the last few years, that people are very fascinated. And I wish we could sort of
turn that fascination into like a sort of healthy skepticism about the idea that doctors are just running around. I mean, because really I've seen, you know, it's not just my kicks and bugs work. There was a big article in New York Magazine that was about, you know, that was really going after a doctor in Florida. And I've seen, you know, just this trend of sort of painting a scapegoat, a single doctor or a single expert and make it sound as though that doctor had something to gain and
by reporting. Doctors are mandated reporters. And I don't imagine that it would be a good time to report someone for abuse. I read these wild leaps of logic of like, well, this person was making money off of state referrals. I just don't imagine. Can you think of a
personal stake that a doctor would have. No, I once had a defense lawyer say to me in court, "Well, don't you get money for every case you report?" And I said, "You mean like a bounty?" And he said, "No." And I said, "Boy, I wish I did. We'd make a whole lot more money than we make now." But the point is, no, the downside is very great. It's very stressful. You have to go to court. You have to take a lot of grief from a lot of sources.
And I think that the number of cases that go unreported are very, very much outweigh the number of cases that get overreported. And so I would much more worry about those underreported cases than I would the overreported cases because most of the cases that we end up proving and that end up getting proven in the system have been to many other hospitals. Right.
And just slide right under the radar. And when you say proven in the system, do you mean...
End with a criminal conviction or end with the medical record review showing that abuse has happened? The medical record review shows that it happens. The child gets protected by the social service system. Rarely do these go to conviction, go to criminal cases, except in a few places like Texas. But I think in, for instance, in Washington, D.C.,
I think there's maybe even two criminal convictions. I was involved in one. And that's, we do 12 cases a year maybe that we would say are definitely founded and social services agrees with us. But they rarely, even when we have video evidence of the mother doing something overt to the child, like draining the formula out of the stomach,
or giving substances to the child. The defense can always be mental illness. And in fact, the Munchausen's by proxy being a mental illness or something wrong with the mother is a really good defense.
But it seems to me even in that case where they're using it as a defense – and I know that's kind of one of the reasons that it sort of – that's one of the arguments against classifying as any sort of mental disorder –
Even so, it seems to me then the child should not be with that parent. Right. And again, protecting the child is the number one goal. And once we make sure that happens, then we hand it off to the authorities. But to me, even in very grotesque cases where the child has been obviously and terribly hurt, it rarely goes to
criminal court. And what about family court? Well, again, it goes to family court and sometimes they do the right thing and often they don't. It's expensive. It costs a lot of money.
to do the right thing in these cases. Just because of all of the... You have to hire experts and you have to have... The complexity of the cases. Yeah, they're very complex. And like the usual family court lawyers don't know how to handle this. I mean, these are very complex cases. So family court makes mistakes.
And, you know, like the case I was talking about recently that was in another state where the child almost died twice. CPS did the right thing, but the family court just totally messed it up. I understand that all of these systems are, you know, both discrete and sort of interlocking. It just defies my understanding of why you would have CPS petitioning for dependency and
and experts testifying, you know, to support that case.
Why a judge would ignore that? It just I can't understand it. And I don't know if it's just a lack of a lack of knowledge about what these cases are, if it's just that resistance to seeing what appears to be a loving mother as a criminal. I suspect and I wonder if you agree, like when we talk about these other kinds of abuse, we talk about abusive head trauma, we talk about, you know, child sexual abuse, which is mostly men, mostly male perpetrators.
Like, is there something about specifically women, specifically moms, specifically moms who may appear on the surface to be very loving? Is there something about that that just people really have a hard time metabolizing the idea that they could be doing this most horrific thing?
Well, I don't know what the education is of the judges. I don't know if they get any education on this. Zero, I believe. So I don't know if they have any idea what this is. So someone sort of trying to process that as they're hearing –
you know, the most horrifying story they've ever heard. And like this complicated medical stuff. And again, as you said, like the, the, the medical system and the legal system are set up really differently. And I thought that was like a really interesting point that you guys made in the book where you're saying like, you know, doctors are sort of like have, have this way of thinking where it's not a, we need to take both sides of the issue. And obviously the legal system and for good reason, right. Is set up as sort of prosecution and defense. And you have a
supposedly neutral party in the middle that's going to make a call, right? And so doctors aren't necessarily well-suited to be, you know, to be sort of like defending something when they feel like the facts are there and like the facts speak for themselves. So I don't understand why the juvenile court system doesn't have expert panels of
Excuse me. People who are knowledgeable about physical abuse and sexual abuse and medical abuse and child development and substance abuse and antisocial personalities. I don't know why they don't use outside experts. I know in Europe they do. Right. But here's a judge –
in any case, who haven't only knows what their own biases are or what their own education is, most of them, I'm sure, don't have any education in sociology, in psychology, in any medical field. They have no knowledge in anything that would lend them to be able to make reasonable judgments
And then they have people presenting things to them in various ways that may or may not be effective. And they may or may not have biases. And so who knows? With the understanding that there's not much specifics we can get into about Megan's case, one of the worries I have about
the media coverage of these cases that we've discussed. And I think that that's a cogent point of there's a more interesting narrative if it was a false accusation. But what often happens when that's the narrative is that the person who gets blamed for taking the child away, now, of course, that's not how it works, right? A doctor has to report and get, you know, and CPS has to be involved and a judge has to give approval. So it's not as though a doctor can single-handedly say, take this
child away from their parents. But that is the narrative that gets put in. This doctor is responsible for separating this family. Like in the case of Dr. Woods, she was absolutely dragged through the mud in the media. And I have to imagine other doctors see that and they're
probably that would inhibit people from reporting. And to my mind, that might make doctors more likely to say, you know, I'm just going to stop seeing this patient rather than basically put myself on a plate for this kind of treatment. That is why I have such a problem with that reporting. It feels so irresponsible to me because it's not just about this one story. It's about the entire community.
We know there are bad doctors out there, obviously. There are doctors, you know, malpractice is a real thing. There are doctors who do bad things. You know, parents have the right to talk about it in the media if they feel they've been wronged. Like, all of that is true. But...
You know, I also think when that reporting is not responsible, when it doesn't look at the full documentation or take the entire thing into account, which this piece did not. And I have explained in my conversation with Detective Mike all of the reasons why that is true. You are really contributing to a narrative that doctors should not report this abuse when they suspect it.
I expect that has a very inhibiting effect on reporting. Who wants to go through that kind of stuff? And when I have been in a situation where a parent has made gross accusations and then the media comes to me and says, they've said these terrible things about you, I say, I'd be happy to talk to you if you will get the parent to sign this
to let me give full access. I will give you my report. I'd be glad to sit down with you. And then that never happens.
So if – like in the case that you're talking about, if they would give me full access, if the parents would sign and say, please, do talk to the media. Please release your report. Let them hear the whole story, both sides of the story. I'd be happy to do that. Well, the thing that was truly stunning to me about the reporting on that case, which sort of taking it away from the case itself –
The entire point of that article, which was a joint investigation, they referred to it as an investigation. I would maybe quibble with that terminology. The entire sort of thesis of that piece was that because Dr. Woods was not a child abuse pediatrician, she did not have the right to report abuse, which is wrong on its face.
Every doctor is a mandated reporter. That's all she did. She reported abuse and she, you know, did her job essentially. Right. And –
So they have this whole thesis of she wasn't a child abuse pediatrician. They quoted someone about child abuse pediatricians and et cetera, et cetera. Meanwhile, they link to the judge's order, which I don't believe would have been public record otherwise, but they link to the order written by Judge Amini. And right in there is your name.
And you are, in fact, a child abuse pediatrician. So the fact that they make this whole argument that the reason that this is the sort of thing that they're hanging on this being a false accusation is because Dr. Woods wasn't a child abuse pediatrician and completely neglect to mention that there was also a child abuse pediatrician doing the medical record review is so irresponsible. I asked Mike Kixenbog if he'd like to come on the podcast. Yeah.
He so far has turned me down. But yeah, I can't I can't imagine why you would ignore that information. That seems like such a massive omission. There is something else. And again, we should say, you know, as you mentioned, one of the things that makes these articles, all of the articles about these cases so skewed is that.
You or Dr. Woods or any other doctor involved in any of these cases cannot talk to the media without the parents' permission. Right. Why would the parents give you permission? Now, OK, if I was actually a falsely accused parent, I would actually think I would say, yeah, show the records. No parent is going to – if what you're interested in is just getting your side out there and the reporter is only interested in that too, then you can't say anything because of HIPAA. Right.
Um, there was something in that judge's order. There was something that jumped out at me and just completely, you know, bowled me over when I first read it. And the judge mentioned several times in the opinion that she wrote that you had, Dr. Jenny, had testified that my sister was herself a victim of medical child abuse and
And that that made her more likely to be a perpetrator. And that because Judge Amini did not see any evidence that she was a victim of medical child abuse, she used that to basically discredit you and Dr. Woods. I don't understand that. Essentially, right now, there is a public record that you and Dr. Woods sat on the stand and accused my parents of abuse.
That never happened. I can tell you that in the medical record, which is my only source of information, there was no evidence of any abuse of the mother. Right. Of any kind. In the medical record. That's all I have. I had no outside sources. I had no investigation. Yeah. I'll read you the piece that you and Dr. Woods testified. Oh, Megan was a victim of medical child abuse. And so that's why she perpetrated medical child abuse.
I said that? According to Judge Amini, yes. Well, that was not in the medical record. Did you testify that my sister was a victim of medical child abuse? No, not that I recall. I wouldn't say a thing like that. Okay, so here is one of the instances.
I never said that. That's crazy.
That was not my opinion. So this is another paragraph about you. Okay.
Dr. Jenny, who has extensive experience, was factually mistaken at times and at other times did not support her opinion with the underlying facts.
Her testimony showed that in her review of the record, she basically rubber-stamped Dr. Wood's findings without a critical view of her findings. For example, both doctors claimed that the mother was a victim of medical child abuse. Neither one investigated this claim. There is no evidence to prove this claim, but they used it as a factor against the mother. I never said that. That's crazy. And—
This claim that you rubber-stamped Dr. Wood's findings, you were still in the middle of the record review at this time. I had only halfway through it, and I was put on the stand when I didn't have a complete record. On the other hand, the record was so compelling.
There was no doubt in my mind as to what I testified. And, you know, the rubber stamp, I guess you can say if the evidence is there, it's there. And if we both quoted the same evidence, there you go. Yeah.
Right, because as you said, I mean, it's interesting because like doctors, that's their paradigm, right? That's the way they look at things is here is the evidence. So if you're both saying the same evidence, then yeah. And what I would really like would be for –
the news, whoever is interested to go back to the court. Well, not even the court because that was only half the evidence, but go back to the people that have my final report, get permission from the parents to have it released and read the whole 37 pages single-spaced that I wrote.
and see, you know, what the evidence actually is. Yeah. So while we, you know, we have reached out to the prosecutor about this case, I sent a letter to Judge Amini yesterday letting her know that we're going to be discussing her decision and some of the
factual errors in it and wondering if her office would like to comment. And in fact, Andy Carter, my brother, my sister's husband, has many times said on social media and elsewhere that I am lying, essentially, and that he has documentation to prove it. I assume he's referring to the judge's opinion, but we've invited him on here. And certainly if he wants to share with me or any other media outlet that
this documentation, I would be happy to look at it. And yeah, so we will again invite them to give Dr. Jenny permission to share her report. Okay.
