Misdiagnosis of Child Abuse

graber.mark at GMAIL.COM graber.mark at GMAIL.COM
Tue Oct 13 22:43:38 UTC 2015

Dear Listserv Members:   Maxine Eichner (meichner at email.unc.edu) is a law professor at UNC working on cases where parents of children who may equally well have a congenital or acquired medical condition are accused of child abuse (eg shaken baby cases).  An email from Maxine is included below, and you can read the articles she has written on this via the links provided.  She would like to identify people in our community who might be interested to discuss this issue.  Apparently in several cases, experts on chiild abuse have asserted with ' medical certainty' that abuse has taken place, an argument that has won out over medical or pediatric subspecialists who make the same assertion in regard to specific congenital disorders.  If anyone is interested, feel free to respond to this listserv announcement, or to Maxine directly.  

Thanks to Kate Judson (katherine.judson at wisc.edu), a Litigation Fellow with the Wisconsin Innocence Project for bringing this all to our attention.


Mark L Graber, MD FACP
President, SIDM


Email from Maxine:

Thank you, Mark!  It was a pleasure to talk to you, and I appreciate being connected to the rest of you, as well.  Here are a couple of paragraphs that I hope describe the help I need:
I’m working on an issue related to a new medical diagnosis called “medical child abuse.”  That diagnosis is intended to replace the diagnosis that used to be called Munchausen’s Syndrome by Proxy, in which a parent intentionally made a child sick or lied about the child being sick for the parent’s own secondary gain.  Because of the controversy relating to the MSBP diagnosis (critics said that child abuse pediatricians were not qualified to make that diagnosis because they were not psychologists, generally hadn’t even examined the parent, and some disputed that it constituted an identifiable psychopathy rather than simply criminal behavior) child abuse pediatricians are now diagnosing this behavior as MCA.  MCA, they claim, is a better diagnosis because child abuse pediatricians are expert in diagnosing in child abuse, and therefore have expertise in distinguishing this condition from genuine medical conditions.  These pediatricians have expanded the behavior covered in the shift from MSBP to MCA.  They define MCA to be present any time the child receives medical treatment from a medical provider that is unnecessary and potentially risky.  The fact that this treatment was provided by a doctor does not negate the diagnosis.  Further, the fact that the child has some genuine medical condition doesn’t negate the diagnosis if the charging doctor believes that the condition was over-treated. 
There are, you can probably see, many possible problems with MCA.  What I’m hoping for assistance from doctors in your group relates to repeated claims from child abuse pediatricians in these cases that they can identify MCA cases with reasonable medical certainty with little overt proof of malfeasance by the parents.  Although the process of diagnosing MCA is largely one of excluding diagnoses of organic conditions, these pediatricians assert they are equally able or even more able to exclude these other diagnoses than experts in that particular field.  For example, in a number of cases, children have been taken away from their parents based on an MCA diagnosis by a child abuse pediatrician even though a mitochondrial disease expert believes that the child has mitochondrial disease.  To make MCA diagnoses, child abuse pediatricians often rely on the flawed personality profile developed of Munchausen’s mothers, as well as on other factors that have not been shown in any good empirical study to distinguish parents of genuinely sick children from parents with MSBP (for example, taking the child to see a number of specialists, or seeking a feeding tube for the child).  They also seek to point to errors in the child’s medical history records which, they claim, demonstrate that the parent was lying to doctors in order to get the child unnecessary medical treatment.
I discuss the problems with MCA charges more in an op ed I wrote for the New York Times here:  http://www.nytimes.com/2015/07/12/opinion/sunday/the-new-child-abuse-panic.html?_r=0 <http://www.nytimes.com/2015/07/12/opinion/sunday/the-new-child-abuse-panic.html?_r=0>
A good series in the Boston Globe on one MCA case can be found here:
https://www.bostonglobe.com/metro/2013/12/15/justina/vnwzbbNdiodSD7WDTh6xZI/story.html <https://www.bostonglobe.com/metro/2013/12/15/justina/vnwzbbNdiodSD7WDTh6xZI/story.html>
A recent MCA case that resulted in a criminal conviction (most MCA cases involve child protection proceedings rather than criminal proceedings) is described here and here:
http://www.houstonpress.com/news/state-says-mom-poisoned-daughter-with-salt-to-seek-attention-from-facebook-group-7764454 <http://www.houstonpress.com/news/state-says-mom-poisoned-daughter-with-salt-to-seek-attention-from-facebook-group-7764454>;http://www.chron.com/news/texas/article/Texas-nurse-found-guilty-of-poisoning-daughter-6527834.php <http://www.chron.com/news/texas/article/Texas-nurse-found-guilty-of-poisoning-daughter-6527834.php>
If anyone has light to shed on these issues, or is willing to help think them through, I’d be grateful.
Maxine Eichner

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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