Medical Child Abuse

Hess, Dr. Donald dhess at SUSQUEHANNAHEALTH.ORG
Tue Nov 15 13:58:07 UTC 2016

I've started reading the Eichner article. Here's a quote that stopped me:

Almost 40 years ago in the pages of the Yale Law Journal, Joseph Goldstein, a Yale law professor and one of the leading scholars in the field of American family law, cautioned against the misuse of "the vague and subjective language of neglect and abuse statutes" to "give the state unguided discretion to supervene parental decisions with regard to health care for their children." Professor Goldstein warned that such statutes could be misconstrued to "release the rescue fantasies of those it empowers to intrude" - those "well-intentioned people who 'know' what is 'best' and who wish to impose their personal health-care preferences on others."

This indeed is an issue, particularly among the Amish in my region. Keep in mind that they do not have health insurance and generally avoid our healthcare system in order to not suffer financial harm. They are a frugal people and often choose more affordable treatment options outside our healthcare system. They generally seek care from us when they have a reason to purchase our technology, or when they perceive their problem is a medical - surgical emergency. They are capable diagnosticians and often will challenge physicians who recommend a test or x-ray with 2 questions: How much does it cost? & Why is it necessary? When they do come to the ED with a sick or injured child, they are sometimes judged by the ED physician to have medically neglected their child, even though the parents were doing their very best to care for their child within the context of the Amish culture.  The fear of having their children taken away from their home compounds the fear of a huge bill and gives them reason to think twice about going to an ED. Is it any wonder that they view hospitals as agents of the state. And on it goes.

Is it appropriate in situations like this to even consider medical child abuse/neglect as a "diagnosis", when it seems to be more of a culturally-entangled judgement?


Dr. Donald Hess

-----Original Message-----
From: graber.mark at GMAIL.COM [mailto:graber.mark at GMAIL.COM]
Sent: Saturday, November 12, 2016 11:59 PM
Subject: [IMPROVEDX] Medical Child Abuse

This is hopefully not a diagnosis you'll encounter, but the relatively new diagnosis of "medical child abuse" is taking hold in certain areas of the country.  Parents so charged can lose custody of their children and be subject to criminal proceedings.

The enclosed review by Maxine Eichner studies this issue from a diagnostic error perspective, and concludes that this diagnosis has no firm criteria, and may often be incorrect.  Her scholarly article will hopefully shed some light into this dark and messy area. The review was just published online by the UC Davis Law Review {50 UC Davis L. Rev. 205 (2016)}


Mark L Graber, MD FACP

President SIDM

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