Munchausen Syndrome by proxy: 'Do no harm': Part two of superb NBC News/Houston Chronicle Collaboration: (Reporters Mike Hixenbaugh and Keri Blakinger). This part, headed 'Imminent Danger' focusses on doctors who report mothers to the authorities because they are seeking excessive medical care - and points out that "sometimes it's the evidence that's overstated."

PUBLISHER'S NOTE: In a  previous note affixed to Part One of this extraordinary series on doctors trained  to spot child abuse who  overstated their ability to determine when a child had been harmed. often with dreadful results, I stated: "Rarely do I see such a hard-hitting, deeply probing  journalistic masterpiece. This collaboration meets all the tests. I look forward to the up-coming installments." My high praise is confirmed with Part Two, the subject of this post, which delves into the controversial world of Munchausen Syndrome by Proxy. As with Part One,  this article simply cannot be reduced in size. (Except for the few opening paragraphs I have provided for a 'taste.') I recommend reading it word by word. 

Harold Levy: Publisher: The Charles Smith Blog.

------------------------------------------------------------

PASSAGE OF THE DAY:  "Physicians diagnosing what’s now known as “medical child abuse” are not required to assess the mental health of the parent or their intent. Instead, doctors must show only that a child received unnecessary or excessive medical care and that a caregiver instigated it. With this vastly widened net, critics say doctors have wrongly accused some mothers who expressed genuine concerns about their children’s health, leading to painful family separations and threats of criminal charges. Often, the doctors making these accusations are child abuse pediatricians, a small but growing medical subspecialty trained to assess suspicious injuries and report their findings to child welfare agencies. Only a small fraction of the cases handled by these doctors involve concerns of medical abuse. Texas Children’s handles about two dozen a year, according to one of its doctors, and one expert estimates about 1,600 mothers nationally are reported to authorities annually. As part of a broader investigation into the work of child abuse pediatricians in Texas, reporters for the Houston Chronicle and NBC News scrutinized seven cases of mothers from across the state who were accused of medical child abuse."

--------------------------------------------------------------

QUOTE OF THE DAY: "Few experts question that some mothers, in rare instances, intentionally harm their children through medical treatment, perhaps for sympathy or financial gain, experts believe. But critics say the medical child abuse diagnosis is too broad, poorly defined and, therefore, easy to get wrong. “The process for diagnosing what they call medical child abuse is subjective, it’s vague, it doesn’t have a clearly tested error rate,” said Maxine Eichner, a professor at the University of North Carolina School of Law who has studied the way medical child abuse allegations play out in court. “This is a process of belief. This is not a process of scientific testing.”

---------------------------------------------------------------

STORY:"Imminent Danger: Doctors report moms who seek excessive medical care. But sometimes it’s the evidence that’s overstated,"a joint production by NBC News and The Houston Chronicle, by reporters Mike Hixenbaugh and Keri Blakinger, published  on October 10 2109. (Mike Hixenbaugh is a national investigative reporter for NBC News, based in Houston. Kero Blakinger  is a Houston Chronicle reporter specializing in criminal justice.  Elizabeth Conley is a an award-winning staff photographer for the Houston Chronicle.

THE STORY SO FAR:  "A Houston Chronicle and NBC News investigation found that doctors trained to spot child abuse had in some instances overstated their ability to determine when a child had been harmed, triggering traumatic family separations. In response, some Texas lawmakers have begun calling for additional safeguards to protect families."

GIST: "British pediatrician Roy Meadow was the first to document the bizarre phenomenon in 1977, when he published a case study of a woman who’d apparently been contaminating her child’s urine samples, leading to false diagnoses, and another who kept her child sick through repeated salt poisoning. Based on those examples, Meadow dubbed the disorder Munchausen Syndrome by proxy, a nod to the already established psychiatric ailment in which patients seek medical care for imagined diseases. The name stuck, and soon doctors across the globe were reporting cases of disturbed mothers — it is almost never fathers — and over-medicalized children. In more recent years, after a string of overturned convictions abroad raised doubts about the reliability of the Munchausen diagnosis and the doctors making it, child abuse specialists in the U.S. proposed a new, simpler way of categorizing mothers who seek unnecessary treatments for children. Physicians diagnosing what’s now known as “medical child abuse” are not required to assess the mental health of the parent or their intent. Instead, doctors must show only that a child received unnecessary or excessive medical care and that a caregiver instigated it. With this vastly widened net, critics say doctors have wrongly accused some mothers who expressed genuine concerns about their children’s health, leading to painful family separations and threats of criminal charges. Often, the doctors making these accusations are child abuse pediatricians, a small but growing medical subspecialty trained to assess suspicious injuries and report their findings to child welfare agencies. Only a small fraction of the cases handled by these doctors involve concerns of medical abuse. Texas Children’s handles about two dozen a year, according to one of its doctors, and one expert estimates about 1,600 mothers nationally are reported to authorities annually. As part of a broader investigation into the work of child abuse pediatricians in Texas, reporters for the Houston Chronicle and NBC News scrutinized seven cases of mothers from across the state who were accused of medical child abuse. They reviewed thousands of pages of medical records and court documents and interviewed dozens of physicians, lawyers and social workers, as well as the accused parents. These cases often begin with a child abuse pediatrician or another physician second-guessing years of treatments for complex or rare medical conditions. In some instances, the child’s treating physicians disagree with accusing doctors, leaving child welfare workers, who often have little medical training, to determine what’s best for the child. The evidence is rarely straightforward, but reporters identified problems with the ways doctors handled some of these cases. In one from 2017, a Child Protective Services worker told parents that the medical team that flagged potential child abuse did not believe their daughter really suffered from a bleeding disorder. The family recorded the conversation and shared the audio with reporters. Records later showed, however, that the bleeding disorder had been verified via medical testing. In another case from that same year, a child abuse pediatrician ordered covert video surveillance of a mother whom she suspected of exaggerating her teenage daughter’s chronic pain and digestive issues, symptoms that the doctor believed were mental, not physical. The doctor wrote that she was concerned the mother might tamper with the girl’s medical equipment, records show. The secret hospital-room recording did not reveal anything unusual, however, and months later, another doctor identified the cause of the girl’s digestive problems and repaired it with surgery. Few experts question that some mothers, in rare instances, intentionally harm their children through medical treatment, perhaps for sympathy or financial gain, experts believe. But critics say the medical child abuse diagnosis is too broad, poorly defined and, therefore, easy to get wrong. “The process for diagnosing what they call medical child abuse is subjective, it’s vague, it doesn’t have a clearly tested error rate,” said Maxine Eichner, a professor at the University of North Carolina School of Law who has studied the way medical child abuse allegations play out in court. “This is a process of belief. This is not a process of scientific testing.”

Up-coming parts:
Part 3: Burned by ‘bad science’
Part 4: Short falls, serious injuries

PUBLISHER'S NOTE: I am monitoring this case/issue. Keep your eye on the Charles Smith Blog for reports on developments. The Toronto Star, my previous employer for more than twenty incredible years, has put considerable effort into exposing the harm caused by Dr. Charles Smith and his protectors - and into pushing for reform of Ontario's forensic pediatric pathology system. The Star has a "topic"  section which focuses on recent stories related to Dr. Charles Smith. It can be found at: http://www.thestar.com/topic/charlessmith. Information on "The Charles Smith Blog Award"- and its nomination process - can be found at: http://smithforensic.blogspot.com/2011/05/charles-smith-blog-award-nominations.html Please send any comments or information on other cases and issues of interest to the readers of this blog to: hlevy15@gmail.com.  Harold Levy: Publisher: The Charles Smith Blog;