Thursday, August 27, 2020

Rise of the child abuse paediatricians: The Marshall Project in partnership with The Atlantic takes on this dangerous, growing phenomenon, in an outstanding article by author Stephanie Clifford headed, "Two families, two fates: When the misdiagnosis is child abuse..."A review of dozens of cases, including thousands of pages of medical records, child-welfare agencies’ records, and testimony, along with court decisions, contracts, and emails from child-abuse pediatricians, shows that these doctors can have near-unilateral power in labeling abuse—even though their conclusions are sometimes at odds with the opinions of specialists like orthopedists and hematologists. Their judgments are echoed, amplified, and often unblinkingly accepted by investigators. Indeed, instances in which medical professionals make reports to child-welfare agencies are 40 percent more likely to be substantiated—meaning the agencies found that abuse occurred—than reports by nonmedical professionals, according to a Marshall Project analysis of the National Data Archive on Child Abuse and Neglect. But child-abuse pediatricians may have a conflicted perspective."

PUBLISHER'S NOTE: I got goose bumps when I began hearing about 'Child Abuse Pediatricians. (CAP'S).  Charles Smith, the tainted namesake of this Blog may not have been called a CAP, but he acted like the ones featured  in this excellent Marshall Project/Atlantic article by Investigative Journalist  Stephanie Clifford. Smith espoused the notorious 'think dirty' doctrine made popular by a former Chief Coroner who had a distaste for evidence-based death investigations. Like many Child Abuse Practitioners, Smith often assumed criminality when a child died - especially where the parent was a single mother or for whatever other reason didn't fir into his concept of the pure, loving Christian family. He was invariably supported by The  Toronto Hospital for Sick Children SCAN Team whose glaring biases were revealed during the independent public inquiry into many of Smith's cases. In one Toronto Star article I wrote about a senior member of the team who believed  that he and his colleagues could tell if a child had been abused just by looking at it. In another article I described a heart- wrenching case in which the Sick Kids SCAN team was so focused on finding abuse that they overlooked the serious medical condition  that  had been misinterpreted as  showing signs of abuse. The parents had to go through the pressure and expenses of hiring medical experts to disprove the SCAN Team's opinion.  To its utter discredit, the SCAN team tricked the parents into bringing their other young child with them to an appointment, whereupon that child too was seized by the Hospital and handed over to Child Welfare authorities. That was years ago. Smith is long gone (kicked out of medicine in Ontario)  and the SCAN Team has evidently been reformed.  However, this ramble may explain why I cringe every time I learn more about the rise of the Child Abuse Paediatrician movement - and why i will continue to follow  cases involving the practitioners closely.  Congrat's to author Stephanie for the fine job he has done exposing it. 


STORY: "Two families, two fates: When the Misdiagnosis is child abuse," by author Stephanie Clifford," published by The Marshall Project in partnership with The Atlantic.

MARSHALL PROJECT SUMMARY: "Bad medicine. The unilateral power of child abuse pediatricians, whose evaluations and courtroom testimony on behalf of prosecutors often decide the fates of parents and their children, is highlighted in this riveting story about two families wrongly accused of child abuse. The pervasive use of these doctors raises questions about conflicts of interest because many of their salaries are paid, in part, by the child-welfare departments charged with separating parents and children. In collaboration with The Atlantic, Stephanie Clifford has our story, with additional reporting from our Weihua Li."


AUTHOR'S NOTE: "The day before my little boy had a routine pediatrician appointment, he fell and bumped his head. When his babysitter, an experienced caregiver, saw the bruise, she became alarmed—not about his injury, but about the doctor. Cancel the appointment, she told me: if the doctor sees that bruise, he might think you’re hurting the child. At the time, I brushed off her advice. After investigating this story, I know differently. Even to specialists, innocent injuries and complex medical problems in children can present like child abuse “Two Families, Two Fates: When the Misdiagnosis is Child Abuse,” published today with The Atlantic, follows two families—Josue Santiago and Glendalyz Galarza, and Molly Hayes and Daniel Namie—whose lives were transformed by such a hospital visit. Both assumed a doctor’s assessment would help their children; instead, they were accused of child abuse and in one case, murder. As my feature explores, child abuse—a scourge that claims innocent young victims—is difficult to diagnose. There was no obvious explanation for why Elihu Santiago was having brain hemorrhages, nor why Alex Namie had fractures on his ribs. So intake doctors and other hospital staff called in specialized child-abuse pediatricians for their assessments. But neither set of parents realized they were being interviewed by child-abuse pediatricians, nor that their conversations would become part of a case against them. Through my reporting, I learned that once child welfare or the police get involved in a case, these pediatricians’ opinions are taken as hard evidence of abuse. And in the family court system, the state has a relatively low burden of proof as it tries to prove its case. At stake is whether or not parents will get their children—or their freedom—back. I hope that you’ll read “Two Families, Two Fates: When the Misdiagnosis is Child Abuse” to learn what happened to each of these families after their lives were upended by a hospital visit. (Stephanie Clifford is an investigative journalist and a novelist. As a New York Times reporter, she covered courts, business and media. She’s won the Loeb award for investigative reporting and the Society of American Business Editors and Writers award for explanatory writing, among other awards. She covers criminal justice and business for the Times, the New Yorker, Wired, Marie Claire and other publications. Everybody Rise, her first book, was a New York Times bestseller and New York Times Book Review editor's choice, with movie rights optioned by Fox 2000. She graduated magna cum laude from Harvard and lives in Brooklyn with her family):

PASSAGE OF THE DAY: "Even if a parent can mount an aggressive defense, doing so might antagonize the child-welfare worker deciding whether to reunite her with her child. “If you put up a fight, it’s going to look worse,” says Aaron Goldstein, the head of the civil division of the Cook County, Illinois, public-defender’s office. Child-abuse pediatricians are not required to identify themselves as such, or to notify parents or caregivers that they’re being interviewed as part of a potential child-abuse case. Parents’ flustered conversations might become for-the-record statements without their realizing it. Child-abuse pediatricians consider it suggestive of abuse when parents can’t explain an injury, or when their explanation changes. Unaware that they’re being formally questioned, parents may offer ideas about the cause of the injury, and the pediatrician may see this as a shifting account."


STORY: Two family, two fates,  when the misdiagnosis is child abuse," by Stephanie Clifford, published by The Marshall Project in partnership with The Atlantic, on August 20, 2020.

SUB-HEADING: "The power of paediatric child abuse specialists and parents unequal journey to justice."

GIST: This lengthy  story deserves to be read in its entirety at the link below. For now, here is a taste. ""A review of contracts and correspondence from several states shows a close relationship between child-welfare departments and child-abuse pediatricians.

Child-abuse pediatricians can have the majority of their salary paid by child welfare. Take Houston’s UTHealth: Last year, the Texas child-welfare department covered 62 percent of the lead child-abuse pediatrician’s salary, or about $113,000, plus $24,000 in benefits, $13,000 in travel for her team, and supplies such as computer disks. Contractually, the child-abuse-pediatrics team must assess cases, testify, and send the child-welfare agency monthly progress reports. Child-abuse pediatricians are financially dependent on contracts like these, along with academic institutions or grants, since little of their work with patients is billable. In a 2019 contract, a child-abuse pediatrician at Comer Children’s Hospital, in Chicago, got 75 percent of her salary paid by Illinois’ child-welfare agency, via an organization coordinating child-abuse pediatricians’ work. It also paid for most of her team, a total of more than half a million dollars a year. Narang, the Lurie doctor, received about $45,000 of his $233,000 salary from Illinois’ child-welfare agency via that coordinating organization in 2018. Once they’ve diagnosed abuse, child-abuse pediatricians basically become prosecution witnesses rather than independent investigators. This is clear in e-mails obtained by The Marshall Project between Florida child-abuse pediatricians and the state’s child-welfare department: A child-welfare lawyer emails a Miami child-abuse pediatrician to get his thoughts on “medical records that I received from the parents’ attorneys.” A St. Petersburg pediatrician warns a child-welfare lawyer to look out for a doctor who’s been providing “irresponsible testimony” in child-abuse cases. The doctors’ legal sophistication adds to their authority. In recordings of trainings for child-abuse pediatricians reviewed by The Marshall Project, doctors learn about law-school topics such as Frye and Daubert evidentiary hearings, and how certain doctors need to be to use the term reasonable degree of medical certainty in court—“all you really mean is you’re pretty sure you’re right,” according to the law professor instructing the doctors. Child-abuse pediatricians defend their work as important and nuanced. Shalon Nienow, a child-abuse pediatrician in San Diego, told me that every consultation takes a minimum of one to two hours, and she often rules out abuse when families’ descriptions are “inconsistent” with the injury: “Sometimes people assume that a history is inconsistent, and it’s because they haven’t taken the time to ask the right questions,” she said. Haney, of the American Academy of Pediatrics Council on Child Abuse and Neglect, who is an Omaha child-abuse pediatrician, said that “we really understand the ramifications of erring either way, whether it means a child who’s returned to a risky situation, or a child who is removed from a loving home.”

Spurred by press coverage of questionable child removals, some lawmakers are thinking about ways to fix the system. In Texas, after an NBC News/Houston Chronicle series, legislators are considering asking child-welfare services to get a second medical opinion before removing children, or asking courts to appoint independent experts to evaluate medical assessments. Another solution starts with analysis of outcomes in previous cases. In instances of missed abuse, who missed it and how? In cases where a pediatrician diagnosed abuse, what happened later? Krugman, a professor at the University of Colorado School of Medicine’s Kempe Center, a pediatric-abuse division, recently co-founded an organization to fund research on and raise awareness of child abuse. “I can’t think of any other field,” he says, where “they practice without having any idea what the outcomes of their practice are.” Eli Newberger also urges data-based efforts. “Doctors make mistakes all over the place, but in this area of practice, there’s no review,” he said.""


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: Information on "The Charles Smith Blog Award"- and its nomination process - can be found at: Please send any comments or information on other cases and issues of interest to the readers of this blog to:  Harold Levy: Publisher: The Charles Smith Blog;
FINAL WORD:  (Applicable to all of our wrongful conviction cases):  "Whenever there is a wrongful conviction, it exposes errors in our criminal legal system, and we hope that this case — and lessons from it — can prevent future injustices."
Lawyer Radha Natarajan:
Executive Director: New England Innocence Project;