Even thought this article is seven years old this is exactly what happens. The thing is those who are poor have no money for a decent lawyer, they have to depend on public defenders.
Persecuted parents or protected children?
Allegations cost their reputations, their money and nearly their kids
Wednesday, August 7, 2002
By CAROL SMITH
SEATTLE POST-INTELLIGENCER REPORTER
The pounding on the door late that August night set Chris Brooker’s heart hammering.
He and his wife were just getting ready for bed. His stepdaughter and grandson, who lived with them, had gone to Disneyland and the older couple were enjoying the unaccustomed peace of an evening alone.
Now four police cars were blockading the street in front of his house, their flashing lights creating an eerie strobe against the Renton neighborhood’s modest split-levels.
Brooker opened the door and stared into the face of a beefy detective, one hand on his holster, the other thrusting out a warrant. He was flanked by three more officers.
Christopher Bateman and his mom, Michelle, cut out a paper airplane. Bateman was accused by Dr. Kenneth Feldman of intentionally poisoning her son. Bateman lost custody of her son until a CPS inquiry cleared her. Grant M. Haller / Seattle Post-Intelligencer
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They came to take Brooker’s 4-year-old grandson into protective custody.
And to gather evidence against the person accused of poisoning him — the boy’s mother.
With that, the Brookers plunged down a rabbit hole of accusations into the bizarre world of Munchausen syndrome by proxy. It would take nearly three years and $100,000 in legal fees to find their way out and clear their daughter’s name.
They blame their odyssey on a Seattle pediatrician named Kenneth Feldman.
So do at least five other families who claim they, too, were victimized by a misdiagnosis that ripped apart their lives.
Feldman, one of Washington’s top child-abuse experts, considers himself an authority on Munchausen by proxy — a controversial mental illness that drives mothers to deliberately make their children sick, or falsify symptoms, in order to get attention for themselves. Fathers are almost never diagnosed with the disorder.
Many experts believe the syndrome to be rare, but Feldman is convinced otherwise. During the last 25 years, he’s been involved in more than 100 Munchausen cases — far more than any other doctor in the state.
Because Feldman works for Children’s Hospital and Medical Center in Seattle and consults for the state’s Child Protective Services agency, those allegations invariably trigger strong emergency responses, often resulting in the removal of young children, at least temporarily, from their homes.
It’s that power that is now being publicly questioned. At least five families have sued Feldman over the past six years, claiming he was negligent or reckless in misdiagnosing Munchausen by proxy. In each case, CPS investigators found no evidence of Munchausen, poisoning or any other abuse. Children were returned, cases closed. Never were any criminal charges filed.
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But the consequences were severe: One family lost a child they were in the process of adopting. Others spent their life savings getting their kids back, undergoing intense psychiatric testing.
“It was like the Salem witch hunts,” Brooker said. “You are guilty until proven innocent.”Once a mother is labeled a Munchausen by proxy suspect the stigma is severe. The suspicions follow families, often from state to state. They become pariahs in their communities. They fear taking sick children to the doctor. Some children are traumatized from forced separations.
Feldman has so far escaped legal penalties or sanctions because he’s required to report suspected abuse, and he’s protected even if he’s wrong.
On the advice of his attorney, Feldman won’t say whether he has ever been wrong or changed his mind regarding a Munchausen case.
“It’s always a balancing act when you’re dealing with the safety of the child versus the family’s integrity and the family’s well-being,” he said in a recent interview. “We do our best to narrow the level of uncertainty.”
But other experts who have reviewed the cases are convinced Feldman’s conclusions distorted the evidence, unfairly implicating parents.
“It looks to me like there is a big epidemic of Munchausen surrounding Dr. Feldman,” said Dr. Gil Kliman, a San Francisco psychiatrist who testified against Feldman in several of the lawsuits.
“Even if he were seeing a million patients a year, he couldn’t diagnose that many,” said Tom Ryan, an Arizona attorney who has handled dozens of cases in which mothers have been falsely accused of having Munchausen by proxy.
While Feldman believes most pediatricians have undetected Munchausen-by-proxy parents in their caseloads, he’s claimed in depositions to have seen an equal number of cases in which he’s ruled out the syndrome. Because there’s no central place where documented cases are reported, it’s impossible to tell how common Munchausen by proxy is. Estimates by experts range from 1 in a million to 2.5 in 100,000.
Prosecutions of Munchausen cases are rare as well. King County authorities could only recall one or two criminal prosecutions in the past 20 years.
The rate of Feldman’s allegations so alarmed Kliman that he filed a complaint with CPS, citing the “error rate Dr. Feldman has in making this diagnosis, and the frequency with which the children have other causes for their conditions.”
All of the children involved in the cases that triggered lawsuits had been or were eventually diagnosed with verifiable diseases or disorders that explained their symptoms. One child, for example, was later diagnosed with cerebral palsy, after her mother was first suspected of Munchausen.
When the lawsuits came, Feldman claimed immunity under child-protection reporting laws and won. The cases were dismissed before trial.
As a physician, Feldman is a “mandated reporter,” which means he’s legally required to report abuse if he has “reasonable cause to believe” that a child is being harmed. He doesn’t need proof, and if he makes a mistake, unlike a treating physician, he can’t be held accountable for a wrong diagnosis and its aftermath. In the most recently appealed case, however, Washington Court of Appeals Judge Kenneth Kato wrote a stinging dissent.
Ida Brooker, left, and her husband, Chris, second from right, spent $100,000 clearing their daughter, Michelle Bateman, of accusations that she abused her son, Christopher. Grant M. Haller / Seattle Post-Intelligencer
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“Dr. Feldman apparently has a penchant for diagnosing (or misdiagnosing) MSBP, notwithstanding its rarity and his questioned qualifications to make that diagnosis,” Kato wrote in May. “Whether the doctor acted in good faith cannot be determined as a matter of law in these circumstances. It is a question for the jury to decide, not the court.”
Lawyers for the family that filed the appeal are now asking the state Supreme Court to review the case. A decision is expected within a few weeks.
The families who have dealt with the Munchausen allegations say they’ve suffered emotionally and financially. They want Feldman, CPS and Children’s Hospital to be held accountable.
Doug and Melissa de Jong lost their daughter for six months in 1997 when she was still breast-feeding. They spent $17,000, maxing out their credit cards in the process, to handle legal fees.
The experience was so distressing they moved to Birch Bay, Wash., to be away from the Seattle doctors. Their daughter was eventually diagnosed with cerebral palsy.
“We’re still to this day paying for it, emotionally and financially,” said Doug de Jong. “They put the burden of proof on the parents to prove our innocence.”
Dena Royal can no longer find a local pediatrician willing to treat her three school-age children, two of whom have chronic medical problems, because of the stigma of suspected Munchausen.
CPS closed its investigation of her family in April after preliminary tests showed many of one son’s unusual symptoms may be the result of a rare genetic disorder. Even though the case was closed as unfounded, Feldman has refused to remove the red child abuse alert on her children’s medical charts at Children’s, where her kids see specialists. Royal feels the alert is affecting their medical care by making specialists fearful to pursue tests as questions arise.
“It’s like being branded with a big scarlet letter,” she said.
Kevin and Nancy Grennan traveled from Illinois to see specialists at Children’s in 1995 in hopes of curing their daughter’s epilepsy. Previous treatments hadn’t alleviated the seizures, which were affecting her ability to speak.
Instead, Feldman reported the case to Illinois child-protection authorities and they lost their daughter for three months. They spent about $30,000 before the child-abuse case was closed.
Robert and Kristi Yuille were planning to raise a family on their ranch in Republic, Wash., when Munchausen allegations derailed the dream. A baby they were in the process of adopting was taken away in 1996 after living with them for nearly a year.
Although CPS closed the case, the Yuilles had to sell their ranch to fund their legal battle to get the baby back. They never did.
In each case, the families got swept into the child protection system with no independent evaluation of whether Feldman had made the right call.
Indeed, Feldman himself admits in court documents that as a pediatrician, he is not qualified to assess the mental health of the mother, which would require a psychiatric evaluation.
Yet when a parent suspected of Munchausen is reported to CPS, the agency calls on a list of medical specialists to evaluate the case. Because of his reputation, Feldman is the specialist most frequently called.
CPS said the lawsuits haven’t affected Feldman’s standing as a consultant. “You are innocent until proven guilty,” said Bernie Friedman, a risk-management official with the agency.
Feldman reviews the child’s medical history looking for “inconsistency and elaborations” or outright falsifications. He admits he doesn’t always have access to all the child’s medical records.
He usually doesn’t interview the mother because he says the mothers, by definition, will misrepresent the situation. But he will sometimes try to interview another family member about her. Sometimes, he also recommends covert video surveillance during hospitalization to catch the mother in the act of harming her child.
If Feldman decides the mother likely has Munchausen by proxy, the agency mounts a full child-abuse response, typically removing the child from the home pending a dependency hearing. In most cases, parents have to find and pay for their own second opinions to get their children back.
Feldman is paid for his consultations with CPS through a consulting contract funded by the state and managed by the University of Washington. He is also one of the main medical advisers to the Child Protection Team at Children’s.
Typically, the team meets to discuss the case before making a referral. Outsiders, such as the child’s regular doctors, may be invited to that meeting. Feldman reports his findings to the team.
“He’s viewed as someone with an awful lot of expertise and because of his report, his expertise needs to be listened to carefully,” said Dr. Richard Molteni, medical director at Children’s.
Angry accused parents and lawsuits come with the territory of child-abuse consulting, Molteni said. So does the risk of being wrong.
“I know what it must feel like to be accused unjustly,” Molteni said. “I also understand the consequence of not doing that. … It’s a lot harder to look a relative in the face and have to say I’m sorry we didn’t report (suspected abuse) when we had the chance and now a child is dead.”
Critics say there aren’t enough safeguards built into the system.
“The destructive force it unleashes on these families is tremendous,” Ryan said. “It’s like being sucked into a black hole. … The state can expend millions and the poor family is absolutely overwhelmed.”
That was true for Michelle Bateman and her parents, the Brookers.
As police meticulously searched their house, even rifling through their spice drawers, the stunned grandparents tried to piece together what was happening.
Police eventually found what would become a key piece of evidence against their daughter: a small bottle of syrup of ipecac.
Ipecac is a common first-aid supply used to induce vomiting in accidental poisonings and found in most households with young children. The bottle, still sealed and past its expiration date, was on the top shelf of the family’s hall medicine cabinet.
Bateman was 20 when her son, Christopher, was born. Unmarried, she and her baby lived with the Brookers so she could go to nursing school.But the baby was fussy and uncomfortable nearly from birth, said Ida Brooker, who recalls walking the inconsolable baby for hours before dawn. The family grew increasingly frustrated as doctors couldn’t help them.
Finally, they were referred to Dr. Ross Kendall, a pediatric gastroenterologist at Mary Bridge Children’s Hospital and Health Center in Tacoma. Although he diagnosed Christopher with cyclic vomiting stemming from abdominal migraines and started him on medication, he admitted in depositions that he suspected Bateman of Munchausen from the start.
Doctors say their suspicions that Michelle Bateman suffered from Munchausen syndrome by proxy were triggered by Christopher’s many trips to the hospital. Grant M. Haller / Seattle Post-Intelligencer
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Her “hostility” to people who suggested other diagnoses, persistent doctor visits and Christopher’s lack of response to treatment reinforced this belief, he said later in court documents, noting: “Mother fits the profile.” Over the next two years, without telling the family, he began testing Christopher’s urine for ipecac to see if Bateman was intentionally dosing him to make him vomit.
After three times, a test came back positive. Kendall reported Bateman to state authorities. And CPS went to Feldman.
Without seeing Christopher or talking to Bateman, and based on his own reading of certain records and discussions with Kendall, Feldman told CPS, “Christopher clearly fits the primary criteria for Munchausen syndrome by proxy.” He based part of his assessment on her repeated trips to the emergency room to treat Christopher’s vomiting. Yet Kendall’s orders were that she was to take him to the ER after each episode for IV infusions of an experimental drug called Kytril.
The ipecac test also figured prominently in Feldman’s analysis, even though toxicologists say it cannot distinguish ipecac from pseudoephedrine, a common cold medicine ingredient Christopher was taking on Kendall’s advice.
Based on Feldman’s recommendation, the state removed Christopher from his home.
Bateman was devastated. So was Chris Brooker, who recalls breaking down on his front porch that day.
“I just sat out there and cried for two hours,” he said.
To mount a legal defense, Ida cashed in her Boeing retirement fund. He sold stock and other assets, including a cherished collection of rare military helmet plates.
They petitioned the court to become Christopher’s legal guardians and won, but only on the condition that Bateman move out and her visits be restricted to two hours a week. For the next 2 1/2 years, she was supervised and tested by CPS until authorities were finally satisfied she didn’t have Munchausen and closed the case in 1999.
Christopher, now 10, is still in counseling to deal with the experience.
According to the family, Kendall contacted them years later through their attorney and apologized for “the inconvenience” he had caused them.
“I lost my child, my home, my job, my parents. My son lost his mother, his home and his security,” Bateman said. “That’s an inconvenience?”
Kendall could not be reached for comment. Feldman, who declined to discuss specific cases, has never contacted the family.
Many parents fit ‘profile’
Bateman’s case illustrates the dangers of “profiling” parents, experts said. Parents of very sick children, young or anxious parents, or those who advocate aggressively for their children all “fit” the profile of people suffering from Munchausen by proxy.
Those who seek multiple opinions, who have worked in the medical field, or who go to the doctor frequently also fit, as do those whose children have multiple illnesses that don’t match known syndromes.
Some specialists point out that many of their patients’ mothers have been accused of Munchausen before their children were eventually diagnosed with unusual disorders.A parent who is calm in the face of serious difficulties, or one who gets extremely angry and demanding both fit the profile. Also fitting the profile are parents of sick children who frequently acquire detailed knowledge about diseases, leading them to appear “obsessed” with their children’s disorders.
And in a particularly Kafkaesque twist, denial that you have Munchausen is a sign you have it.
“There are individuals who see Munchausen by proxy around every corner,” said Dr. Marc Feldman (no relation), an Alabama psychiatrist who has testified on both sides of those cases.
“Some people became intrigued with the novelty and drama of it and have sought to establish themselves rapidly as experts in the field,” he said. “One way to do that is to say you’ve seen a whole lot of cases.”
But that doesn’t mean all those reported cases were truly Munchausen.
“It can lead to pinhole vision, where only those features that matched Munchausen by proxy were commented on and all information contrary to the diagnosis was disregarded,” he said.
Being sued five times for alleged misdiagnoses, he said, should raise red flags.
“That’s pretty high,” he said. “If I’d been sued five times for anything, I would probably ask for supervision for my work before I proceeded.”
Molteni, of Children’s Hospital, stands behind Kenneth Feldman’s work, saying that despite the lawsuits and complaints there’s no need for any additional review or auditing of the Munchausen diagnoses.
But in recent years, a half-dozen families have complained about Feldman to the state licensing board alleging unprofessional conduct related to misdiagnosing the disorder. In five of those cases, the Washington State Medical Quality Commission closed the complaints after reviewing Feldman’s explanations for his actions, asking for no further review. One case is still under investigation.
A strong advocate
None of this fazes Feldman, who lectures around the region on the threat of Munchausen by proxy.
Bespectacled and soft-spoken, Feldman, 58, betrays little of the passion that has given him a reputation as a tireless advocate for children’s welfare. He doesn’t flinch at criticism, but admits to being wearied by the relentless legal challenges. “It’s stressful to be involved in any way, let’s just leave it at that,” he said. “But someone has to do it.”
Feldman, who went to medical school in his home state of Wisconsin, came to Seattle in 1970 as an intern in pediatrics at Children’s. Over the years, the father of two increasingly focused on childhood-injury prevention. He claims to have seen his first case of Munchausen by proxy in the ’70s before the phrase was even coined.
Today, he divides his time between his work in general pediatrics at Children’s, research and child-abuse consulting and work with low-income families.
He operates out of a cramped, windowless office at Children’s, lined with case files. The Munchausen database he keeps is one of the only ones like it in the country.
“He’s a pioneer in Munchausen,” said his former teacher, Dr. Abe Bergman, a pediatrician at Harborview Medical Center and head of the child abuse medical consulting network run by the University of Washington, through which Feldman consults.
Feldman, whom Bergman said was a conscientious objector during the Vietnam War, is accustomed to fighting for causes he believes in.
His research on the effect of water heater settings on scalding injuries has been credited with reducing the national incidence of tap-water burns. In the mid-’80s, he fought to get legislation passed that reduced settings on water heaters.
Admirers say Feldman is a brilliant diagnostician.
“He knows every rare disease,” said Bergman. “His mind is like a computer.”
Feldman said he deals aggressively with suspected Munchausen cases because children are in grave danger. “About 1,200 kids will sustain new events of suffocation and poisoning in the United States this year,” he said. “And that’s probably an underestimate.”
Children should not be reunited with mothers who’ve been diagnosed with Munchausen, he said. And he faults the courts for returning them.
“It’s hard for the court system to get a handle on this,” he said. “Juries tend to believe a parent wouldn’t do it. Judges tend to believe they wouldn’t do it.
“Children are usually returned. But that doesn’t obviate the diagnosis.”
Families call for oversight
Given the murky nature of most Munchausen cases, some experts are calling for more oversight before a child is removed from his parent.
One solution is to get rid of the label altogether. If a parent is suspected of harming a child, investigate it as a criminal assault case, not a vague psychiatric condition, some experts say.
Others say the state should not let a pediatrician alone make what is essentially a mental health assessment. And before a child is removed from a home, the family should have the opportunity to get an independent assessment.
Experts also recommend that all records be scrutinized in determining whether a mother has lied or mischaracterized her child’s medical history, not just some of them.
“Munchausen by proxy should be diagnosed based on objective signs and symptoms, not based on one’s impression of the parent,” said Marc Feldman, the psychiatrist.
The families that have sued Kenneth Feldman argue that there needs to be some way to hold him accountable. “I understand the need to protect our children, but the way the system is set up there are severe penalties if you don’t report, but nothing on the other side,” said Doug deJong, who nearly lost his daughter to a Munchausen allegation.
“If you falsely accuse or make a mistake, there is no penalty. There’s no incentive to be careful.”