Facts Against Medical Child Abuse

1- Medical Child Abuse or MCA (aka- Munchausen Syndrome By Proxy, Fabricated Illness Induced By A Caregiver) was originally a condition that was only identified within intentional criminal acts of child abuse (1); acts such as giving a child a bottle of aspirin and claiming hemophilia, suffocating a child and claiming apnea, inducing a seizure through massive ingestion of salt etc. Regardless of the method of abuse all were intentional acts of abuse, and all were subject to direct evidence via testing.

2- MCA accusations dramatically broadened over time to include (even target) children with verifiable medical/developmental conditions. These special needs children, unlike the original victims, were children under the care and treatment of licensed specialist doctors. Intentional infliction of harm was removed as a diagnostic consideration of MCA (2). However, intent to cause harm continues to be needed within criminal cases; thus the vast majority of MCA cases are never criminally charged. Destroying a family forever requires a lesser burden of proof than a weekend confinement in jail, per current legal standard. These contemporary MCA allegations are little more than a differing medical opinion in which parents are caught in the crosshairs of doctors. This is nothing short of an attempt to hold parents directly responsible for the care rendered by licensed doctors; but it in no way reduces the legal and ethical responsibilities that continues to be held by the treating doctors.

3- Medical errors are the 3rd leading cause of death in the United States (3). The reality is that medical mistakes commonly occur. 80% of all people taking a medication have to discontinue it at some point due to adverse effects. Holding unqualified parents to a higher “no harm” standard than veteran specialists is dangerous and damaging to children and their families.

4- Forensic child abuse doctors are general pediatricians with speciality in abuse (4), they hold little to no training on complex medical issues; for specific issues such as cardiology, neurology, genetics one would see a specialist doctor that holds advanced and specific training on diagnosis, treatment, and medication related to their specialty field. MCA has allowed general pediatricians with significantly less training in complex conditions to reach above the credentials and expertise of specialist doctors.

5- There are approximately 7000 recognized rare disease that impact 1/10 Americans or (10% of the American population). 80% of these conditions are rare genetic disorders that a child is born with, but symptoms tend to evolve over the course of many years and these conditions are notoriously difficult to diagnose. These rare diseases often have only a handful of leading specialists devoted to their diagnosis and treatment (5). Other diseases once thought to be rare, such as mitochondrial disease, have now been discovered to be as prevalent as Cystic Fibrosis upon further genetic research (6); mitochondrial disease, because of its prevalence and range of complex symptoms, continues to be the disorder frequently identified within MCA cases (6).

6- In America it takes an average of 7.8 years for patients to receive the correct diagnosis. Prior to receiving the correct diagnosis a patient will be incorrectly diagnosed 2.5 times, and see approximately 8 physicians (7). The very process by which patients must seek diagnosis and treatment is the cardinal diagnostic feature used by the forensic pediatricians to establish MCA (8).

7- The very diagnosis of MCA by these lesser forensic pediatricians is unlawful within the vast majority of these cases, as the courts have held that MCA is a “diagnosis of exclusion” (9), given the prevalence of diseases that impact the pediatric community it is nearly impossible to effectively rule-out biological and unintentional environmental causation. Certainly, specialists within the child’s field of symptoms would be best equipped to be accurate diagnosticians of MCA versus a legitimate medical/developmental condition, as they alone hold the expert knowledge regarding identification, diagnosis, and standards of care.
8- Medical diagnosis and treatments must comply with established best practice standards that are evidence based scientific measures which: formulate a clear clinical question of a patient's problem, search the literature for relevant clinical articles, evaluate (critically appraise) the evidence for its validity and usefulness implement useful findings in clinical practice (10). MCA is not even a diagnosable medical condition, as it lacks a recognized and accepted diagnostic process, no confirmation testing exists, and it is a “diagnosis of exclusion” (11).

9- “There has never been a good empirical study on the base rate of MCA within the general population, but even MCA proponents concede that it is quite rare. The figures that they supply puts the base rate at approximately 0.5-2.0 per 100,000 children younger than sixteen years. Mitochondrial disease occurs in 1 per 4,300 children- Ehler Danlos Syndrome occurs in 1 per 20,000 children- Eosinophilic Esophagitis occurs in 11 per 100,000 children- using only three conditions (out of the 7000 rare diseases) we easily arrive at a rate of 39 per 100,000 children whose conditions are frequently mistaken for MCA” (11). If all rare disease were factored in we would see that 1000 per 10,000 children will have a rare disease, making rare disease nearly 1000 times more common within a medical setting than MCA (4).

If we add environmental effects that cause human illness and/or death we learn that approximately 25% of all deaths are tied to environmental effects (12). Within the US alone we spend over 76.6 billion dollars annually treating environmental caused illness and disease in children (13). An estimated 20% of all children will suffer medical or mental illness related to environmental causes (14). Like rare disease the causation of environmental illness is often difficult to isolate and identify, and it requires expertly trained specialists in many cases. Parents raising previously healthy children that become medically or mentally ill as a result of environmental effects also find themselves accused of MCA.

Using just rare disease and environmental illness we see that 3000 per 10,000 children will be affected, making these two groups of causation nearly 3000 times more common in a medical setting than MCA. It would be nearly impossible to identify and calculate all conditions that could be mistaken for MCA; yet one would need to accomplish that within each case of MCA, since it is a diagnosis of exclusion. MCA is extremely rare, but grossly overdiagnosed by under-qualified forensic pediatric doctors.

10- Parents hold Constitutionally protected rights to make healthcare decisions on behalf of their children (15). It is within the best interest of children and families that complex medical and developmental conditions be left to the expert specialist doctors, and not subject to the lesser medical opinions of general pediatric doctors. Physicians and patients currently enjoy a protected and confidential relationship free of interference (16), this process is illegally and unethically being subverted by Oregon DHS and CARES NW.

Summary:
Families raising special needs children need to be protected from greatly overdiagnosed allegation of medical child abuse at the hands of under-qualified pediatric doctors. Parents must be safe to rely upon the expert care and guidance of the specialists they entrust with their children’s medical care; the alternate is neglect of potentially life limiting medical conditions. We believe it is imperative to the health, welfare and protections of special needs children and their families that legislators sponsor and enact the Physician-Parent-Child Protection Bill within our state.

(a) A parent or legal guardian shall not be charged with abusing or neglecting a child’s need for medical care if:

(i)    the parent or legal guardian has sought medical care for the child from a licensed medical or mental health provider;

(ii)    the licensed medical or mental health provider has made a diagnosis;

(iii)    the licensed medical or mental health provider has prescribed a lawful course of treatment; and

(iv)    the parent or legal guardian is following or willing to follow the recommended course of treatment.

(b) No mandatory reporter, shall file a report of abuse or neglect based solely on a parent’s or legal guardian’s decision to follow the recommended treatment of a licensed medical or mental health provider. A parent or legal guardian has the right to follow the advice and treatment plan of a licensed medical or mental health provider over a contrary opinion or recommended treatment plan of another licensed medical or mental health provider when the decision does not involve immediate life-threatening conditions. Even in //the case of life-threatening conditions, the decision of the parent or legal guardian to follow the advice or treatment plan of a licensed medical or mental health provider shall not be overridden unless there is clear and convincing evidence to the contrary.

Referenced Materials:
1- Intentional Acts of Abuse As Basis of Accusation:

2-  Removed Intentional Infliction From MCA Criteria:

3- Medical Mistakes:

4- Forensic Pediatricians vs Specialists:

5- Rare Disease Statistics:

6- Rare Disease Care:

7- Prevalence of Mitochondrial Disease:

8- Correct Diagnosis of Rare Disease:

9- MCA Diagnosis of Exclusion: Delaware v. McMullen, 900 A. 2d 103, 108, 119 (De. Super. Ct. 2006)

10- Evidence Based Medicine:

11- MCA:

12- Nearly 25% of All Deaths Environmental Cause:

13- Annual Cost Environmental Illness in Children:

14- Percentage of Children Ill by Environmental Cause:

15- Parental Rights and The Constitution:

16- Physician and Patient Relationship Ethics by the American Medical Association:

Additional information for consideration:

17- Harmful Effects of Foster Care On Children-

18- Special Needs Children In Foster Care:

19- Foster Care by Senator Nancy Schaefer: