Last spring,
2-year-old girl ran into a sliding glass door at daycare and sliced her
forehead. The cut was deep, nearly reaching the skull. Her parents, brought her
to me, their pediatrician, and her father held her arms as I stitched her up.
The day I
removed the stitches, the child’s mother showed me a row of thin bruises on her
daughters right buttock, explaining that her accident-prone toddler had fallen
when climbing over a baby gate and landed on a heating grate. The bruising—3 straight, parallel lines about
the length and width of matchsticks—appeared to match the explanation. Having
no concerns about child abuse, I told the mother that the bruising pattern was
normal and the marks would soon fade.
A few days
later, the girl’s father was stunned to receive a call from Child Protective
Services. His daughters’ daycare had reported that Sammy had concerning bruises
on her arm and right buttock. On the phone with CPS, the father explained the
incident with the baby gate, and also that he’d had to restrain his daughter as
she got stitches.
Still, the
process moved forward, and the case was assigned to Robin Duer, a CPS caseworker.
The family found themselves plunged into a nightmare that is becoming all too
common. The legal system—bolstered by
the opinion of a “child abuse expert”—turned their lives upside down, despite
the fact that the bruises were so inconsistent with the markings of adult hands
that the police detective assigned to the case concluded it was almost impossible they were finger
marks.
The family lives
in Washington State, and gave me permission to share their story
anonymously. But a recent investigation
conducted by the Houston Chronicle and NBC News revealed an alarming trend—children
are being taken from their parents based on disputed medical opinions from
physicians trained to spot abuse. After
speaking with more than 100 attorneys, doctors, and state employees, the
investigation uncovered over 40 cases in Texas alone where families were torn
apart after “child abuse physicians”—on contract with states’ child protective
agencies to assist in borderline cases—overcalled child abuse.
As a result
of the investigation, Texas lawmakers have called for stronger safeguards in
the state’s child welfare system and to create an avenue for accused families
to seek a second opinion before the state removes children from their homes.
Washington State lawmakers should consider doing the same.
This is of
course not to downplay the vital role that child abuse pediatricians play in
protecting society’s most vulnerable members: Their expert reports and court
testimony shield countless children from harm. However, definitively
determining whether or not injuries resulted from abuse can prove extremely
difficult, which means that even these experts are bound to make
mistakes—erroneously implicating innocent parents, with terrible ramifications
for the entire family.
Given the
inherent trickiness of diagnosing abuse, specialized child abuse training
programs have been established, which incorporate elements of forensics, law,
and puzzle-solving. Since 2010, in order to be certified, child abuse
specialists must complete three years of additional training, known as
fellowship. Only half of the 375 child abuse pediatricians currently in
practice nationwide are fellowship-trained. The rest have completed only a three-year
pediatric residency in general pediatrics, as I did.
In this case,
CPS called upon child abuse pediatrician Dr. Elizabeth Woods, a new director at
the Child Abuse Intervention program at Mary Bridge Children’s Hospital in
Tacoma. Although she told me on the phone she had “14 years of child abuse experience,”
in actual fact, Dr. Woods resume tells a different story. She completed only a residency in general pediatrics
in 2010 and has not completed a child abuse fellowship. And recently, NBC news reported
on a family wrongly accused of medical child abuse by Dr. Woods. It took the
Carter family 14 months to get their children returned by the courts.
After reviewing
photos of the child’s bruises taken by Ms. Duer of CPS, Dr. Woods determined they
were “consistent with a hand mark.” Dr. Woods ignored the fact that this child
had been restrained for stitches, and also that the pattern of bruising could
be consistent with lines on a baby gate or a heating grate.
Contrary to
Dr. Woods, after reviewing the same photos, a police detective assigned to the
case concluded that “the bruising appears to be very inconsistent, almost impossible
to be hand, finger, fingertip marks.” The officer added, “it is a little
difficult for me to understand what the medical professionals are talking
about.”
The CPS
caseworker would ultimately disregard the opinion of the veteran police
detective, as well as my own findings, as the pediatrician, instead favoring
the objectively illogical conclusions of Dr. Woods. On the basis of a single piece of evidence,
Dr. Wood’s opinion, Ms. Duer decided the allegations of abuse were
“founded”—meaning the state believed it was more likely than not that the
family had intentionally inflicted harm on their 2-year-old.
The battle to
keep their child cost this family more than $10,000 in legal fees. Unfortunately, when compared with stories
like the Walkers,
who were sentenced to 25 years in prison when wrongly convicted of intentionally
burning their granddaughters feet in the bathtub, the cost to my patient’s
family means they emerged relatively unscathed. Both involved overzealous child abuse
pediatricians who made mistakes. Those
with fewer financial resources have had their children mistakenly torn from
their homes while battling against an agency that considers parents guilty
until proven innocent.
What other
choice do good parents have? Seemingly
none. What happened to this family could
happen to any of us.
Washington
State lawmakers should implement stronger safeguards to protect families when Child
Protective Services defer to contracted “child abuse experts” whose opinions
are in dispute by primary care physicians. Keeping families intact should always be a top
priority.
*Details and
identifying information has been altered to protect identity
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