Proving medical child abuse: the time is now for Ohio to focus on the victim and not the abuser.

Author:Allison, Tiffany S.
  1. INTRODUCTION II. THE SHIFT FROM MUNCHAUSEN'S SYNDROME BY PROXY TO MEDICAL CHILD ABUSE A. What Is Munchausen's Syndrome by Proxy? B. Elements of Proof for Munchausen's Syndrome by Proxy C. History of Medical Child Abuse D. Cases Involving Medical Child Abuse E. New Elements of Proof for Medical Child Abuse F. Key Differences Between Munchausen's Syndrome by Proxy and Medical Child Abuse III. LEGISLATION A. Ohio's Current Legislation That Effects Medical Child Abuse B. Federal Legislation Regarding Child Abuse C. The Law in Other States: A Statutory Review 1. Rhode Island 2. Texas D. The Future of Ohio Legislation IV. THE EFFECT AND IMPACT OF OHIO'S NEW LAWS A. The Effect on Physicians and Other Health Care Practitioners B. Programs Implemented by Hospitals C. Best Interest of the Child V. CONCLUSION I. INTRODUCTION

    "Medical child abuse" is a term unfamiliar to most lay people and many individuals in the medical community. In fact, the term evokes an erroneous image of medical professionals abusing their minor patients. (1) Medical child abuse, however, is not a new phenomenon. It is merely a new term for the better-known phenomenon of "Munchausen's Syndrome by Proxy." (2) This Note discusses the differences between medical child abuse and Munehausen's Syndrome by Proxy and why professionals in the medical community are pushing for the use of a broader term, such as medical child abuse, (3) or simply, child abuse that occurs in a medical setting. (4) "Medical child abuse occurs when a child receives unnecessary and harmful or potentially harmful medical care at the instigation of a caretaker," (5) wherein the caregiver is most likely the mother of the child. (6)

    To understand the medical child abuse phenomenon, the following case study illustrates the typical interaction between the abusive caregiver and the medical provider and the insufficient, yet predictable, outcome produced by our current legal framework. In Ellis County, Texas, Susan Hyde medically abused her three daughters by subjecting them to more than one hundred-fifty emergency room visits over the course of four years. (7) The girls were treated for "cerebral palsy, cystic fibrosis, headaches and seizures." (8) Hyde used her knowledge as a paramedic to deceive doctors into believing that one of her daughters needed a feeding tube and another needed a wheelchair, leg braces, and a safety helmet. (9) Hyde "doctor shopped" by seeking out medical professionals in Texas, Nebraska, and Iowa. (10) Hyde would then change medical professionals before anyone detected a pattern of abuse. (11) After the investigation began, Hyde's paramedic certification was revoked. (12)

    The Assistant District Attorney for the Crimes Against Children Unit of Tarrant County, Texas, stated that "[o]ur laws are not written to prosecute cases such as these." (13) The Assistant District Attorney also felt that the inability of the criminal justice system to prosecute parents for medical child abuse "is a problem, and there should be some way to incorporate these cases in our laws to be able to protect children from situations such as this." (14) Unfortunately, it is usually difficult to catch medical child abuse perpetrators because their "doctor shopping" habits may span several different states. (15)

    Some generalizations can be made regarding the typical medical child abuse perpetrator. For example, the perpetrating caregiver is generally the minor patient's mother. (16) Additionally, the caregivers know what they are doing and often have a medical background. (17) Further, these perpetrators are generally excessively attentive, concerned with the medical staff and crave the attention they receive from medical professionals when they bring their children in to be treated. (18) Perpetrators may seek "care, warmth, affection, and attention" because her needs were ignored or neglected. (19) Medical child abuse may also be a way for a woman to fulfill a void for attention from a spouse. (20) A child becomes a "representative of [a woman's] needy self' for the mother to satisfy her emotional needs. (21)

    According to a clinical professor of psychiatry at the University of Alabama at Tuscaloosa, medical child abuse is "child maltreatment, undeniabl[y]. It may be the single most lethal form of child abuse there is." (22) Prosecutors, however, face difficulties when attempting to prosecute abusive caregivers because it is difficult to gather the medical records from each medical institution that treated the child. (23) Despite the challenges faced by prosecutors, there have been some successful cases in which the abused child was removed from the custody of the perpetrating caregiver. For example, Susan Hyde, the Texas mother discussed above, was successfully prosecuted. (24) As a result of Hyde subjecting her children to medical child abuse, one daughter now lives with her biological father and the other two, who have a different father, are in foster care. (25)

    Ohio must amend its legislation to make it clear that medical child abuse is a type of abuse that necessitates a shift away from a focus on the caregiver's mental state and intentions. Focusing on the caregiver produces uncertainty as to whether an individual suffers from Munchausen's Syndrome by Proxy; therefore, the proposed legislation needs to focus on the best interest and safety of the abused child. Furthermore, the country needs to depart from the term Munchausen's Syndrome by Proxy and refer to this scenario as medical child abuse to better ensure the safety of our children. The legislation changes must include a specific definition of medical child abuse. A specific definition will make it easier to prosecute perpetrating caregivers and will prevent children from remaining in the harmful parent's custody solely because the caregiver's mental state could not be proven.

    Part I of this Note will discuss the history of Munchausen's Syndrome by Proxy and how the medical community is trying to make the general public aware of medical child abuse. Part II provides a history of Munchausen's Syndrome by Proxy and medical child abuse. It also highlights the differences in how litigation was previously handled under the nomenclature of Munchausen's Syndrome by Proxy and how litigation should be handled in the future under the nomenclature of medical child abuse. Part III identifies Ohio's current statutes and federal legislation that have an effect on child abuse. Part III also identifies individuals with a duty to report child abuse, analyzes other states' laws, and discusses the efforts that have been taken to successfully prosecute medical child abuse. Part III also proposes Ohio legislation that includes a specific definition for medical child abuse. Finally, Part IV analyzes how the proposed Ohio legislation will affect physicians, the medical community, hospital programs, and children that need to be removed from the custody of harmful caregivers.


    1. What Is Munchausen's Syndrome by Proxy?

      The term "Munchausen's Syndrome" was first used by Dr. Richard Asher in 1951 as a way to describe self-induced illnesses (26) caused by providing eccentric, but incorrect, medical histories and symptoms in a dire attempt to seek medical care. (27) Munchausen's Syndrome by Proxy (hereinafter "MSBP") was first coined in 1977 by Roy Meadows, (28) when he reported that MSBP occurred in situations where adults fabricated illnesses or deliberately produced life-threatening symptoms in children. (29) MSBP is "a type of factitious disorder, [or] a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick." (30) The term was first "introduced early in the history of child abuse as a pediatric entity. It came into use when most child abuse was still referred to as battered child syndrome." (31)

      Mothers are the most common group of people to suffer from MSBP. (32) When MSBP was a newly minted disorder, the primary role of women was to care for their children. Because mothers were home with their children all day, and because most of the children were under the age of six, mothers had ample opportunities to induce symptoms in their children that seemed to require medical attention and treatment. (33) Caregivers who suffer from MSBP may: falsify medical records; lie about the symptoms a child is actually experiencing; put a child's life in jeopardy; induce symptoms; and, withhold medical treatment. (34)

      The causes of MSBP vary widely. A person might suffer from MSBP because he or she: wants to become closer to a spouse; craves attention; was a victim of abuse as a child; or feels a strong need to develop relationships with others. (35) Because those who suffer from MSBP are often dishonest, however, the psychiatric disorder is difficult to detect and treat. (36) Once the disorder is diagnosed, however, the first concern is to separate the individual from any potential victims. (37) From there, treatment can be challenging because individuals with MSBP may deny there is a problem. (38) These individuals often have difficulty separating reality from fiction. (39) Psychotherapy is the main treatment used for MSBP, and it involves changing the thoughts and behaviors of the affected individual to determine the causes and contributing factors of the illness. (40)

      There are several warning signs when recognizing and diagnosing an individual with MSBP. Some of these signs include: (1) the abuser is often a parent, a mother in most circumstances; (2) the individual may now be, or was previously, employed in the healthcare field; (3) the individual is friendly and cooperates with the health care staff and providers; and (4) the individual appears to be concerned about the patient, and at times may seem overly concerned. (41) Additionally, there are warning signs to look for in the...

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