February 4, 2020 by Robert Franklin, JD, Member, National Board of Directors
This excellent article is the latest in a series by NBC News and (sometimes) the Houston Chronicle (NBC News, 1/27/20). The series deals with the rising “specialty” of child abuse physicians, i.e. those who are supposedly uniquely trained and qualified to diagnose intentional injuries to children. Those physicians don’t necessarily have a conflict of interest, but, as the article demonstrates, they often seem to adopt one. Plus, as the NBC piece also makes clear, the very existence of the specialty can produce other more sinister ethical violations.
The piece is long and too detailed to adequately describe here. Suffice it to say, that Dr. John Cox, an ER physician and his wife, Dr. Sadie Dombrozsi, an oncologist and hematologist, were in the process of adopting a baby girl. They’d already adopted two boys and appear to have been entirely loving and fit parents to them. But, not long after they’d brought home their one-month-old daughter-to-be, Cox fell asleep with the baby beside him. When he awoke, he was partially on top of her. The child was in no distress, but Cox was concerned. He called his wife who was out of town with the boys and together they decided to “err on the side of caution” and take the baby to Children’s Wisconsin hospital at which they both worked.
As events developed, that turned out to be the least cautious thing they could have done. Months later, the baby has been taken from them by the Wisconsin Department of Children and Families and John is under felony indictment for child abuse. The latter of course threatens not only his freedom, but his livelihood. That is all true despite the fact that there is no clear evidence of abuse, the pair have always been good parents to their other children and numerous doctors have looked into the case and found no reason to believe abuse occurred.
What followed, according to more than 15 medical experts who later reviewed Cox’s case, was a series of medical mistakes and misstatements by hospital staff members that has devastated Cox’s family and derailed his career. A nurse practitioner on the hospital’s child abuse team confused the baby’s birthmarks for bruises, according to seven dermatologists who have reviewed the case. A child abuse pediatrician misinterpreted a crucial blood test, four hematologists later said. Then, two weeks after the incident, armed with those disputed medical reports, Child Protective Services took the child.
Actually, that recap of the problems in the case seriously understates the doggedness with which child abuse specialists, a nurse practitioner and others, and caseworkers with the WDCF credited medical interpretations that concluded abuse had occurred and ignored those saying otherwise. That’s a process that one independent medical expert, orthopedist Dr. Matthew Wichman called “quite preposterous.”
But it’s worse than that, far worse. On several occasions, child abuse pediatricians at Children’s Wisconsin have apparently attempted to get doctors to falsify medical records to enhance the state’s possibility of securing a court order to remove a child from its parents. Needless to say, that’s an outrageous breech of medical ethics that warrants discipline by the appropriate licensing agency, if proved.
A dozen members of the hospital’s medical staff spoke to a reporter on the condition of anonymity, worried that they would be punished for discussing their concerns publicly.
Several emergency room doctors described an “out of control” child abuse team that is too quick to report minor injuries to authorities and that is too closely aligned with state child welfare investigators. Three of the doctors recalled being pressured by child abuse pediatricians to alter medical records, removing passages where they had initially reported having little or no concerns about abuse, though there’s no evidence that happened in Cox’s case.
“Essentially they’ve asked us to edit medical records to help the state prosecute parents,” one doctor said. “It’s completely inappropriate.”
It also shows what’s perhaps the most important takeaway from this and other cases involving child abuse doctors – their tendency to become less doctors caring for young patients than advocates for state child protective agencies. Obviously, the line between the two can be unclear, but when a doctor’s title and job description involve seeking out abuse, the tendency to find that abuse where others haven’t increases.
For example, several staff members told a reporter that child abuse pediatricians at the hospital routinely review medical records of children who’ve been admitted to the ER — even when no doctor has asked for their opinion — and then weigh in on whether Child Protective Services should be called. Sometimes child abuse specialists send notes scolding ER physicians for failing to flag children, even though those physicians did not believe the child had been abused, several doctors said.
Plus, as I and others have said before, parents trying to deal with an injured child, who take that child to a hospital and are confronted with a welter of doctors, nurses, administrators, etc. may well not be aware of the child abuse doctor’s dual role, i.e. that of caregiver to the child and potential adversary to the parents. Needless to say, that conflict of interest may not be disclosed at all and certainly not in the early going.
I’ll say more about this next time.