Is medical child abuse essentially different than physical abuse, sexual abuse or neglect?
The case of Justina Pelletier, a teenager with a mysterious medical history who was hospitalized and subsequently placed in protective custody by the state of Massachusetts, raises questions about what constitutes necessary intervention.
What Happened to Justina Pelletier?
According to FoxCT, the family’s local Fox news channel, doctors at Tufts University diagnosed Justina with mitochondrial disease in 2010. She continued to be treated at Tufts until February 2013 when she came down with flu-like symptoms. FoxCT says, “Her parents admitted her to Boston Children’s Hospital to see a specialist who recently transferred there from Tufts Medical Center.“
The doctors at Boston Children’s Hospital rejected her existing diagnosis, and diagnosed her as having a psychosomatic illness instead – that’s an illness in which symptoms come from your mind, rather than an underlying disease process. The Department of Children and Family became involved when the parents disagreed with the new diagnosis. Justina spent nearly a year in a state psychiatric hospital, then went to a group home before being returned to her family.
The state of Massachusetts alleged that the parents were over-medicating the child, agreeing with the doctors who diagnosed her illness as psychological in nature. The parents contend that Tuft Medical Center in Connecticut had diagnosed her with mitochondrial disease and, as Townhall.com reports, they were only following doctor’s orders.
After sixteen months in protective custody, the teenager, now sixteen years old, is at home with her parents. Justina now uses a wheelchair.
Although the teen is quoted as saying, “No one was on my side,” the opposite may be true.
The issue is that the Massachusetts Department of Children and Families and physicians disagreed with parents regarding what was best for her. The state of Massachusetts alleged medical child abuse, siding with doctors in their own state who believed Justina’s illness was psychosomatic, and parents were over-medicating her.
The true crime is the time it took to unravel the problem and return Justina to her home.
The History of Child Protection in the United States
Prior to 1875 occasional court cases were brought against parents, but as law professor John E.B. Meyers stated in A Short History of Child Protection in America, protection was sporadic.
In 1875 the first agency was founded to protect children in the United States, the New York Society for the Prevention of Cruelty to Children or NYSPCC. The NYSPCC formed following efforts to protect a child, Mary Ellen Wilson, in New York’s Hell’s Kitchen who was “routinely beaten and neglected.”
Meyers writes by 1922, “300 non-governmental organizations” existed to protect children, but not all areas of the country were covered. In 1935 the Social Security Act funded Aid to Dependent Children. Aiding and “establishing, extending and strengthening” child-welfare protection was included in the act.
1962 ushered in increasing public interest in protecting children with the publication of The Battered-Child Syndrome published in the Journal of the American Medical Association by Dr. Henry Kempe and colleagues. Kempe wrote the syndrome was “a frequent cause of permanent injury or death” and admitted that the “psychiatric factors” behind the phenomena were not well understood.
According to Meyers, this article spurred subsequent legislation requiring states to address child welfare services available statewide by 1975. Initial public focus was on physical abuse, but an emphasis on intervening to stop sexual abuse of children soon followed.
By 1967 all states had mandatory reporting laws requiring physicians to report suspected abuse.
What is Munchhausen Syndrome by Proxy?
In the Pelletier case, the Boston physicians stated that Justina’s illness was psychosomatic. The physicians, appear to have suspected medical child abuse, also termed Munchhausen Syndrome by proxy (MSP) – and are required to report such cases.
According to the Cleveland Clinic, “[T]he adult perpetrator has MSP and directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age. It is considered a form of abuse by the American Professional Society on the Abuse of Children.”
The article estimates “1,000 of the 2.5 million cases of child abuse reported annually are related to MSP.” The family member, often a mother, desires to the emotional sympathy that comes with having an ill child and seeks unnecessary, and potentially dangerous, medical care – sometimes harming the child or giving the child medication to increase the chance they will appear ill.
The Cleveland Clinic states, “[T]he first concern in cases of MSP is to ensure the safety and protection of any real or potential victims. This might require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes social workers, foster care organizations, and law enforcement, as well as the health care providers.”
In the Pelletier case, it appears that parents, following the recommendations of Tuft’s physicians for treatment, were unable to convince the state of their good intentions. The New York Daily News quotes Justina regarding the actions of the Department of Children and Families, “They were just trying to make excuses … twisting words around my family who weren’t doing anything wrong.”
Justina Pelletier Reunites with Family
39 years following the 1975 federal mandate, Jusina Pelletier returned to her family. According to the New York Daily News, the family was united after “Pelletiers complied with the state’s Health and Human Services reunification plan”
The state was charged with ensuring the health and safety of Justina, and an investigation was required once Boston Medical Center doctors made the report of suspected abuse. Taking sixteen months to investigate the case and ensure the child was not being medicated for false or nefarious reasons, however, is hard to justify.
If, as Townhall.com alleges, Justina did not receive any education while in a state-run psychiatric ward, the state failed to uphold the child’s fundamental right to a free education.
Rolling back mandates to report and investigate suspected child abuse is unwarranted, and dangerous. Nevertheless sixteen months is long time in the life of a young person. Hopefully the state of Massachusetts will close the next case of medical child abuse in far less time, and with fewer miscarriages of justice.
Decoding Science. One article at a time.