Allegations of child abuse can come from a number of sources. Teachers, caretakers, physicians, and some other professionals are required to report their suspicions of abuse due to Arizona’s “mandatory reporting” statute (A.R.S. § 13-3620), leading to CPS investigations in many instances.
The ‘mandatory reporter’s’ suspicion is also a matter of potential confusion – the classic example of a doctor or teacher discovering abnormal bruises or other injuries that they suspect are the result of abuse does occur, but the scope of potential abuse allegations has grown well beyond the realm of physical evidence. Although infrequently, Arizona child abuse and neglect defense attorneys sometimes encounter accusations of medical abuse or neglect by way of “factitious disorders.”
A factitious disorder is one in which the individual fabricates symptoms or deliberately produces injuries in order to assume the “sick” role and receive attention or affection from medical professionals, family members, or others.
In rare cases, caretakers may substitute children in the “sick” role by ascribing symptoms to them and repeatedly seeking medical help on their behalf. The caretaker may subject the child to frequent hospital visits, demand multiple opinions, elaborate examinations, and laboratory screenings, and even falsify test results or poison and injure the child in order to make their claims legitimate.
Munchausen syndrome is a mental health disorder identified using criteria from the Diagnostic and Statistical Manual IV, or DSM-IV. The DSM-IV provides guidelines for detecting and treating mental health problems, but there is little information available to professionals who are tasked with diagnosing symptoms like those experienced by sufferers of Munchausen.
For practical legal purposes, this means that Munchausen is difficult to prove or disprove. CPS may uncover medical records which are inconsistent with the child’s symptoms when investigating a Munchausen by proxy allegation, but such records may be incomplete or misleading – a child who takes his cue from Ferris Bueller’s Day Off and fakes illness might convince his parent to take him to the doctor’s office for tests, leaving behind a trail of paperwork which could indicate foul play when viewed under the Munchausen magnifying glass.
A child who repeats this behavior many times – children with learning or developmental disabilities, problems with school bullies, or difficult-to-spot medical problems may actively attempt to avoid going to school on a regular basis by feigning illness – could be seen as a victim of Munchausen by proxy when the reality of the situation is that their concerned parent properly sought medical care for their child.
Because Munchausen by proxy is factitious (not to be confused with fictitious, although there are many parallels between the two), the disorder is nearly impossible to demonstrate or disprove beyond a preponderance of available evidence. Unfortunately for falsely accused parents, however, CPS workers may establish a strong presumptive claim using medical records, expert testimony, and any incriminating history about the parent that they are able to uncover (evidentiary rules which may stop attorneys from using evidence of past acts as evidence in court do not apply with the same heft in child abuse cases).
For parents falsely accused of abusing their children via Munchausen by proxy, a complex legal battle awaits. Strategic use of expert testimony, intimate knowledge of evidentiary limitations, and understanding of both legal and medical rules and terminology may all necessary to parry a false allegation of Munchausen-related abuse.