Munchausen by Proxy?

It’s a tragic story. Garnett Spears, a 5-year-old boy, was given deadly amounts of sodium through his feeding bag, allegedly by his mother.

After beginning treatment, hospital tests revealed unusually high amounts of sodium in the boy’s body, which accounted for his neurological symptoms. With this bizarre finding, the doctors at the hospital immediately notified CPS, who began an investigation into the matter.

Children at hospital

In Arizona, according to A.R.S. § 13-3620, it is mandatory for treating physicians to report any reasonable belief that a minor is a victim of physical injury or child abuse. For instance, if a Mesa mother brought her son to Cardon Children’s Medical Center with burn marks that appeared to be caused by a cigarette, they would likely contact CPS to investigate the incident.

New York has a similar law, NY SOC SERV § 413, which states that physicians are required to report if a child has been maltreated or abused and has come to them in their official capacity. The doctors in this matter saw a red flag in the unusual test results and knew they must report the incident immediately.

While the boy was in the hospital, his mother called a neighbor to dispose of his feeding bag. The neighbor, suspicious of the odd request, decided to retrieve the bag but instead of disposing of it, turned it over to investigators looking into Garnett’s death.

Mother and ChildWhen the authorities received the feeding bag from the neighbor it was tested to determine if he was being fed the high amounts of sodium through the feeding bag inserted into his abdomen. Tests revealed the bag indeed contained high levels of sodium that accounted for the dangerous levels of the chemical that killed him. Unfortunately, it was too already late for Garnett.

Through investigation, authorities found that the mother had been documenting the son’s multiple illnesses through social media. They believe Spears may suffer from Munchausen by proxy and caused her son’s illness, and ultimately death, for attention. It is likely she did not intend to cause the untimely death of her son but that was the regrettable result.

Family and friends gathered in support of Spears through her posts regarding her son’s illness and his stay at the hospital was no different. Spears denies giving her son the excess amount of sodium, but authorities are still investigating the matter and will likely charge her with the crime.

Munchausen by Proxy Allegations in Arizona

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.”

Factitious disorders, most notably Munchausen Syndrome by proxy, can be generally described as follows:X-ray (Woodnick)

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, USCA (Woodnick)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.

Defending A Parent Accused of Munchausen By Proxy

Defending A Parent Accused of Munchausen by Proxy

Munchausen syndrome is a ‘sexy’ diagnosis and allegation.  While the term only entered legal and medical vocabulary in the mid-1970s, it has become rather in-vogue.  Hollywood made it popular in movies such as The Sixth Sense and with television shows such as ER and The X-files.  Even Eminem used his chops to sing about his childhood plagued with “…going through public housing systems, victim of Munchausen syndrome. My whole life I was made to believe I was sick when I wasn’t….”

What is Munchausen Syndrome?

Let me give credit to the Cleveland Clinic for this answer:

“Munchausen syndrome is a type of factitious disorder, or mental illness, in which a person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Some will secretively injure themselves to cause signs like blood in the urine or cyanosis of a limb. Munchausen syndrome is a mental illness associated with severe emotional difficulties.”

Or…in layman’s terms…people perceive or fabricate their own illness, or others (usually their children) for reasons related to their mental health.

What does Munchausen by proxy (to another, typically their child) look like:

  • Child hospitalized or seen by medical providers of unusual and unexplained symptoms
  • Those symptoms seem to only be present when the caregiver is around
  • Symptoms do not comport with anticipated test results
  • Symptomology seems to worsen with parent and improve while the child is hospitalized or under supervised medical care
  • In dramatic instances there are chemicals in a patient’s system
  • The parent works in the healthcare field often with Extensive understanding of medical terminology. 
  • Parent is eager to have medical testing and procedures performed on the child
  • The parent goes doctor and hospital “shopping” for care and opinions

How do I defend the parent accused of abuse via Munchausen?

It is important to understand how these cases come about.  Usually a report of MBP comes through a medical provider who has surmised that the medical records do not match the level of treatment and testing that the child has overcome.  Perhaps the report comes from a pediatric specialist, such as a Gastroenterologist in the hospital, who is wondering why the parent has been referred for a procedure when nothing was found the last time a similar procedure occurred.  The parent presents as ‘too eager’ for the child to be put under general anesthesia and the Doctor surmises that the problem is the parent’s, not the patient’s.  The doctor will then be under an obligation to report the suspected abuse pursuant to Arizona’s Mandatory Reporting Statute.

CPS must then intervene and conduct their investigation.  If they are told by a physician (and probably the hospital social worker) that they suspect Munchausen’s, it is likely a TCN (Temporary Custody Notice) will be served and the child will be placed in CPS care while the matter proceeds to Court.

CPS will then consult with an expert on Munchausen’s. Often the Department will look out of state for an expert and frequently relies on providers from the University of California, Los Angles (UCLA). It is usually recommended that the only way to tell if a parent is fabricating is to separate the child from the parent and see if the condition improves.  Of course this means that the child will be removed from the home and placed in foster care.  Some psychologists believe that the child cannot be placed with a relative, despite Arizona’s kinship priority statute (A.R.S. 8-514.03) as somehow they too may be duped into believing that the ‘fabricated’ condition exists.

Defending parents in these cases is challenging as there is no unified mental health consensus as to the diagnosis/treatment of the disorder.  The State’s expert will no doubt discredit every medical decision made by the parent.  Engaging quality experts on Munchausen by proxy and possibly other medical professions is critical.