Medical Child Abuse Panic

A Child Abuse Pediatrician’s Ethical Obligation to “first do no harm”

Rookie child abuse pediatrician deemed expert above all others

CARES Northwest Pediatrician Heather McKeag was the State’s primary witness to her own diagnosis of Medical Child Abuse (MCA) in the Oregon dependency case against Trisha DeLaurent. In a May 2nd jurisdictional decision, Judge Susan Svetkey repeatedly praised Dr. McKeag’s work on the case in spite of glaring inconsistencies and circular referencing in the young pediatrician’s diagnostic report.

In stark contrast, Judge Svetkey discounted–as neither credible nor helpful–the opinions of  nationally recognized Neurologist, Dr. Robert Shuman, and Epidemiologist/Fulbright Fellow, Dr. Michael Freeman, who each offered substantial testimony directly refuting the validity of Dr. McKeag’s decision-making process and theory of medical abuse.

In her written opinion, Judge Svetkey complimented Dr. McKeag on her “thorough and impressive review” of medical records dating back to 2003. The trier of fact failed to mention that the exact same medical records, as well as Dr. McKeag’s report, were thoroughly reviewed by the renowned medical specialists who testified for the defense.

The historical medical files relied upon by all expert witnesses contained technical data, diagnostic information, and prescribed treatment plans in highly specialized medical fields for which Dr. McKeag holds no certification nor experience.  During her evaluation, McKeag failed to contact any of the treating physicians identified in record before reaching her conclusion that the 14-year old boy in question had been medically abused by his mother.

A problematic process

Dr. McKeag should have noticed, but failed to disclose in her report, that there was not one corroborating notation in record to indicate treating physicians had concerns about the mother’s behavior or truthfulness in reporting.  In her ruling, however, Judge Svetkey deferred to Dr. McKeag’s report when she wrote:

Dr. McKeag points out that pediatric care depends on truthful histories and truthful observations provided by a child’s caretaker.  Medical providers made medical decisions and recommendations based on mother’s untruthful reporting.”

The above claim made by Dr. McKeag, and relied upon in Judge Svetkey’s ruling, was not only absent from over 12 years of medical documentation, but was also not stated in testimony by care providers who took the witness stand for the prosecution or the defense.  Among medical witnesses, it was Dr. McKeag alone who made this presumptive statement.  Common sense would dictate that if physicians developed treatment plans and prescribed medications based on the reports of parents as Dr. McKeag indicated in her report, the potential for medical malpractice would be catastrophic.

Judge Svetkey referenced only the expertise offered in “The McKeag Report” when she wrote:

  • “[Marcus’] symptoms, according to Dr. McKeag could well be related to his extensive and increasing doses of medications–medications prescribed solely due to mother’s reports….”
  • “The medications, dosage of the medications and apparent lack of medical basis beyond mother’s reports for these medications led to disastrous results….”
  • “This medication was provided on mother’s reports alone.”

And in relation to another child who wasn’t alleged in Dr. McKeag’s report to be a victim of MCA, Judge Svetkey wrote:

  • “[Austin] also underwent medical tests and procedures based on mother’s reports alone.”

Judge Svetkey’s ruling is filled with similar statements to those above revealing  Dr. McKeag’s belief that medical providers involved in the care of DeLaurent’s son were deliberately tricked, manipulated and fooled. When the theory is followed through logically, Dr. McKeag’s narrative, and Judge Svetkey’s subsequent ruling, would require that involved medical providers failed to perform their own diagnostic testing or rely on their training and experience, but instead took medical action based on the reports of a parent during a 12+ year span of time.

Eyewitness testimony and medical documentation swept under the rug

During the dependency trial, numerous eyewitnesses and co-caregivers took the stand and testified under oath to observing the same symptoms, including seizures, that Trisha DeLaurent reported to medical professionals over the years. In her written ruling, Judge Svetkey dismissed the multi-witness corroboration without alluding to any of their specific testimony as follows:

  • “Mother reported seizure behaviors that were not seizures…”
  • “Mother educated teachers and others to interpret certain behaviors as seizures…”
  • “Mother called several friends as witnesses…some were impressive in their own right.”
  • “Mother gathered these friends and educated each to see seizures.”
  • “None was aware of mother’s fabrications. Each was a strong supporter of and advocate for mother and her position in this case.”

The eyewitnesses referenced in the above statements include teachers, care-givers, a longtime neighbor who is also a nurse, step-father to the children who lived in the home, family friends of 10+ years who had personal relationships with the children, and mothers of other medically-fragile children. Judge Svetkey’s inference is that each of these individuals, in spite of backgrounds that would have allowed them to make their own judgments, instead relied only on the prompting of Trisha DeLaurent, and thus provided false or incorrect testimony.

Even more powerful is the fact that there is actually a medical record that documents medical staff witnessing a seizure and administering emergency seizure medication.  Dr. McKeag concluded that Trisha DeLaurent “lied” to her son’s physicians.  A lie is a specific, identifiable statement.  Not one medical record was presented to the court to demonstrate a “lie” occurred.

Dr. Heather McKeag, who presented her diagnoses of Medical Child Abuse within weeks of the “anonymous” CPS Hotline calls from the children’s grandmother in September of 2016, likely became aware as time passed that her claims were flawed. As she realized the potential for her theory of medical abuse to backfire, she sent a March 22, 2017 email to Portland Police Bureau investigator, Robert Harley (referenced and included below).

Violation of medical ethics, witness tampering, or both?

According to the AMA, physicians have an ethical obligation not to act as law enforcement investigators or to engage in witness interrogations. According to the law, those who seek to change or influence the testimony of potential witnesses may be guilty of “Tampering with a Witness”.

Child Abuse Pediatricians like Dr. McKeag who operate as part of a team in coordination with law enforcement and the prosecutor’s office are at risk of crossing both ethical and legal lines. Through her email to Detective Harley, Dr. Heather McKeag appears to have crossed those lines as she sought to influence the testimony of other medical witnesses by…

  1.  Assuring them that their decisions and treatments were not in question: “The decisions themselves are not in question, nor is any of the treatment provided.”
  2. Imposing her opinion and the State’s position:  “The assumption is that the physicians were provided inaccurate histories, misinformation, or straight up lies.” 
  3. Guaranteeing a lack of scrutiny regarding their testimony: “The physicians you interview may feel they themselves are under scrutiny, which is not the case.”
  4. Naming the medical witnesses as “victims in this fabrication”:  “They are part victim in this fabrication, and I am certain they do not take lightly how they were used and manipulated.”

In addition, Dr. McKeag presented herself as a resource to medical witnesses and provided her contact information.  She offered her condolences to the physicians, “it was a pleasure to read through how thoughtfully and carefully [you] tried to offer the best care possible… and equally frustrating to know that [your] best professional intentions were manipulated by an untruthful caretaker.”  The email included a list of questions (not included in the excerpt below) prepared by McKeag and designed to elicit desired testimony to match her report.

 Read the reprinted article below for more about ethics concerns regarding the work of Child Abuse Pediatricians.
The following review of a study published by the Family Defense Center in Chicago highlights the growing controversy surrounding ethical concerns within the practice of Child Abuse Pediatrics, a medical sub-specialty certification that was established only within the last decade.  The review below is reprinted from:

“Medical Ethics Concerns” in Review

medical

Writing for the Family Defense Center in Chicago, George J. Barry and Diane L. Redleaf published their criticism of the sub-specialty of child abuse pediatrics. In studying the day-to-day practices of the profession, Barry and Redleaf found that more often than not the “experts” violate several core principles adopted and recognized by the American Medical Association Code of Ethics and the Committee on Child Abuse and Neglect of the American Academy of Pediatrics.

“We submit, in this Paper,” reads the executive summary, “that this system of child abuse investigation and medical assessment is failing the children and families. We also submit that the failings are due at least in part to practices that are ethically questionable at best or plainly unethical at worst…. [W]e believe that the medical profession has turned a blind eye to the treatment of children and families who are the victims of misplaced child abuse allegations and we are concerned about developments in the handling of medically complex allegations that make these problems worse, not better.”

The paper does not look so much at the legality of these new practices – how they compare to the dictates of law – as at the question of whether they are ethical – how they comport with “medical ethics” as declared and adopted by respected medical associations.

Redleaf, who is a 1979 graduate of Stanford Law School and the legal director of the Family Defense Center, drew upon her experiences defending actual parents in family court, in part by including 5 real-life case studies in her paper.

“In the typical Family Defense Center medically complex case,” she summarizes, “parents are eventually exonerated and children are returned home, but only after intervention by the child protection system that lasted weeks, months, or even years.” That intrusion, the paper holds, causes permanent damage to the entire family.

“In the spirit of ‘first do no harm,’” the authors conclude in part, “the medical profession should recognize when its practices cause harm and should work to mitigate that harm whenever possible.”

Barry and Redleaf also argue that child abuse specialists who interview parents for primarily forensic (evidence-gathering) reasons and not medical reasons violate the principle that doctors are ethically prohibited from participating in interrogations.

These and other concerns fill the 114 pages of the review, which is well worth the read to parents caught in the cross hairs of a failing system, and to doctors troubled by the ethically-questionable direction their profession has taken in recent years.

You can read the paper in its entirety here.

Sincerely,

Michael Ramey
Director of Communications & Research

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