What is MCA?

Quick Facts Regarding Medical Child Abuse 

[Reprinted with permission from Family Rights Foundation]

1- Medical Child Abuse or MCA (aka- Munchausen Syndrome By Proxy, Fabricated Illness Induced By A Caregiver) was originally a condition that was only identified within intentional criminal acts of child abuse (1); acts such as giving a child a bottle of aspirin and claiming hemophilia, suffocating a child and claiming apnea, inducing a seizure through massive ingestion of salt etc. Regardless of the method of abuse all were intentional acts of abuse, and all were subject to direct evidence via testing.

2- MCA accusations dramatically broadened over time to include (even target) children with verifiable medical/developmental conditions. These special needs children, unlike the original victims, were children under the care and treatment of licensed specialist doctors. Intentional infliction of harm was ​removed​ as a diagnostic consideration of MCA (2). However, intent to cause harm continues to be needed within criminal cases; thus the vast majority of MCA cases are never criminally charged. Destroying a family forever requires a lesser burden of proof than a weekend confinement in jail, per current legal standard. These contemporary MCA allegations are little more than a differing medical opinion in which parents are caught in the crosshairs of doctors. This is nothing short of an attempt to hold parents directly responsible for the care rendered by licensed doctors; but it in no way reduces the legal and ethical responsibilities that continues to be held by the treating doctors.

3- Medical errors are the 3rd leading cause of death in the United States (3). The reality is that medical mistakes commonly occur. 80% of all people taking a medication have to discontinue it at some point due to adverse effects. Holding unqualified parents to a higher “no harm” standard than veteran specialists is dangerous and damaging to children and their families.

4- Forensic child abuse doctors are general pediatricians with specialty in abuse (4), they hold little to no training on complex medical issues; for specific issues such as cardiology, neurology, genetics one would see a specialist doctor that holds advanced and specific training on diagnosis, treatment, and medication related to their specialty field. MCA has allowed general pediatricians with significantly less training in complex conditions to reach above the credentials and expertise of specialist doctors.

5- There are approximately 7000 recognized rare disease that impact 1/10 Americans or (10% of the American population). 80% of these conditions are rare genetic disorders that a child is born with, but symptoms tend to evolve over the course of many years and these conditions are notoriously difficult to diagnose. These rare diseases often have only a handful of leading specialists devoted to their
diagnosis and treatment (5). Other diseases once thought to be rare, such as mitochondrial disease, have now been discovered to be as prevalent as Cystic Fibrosis upon further genetic research (6); mitochondrial disease, because of its prevalence and range of complex symptoms, continues to be the disorder frequently identified within MCA cases (6).

6- In America it takes an average of 7.8 years for patients to receive the correct diagnosis. Prior to receiving the correct diagnosis a patient will be incorrectly diagnosed 2.5 times, and see approximately 8 physicians (7). The very process by which patients must seek diagnosis and treatment is the cardinal diagnostic feature used by the forensic pediatricians to establish MCA (8).

7- The very diagnosis of MCA by these lesser forensic pediatricians is unlawful within the vast majority of these cases, as the courts have held that MCA is a “diagnosis of exclusion” (9), given the prevalence of diseases that impact the pediatric community it is nearly impossible to effectively rule-out biological and unintentional environmental causation. Certainly, specialists within the child’s field of symptoms would be best equipped to be accurate diagnosticians of MCA versus a legitimate medical/developmental condition, as they alone hold the expert knowledge regarding identification, diagnosis, and standards of care.

8- Medical diagnosis and treatments must comply with established best practice standards that are evidence based scientific measures which: formulate a clear clinical question of a patient’s problem, search the literature for relevant clinical articles, evaluate (critically appraise) the evidence for its validity and usefulness implement useful findings in clinical practice (10). MCA is not even a diagnosable medical condition, as it lacks a recognized and accepted diagnostic process, no confirmation testing exists, and it is a “diagnosis of exclusion” (11).

9- “There has never been a good empirical study on the base rate of MCA within the general population, but even MCA proponents concede that it is quite rare. The figures that they supply puts the base rate at approximately 0.5-2.0 per 100,000 children younger than sixteen years. Mitochondrial disease occurs in 1 per 4,300 children- Ehler Danlos Syndrome occurs in 1 per 20,000 children- Eosinophilic Esophagitis occurs in 11 per 100,000 children- using only three conditions (out of the 7000 rare diseases) we easily arrive at a rate of 39 per 100,000 children whose conditions are frequently mistaken for MCA” (11). If all rare disease were factored in we would see that 1000 per 10,000 children will have a rare disease, making rare disease nearly 1000 times more common within a medical setting than MCA (4).

If we add environmental effects that cause human illness and/or death we learn that approximately 25% of all deaths are tied to environmental effects (12). Within the US alone we spend over 76.6 billion dollars annually treating environmental
caused illness and disease in children (13). An estimated 20% of all children will suffer medical or mental illness related to environmental causes (14). Like rare disease the causation of environmental illness is often difficult to isolate and identify, and it requires expertly trained specialists in many cases. Parents raising previously healthy children that become medically or mentally ill as a result of environmental effects also find themselves accused of MCA.

Using just rare disease and environmental illness we see that 3000 per 10,000 children will be affected, making these two groups of causation nearly 3000 times more common in a medical setting than MCA. It would be nearly impossible to identify and calculate all conditions that could be mistaken for MCA; yet one would need to accomplish that within each case of MCA, since it is a diagnosis of exclusion. MCA is extremely rare, but grossly over diagnosed by under-qualified forensic pediatric doctors.

10- Parents hold Constitutionally protected rights to make healthcare decisions on behalf of their children (15). It is within the best interest of children and families that complex medical and developmental conditions be left to the expert specialist doctors, and not subject to the lesser medical opinions of general pediatric doctors. Physicians and patients currently enjoy a protected and confidential relationship free of interference (16), this process is illegally and unethically being subverted by Oregon DHS and Child Abuse Centers.

Summary: Families raising special needs children need to be protected from greatly over diagnosed allegation of medical child abuse at the hands of under-qualified pediatric doctors. Parents must be safe to rely upon the expert care and guidance of the specialists they entrust with their children’s medical care; the alternate is neglect of potentially life limiting medical conditions.

Is Medical Child Abuse a valid medical diagnosis?

The term “medical child abuse” is ​not​ a medical diagnosis. The codification book for medical diagnoses is the ICD-10 produced by the World Health Organization.

The ICD-10 provides numbers for all the possible medical diagnoses. It’s used as the foundation for insurance billing. Insurance billing always requires an ICD-10 diagnosis for all medical disorders.

The public availability of the ICD-10 as a diagnostic entity for all medical diagnoses allows the Internet to set up search engines for medical diagnosis codes.

For example, at the following website you can enter search terms at the top, like “diabetes” and “medical child abuse” ​and​ this search engine will produce the relevant ICD-10 medical diagnoses.

http://www.icd10data.com

Do it first for “diabetes,” just to get a feel for the type of diagnoses it returns for the search term diabetes. For example, the first return is for:

Diabetes Insipidus: ICD-10 Code E23.2

What is the ICD-10 Code is for Medical Child Abuse?​ ​There is none.

See for yourself. Do a search on the term medical child abuse. Nothing. It matches to the term “abuse” by itself, there’s sexual abuse, and psychological abuse, and physical abuse, and then the search results move further and further away. No “medical child abuse.” Child Abuse Pediatricians are “diagnosing a condition that does not exist per medical standards, and it is destroying the lives of countless families.

To any Doctor I’d pose the following questions:

1. Is the ICD -10 (produced by the World Health Organization) the codification system for medical diagnoses? —– A: Yes.

2. Does the ICD-10 have a code number for all recognized medical diagnoses? —– A: Yes.

3. Is there an ICD-10 Code for “medical child abuse?”——- A: No. Medical child abuse is not a recognized diagnosis. It is not in the ICD-10. It is a term coined by two authors, Roesler and Jenny.

From Flaherty& MacMillan in the American Academy of Pediatrics:

“Roesler and Jenny concurred that pediatricians should focus on the maltreatment that happened to the child rather than the offender’s motivation. They coined the term “medical child abuse” which they defined as…” (p. 590)

Medical child abuse is ​not​ a recognized medical diagnosis. Nor is it a recognized psychiatric diagnosis. It is a term “coined” by two authors.

What is the diagnostic criteria being used by Child Abuse Pediatricians to diagnose Medical Child Abuse?

I don’t know – you don’t know – nobody knows, as ​without a genuine diagnosis there cannot be diagnostic criteria​. This is fully akin to the Salem Witch Trials, as the mere accusation and fear mongering keeps from focus the fact that there is no medical or scientific process by which to confirm or deny the existence of Medical Child Abuse per current medical standard, because this is not a recognized diagnosis.

Currently, if a Child Abuse Pediatrician thinks it’s Medical Child Abuse, then DHS treats that opinion as fact and destroys vulnerable families. DHS removes children because Child Abuse Pediatricians “diagnose” Medical Child Abuse. Yet, there is no actual medical diagnosis (ICD-10 Code) to support this decision. There is no psychiatric diagnosis to support this decision. All there is a motivated opinion that stands above all other specialist opinions, and that opinion hinges upon a coined-term and description, not​ a medical diagnosis.

Oregon parents lose their children because Child Abuse Pediatricians are over identifying this coined-term and description, and DHS is acting upon it because a “doctor” may be the one pointing the finger. Using completely arbitrary criteria, a Child Abuse Pediatrician just decides it is Medical Child Abuse, DHS acts upon this information, and families are destroyed. This is not fair or safe.

No one is questioning the extremely harmful and damaging fallout to vulnerable families once this accusation occurs. For the sake of argument let us assume the following facts so that we can weigh the impact of Medical Child Abuse upon Oregon Children:

1. Approximately 858,000 children reside in Oregon

2. Medical Child Abuse occurs at a rate of 1 or 2 per 200,000

3. In the most aggressive estimates Medical Child Abuse holds a 9% mortality rate.

Conclusion: In Oregon we have (at most) 8 children impacted by Medical Child Abuse, with a 9% mortality rate we will likely not experience a death due to this form of abuse.

This incidence rate is thousands of times lower than nearly every other form of recognized abuse.

If a parent or caregiver intentionally uses the medical system to cause harm to their child that intention to cause harm is a criminal act of abuse, by which there are already systems in place to prevent and punish. There are procedures and policies within all children’s hospitals to use covert surveillance when such things are suspected, and hospitals hold relationships with DHS and law enforcement to protect children that have been conclusively proven to be victims of abuse. The families being accused are not intentionally harming their children, they are trusting expert doctors, and medicine is not a perfect science, mistakes can and do commonly occur.

We must protect the countless families that are doing the best they can raising children with special needs. Everyday parents that must rely upon their child’s expert physician to diagnose and treat complicated medical and developmental conditions. Most citizens already believe that doctors are responsible for the diagnoses and treatments they render, because they went to medical school, are experts, and they hold the ethical and legal responsibilities to render care. Parents do not, and therefore parents must be safe to follow the expert care and advice rendered by specialist doctors.

Ethical problems within the DHS and Child Abuse Center relationship

Family Rights Foundation wishes to express concern regarding the professional relationship shared by Child Abuse Centers (CAC) and Oregon DHS. We believe this relationship should be examined under great legal and ethical scrutiny. CAC’s are contracted forensic pediatric groups for identifying child abuse; they hold multi-million dollar state contracts for this service. CAC’s may be equipped to do good work in cases of broken bones and child sex abuse, but they are poorly equipped to evaluate medical child abuse. Within the medical field there are general physicians that treat general conditions, and specialists that address specific concerns such as heart defects, epilepsy, genetic abnormalities, etc. This is the accepted standard within medical community, and DHS subverts this process by using inferior general doctors to arrive at medical conclusions that do not conform to any best practice standard recognized by specialists that would otherwise manage these specific conditions.

To provide one example of the medical errors that are commonplace with CAC’s within these complex medical cases, we share the following details within an alleged medical abuse case pending before Multnomah County Court: the CARES NW stated that an adolescent was subject to medical child abuse dating back to when the child was a toddler, as evidenced by treatment for diabetes. The CARES NW doctor simply confirmed that this child had been briefly treated for diabetes. The CARES NW doctor failed to investigate the records within their possession, as they would have showed the child had documented high blood at the doctors, at the hospital, and that the child was under the care of a pediatric endocrinologist who diagnosed this condition; therefore the parent did not fabricate this important medical history. Further testing showed the child did not have diabetes, and it was explained to the parent that sometimes normal childhood viruses can cause disruptions in blood sugar levels within young children. The child was no longer treated as diabetic, nor presented as diabetic. This in no way represented medical child abuse.

It is essential that parents raising children can safely access medical care without fears of being held responsible for the actions of the treating physicians. Parents do not diagnose their children. Parents do not order tests for their children. Parents do not prescribe medications for their children. Parents do not set treatment plans for their children. Instead, parents work with doctors they trust to provide medical care for their children. Holding parents responsible when medical mistakes occur is asinine. Further, doing so sidesteps the ethical and legal responsibilities that continue to be held by physicians for the medical care that they render or fail to render.

Medical errors are the 3rd leading cause of death in the United States. The reality is that medical mistakes commonly happen. 80% of all people taking a medication have to discontinue it at some point due to adverse effects. Who is at fault when these mistakes occur? Speaking generally, we would say that no one is. Mistakes, unless due to gross negligence, are simply part of practicing medicine and/or receiving medical care, the courts concur. Oregon DHS seems to believe differently, so doctors are given the choice of assuming liability for medical errors or pointing the finger at the parent.

Pitting parents and doctors against each other creates a predictable scenario that plays out time and again. Medical specialists are affiliated with hospitals, hospitals employ in-house legal teams, and medical specialists take their directives from these legal teams; and that doesn’t even address the counsel from insurance companies. When a physician’s legal team is faced with a malpractice claim or obfuscating responsibility off onto the parent they blame the parent, in an attempt to protect themselves from liability. Yet, none of this does away with the actual legal and ethical responsibilities held by doctors, so cases become further
convoluted; CPS is accusing the parent in dependency court, while the parent is suing the doctor in a civil lawsuit.

It is essential that parents and doctors be allowed to hold a protected relationship. It is unquestionably against the best interest of children to have parents afraid to seek expert care. The worst part is that the fear held by parents is reasonable in the state of Oregon, as these cases are grossly over identified by both DHS and the pediatricians at CACs. Our laws and courts are designed around the belief that doctors and patients hold a protected relationship, and that within that protected relationship patients needs are best met by working directly with their trusted and chosen doctors.

Neither DHS nor pediatricians of CACs should have any authority to break the sanctity of the relationship held between treating physicians and their patients, as this undermines the integrity and trust that must exist within these protected relationships. It is akin to the debates regarding an insurance company’s right to dictate patient care above a that of a treating physician.

The mutually beneficial financial relationship between DHS and CACs cannot continue to be overlooked. CACs makes a lot money being the primary evaluator for Oregon abuse cases. DHS in turn collects significant amounts of federal funding based upon CACs findings. Both are cogs in the same system, feeding off of the same cases financially. Courts have held that treating doctors and their patients make the most appropriate medical decisions for individual patients. To our knowledge, forensic pediatricians are the only general doctors that do not defer to the superior medical opinions of specialists. Specialist have many additional years of specialized training and expertise, and it is unconscionable that that a doctor of lesser experience and credentials would be brought in and presented as an authority.

Oregon families raising children with special needs are under attack and in need of your assistance. We humbly ask that you consider protecting t the rights of Oregon families from the harmful and disastrous accusation of medical child abuse. Within our system we already have a process by which the rare medical abuser is held accountable, and that is criminal court. ​Anything less than criminal abuse is simply a differing medical opinion.​ DHS cannot be the arbitrator of what level of care is needed, CACs lack the expertise, we need to leave medical care to families and their trusted expert physicians.

Referenced Materials

1- Intentional Acts of Abuse As Basis of Accusation: ​http://adc.bmj.com/content/75/1/57

2- Removed Intentional Infliction From MCA Criteria: http://www.uptodate.com/contents/medical-child-abuse-munchausen-syndrome-by-proxy

3- Medical Mistakes: ​http://www.bmj.com/content/353/bmj.i2139

4- Forensic Pediatricians vs Specialists: http://www.sciencedirect.com/science/article/pii/S134462231530052

5- Rare Disease Statistics: ​https://globalgenes.org/rare-diseases-facts-statistics/
6- Rare Disease Care: ​https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=126
7- Prevalence of Mitochondrial Disease-​ http://www.mitoaction.org/mito-faq

8- Correct Diagnosis of Rare Disease: https://globalgenes.org/wp-content/uploads/2013/04/ShireReport-1.pdf

9- MCA Diagnosis of Exclusion: Delaware v. McMullen, 900 A. 2d 103, 108, 119 (De. Super. Ct. 2006)

10- Evidence Based Medicine: https://library.med.nyu.edu/library/instruction/handouts/pdf/ebmdefinitions.pdf

11- MCA: ​https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2880569

12- Nearly 25% of All Deaths Environmental Cause: http://www.who.int/mediacentre/news/releases/2016/deaths-attributable-to-unhealthy-environments /en/

13- Annual Cost Environmental Illness in Children: https://cfpub.epa.gov/ncer_abstracts/index.cfm/fuseaction/display.files/fileID/13544

14- Percentage of Children Ill by Environmental Cause: https://www.epa.gov/sites/production/files/2015-06/documents/ace3_2013.pdf

15- Parental Rights and The Constitution: http://www.parentsinaction.net/english/Legal/Case%20Law.htm

16- Physician and Patient Relationship Ethics by the American Medical Association: https://www.ama-assn.org/delivering-care/ama-code-medical-ethics

Additional information for consideration: 17- Harmful Effects of Foster Care On Children- http://www.stirjournal.com/2014/05/12/u-s-foster-care-a-flawed-solution-that-leads-to-more-long-ter m-problems/ 18- Special Needs Children In Foster Care: http://www.childrensrights.org/wp-content/uploads/2008/06/forgotten_children_children_with_disabili ties_in_foster_care_2006.pdf

19- Foster Care by Senator Nancy Schaefer: https://parentalrights.org/child_protective_services/