What's Happening in Lehigh?

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Before we begin, a quick warning that in this show we discuss child abuse and this content may be difficult for some listeners.

If you or anyone you know is a victim or survivor of medical child abuse, please go to munchhausensupport.com to connect with professionals who can help.

The Maya Kowalski case is certainly the most flashy, headline-grabbing story about a, quote, false accusation of Munchausen by proxy or medical child abuse.

And I certainly have not seen a case that has quite the potential to singularly undermine the ability of doctors to protect vulnerable kids.

But it's not an isolated story.

These stories have really become a trend.

So, notably, you have Mike Hicksenbog's 2020 series for NBC, Do No Harm, which featured, among other people, my sister Megan Carter.

And by the way, there's also a lawsuit against a children's hospital in San Diego where parents are suing over the video surveillance of their teen during a medical child abuse investigation.

And there is a situation in Lehigh, Pennsylvania, that really started boiling over this past summer.

And that's the one we're going to dig into today.

People believe their eyes.

That's something that actually is so central to this whole issue and to people that experience this, is that we do believe the people that we love when they're telling us something.

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Right now, I am deep diving the Justina Pelletier case with Dr.

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In some sense, if you've seen one of these stories, you've seen them all.

A family, usually a white family, but not exclusively, claims that they brought their child to the doctor looking for help only to, out of nowhere, have that child snatched away or medically kidnapped, as the parlance goes, and then be accused, falsely, of course, of munchasm by proxy.

And what do you know?

When someone in the media takes up the cause, suddenly they hear from so many families who've also been falsely accused.

And then what was one sad story begins to look like an epidemic.

Here's Daphne Chen in the Netflix film, Take Care of Maya.

She is the reporter who broke the Kowalski story.

And here she's talking about what happened after that piece was published in the Sarasota Tribune.

It was January 2019 when I hit publish on that piece about the Kowalski family.

And I kind of thought I'd move on to the next thing.

But that was when the call started coming in and the email started coming in.

And I realized realized that this was a lot bigger than just the Kowalskis.

Kaylin Keating, the film's producer, has also described a similar experience in many of her interviews.

This is a clip from a podcast called Guys We Fucked.

This is a podcast that's all about female sexuality and they also broaden the scope sometimes into sort of these bigger, far-reaching feminist issues.

This was an interview that came out shortly after the film debuted.

And again, like since the film came out like a week, not even a week and a half ago, I mean, every family writing me without knowing their background or anything about their case, right?

Not everyone's going to be telling the truth, I'm sure, out there, but yeah, but a lot of people are, and they all stand out to me.

I mean, they're all just like it's been years in some of these cases, and they're struggling.

Like, they lost their job, they lost their home, they lost their reputation, their mugshots in the paper, it's going to be on the internet forever.

It's like they all have the same story, it's just like different face, different name, different place.

Honestly, listening to this, I can't quite imagine what it would be like after the life experience that I've had to just assume that everyone who gets in touch with me is telling the truth.

That must be kind of nice.

These stories are more or less all constructed the same way.

They have the utmost credulity towards the parents who've claimed they've been falsely accused, and they omit any pieces of the story that might be a bit inconvenient to the narrative.

They usually include a no comment from the doctor being attacked with no mention of the fact that the doctor can't legally comment on the case because of HIPAA.

And there's usually a PRE-type statement from the hospital about how their patient's safety is the utmost important to them, et cetera.

So there's often a lot of talk about how the doctor's report in these cases was wrong, but the actual report itself, which any of these parents could release to the media if they wish to do so, is never shared.

They get to publicly excoriate the doctor, all while keeping their own privacy intact.

And all of these, quote, falsely accused parents, they're starting to organize.

And in the wake of the Kowalski verdict, the chances that they'll wield significant political power is very real.

What began with these more fringy groups like Mama, that's Mothers Against Munchausen allegations, is becoming a real mainstream movement.

And in my view, it's on its way to creating a full-blown moral panic.

And in Lehigh, local politicians are taking up the cause.

Mark Pinsley, a county controller in Lehigh Valley, released a report last summer on what he called the quote systematic overdiagnosis of medical child abuse in the county.

This clip is from Channel 6, a local news station in Philadelphia.

An elected official in Lehigh County is calling for action after he says he discovered an unusually high number of rare medical diagnoses.

And he says they led to multiple parents losing custody of their children.

Action News Investigative Reporter Charbidelli has the exclusive details and takes us inside the complex issue of medical child abuse.

So we brought in Dr.

Mark Feldman, friend of the show and my friend in real life, to help us try and figure out what's going on here.

I'm Dr.

Mark Feldman.

I'm a clinical professor of psychiatry at the University of Alabama.

I've been studying Munchausen by proxy, also called medical child abuse, for about 30 years.

Dr.

Mark Feldman has been at the front lines of trying to push back on misinformation about medical child abuse in the media for decades now.

And he's become very concerned about this situation in Lehigh.

So I read some of the initial coverage, saw that nobody had interviewed an expert in the field.

And so I had to reach out to one of the reporters and frankly ask her to interview me.

She did because I wanted to get a balanced perspective, but then my quotes were sort of buried in the resulting article, though I think she tried.

I reached out to others and got no response from any of them.

And it was also obvious that a doctor there, a board-certified child protective services advocate who is also a pediatrician named Dr.

Jensen, was being targeted, which is what you see in case after case all over the country.

They vilify one board-certified child abuse pediatrician and attempt, in essence, to destroy that person's life.

Dr.

Feldman is unique in his media savvy.

He's been interviewed by well over 100 publications, and this is something that most of our expert colleagues really won't go near.

And understandably, as the response to his comments in the media is not always exactly measured and kind.

I did get hate email from the rather benign and brief comments that were included in Lehigh Valley News, kind of the sort of emails you would expect an impulsive and sociopathic individual to send.

I asked Mark what he thought about Mr.

Pinsley and his report.

All I know about him, and I've never spoken to him, is that he was responsible and still is because he shortly thereafter, after the press conference, won re-election, he is responsible for financial expenditures and for monitoring the financial expenditures in that area.

And that's how he justified his not being a clinician in any way, his knowing very little about Munchasm by proxy, but his getting involved.

He said that this was in essence a waste of time.

It was brutal for the the families.

And it was also costly to place the children out of the home and to involve CPS and the judges who made the ultimate determination.

So that's how he kept trying to tie himself to this cause.

So someone who is not a doctor inserting themselves into a conversation they have no knowledge about for their own political gain.

That's really the vibe in America right now, isn't it?

And Pinsley tied it to that old political chestnut that he's just looking after taxpayers' pocketbooks.

And as Dr.

Feldman and I discuss, rather than looking for a real problem to solve, of which there are plenty, Mark Pinsley essentially creates a fake one.

There were a disproportionate number of accusations or reports to CPS of medical child abuse as he viewed it.

And he thought that that was telling and that meant that innocent people were being accused and that monies were being wasted.

As I pointed out when I gave the interview, I said, you know, they should be delighted to be one of the few areas in Pennsylvania that has a board-certified child protective services and abuse pediatrician that knows about this subject.

There are only 350 in the country.

It's a very rigorous process.

And so the message I took away was that the rest of Pennsylvania is not doing a good job identifying these cases.

Dr.

Jensen should be praised rather than vilified.

So there are very real problems with the child welfare system in this country.

According to Dr.

Price, 76%

of DCF investigations are happening because of, quote, neglect issues that are mostly things related to poverty and that are really a resource problem.

And also families of color are really disproportionately affected.

So there are those real problems and this report does not address any of those things.

There was a big press conference that the controller held with 70 people.

So clearly it was all prearranged and the media were alerted.

All of the families that attended claimed to have been the victims of misdiagnoses of munchasm by proxy or medical child abuse.

And it was obvious that it's certainly self-serving for people who have engaged in medical child abuse to claim that they didn't.

In addition to these anecdotes from parents, Pinley references some data to make his case, but it's pretty flawed.

Pinsley also used some research that's obsolete, was in England and the Republic of Ireland from the early 1990s, 1990s saying that the real rate of munchasum by proxy, the term they used in that report, was extremely low.

Well, again, that study has been criticized as defunct, but he relied on it over and over to say that medical child abuse is so incredibly rare.

that whenever anyone makes the diagnosis, they're bound to be wrong.

Mark hits on something here that has really struck me listening to this discourse around the Maya Kowalski case and this entire, quote, medical kidnapping debate, which is that the people having this conversation are coming from a place of essentially this abuse isn't real because there just doesn't seem to be a case where they could be convinced.

If you can look at the evidence in the Kowalski case, in the Justina Pelletier case, another famous case where the family attempted to sue a hospital, this time unsuccessfully, or even in my sister Megan's case, and say, oh, no, this was definitely a false allegation.

If you can look at these cases and not even see the possibility of abuse, then you don't believe it's real.

And as Mark points out, we don't treat other forms of abuse this way.

There's something really curious going on, which is if somebody accused of sexual abuse or rape says they didn't do it, We don't then say, well, they didn't do it.

They denied it.

Therefore, they didn't do it.

But there's something about about medical child abuse and this arose in this report where just because the parents said they didn't do it that's proof that they didn't in his mind and every bit of the report relies on that misbelief he may think that out of the 10 or so families they're all innocent and maybe some of them are but i think that's really unlikely that it's more than maybe one or two, because again, there was a skilled child abuse pediatrician involved who also does not make the final decision about whether a case is founded or not.

It seems that it's a board of judges that determines whether something is founded or not in terms of accusations.

And judges are not clinicians.

Neither is Mr.

Pinsley or any of the the other people he interviewed.

They wouldn't know a patient if they fell over one.

And so he did talk to

three

people who are supposed to be experts, but know nothing about the subject.

One or two of them admitted to that.

One or two of them are statisticians.

The third is a law professor who is famous for denying the existence of medical child abuse, even in cases in which it's obvious.

That's my opinion.

He did not go to an authentic expert he did not ask questions of the american professional society on the abuse of children he did not look at those guidelines and he did not reference the references that they include in those national guidelines There's also an underlying assumption in all of this that judges and politicians take the opinions of doctors and experts extremely seriously, meaning that if a parent isn't charged and gets their children back, there must be a good reason for it, that there must have been compelling evidence on the parent's side, and that the doctor's opinions were duly considered in court.

Unfortunately, that's not the case, even when the evidence is so compelling that I think I can offer a very thorough report, written and oral, when I testify, because there is a bias towards reunification.

I even had a guardian at Lydum in one case say in her report and to the court, a child belongs with his mother.

Well, there was no doubt that this was an abusive mother.

And my fear is that the Pinsley report will shape so many perceptions because there were inflammatory headlines in the morning call, newspaper, and elsewhere, that if that's all you read or you just read the beginning and the end of the article, you'd think that all of his points were valid when very few were.

Now, I do respect his request, if not demand, for a review of the process and more education.

And he does advocate involvement of law enforcement in every case, which makes sense to me because I think criminal charges are too infrequently brought.

That's not why he wants law enforcement in there, but that's the way I read it.

So there are some valid points.

But overall, from the very first sentence to the end, I highlighted the problems and almost all of the report is highlighted in green as a result because of the problems, errors, misunderstandings.

And it's clear that if the judges on what's called the BHA there, Bureau of Hearings and Appeals, say that medical child abuse didn't take place, he views that as the final judgment.

But I know from personal experience over 30 years, they often get it wrong.

And that's heartbreaking because the children then are imperiled further.

Politicians love to use the idea of doing something, quote, for the children as a political football, but that doesn't mean that they've really got their best interest at heart.

Abused children don't vote.

That's one issue.

Their parents do.

Their parents can carry posters in front of the hospital demanding Dr.

Jensen's removal, for which they were apparently pretty successful.

That's what's happened in case after case after case.

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I would never say that all parents are treated fairly by the system.

There is so much that could be done to help parents who are struggling rather than just punishing them.

There's so much that could be done to help prevent child abuse.

And in fact, we're going to talk to a fantastic expert in the next episode about just that.

But that is not what this movement is about.

Those are not the rights these parents are advocating for.

The parents' rights movement is really saying parents have the right to torture their children.

They have the right not to give them vaccines, regardless of how indicated they are.

They have the right to say that the child has brittle bone disease when, in fact, they've beaten the child and that's why there are fractures of different ages that show up on x-ray.

I'm not saying all of them have done that, all of them are evil, but some of them are.

And hiding behind the mask of the term parental rights makes it sound valiant, really justified, and perpetrators can come across as very believable.

The tears flow, the explanations that may include a lot of lies flow.

The husbands tend to be unaware unaware of the reality, but reflexively support the mother who is the usual perpetrator.

And the question that Mr.

Pinsley asked of the three outside experts was, what's the likelihood that both father and mother in a family would have, as he put it, munchhausen by proxy?

Well, That's a false bogus question.

It's usually the mother.

We know that from research.

It's almost always the mother and the father tends to have jobs that keep him far away or they have traditional families where the mother is assigned all the care, giving responsibilities and the father doesn't get involved.

Or the father loves the mother and doesn't want to believe something as bad as this could occur.

Mark is getting at something that I have been thinking about a lot in the wake of the Kowalski case and as I've been digging into the Pelletier case on the subscriber feed.

And by the way, I will be talking about that case on the main feed too at some point.

Both of these cases are instances where the fathers were not just oblivious, but I believe culpable.

I believe that they ended up acting as co-conspirators for their own complicated psychological and emotional reasons, as Mark points to.

And this, as I've mentioned before, presents an obvious danger to casting Munchausen by proxy abuse as a psychiatric issue in the mom, rather than what it is, abuse and torture of a child.

And just as mothers sometimes cover for and collude with spouses who are sexually abusing their children, it doesn't mean that that mother has pedophilic disorder, and no one would ever make that argument.

And as for this special argument that Pinsley is making about finances, it falls apart upon closer inspection, especially as one of his recommendations in in the report is that each case should get a quote, second opinion from an expert of the parents' choosing.

That's another issue that he's so concerned with costs, he says, but gives no accounting of how much time and money of this is taxpayer dollars was spent on a report that is so one-sided.

If we're going to talk about money, it takes me 10 to 20 hours typically of reviewing records to arrive at a decision as to whether or not this might be a case of medical child abuse and potentially to write a report about it.

Mr.

Pinsley acts like it takes one visit, an outpatient visit, or an hour with the family to do it.

Well, experts aren't going to do it for free, and he should have evaluated the costs of getting a second opinion on every single case, and he should have commented on the bias that would be inherent in the parents choosing who does that.

The costs would be overwhelming, astronomical.

And I think he wants to go back five years to review all the cases reported of medical child abuse without thinking about the taxpayers and what that would cost and who would be willing to do that once the work has already been done by somebody who's board certified in the field.

As Mark dove into this report, he realized that Pinsley was basically advocating to dismantle every step in place to protect kids from medical child abuse.

Mr.

Pinsley advocates the parental consent prior to what we call the separation test, which is trying to separate potentially abused child from the parents to see if the child improves when mom is not around.

And often we see that, and then mom is allowed to return, the child gets sick again.

Separation tests can be as close as we can get to a smoking gun.

And obviously, an authentic perpetrator is not going to consent to a separation test and unmask themselves.

Instead, what they're going to do is sign the child out of the hospital, whether it's against medical advice or not, unless there are strong mechanisms to prevent that.

And Mr.

Pinsley does not speak to that important issue.

The child may be taken to another jurisdiction.

I know of cases where the children have been taken to other countries to evade the separation test or evade prosecution or separation from the child, even very briefly to see what happens.

So I think that's another, to be bold, bad idea that crops up so commonly in this report.

The media coverage around this topic often invokes the specter of an earlier moral panic over medical child abuse that involved Dr.

Roy Meadows.

He was the doctor who coined the term Munchausen by proxy in The Lancet in 1977.

Outlets often refer to Meadows as disgraced or discredited, but this too is false, as Mark explains.

He and another doctor named Dr.

David Southall were targeted relentlessly in the 1990s in in the United Kingdom by parents' rights groups.

Once he identified munchasm by proxy and people became aware of the phenomenon in a professional community, they were sometimes able to call it out and intervene.

Well,

there are people who don't believe that medical child abuse even exists, like shaken baby syndrome doesn't exist.

the implication of broken bones doesn't exist, that you have to see bruises, bleeding, and other overt signs of trauma for it to be diagnosed as an abuse case.

They went after him.

And I'm sorry to say, I was misled about a documentary that I participated in, which was actually a hatchet job on him.

It was intended from the start to destroy his career.

He was briefly, due to the public outcry mobilized by these parents' rights groups, struck from the Registry of Physicians.

But then he was added back.

And that's the part of the story they never tell.

He was added back.

Dr.

Southall was struck, and he was added back.

They realized that is the regulatory bodies, that this was a public relations campaign against them, that they weren't perfect, but they had done good work.

But you can't get the real end of the story told anymore.

The Wikipedia entry on Munch Hasn't by Proxy is full of lies, overt lies, deliberate lies, and perhaps accidental errors.

I attempted to correct it because they refer to him as disgraced and that he was struck from the registry of doctors.

And bizarrely, someone, I guess an editor at Wikipedia, contacted me and said if I continued to try to change the entry, they would sue me.

I mean, it's beyond belief, and it just showed how crazy people get.

They dig their heels in rather than want to learn the truth.

Since I did this interview with Mark, Dr.

Jensen has been forced to retire, and a number of parents are organizing a civil lawsuit against her.

Directly after the Mayakowski verdict, and I spoke to Ethan Shapiro about this as well, I said that this verdict was likely to result in many other copycat lawsuits.

And that is exactly what is happening, not just in Lehigh, but around the country.

These lawsuits are popping up everywhere.

It's really frustrating to see the way that as a culture, rather than addressing any of the actual problems with the child welfare system, these things we've talked about, the racial and economic disparities and just all of the issues in this country that make it next to impossible for so many families to care for their children.

Everything from like unaffordable childcare and healthcare, housing crisis, the opioid epidemic, like we do have real problems that affect the children in this country.

But instead of addressing those, we're inventing a fake epidemic to enrage and distract people.

And it's the story that just makes no sense that evil doctors are breaking families apart for fun and profit.

I mean, there's no motive here.

And I think that that's kind of your first sign that this is a conspiracy theory.

You know, the way that conspiracy theories function is that they divide people and they distract from the legitimate issues.

And as we are doing that, it's going to have the effect of making children who are in these vulnerable positions, abused children, less safe.

And, you know, I think a lot about the satanic panic that happened in the 1980s.

And I have had people say that I'm sort of trying to create a similar panic about medical child abuse and that it's happening everywhere.

And even, you know, people like Maxine Eichner, who've written about this in the New York Times, this was from an article that was years ago, you know, called medical child abuse in and of itself a moral panic.

And I think they're taking the wrong lesson from the satanic panic of the 1980s.

So

this was a time when there was this mass collective outrage over thousands of ultimately unsubstantiated claims of abuse from daycare workers that they were sexually abusing children as part of satanic rituals.

Sounds kind of wild to say that now, but it was really widely believed at the time.

And I think one of the things that this was a result of, as I've sort of metabolized all of this and been researching medical child abuse for the last few years and seen how difficult it is for people to accept.

I think one of the things that led to the satanic panic was that it happened at a time when we were collectively reckoning as a culture with the idea that child sex abuse was

real and that it was nowhere near as rare as it was previously believed to be.

And, you know, As crazy as it sounds, I honestly think it was more comforting to believe the satanic ritual story than it was to confront the reality of this abuse, which is that it's most likely to happen at the hands of someone who is close to the child.

If the problem is Satanists, it's easier to solve.

Just get rid of the Satanists.

But when it's dear old Uncle Johnny or a nice baseball coach, Boy Scout leader, parish priest, it gets a lot more complicated.

It also, the Satanist comparison gets at a sort of second thing, which is the, it won't happen to me.

It won't happen in my family.

It won't happen in my neighborhood.

And if you are recognizing, as we all mostly do now, that child sex abuse does happen in every community.

No one is sort of quote safe from it, and you can't just avoid Satanist daycare workers, then it's much scarier.

So if the problem here is power-mad child abuse pediatricians, well, that's pretty simple to solve.

Fire the child abuse pediatricians, burn them in public effigy.

There you go.

But what if it's not them?

What if they're just the people who are are asking us to look at a problem that we don't want to see?

That maybe that really nice mom on the PTA or the one who's fundraising for her child's rare disorder, you know, the one who's dedicated her entire life to advocating for her sick child's care.

What if she's the real problem?

You know, in the end with the satanic panic, we did face it.

What was once this just totally aberrant, unbelievable idea that people within a community that we trusted were sexually abusing children is now just accepted as common knowledge.

We all understand at this point for the most part that if someone's sexually abusing a child, it's most likely the priest, the Boy Scout leader, the coach, a family member.

No pentagrams involved.

But this movement around this idea that all of these false allegations of child abuse are happening because of child abuse pediatricians really threatens to undo all of that progress.

You know, the majority of the work that child abuse pediatricians do is not around medical child abuse specifically, though there's been a lot of focus on it in these articles.

It's also with physical abuse and sexual abuse cases.

And without these highly skilled doctors, the children in any given community are less safe.

But hey, kids don't vote, do they?

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