What “The Preventionist” Left Out with Dr. Randy Alexander

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Over the past several weeks, we've been talking about Serial's new podcast, The Preventionist, and the significant issues with their reporting on child abuse pediatricians.

And the harm this reporting does is very real, first to the children involved, but certainly also to the doctors who are tasked with protecting them. Dr.

Stephen Boose, a child abuse pediatrician we spoke to at length for our upcoming season, said in an interview with journalist Naomi Riley last month that his colleagues are the subject of so many threats that many have had to install security systems.

He also notes a concern about attracting young doctors to the profession, and Dr.

Sally Smith spoke to us the other week about the death threats and harassment she's received as a result of misleading media coverage that she's been the subject of.

Which I dare say may very well be the point of all this. And it can be pretty challenging to unring the bell here.

For example, there was endless media coverage of the Kowalski's lawsuit against Johns Hopkins' all-children's, mostly extremely favorable to them. However, the appeal in the hospital's favor?

Not so much.

And while we can't speak to Dr.

Jensen at the moment because of the pending litigation, as we've been discussing, the people who should actually be evaluating whether child abuse pediatricians are doing their work properly are people with expertise in the field.

And thankfully, thankfully, there's almost no one in the country with more expertise than today's guest, Dr.

Randy Alexander, a professor of pediatrics and notably the one child abuse pediatrician whose voice was featured in The Preventionist.

Not only does Randy have a wealth of experience in the field, he also knows both of journalist Diane Neary's targets, Dr. Deborah Jensen and Dr.
Sally Smith, quite well.

That's right, I was actually their boss.

And so

Sally was, I was this, for 10 years 10 half years I was the statewide medical director for all the child protection teams in Florida and Sally was one of my medical directors so she reported to me and I got to see her work I've looked at many many of her reports through the years

on other cases and the same thing with Deb Jensen she was my medical director and she was stationed in Gainesville And what I did with her, because she was somewhat newer, Sally had been around for more, for a lot of decades.

Anyway, I looked at everything she did for about six months. Everything she wrote, I saw.
And then thereafter, with both of them, I would, you know, they would call me up about cases and all that.

So I reviewed their work.

And in essence, I'd say I know them quite well in terms of what they were doing. I always challenged the community, as I did with other people.

I said, if you think they did anything wrong, just send it to me and I'll look it over. And I also would somewhat tease them,

that wasn't completely teased. I would say, if you ever do anything wrong, I'm going to call you out on it.
And they said, sure, go for it. Because in medicine, we're used to that.

When we first start out as a medical student, we expect that our work is going to be critiqued.

And all the way through our training, there's always somebody that's going to look it over and always give us some critique one way or the other. And so it's not anything new.

It's just kind of part of your normal life that you think that way and you don't take any offense about it or anything. And they were both wonderful that way.

And then of course,

in Sally's case, I did testify in that trial. You testified in the Kowalski trial.

Yeah, they didn't go along with it, but I said she operationally did all the right stuff that I expect of a child protection team person to do.

And yet. Apparently, that wasn't entirely the way that everybody else in the trial saw it.
Right, well,

I was right, nevertheless. Yes, well, actually, you know, the Appeals Court of Florida entirely seems to agree with you

as this recent decision that came down a few weeks ago. And we were able to, we had this other, another interview with Sally scheduled just to talk about the preventionist.

And lo, we ended up being able to talk about the appeal as well. And, you know, what that court decided, it was quite a strong decision

in favor of the hospital and basically said that the stuff regarding the doctor's actions and protective actions should never have even gone to trial.

Well, and the thing I said at trial, and, you know, it's something I believe for anything, is she did the things that she's supposed to do.

She followed procedures, she followed the law, she did exactly the right stuff.

I mean, you would want someone to follow up on your child and see, you know, when somebody gives, says there's this possible case coming up, you want someone to look in that and help you.

That's what she did. There's not, not only is nothing wrong with it, but her job as medical director was to do that very thing.
Yeah.

Having known these two doctors, is it a surprise to you the way they're currently being represented in the media?

Because if you were to look at the media coverage of these two doctors, you would think

that they had had, you know, these very fraught careers where there'd been all these complaints about them and that they are committing, you know, malpractice of some kind and that they are extremely arrogant and don't listen to anyone else.

And I mean, that's the way they've both been portrayed. Does that match up with the reality of what you know of these two doctors? Never my experience.

And I actually never did have a complaint about them, which I would have been happy to look into. I would have been happy to argue it with them if I thought there was something to it.

But if that situation never came up, I think if I had a child and I was looking at primary care, these would be two great pediatricians to have, you know, take care of your particular child.

There's a little bit that I don't want to sort of suggest something that, you know,

goes beyond its bounds, but

I wonder if they're, because they're women, if they're a little more prone to being picked on.

You know, I think it's kind of provable. The field has more women than men.
So, you know, just statistically, you know, if you're going to pick on anybody, you'd probably pick on a woman.

But nevertheless, you know, would I... they pick on a guy quite the same way and i'm not so sure so i wonder if there's a little bit of bias that way and

you know it's kind of unprovable you know that sort of thing but you know it it concerns me a little bit you know that that that might be an element I have absolutely clocked some misogyny in the media coverage and certainly in the comments about both doctors their supposed arrogance their unwillingness to be challenged even their hand gestures and facial expressions are presented as evidence that they're too powerful and it's not a huge leap to say that people frequently bristle at certain qualities in women that we might admire in men.

Both of them are the types that upset the apple cart a little bit.

They will be persistent in pursuing a case.

I mean, if you had a child that had some infection and they were persistent in trying to get the right antibiotic, get them take care of, you'd say that's a wonderful thing.

And on child abuse things, they're persistent, but they stay within their lane. I mean, they're not out there prosecuting cases because they're not prosecutors.

But they're doing the medical stuff they're supposed to do. But for some people, it's like, it's inconvenient that you're calling out and saying, well, you know, we have to

do something about the case. We just recently, my institution, we had a thing where department showed families kind of wasn't paying a lot of attention.
Kid had bruises all over.

And you take one look at it and you gasp. It's like, what? And so we had to kind of prod them to bring the child in and then do do our evaluation and all that sort of stuff.

And when you have people that do that, sometimes you make a little bit of waves.

And it was both Sally and Deb, I think, you know, at times they did that, but it's always, if I had done it, it would have, I think it might have been better,

you know, just as a male and older.

All that stuff is a cultural stereotype. And I think that was one thing that's a little harder.
Having said that, they've done this stuff for decades.

And, you know, these couple things that come up is not the same as all the hundreds and hundreds of cases they've done that they've not had these issues with.

And so, you know, we can speculate about all the various cultural factors that occasionally work against them. But in point of fact, imagine that somebody says, I didn't do it, I'm innocent.

It's like, well, I think the jails are full of people that say that. And there might be one or two people where that's true, but you know, most of the time it's not.

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I think one of the ways that they construct these stories is that they

make it sound simultaneously, they sort of collapse the entire process of getting criminal charges or a child removal.

They collapse that all into this one moment when a doctor is making the diagnosis. And

they do this thing where they both

make it sort of like this double-edged sword where if a doctor,

if a conviction goes through or if charges go through or if something happens, that's an evidence, that's evidence of the doctor having too much power.

However, if there's any challenges to her along the way, then that's an evidence that she, then that's evidence that she got it wrong.

So it just completely negates, you know, everything that goes into

actually having any kind of action from the court on a child abuse case, which is not just based on a doctor's diagnosis.

And also like something not going through charges is not evidence that that doctor got it wrong.

Can you just kind of talk us through this willful misunderstanding of the process that's being put forth in these media pieces? Well, first of all, it's

that kind of stuff does occur. It doesn't occur in all the cases by any means, but it does occur.
And it's a

basically a defense attorney strategy of sorts, or if it's not conscious, at least it's what they're unconsciously doing.

And their job is to try to get their client off.

And

we're interested in the child. I mean, as pediatricians, guess what? That's what our job is.

So we're going to look at it that way. So, first of all, when we've got a case, we have to decide, is this a case we're going to see? So that's barrier number one.

Then we decide it's a case that we are going to see. Then we have to see it and see what we think is going on.
We make some sort of determination about the case.

But let's say it's a case that you think is going to be bad and it's probably going to go to trial.

Well, then you have to convince the child protective services worker or the police to pursue it in some ways and get their verification of it. They then take that to the prosecutor and they have to

say that, yeah, they think there's enough to go on. And then they have to present it to the judge.
So there's all these multiple barriers,

in essence, that the child has to overcome if they want their story heard. And their story certainly doesn't end with the child abuse pediatrician.
It's really part of the beginning.

And they have to get through all these other sorts of things. Then there comes the trial itself.
And then the question is, you know, what are they going to decide during the trial?

And then what's the determination the judge is going to make?

And it's almost kind of something we laugh at. We wish that we had that much power.
The child abuse pediatrician, oh yeah, we can make the world shake and do all these things. No, we don't.

That's not our job. We can't do the prosecution.
I have never won a case. I've never lost a case.
They're not mine to win or to lose.

I'm just there to report on the medical stuff and, you know, what I think is a determination about health and safety. But the prosecutor's got to prosecute the case.
That's not me.

And

I think that, you know, portraying it that it's somehow otherwise is wrong. That's not how it works.
And

they're doing it for some sort of agenda purposes, trying to make us out the bad guys. So if eventually they say, well, the child abuse pediatricians have too much power, let's make them all go away.

Then you're going to have the forensic pathologists. What are they doing making decisions about what went on? And they decide, well, it's a homicide.
Well, who are they to say?

And you can imagine all the different specialists, radiologists, let's pick on them. Let's pick on all of these people, particularly in complex cases.

It would be very common to have six or seven different kinds of doctors involved in the case. And then you're saying, well, let's just pick on one kind of those.
I even had a case where

there were three of us child abuse pediatricians involved, and the media decided to pick on one of us,

one and not the rest of us. And it's like, wait a minute, you know, particularly me, because they weren't picking on me.
And it's like, I was involved in that case. Why didn't you come after me?

And that's because they had a female doctor to pick on.

I don't really buy Serial's explanation that this series is meant to be only about Dr.

Jensen and not all caps, mainly because Neri broadens the scope to include all caps as she lands her closing argument in the third episode.

But even if we take them at their word that this is just about Dr. Jensen, I wanted to ask Randy if they made a case for that.

Is there anything in particular that Deborah Jensen does that is outside of the standard of care for child abuse pediatricians that's where she goes way outside her lane.

I mean, do you, is there anything that you've seen that would substantiate that as someone who's known and worked with her?

Not at all. Not at all.
And remember, I've seen hundreds and hundreds of her cases and reviewed them, read her reports, and had the chance to talk to her about even more cases and all.

And, you know, so I can't say on a given case on a given day that I wasn't there. I don't know.
But that is not the pattern I've ever seen.

In point of fact, her work is excellent, and I would hold out as being one of the top people in the entire United States.

So, you know, when you're picking on somebody and you say she has all this power, no, we don't have power like that. But

are you going to pick on the doctor who says you have cancer and say, well, that's a lot of power, you know, we need, you know, lots of other opinions and all that sort of stuff.

I mean, it's kind of ridiculous when you sort of try to apply it across other disciplines because

we have the power in the sense that we evaluate evaluate you. Yeah, we reach a determination and sometimes you don't like that determination.

Well, then like don't hit your kid or something, you know, whatever the situation is or sexually abuse your child or whatever, you know, got you in the first place.

We reflect what has gone on, but we don't have power in the sense that we don't jail anybody. We don't.

We don't have any of that power. That's the court that does it.

Now, the fact the court believes us, well, they believe all kinds of doctors for all kinds of issues, you know, none of which have to do with child abuse necessarily. And that's just the way it goes.

I mean, why do you have doctors if you're not going to ever listen to them? Why, indeed? An excellent question in the year of RFK Jr.

Now, according to Serial's Communications with Me, Neary only formed her opinions about Dr. Jensen's work after speaking with other caps.

And the evidence she uses to counteract Jensen's opinion in the one case she goes into detail about is that she showed anonymized records to several other caps who didn't share the opinion that the injuries were abusive.

I asked Randy for his take on this. I'm one of the doctors, maybe as much as anybody else in the country.

I have for a long, long time reviewed cases from around the country, testified cases around the country.

And when I get a case, like somebody calls me up, say from Arizona, you know, and I'm in Florida,

I'll say, okay, here, you know, they tell me a little bit about the case, and I say, here's all the records I want you to send me. So I go through the records and I read them.

It may be thousands and thousands of pages,

not all of which have to take a tremendous amount of scrutiny, but it's not, you spent hours, you know, kind of going through these things. And I want to see what the raw data is in the first place.

You know, I want to see what the EMS people saw when they went out to the home and got the child originally. I want to see what the radiology is.
I want to see a bunch of these other things.

And it's by going through that sort of stuff that I might have formed an opinion on something like that. But I would be very wary if somebody said,

over the phone, they said, well, here's a few details about the case. What do you think? I'd say, well, I think I need to see more data in the first place.

You know, you can sort of say, I wonder if it's in this area, but I certainly wouldn't want to commit to that without, you know, knowing more facts. It's really important that we be factually correct.

And one of the things that I teach my trainees, I've taught for a long time, is about accuracy. And so you're working a lot lot on accuracy.
None of us wants to see an innocent person go to jail.

And we're not super happy about somebody that's a threat to children not going to jail.

But, you know, obviously the whole system is geared so that we don't convict that much, that, you know, that the barrier is quite high to convict somebody. And that's the way it is.
And,

you know, I think that's something, a truism that's been true way beyond medicine. And it's true in all kinds of areas.
And for the most part, that probably seems to work.

I think that sometimes people find these cases interesting because the perpetrator says, I didn't do it, which, you know, they do that in a lot of things. And then

sometimes they get off on that because they only hear one side of it, you know, from perpetrator and then HIPAA and all these other things, confidentiality stops us from talking about what it is that in the first place that they start thinking, you know, well, we're just going to believe the one thing that we're being told.

And you don't know what all the other stuff is.

i mean i've had cases where the media went crazy about these doctors were terrible and blah blah blah and then the parent admits to it you know take these with a grain of salt you know it's one thing to say the parent said that they didn't do it that's great you know i mean that's a fact but then when you start to pick up on that as an agenda in reporting on it and you say, well, they must be innocent.

No, they said they didn't do it. That's what you know.
You don't really know all the details of it.

And the other thing is, do you really think that doctors who've got busy schedule and are working hard, do you think we just sit around and make things up because we have nothing else to do?

I mean, I'm sorry, what insanity has gripped you that, you know, you think that's how we run our lives?

We don't get up in the morning and, you know, hit the alarm clock and say, well, let's go out and get, you know, somebody in trouble.

We don't do that. And

in particular, again, we're going to be child-centered. And so we want what's best for the child.
And that might be stay with your parents.

That might be that it's a bad situation and you need to go someplace else. We don't know to start out.
So we're going to work off on the facts.

And then if even if we reach a conclusion, this child's unsafe, we still have to, as you said, work through all the various layers of things. You know, does everybody else in the system agree or not?

The media coverage about caps often make it sound as though they are the single deciding factor in everything from CPS to court decisions to police investigations.

And Amanda Saranovsky's lawsuit attempts to lay lay legal responsibility for everything that happened to her and her children at Dr. Jensen's feet.

The introduction to the lawsuit reads, quote, this case is about a remarkably dangerous pediatrician, Dr. Deborah Assernio-Jensen.
And it goes on to say that Dr.

Jensen had been intentionally making false allegations of child abuse against innocent parents like Amanda for decades.

Under the claim of intentional infliction of emotional distress, the lawsuit posits that rather than the prosecutor, CYS, and the courts acting independently, Jensen was intentionally aggressive with these entities in order to knowingly cause Amanda and her children distress.

And though much of the story Amanda tells on the show has to do with custody decisions and dealing with CPS, Serial also points it all back to being an issue with CAPS.

Nearly stops short of saying Dr. Jensen is purposefully falsely accusing parents, as the lawsuit alleges, and instead says that CAPS might be, quote, mistaken.

But it's hard not to see a through line, especially as Serial appears to rely on much of the same evidence that the lawsuit presents as being indicative of Dr.

Jensen's wrongdoing, such as context-free excerpts from family court judge decisions about other families, and of course, the complaints of parents whose children were diagnosed by Dr. Jensen.

And according to Randy, this is a misrepresentation. Well, first of all,

I suspect the critics don't really know how this works

because the way they're portraying it and the way you described it.

That's not how it goes. So I'll just personalize it.
So I'm sitting in my office. How am I going to know if there's a kid in the hospital that we should look at?

That means somebody at the hospital, some other doctor, not a child abuse pediatrician, some other doctor has seen this child, made an evaluation, probably done various testing things, maybe not.

Some things are so obvious, you know, you see right from the beginning.

But they would have made

their own evaluation and said, I think something's going on here. Or maybe they actually think it went on there.
They're not really in doubt about it. And that's when they get us involved.

So we're number two on the scene at the best. We're not there to begin with.
We're not watching them come through the ER door and seeing it that way.

So this notion that the child abuse pediatrician is primary, we are not.

There's already other physicians that think there's an issue there. And so, guess what? There's going to be at least several of us that think this, if not more.

And then we've got all this other specialists that get involved in various cases.

So,

this, again, it gets back into the somehow we're these all-powerful people. And then we get criticized that we have no power.
And, you know, which way is it?

Pick one, you know, and let us know which way you think it is. But

we're only involved when somebody already has a concern for this, and that's when we hear about such cases. I mean,

we don't go walking around to school systems and say, let's check all the kids out and see what's happening with them. How would we even know any of these things?

And so it's a misunderstanding of the medical system. In essence, we're like a consultant

that somebody has to, you know, do something that would get our services.

To say that Diane Neary is misunderstanding the issue at hand is, of course, charitable. Neary and the Serial team spent two years on this story.

They were certainly exposed to accurate information about child abuse medicine and abusive head trauma throughout the course of their reporting, even if they chose to disregard it.

Serial even reports on a trip they took to a medical conference on the subject. She's putting this in the context of how arrogant, you know, some of these unnamed people have found Dr.
Jensen to be.

And she said, I noticed it at a shaken baby syndrome conference that I attended in Utah last year.

There was an us versus them atmosphere, lots of panels devoted to fighting the naysayers, defense attorneys, medical experts who disagree with them, science that questions the validity of shaken baby syndrome.

So I wanted to ask you

about the us versus them

and the science.

that questions shaken baby syndrome because shaken baby syndrome is different than muntas and biproxy, which we've spent so much time on in that we have a lot of data and an extremely broad medical consensus on the science behind abusive head trauma.

So can you just talk us through some of that?

Well, if she'd listened to my keynote at that conference, she would have, I laid out, you know, how it all works and where we stand over the, I think it was a 20-year retrospective in terms of things that stood.

In point of fact, yeah, we do have a lot of data.

We have, I don't know, I'd say 15, but I think it's more than that, organizations, international organizations that all line up and say the same thing.

And she's right in the sense that there are sessions, I wouldn't say a lot of sessions, but there are some sessions where they're talking about what are some of these defense witnesses out there, what kind of theories are they saying?

And of course, part of it is, well, let's listen to what they have to say. But as it turns out, their stuff is garbage.
And so some of the sessions talked about that and why that doesn't line up.

And why do these, all these organizations around the world say otherwise?

And then you have these couple, handful of people, I don't know, maybe 20 people or something, that go around and say these things.

Joseph Scheller is one who comes to mind who just believes that shaking is not a way to cause that brain injury, right? And he has a tendency to say the same thing.

And he's had a couple courts that are not happy with him and not let him do things. And yet they still go on and keep doing this.

And they would be an example of somebody who perfectly well knows what the mainstream medicine says and all these other things.

They probably reviewed testimony that I did, and a hundred other doctors did as well. So it's not that they're uninformed.
They just have an opinion that is counter to science.

You know, I always wonder if they think they're Galileo or they think one way and the rest of the world thinks another.

And I would just remind them that Galileo did science and the world wasn't doing science. And the difference is that nowadays we're the ones doing science.
And so it's not at all the name analogy.

The analogy is totally wrong.

And they don't even agree, a lot of these people, with each other.

But the key thing is, yes, some of the session is devoted to that, but in part because when we get to court, we have to put up with hearing about these things and dealing with these things.

And they're not particularly successful, but they keep coming up because there's nothing else they can do.

These defense experts are an important piece to dive into because, in fact, these are the second opinions that are actually being advocated for when Neary points to second opinion laws that she posits could be a solution to the professed problem of crusading child abuse pediatricians.

In this context, second opinion does not mean bringing in a fellow child abuse pediatrician who has equal knowledge and expertise, someone like Randy, who provided innumerable second opinions in his role as statewide medical director.

It also doesn't mean bringing in someone like Dr. Jensen, who was the second opinion in Amanda Saranovsky's case.
More likely, it means bringing in someone like Dr.

John Galaznik, the expert witness whose findings are excerpted in Amanda's lawsuit. Dr.

Galaznik found Amanda's report that her baby fell, or was tossed, or was pulled, depending on the version, from the bassinet to be completely consistent with medical findings.

The lawsuit claims that Dr. Galaznik concluded that, quote, Dr.

Jensen's opinion that the baby was abusively shaken by his mother, plaintiff Amanda Saranovsky, is not supported by the current experimental, biomechanical, and and animal and human research data.

With the caveat that I obviously don't have the baby's medical records, I shared the near-death report, which summarizes the injuries, with both Randy and Dr. Sally Smith and asked them if Dr.

Galaznik's opinion made any sense with what we know about the story Amanda is presenting and the injuries the child sustained. The short answer is no.

It's possible for babies to sustain a head injury from a fall, yes, but not the type or severity of the injuries recounted in the near-death report matching Amanda's case. And Dr.

Galaznik is a well-known defense expert. In fact, he exclusively testifies for the defense.
Though Dr.

Glasnik appears to be a board-certified pediatrician, he has treated college students in the student health clinic for the past 30 years and has not actually treated an infant or young child since 1980, despite the fact that he nearly always testifies in cases involving physical abuse of children under the age of two.

Importantly, not only has Dr. Galaznik never evaluated a case of suspected abusive head trauma as a physician, he's never evaluated a child with a head injury.
Period.

Dr. Galaznik's CV includes just two peer-reviewed studies.

The first is a case report based on the observation of a single subject, and the second is a lab experiment featuring infant mannequins and a live infant wearing motion sensors.

The latter study was published in the Journal of Forensic Biomechanics, whose publisher has been widely criticized and lost a $50 million lawsuit against the FTC for its lax review standards and deceptive publication practices.

In a 2010 court deposition, Glasnik also notes that he's done many, quote, home experiments on his own.

In this same court deposition, Glasnik explains that his interest in child abuse medicine was inspired not by his clinical practice, but by an experience he had serving on a jury in 1999.

He is well known for opining in court that medical findings typical of abusive head trauma could have instead been caused by minor accidental household injuries.

He frequently posits that you can't diagnose AHT based on medical findings because another explanation could always be possible.

This is well outside the prevailing medical opinion on abusive head trauma, which is, by the way, the subject of extremely broad consensus in the medical community, including the American Academy of Pediatrics.

Glasnik is not a credible expert, and his opinion is frequently disregarded in court.

His testimony was the subject of a Dobert motion, which is used to exclude or limit expert testimony, in a New Mexico case just within the last month.

In this case, the judge ruled that Gelasnik, quote, will not be permitted to testify about any controversy regarding abusive head trauma or shaking baby syndrome.

Even when the quote second opinions come from defense experts like Glasnik, the media often portrays them on a par with people with decades of experience evaluating these injuries.

A quick Google search will come up with innumerable articles about the questions around the very robust science of abusive head trauma.

It's a manufactured debate, but it doesn't stop people like Miri from framing child abuse pediatricians, the actual experts, in the worst possible light.

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I want to talk just a little bit more about kind of this idea of how Dr. Jensen is framed.

Because

she has this, you know, and sort of this, again, this like flattening of the system. And they

used this quote from her in the second episode where I just thought it just was, which I found very frustrating,

where she is talking about how she got into child abuse pediatrics. And so she says, you know, and then I fell into this role and it's an interview with her from a podcast.

But as I fell into the role, it's my responsibility, found that, you know, I really, I can't say I really enjoyed child abuse. Of course, no one enjoys child abuse.

But basically what I'm saying is it's never boring. Child maltreatment and evaluation of children who have been victims is just never boring.

And, you know, they left out what came directly next in the interview where she talks about this whole interdisciplinary process that they have.

And I was like, oh, I know exactly what they're doing with that specific quote, right? They're trying to make her sound like, oh, this is such exciting work for me. And like, this is such a good time.

You know, it just, I found that to be quite a telling

editorial choice.

Well, and again, a total misunderstanding by people that don't do practice medicine. So for instance, what if a cancer person who's worked on a cancer word says, I don't find it boring.

You know, what are we going to do? You know, say there's something nefarious about them. I mean, they're they're doing the cancer stuff.

Now, that's not everybody's cup of tea, but you assume that they enjoy that work in the sense of being able to help people or doing what they can, you know, to relieve things as best and all. And

to say that it's not boring, that's what I want, you know, my can, if it was me, that's what I'm my cancer person to say.

So, and Dr. Jensen is saying the same thing.
Well, that's what you want. It means that they're engaged in what they're doing.

And it's sort of like in an ER. When we work in the emergency room,

every day it's not boring. There's always these little different things that come up.
A lot of times little quirky things that you never heard of before.

Not necessarily wildly different, but you know, just different how it looks. And the same thing is true in child abuse.
We say that. And Dr.
Jensen is not alone in that.

I think just about everybody has said that at various times. And part of that's because people aren't the same.

And so there's always a little bit of difference with each individual person and we try to get to know people a little bit if we can sometimes we pretty well sometimes not so much um

and that's what makes it interesting and

you know what if it was just putting out widgets on a conveyor belt no that's not what that part of medicine is it's not boring it's it's got some interest to it and i'm sure that there's at least for all of us there's some days that are more than others you know yeah well i mean i think this quote really struck me because i say that about my job all the time.

You know, where, because people are like, oh, well, is that hard working on those cases?

And I say, yeah, like it is, there are some really emotionally challenging aspects to doing this work and looking exclusively at child abuse cases. And I always said, I was like, but I'm never bored.

Like it is, it's fascinating work. That doesn't mean that like I'm glad it's happening.
And like, hurrah, I get to be a true crime podcaster because, you know what I mean?

It's like, it's just such a, it's such a disingenuous, it's such a purposefully disingenuous well. And for her to, I don't know what she's suggesting, that life should be boring.

I mean, if it was boring, she should quit her job.

I'm sure she would say, no, she finds it interesting every day. And I think most people that like their job well enough, you know, find it some sort of interest every day.

There's something especially troubling about vilifying child abuse pediatricians, because to my mind, it's kind of a miracle that you can find doctors to do this work at all.

It's emotionally grueling, it's not especially well paid, and now they have to deal with being excoriated in the press and tied up in court with lawsuits. And we need them.

According to the National Institute of Health, 18% of children will experience physical abuse, and abusive head trauma is the leading cause of death from physical abuse in children under two.

And the job of a child abuse pediatrician isn't to, quote, find abuse, as it's often portrayed, but to determine abuse.

And on average, they have positive findings of abuse in only about half of the cases they evaluate. And there's no reason to believe that we're actually catching every case.

Child abuse is much more common overall. Now, most victims of child abuse aren't going to end up in a hospital.
And most victims may never be identified during their childhood.

And so we have all these studies of adults where we're asking retrospectively, you know, what happened to you during your childhood and everything.

But in point of fact, child abuse is not a rare diagnosis. It's not always picked up on,

but but it's something that's out there. And the point isn't so much about arguing that.
The point is, what could we do about it? And, you know,

how could we prevent these sorts of things? And that's one of the works that child abuse pediatricians, who they're trying to vilify, you know, we're particularly interested in about prevention ideas.

What can we do to help this out? Because this is, we want kids to have a great childhood. Can you imagine if everybody by 18 had a terrific childhood?

The chronic diseases, all the other stuff that go along with, you know, having a bad childhood,

we could have the internists, you know, have a lot more time on their hands, you know, if we could really get kids off to a healthy start.

Yeah, I mean, and I think it's so striking, again, in having these conversations with people who are abolitionists.

And that's why I'm so kind of hammering that at the moment to sort of draw these arguments out from each other, because I think this conversation that this is involved in is about parents' rights and whether parents parents have the right to do anything they want to their children or not.

And I think that's what's essentially undergirding this argument, not, you know, this abolitionist argument where it's about what if we had, you know, what if every child had enough food and their parents had enough support?

And like, how could we, you know, these things that there's a lot of robust data that would help prevent so many situations from getting to this point.

And like, to me, child abuse pediatricians, to your point, are engaged in that conversation about prevention.

You know, mileage may vary about how to accomplish that, but that is essentially a good faith, data-backed, science-informed conversation, whereas this is not.

This is a minimization and denial of how frequent child abuse happens.

And I've noticed, Randy, in these pieces by people like Neri and Hicksenbach that I have spent way too much of my one precious life thinking about,

they really avoid, for the most part, talking about child sex abuse. And I think there's a reason.

It's because people's reaction to that is so strong that they know they will not find the same sympathy and the same mileage if you are talking about child abuse pediatricians diagnosing child sex abuse.

Because we've had our sort of cultural revelation about that. That is like reached a cultural acceptance that, you know, Munchausen by proxy certainly has not.

And I think it's really like abusive head trauma now is in a backslide from, you know, this, again, it has a broad medical consensus, but you would not know that from the media.

So I think they're really being choosy about which pieces they're pushing back on for a reason.

No, I think you're right. I think that some things they're more susceptible on doing.

You don't get defense witnesses arguing about sexual abuse particularly. And so not much of an industry there.

So they pick the ones that are, of course, the ones that you have a major felony exposure to, you know, those are the ones you're going to fight more.

And so I understand that, you know, and that's where you're going to see it. And imagine you're a defense attorney.

If you don't find a defense witness somewhere to testify that it's not shaken baby or something like that, they're going to hit you for inadequate defense. And so you got to drum up somebody.

And that kind of, and the legal system keeps that alive.

And it's an artifact, if you will, of the legal system that they do such things, as opposed to saying, well, gosh, I guess we roll over because all these medical people say this is what it is but I assure you in medical schools around the country we're teaching about that about the shake and baby stuff and we're teaching about the munch house and biproxy stuff and there's not a big counter stuff in the medical schools going on in the United States that I'm that I'm aware of and I don't believe exists so This stuff is pretty well accepted and everything.

And we even have some studies, particularly with the abusive head trauma, shake and baby stuff.

We have studies that the acceptance is really high, but that doesn't mean they're not going to argue the case or they'll say, well, this is the exception in court.

And if they've, you know, if they've got a case for it, go for it. I mean, I don't have a problem with that, but you know, a lot of these things we would work out before it ever got to a court.

Court is not the discovery stuff. Discovery stuff is done, you know, back when we deal with it, and you know, on the scene, when we're seen with it, and

I think sometimes people forget that, you know, it's they're used to seeing Perry Perry Mason or Matt Locke or I don't know which ones they're looking at, depending how old you go.

And somehow in the court process, that's when they discover things. And it's like, that's not how the world works.
That stuff's already been done.

And now you're just going to court and arguing, you know, other issues.

Despite the preventionists' claim that this series is solely about Dr.

Jensen, it's forwarding the idea encapsulated in so many other stories that the real problem isn't under-reporting of child abuse, but overzealous and crusading child abuse pediatricians.

And this idea is always presented without any data or evidence that it's actually happening, other than in this series, The Existence of Angry Parents and the Report of a County Controller.

I wanted to just ask you about this notion of cowboy caps. Do you think there's just, I mean, there's not very many caps in the country, right? It's a small,

and I'm sure it's going to be harder to build on that number given how they're being treated in the media. And that's a problem I worry about.
but um

like

can you just respond to the the cowboy cap uh i said defense i i suppose because this is one i've seen come up a lot

well is there one individual out there in the world that's acting crazy i don't know that's probably true for anything in the world um

you know so i mean to generalize that against everybody is ridiculous.

I don't think that that's true. I mean,

I don't get up in the morning. I don't know anybody who gets up in the morning and says, oh, boy, I I hope I see a Munchelson by proxy case.

I mean, if there's anything, I get up in the morning and say, I hope I don't see a Munchelson by proxy case. Because first of all, it's going to be contentious.

It's going to be an amazing amount of hours. I mean, I spent, like in the Kowalski case, I spent 82 hours going through tens of thousands of materials and things.
I don't want that.

You know, I mean, I could be doing a lot of other stuff during that time period and get a better result. You know,

so this isn't anything that we particularly want. We have a system where we look in Florida, we look at all the reports that go to the hotline.
They're medically seen.

That's over 200,000 reports in the state of Florida. And every day in my particular child protection team, we get a stack of paper.
It's like a RIMA paper. It's just in all these different cases.

You know, it's two or three pages that talk about this case that got reported.

And then we have to go through it and make a decision about is that a case that we're going to see in our clinic or at the hospital. And

that is a lot of cases we actually physically look at about 20,000 plus cases per year

you know if I could make that all go away and retire that'd be great and I'm sure the cancer people are thinking the same thing you know for what they do and and orthopedic people or you know whoever we are in medicine we want this stuff to go away it's not like we need it for job security.

We could do other pediatrics at the drop of a hat. It'd be so easy.
So that notion that we're doing that is it's malicious.

It is insulting.

And if a medical student said anything along those lines, we'd have to flunk them or something. I don't know.
You know, it's like, how could you be so wrong?

I mean, they never say that because they're smarter than that.

But, you know, it's like, this is not a job security thing. It's just nuts

to say something like that. And,

you know, I don't know what the motive is that somebody would talk like that,

but it's not a good motive.

Yeah.

And, you know, I think having talked to child abuse pediatricians and, you know, like Sally and others who, you know, have been engaged in this work for a long time, you know, they realized that this was work that they could do that a lot of other people just couldn't tolerate.

And certainly seeing children who've been beaten, sexually assaulted, you know, who've been tortured by munchhausen by proxy abuse, this is, you're looking into something that happens too commonly in society that most people would much prefer to just live their lives and never have to think about.

Sally has talked to us about how

One of the things that really kept her sane doing this work was keeping up with her general pediatrics practice because then she could just see, you know, children who were happy and healthy and thriving.

And, you know, that that was something that really brought her, brought her a lot of balance. And, you know, it's so baffling to me

to choose people that have taken on something so difficult and villainized them. I have seen stuff that a human shouldn't have to see.

Now, it's, you know, police have sometimes had to do that and others as well.

And I can't tell you how discouraging that is. And I get the thing from other medical professionals for years.
They've said, well, I'm really glad you do that. I couldn't do that.
I don't know.

They do some stuff that isn't always my favorite thing to see.

Medicine's full of stuff that is difficult. But

in point of fact, when we go to the hospital and we're, you know, to see some kid that they brought in because they got a child abuse case or they think they have one, they welcome us.

They are so happy to see us because we're going to come in and and help them deal with the case and everything. The people in the hospital, they love us, you know, from that point of view.

Kind of like we're the cavalry coming in to save the day or something.

And of course we don't always, in our outpatient clinic, we have looked at our own one. There's literature on the subject.

Somewhere between about 30 to 50 percent of the time, you don't call it child abuse.

Now, what happens is people suspect it might be, and so they make a child abuse report, and they should do that by law. And then we look it over and we say, well, is that really child abuse or not?

And then it may not be or we may not quite have enough evidence to say for sure.

And that's okay. If we don't have it, we don't have it.
And so, again, the numbers are, depending on what you're looking at, about 30 to 50 percent or so.

So we don't call everything child abuse by any means. In fact,

one of my favorite things, and I know this would be true for Sally Smith, Deb Jensen, and every other child abuse pediatrician in the United States.

One of the favorite things is you walk into a room and it's some other condition and it kind of you can see why they thought about child abuse, but it's not child abuse.

Now, by and large, you're hoping that other condition isn't something that's even worse, you know, like, oh my God, you got a fatal disease, you know, that kind of thing.

But sometimes you get that, and I've had that experience a lot in my life, you know, that there's something else going on. And yet I understand why someone thought it was child abuse.

And they come to us to figure out, you know what's going on and all

so we're not a rubber stamp everything's child abuse at all and people characterize it that way you know they must think that in medicine anytime you go to a doctor with a concern about something they're always going to diagnose something that's always this one thing and it's like come on that's not any part of medicine that's ridiculous what do you think we went through all that college and medical school and training and everything else just to be i don't know even worse than ai would be on such stuff Right.

Yeah. All those oncologists that are staying in business by just anybody who shows up, they diagnose them with cancer, right? Exactly.
You don't do that. Yeah.

That's why you get into like plastic surgery or something, you know, then you can really,

then you can give someone something every time they walk through the door.

Yeah, I mean, and we get all kinds of different kinds of diagnosis we have to think about.

Now, there's a lot that, you know, at a trial they bring up that are ridiculous type of things, but then there are some things that come up, for instance, there's some called ITP.

And I bring that because we just recently had a case it wasn't ITP but I was having my trainees you know talk about it and everything and

I've seen a number of those cases where they show up and they have these blotchy

bruises on their skin and they have a bleeding disorder because they have very low platelets and you take a look at that and you say well that's not child abuse but you got to go to the hospital because we got to do a few things with you anyway and you'll eventually get better from it although it might take months and months you know to do various things

there's other conditions there's something called phytophotodermatitis which we're a little bit prone to in in florida maybe um and that's where you get like say lemon juice on your skin and then you're out in the sun and then you get this reaction and it look kind of look like a bruise

And so I've seen those and my colleagues have seen those, you know, you take a look and say, well, it doesn't quite look like a bruise now that we look at it really, really carefully.

But I understand why someone thought that and then you send it go out the door and have a good life um you know and and it's not an issue and those parents don't call the media though and say hey this wonderful children just yeah they're happy but they don't they're not going to like um take that to you know netflix but we've helped them understand something uh a condition that's that's going on and and they appreciate that like they would anything in medicine you know i mean they could go to their primary care doc and get that diagnosis too perhaps um

you know we're all trying to pull together here to figure out what's going on. And we have no incentive whatsoever to

have it be one way or the other.

We don't care when you walk in. Now, the other thing is

we try not to be swayed whether we like the parents or not.

You know, because sometimes what will happen is not very often, but you get people who say, well, they were nice parents, so they wouldn't do it. And you go, well, what are you saying?

That if you don't like the parents, they must be bad? I mean, that's pretty biased. biased.

In point of fact, you should decide it on the data, not on whether, you know, the parent's nice to you or you're warm on up to them. Otherwise, you're going to introduce bias.
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In addition to being an experienced child abuse pediatrician, Randy is also one of the most well-respected experts in the country on munchausen by proxy abuse.

I know Randy from the APSAC committee that we both serve on. So I wanted to ask him about serial's handling of MBP.

But in the second episode,

they talk about this caseworker from Florida who had had a case with Dr. Jensen,

who he, importantly, could not remember the name of the family, so did not have a ton of information.

But,

you know, this is how, his name was Andrew Caswell. This is how Dianary frames this case.

She said, I want to tell you about one more case from Florida because it's the clearest example I found of someone trying to challenge Dr.

Jensen before a family was affected by a separation and attempted check on her power.

And so the case was from 2012, 2011. Again,

there is

no details about who this family was, anything, any information about them, just this caseworker's recollections.

But I could tell by the way this caseworker describes it that he has no idea what he's talking about.

For instance, he says,

you know, I couldn't figure out why, why she was calling this abuse. And he said, where she saw abuse, I felt that abuse would have been medical neglect if she hadn't taken him to the hospital.

I don't have a teenager, so I don't know what it's like to have a teenager. So he's saying, This mom was taking her child to the hospital.
So how could this be abuse?

Can you just kind kind of help us

address the misunderstandings that this caseworker appears to have about what Munchausen by proxy abuse is?

Well, first of all, that's a really common thing we get. People that overuse the medical system can be abusive.

If every day you got poked with the needle and somebody said, well, you're getting poked with needles, that's good. We'd say, no, it isn't.
You know, at some point, that's not good.

You know, so one of the things is that

when you have a type of thing where it presents as overuse, people fall back on that. Well, they're going all the time to a doctor.
Well, you know what? That can be wrong.

And so, first of all, that's a total misunderstanding. Second of all, it's not a psychological diagnosis, period.

Never was there, it's always a pediatric diagnosis. So the fact that they're trying to find a mental health issue, it's not about mental health issue, it's a child abuse thing, you know, where

you're doing something to the child. Maybe you have a pattern of things that are wrong.
The child suffers.

I had a case once in Nebraska where they were saying that same kind of thing, you know, about the overuse thing.

And I said, every time that we poke somebody with a needle or we do something for them, that's in the medical record.

So I said, get a big box together of all the needles this kid ever endured and all this other stuff, put it in a big box and put it in front of the judge and say, if we assaulted somebody on the street with all that, How do you think that would be?

You know,

you'd think it was assault.

In point point of fact, you think that doctors were nice and safe.

And one of the discouraging parts for me has always been when you give a kid a shot, or actually our nurses give the shots, but you give a kid a shot and

the mom will say, thank the doctor. And it's like, they just gave the kid a shot.
Don't make them thank the doctor, you know. Come on, it hurt.
They didn't like it, you know.

Let's not be a hypocrite, you know, to the kids, you know. I mean, you know, it's nice enough to say goodbye, but, you know,

let's not try to pretend it's something. But they're thinking the doctor is a safe place.
In a lot of ways, we are.

But when you think about it, particularly, say somebody's hospitalized, we hurt children. We put IVs in them, we draw blood from them, we do a lot of that.
We do it for a much better reason.

You know, we're trying to save their life or, you know, try to help their condition or diagnose them or something. And so.

When you see a doctor, to the child's point of view, it's not completely safe, but we certainly hope in its elements it's safe.

And we hope that in the long run we're doing really good for them, despite you know the discomforts that they have along those lines. And I think in a certain sense,

people don't understand that overuse of doctors can be a problem.

Like, for instance, if you drew a lot of blood on somebody that never needed it, if you did a lot of other things, those hurt and they're things.

Now, maybe they're not all life-threatening, but still, there could be a problem there. So, this is a person that misunderstands.

I have to say that as a medical provider, medical providers kind of get it. They understand, you know, well, what's this going to mean, you know, to doing this?

I mean, I don't like doing things to kids that they don't need, and I don't know any other pediatrician that would.

I mean, we try to be as minimalist as need be, but then we know there are things that we have to do, you know, if we care about the child. And so, anyway, that person doesn't really know.

Second of all, if he really had a concern at the time, he could have brought it to me as a statewide medical director. I never heard it.

Well, it sounds like it did go up the chain for review. And then basically he was told

that

Jen Joan is wrong.

I'm the supervisor. So

there'd be nobody else to judge. It sounds like that happened and they took him off the case and he was mad about it.
And like, I just, as a journalist, I mean, as a journalist, this just wouldn't.

pass muster as an anecdote because you've got someone that can't remember any of the specific specifics of the case. They're not not presenting you with documentation.

Had he brought it, you know, up to me, if it had come up the chain, I would have looked at it. If I thought Jensen was wrong, I would have told her in a flash.
I had no problem with that.

And she would have had no problem in receiving that information. She might, you know, want to argue or discuss the case, so that'd be fine.

That's what you do as medical professionals, but it never happened.

And so,

you know, just throwing out these accusations that I didn't agree with something somebody did that was medical that I didn't understand.

It's like, well, I don't know what to do with that, you know? Yeah.

And then there was one other anecdote that she, you know, this is again, I'm sort of including these because this is all she found in two years of reporting on this case, or all she found that suited this narrative.

She certainly found many other things as we've had sort of evidence of. But so she said, I spoke with David Bramowitz.
Is that a name you recognize?

I guess he was the regional director of Department of Children and Families at the time. She said he was responsible for all Northeast Florida, including Gainesville, while Dr.
Jensen worked.

He co-signs what caseworkers told us about the power imbalance and not being listened to. Several things.
One is, yes, he could disagree. He was the DCF

head in that region of the state.

Apparently, he didn't agree with some of the things that she said.

Again, could have brought it, you know, up to Supervisory Chain, and DCF can do that.

It's the way we do things, it's our operations.

And if he disagrees, that'd be fine. And I would say is bring forth your medical data and let's do on that basis.
But don't go on your feeling. You know, well, I think Dr.

Jensen pursues something and that makes me feel uncomfortable. You know, well, yeah, as medicine, we're going to pursue something.
We're there for the child. That's what we call pediatrics.

And one of the things that we do is we're an advocate for the child. And if we think the child needs something, we're going to pursue it.
Now, we won't do it endlessly.

At some point, that's not our, you know, that gets outside our lane. But

But of course, we're going to want to see things done in certain ways. And in DCF world, child protective services, more known generically,

sometimes they don't do what we want them to. And I'm sure there are times that they don't agree with us either.

And we have staffings. We actually sit together and say, if you've got a problem, we're all going to get in the room and we're going to talk over the case.
And we can do that.

And in fact, we do that on a fairly regular basis about things.

And it's not always because of disagreements, but we talk over the case and what have we got, where are we going to go, and everything else like that, as you would want someone to do.

And that means then you have a bunch of professionals that are involved in the case, medical and non-medical professionals. And, you know, that's the forum.

If you have an issue with any of our medical docs, you know, let's do that. And let's talk it over and see what you've got.

We don't have a vested interest in this for the most part. You know,

if somebody's got a better argument, let's hear it.

Yeah, I mean, and I think I'm really struck by this,

you know,

by these episodes that like

any

person who'd been doing this work for this long,

you would be able to go back and find,

you know, a defense attorney,

a former caseworker, you know, like you're going to be able to find a couple of people that didn't like them or didn't. I mean, it's like that, that to me is just not evidence of a bad doctor.

And I asked Sally Smith the same question and I wanted to put it to you because I don't want to get into, you know, I'm always trying to check for my biases and my lens.

I come at this work from a certain angle, of course. And, you know, we all, everyone, every journalist does.
Any journalist that pretends they're not is being disingenuous.

But like, I'm always trying to account for that.

And I don't want to sort of build this argument of like child abuse pediatricians are perfect and there's nothing you could ever tell me about a child abuse pediatrician that would convince me that they're doing a bad job or that there are there are problems with their work.

So help me understand like how should we be better consumers of being better consumers of this media like how should we evaluate whether or not there is a problem with not just child abuse pediatricians but any doctor who's in because most places don't have them most places are not lucky enough to have someone that knowledgeable on staff how should we be evaluating this role and whether or not a doctor is doing it well?

Well, for one thing,

nowadays, not so much in my day and Dr. Jensen's day, but now if you want to be a child abuse pediatrician, you have to do a three-year fellowship.

And then at the end of that, you have to pass a test, a national test that's given. And then you can be a board-certified child abuse pediatrician.
And then

we got grandfathered in in our day back in 2009. And then we had to show that we'd been doing child abuse pediatrics for, I think it was five years or something, at least half time.

And then we had to have letters of recommendation. And then we had to pass the national test to be able to say that we were that.

And then I just completed the cycle, but we get, every quarter we were getting tests online, tests, and we had to pass these questions and everything else.

And it was only after five years of doing that that they gave me what's called maintenance of certification, which is basically kind of like saying your credentials are continued. But guess what?

You're going to get it again. And so this is something where they're constantly testing you on these things to make sure that you're up to speed.
And that's true for many other specialties as well.

I don't know if it's true for everyone, but for a lot of them it is. And so it's sort of a quality control that is being done nationally on all that.

And of course you're getting your feedback from your colleagues that are in your office or you're in your hospital or wherever they are. I mean,

you know, you certainly hear from your colleagues, and they tend not to be shy.

When you get a bunch of doctors together, they talk. And if they had a big worry about you, you'd know pretty quick, you know, that they had concerns about you.

And then we go to conferences,

various child abuse conferences. Most everybody that's a child abuse pediatrician goes to at least several conferences a year or so.
And we discuss various things that are going on and what all.

And of course, we have the literature and all that. So there's really a pretty big educational component that goes on to something like this.
And it's not trivial by any means. And

I guess I just noticed that, you know, people that aren't in the subspecialty aren't doing that.

So, you know, it's not that they are necessarily wrong, but they certainly don't have quite as much proof that they've been working at it as the people that do this. And that's what you want.

I mean, I want my doctor that's in some sort of a specialty. I want them to be really good at it.

and you know keep getting continued education and do all these sorts of things and that's something that the child abuse pediatricians, much less pediatricians in general or anybody else, you know, to To keep up their licenses and things they have to do.

You know, the state has has it too. In my particular state, I have to have 20 hours of training per year, 20 hours of training per year.

To do child abuse work, I have to have eight hours training in child abuse per year. Now that's pretty easily accomplished.
accomplished when you work in the field.

You know, you get that without almost with a blink of an eye because there's so much stuff you're doing. But

in point of fact, people are pretty good at this stuff. And

I would have a fair amount of confidence if I, you know, in general, if I was anybody in the public about, you know, how good, how good this is going. Yeah, and that's, I think that's one of my,

that's one of the other real fears I have about this kind of reporting is that it makes parents afraid to bring their children to the hospital completely unnecessarily, in my opinion.

And I would say, like, if I'm a a parent that brings my child in with an injury that might look suspicious and I'm innocent, I want a child abuse pediatrician to evaluate it.

They're the best person to make that evaluation. Well, you know, kids have accidents and physical injuries and this and that.

Even some kids will get a couple of broken bones and, you know, and a parent will say, oh my God, you know, you're going to think I abused the kid.

And then you laugh about it and we laugh about it and then nobody thinks anything about it afterwards. You know, I mean, we're aware of that.

You know, many of us have had kids of our own and we kind of know what some of these things are about. And so what you're looking for is a deviation outside of the norm sort of thing.

Now, it's interesting you mentioned about being scared of doing it. Sometimes people are scared because they have a history, you know, that's been a little bit checkered.
And so I appreciate that.

Burns are actually one of the ones that we

We get into sometimes a kid will get a bad burn and the parent says, well, I'm not going to take them in because they'll be, you know, they'll want to take my kid kid away or something

which might well be true and then they wait till it gets infected so about three days later we see when they bring in their infected wound and now we're for sure going to see to it their kid gets taken away because it's medical neglect now on top of whatever the problem was in the first place and so um i'm with you i think you know if you've got something and it's an accident or something that's not you know, really is not an abuse issue, you know, feel comfortable.

Come on in. We're not going to, you know, we know about these things, You know, we're sympathetic and we'll be on your side.

I asked Randy about the Amanda Saranovsky case featured in Serial's third episode, which Neary positions as being, quote, obscured by a giant question mark, end quote.

There was a history of abuse in this household and positive abuse findings by doctors and child welfare services. Not to mention that Dr.

Jensen wasn't the one who even made this diagnosis, but rather the doctor who confirmed it. That's not a great

case, no.

And And

you get to cherry pick which doctor you see.

I'm glad that, you know, from your description anyway, it's like changing stories is one of the hallmarks of child abuse.

Now, it's not absolutely certain that it is, but it certainly raises a red flag because most people, if there is a true accident, there's only one story, you know, and they tell you what the story is.

And when you start hearing different versions and everything, it's like, what's going on here? Yeah, and the stories were markedly different.

She says to the paramedics, apparently, she said to the paramedics that she, you know, this happened really early in the morning at like 5.30 in the morning.

She said that she heard screaming and crying and went into the room and found the baby on the floor.

In the version she tells in serial, she said she was woken up by a thud when the baby fell to the floor. I mean, those are two

quite different stories. You know, it's not a matter of like one sort of element.

Need to, yeah, so what we would do then is we go and we probe that history a whole lot lot more and you know we would keep each of the histories that the paramedics or whoever the initial admitting to the hospital people might be We'd certainly look their histories, but we would also go in and try to get really detailed history of our own

We wouldn't interrogate them in the sense of challenge them and have like a I don't know whatever the movies have, you know a bright light on them or something like that. That's not what we do.

But we'd go to the mind and say, we're trying to understand what's going on here. And,

you know, try to get real detail, make sure there's no misunderstandings you know in the history because sometimes when you ask people to do something twice it's slightly different we're not looking for slightly different we want to hear as you mentioned you know if it's quite different then what's that all about and um

and then you know she heard a thud that her child fell the floor how does she know the child fell um

I mean, she could say that she heard a noise and the child was on the floor, but how would you know that's a fall?

And so, you know, you'd be trying to, you know, flesh this out and get a much better picture of what's going on. And then you go back to say, could that mechanism account for the injury?

And you'd see. Now, you said there was a two-year-old that picked up a small child.
Yeah, so she, you know, she claims that she

was, I think, asleep on the couch. And it's not, it's not totally clear from her description where the bassinet was, but, you know, it was a very young baby.
It was a seven-week old.

So the baby was in the bassinet.

And then says that she awoke to this noise and that the baby was on the floor next to the bassinet. And then her two-year-old was in the bassinet.

And so she was saying, you know, she, I guess, is painting this picture. And it made me very uncomfortable how much she took pains to blame this situation on the child throughout this episode.

And that's sort of a whole separate thing. But like,

you know, that the two-year-old had,

I guess, thrown the baby.

I mean, it wasn't like that the bassinet tipped over with both of them in it, like that the two-year-old had sort of, I guess, chucked the seven-week old out of the bassinet, which again, you know, having little kids in this time of my life being really relatively recent,

I don't know if that's impossible, but it's a strange story.

It doesn't sound developmentally possible.

If you recall that a two-year-old, when they are trying to get a baby, first of all, they don't throw them. That takes arm muscle strength they don't have.

So typically what they do is if they hold on onto a baby they're doing like this. They're grabbing them against their body and they're in no position to hold them at arm's length and throw them.

So right there I'd have a problem with that. You're asking people to have a development that's not that's not appropriate for that age.

So now if they said somehow they tip the baby out of the bassinet that'd be fine. But then would that be enough to cause a fracture? And you'd have to know some more details about that.

Every once in a while a shortfall will cause a broken bone. Usually not though.
And And so you'd have to probably have a scene investigation and see more what that looks like.

Just after my interview with Randy, we obtained a copy of Amanda Saranofsky's lawsuit.

And in reading Amanda's account of this incident, I caught yet another discrepancy, giving us a total of three versions of the story.

According to news reports from the time, Saranovsky told prairamedics that she was out of the room when the fall happened and came in when she heard crying.

The story Amanda tells in the media is that she awoke to a thud and found the baby on the floor with its onesie undone, and that her toddler was sitting in the bassinet, which would indicate that the baby was pushed or tossed out.

In her lawsuit, however, Amanda includes what appears to be a direct quote from the hospital, which says that an RN determined that, quote, mother has been consistent in her reporting that the two-year-old pulled the baby out of the bassinet.

A toddler pulling a baby out of its bassinet is more developmentally possible than a toddler throwing a baby out, but it's not the same story.

If the toddler pulled the baby out of the bassinet, why did Amanda find her toddler in the bassinet afterwards? It just doesn't make any sense.

I wish Serial would let me know how they decided that this case was in a gray area, but sadly, they declined my invitation to speak about it.

They did make a gesture at hearing out the other side by publishing a roundtable discussion with a number of child abuse pediatricians on their paywalled newsletter, not on the podcast.

And I wanted wanted to ask Randy what he thought of this attempt to balance serials reporting.

Well,

that particular chat and everything else, my impressions of that, first of all, I know most of those people that they had.

What they were talking a lot about was the process, the way that it was shaped.

They were talking about the process and saying, you know, you really have to think about what you're doing here and, you know, what's going on and all that stuff. And that's true.
You absolutely do.

You don't want to jump to a conclusion. You want to to think it all the way through.

But that doesn't mean at the end of the day, you don't end up having a conclusion and that, you know, you don't have a diagnosis

from this whole sort of thing. And I don't think they were saying that.

Now, a couple of my colleagues seem to say that more explicitly than some of the other ones who are talking about more the process of thinking it through.

Which is right.

Of course you want them to think it through. I wouldn't want any diagnosis to be arrived at real quickly.

I will tell you that there are times where it's obvious and you don't have to spend any time thinking it through.

I'm sorry, I just saw a kid that was all beat up the other day and it didn't take any time to know that. I mean, you know, it's like, how hard is it? And it was more like it's sad.

It's not a diagnostic challenge. And so

I think that in that sense, I'm not sure if that completely came through because they were kind of focused on the operations of doing this,

which was right, but I don't want there to be the sense that there's ambiguity in this or that we're, you know, these things are so hard we can't reach diagnoses.

We do it all the time, and they testify about it all the time as well.

So, and they're called by other doctors to come see the kid because they already decided that there's child abuse issue going on, probably.

But they need us to help confirm it. So,

so in that sense, I think it was okay, but I wouldn't want anyone to walk away, you know,

interpreting it in such a way as to say that a couple of the people were talking about great ambiguity that's not really the case

yeah and i think it's like there is this presentation where

you know because

people like diane neary and mike kicksenbog

i sense this is my just editorializing I think they know they won't be seen as credible if they just outright say, we don't think munchausen by proxy abuse exists and we don't believe the science behind abusive head trauma, right?

So they really do this other sort of roundabout thing of just saying, well, these cases are so gray and how can we know? And I'm like, but you can know.

And like, furthermore, as a journalist, you can know a lot about the case by doing. a FOIA request.
It's like they act like the only way they could get to the bottom of it is if they could get Dr.

Jensen on the record about the case. Now, listen, they could do that in some cases if they got the parents to sign sign a HIPAA release.

They refused to answer that question of whether or not any of these parents had signed HIPAA releases.

And furthermore, you know, half the time you look at these cases, because I've dug into a lot of these that have been covered in the media.

You look at these cases and they're like, sort of present this and they say, well, doctors disagreed about, you know, this diagnosis.

And then you look up the records at, you know, the court records and you find that the doctors who disagreed are one of these, you know, defense experts that is way outside the medical consensus on something like abusive head trauma, you know, and furthermore, like the story the parents are telling about how these injuries happened don't make sense to anyone who's spent time with a human child, let alone, you know, a pediatrician of any kind, right?

So it's like, It's not like these are unknowable, especially if you have the cooperation of the parents and the parents are presumably willing to be transparent with you.

And if they're not, then you should wonder why they're not. You know, it just, it's really, it's just such bad faith.
I think it's just evidence of bad faith.

I can't take it as anything else at this point. Well, I think you're right about the bad faith.

And, you know, there are instances where you'll have one of the parents that isn't.

in on the abuse of something and so they'll tell you a different story it's not always like there there's collusion between parents now in munch housing by proxy as you know um often one of the parents is sort of silent.

The guy usually is mostly silent. And so you're really hearing from the mom for most of it.
I mean, that's not going to be true 100% of the time, but it's true most of the time.

And going back to your head trauma, I've had people tell me they did it. I mean, I'm sorry, what are we going to do with that? Do you think the doctors made that up?

And the laboratory people are just, you know, fantasizing about it. I mean, some of this stuff is just incredible to believe.
And I just wonder why there are enablers of child abuse.

You know, right now we have a big thing going on about sexual abuse, you know, and Jeffrey Epstein and, you know, all these people that in essence are the enablers of sexual abuse.

Well, if the New York Times and all these other people, if they push the boundaries too far, they're enablers of child abuse. Oh, I think they, I think they are.

I think this, I think this falls into that category. I want to be clear, because I think they, you know, and I don't want to say that every journalist is participating in this, but this journalist is.

I really feel strongly about that because she knows better. She does.
I listened to people tell her. I've told her myself.

I've spent two years trying to get, you know, get information to this journalist. She willfully misrepresented this case and she willfully misrepresented the Kowalski case.

And when you are saying, you know, that's the thing. It's like, again, this is.

utterly separate from those arguments that are being made by people about systemic reform and how we can prevent child abuse and how we can, you know, make life better for families,

those are such legitimate critiques. And those people, by the way, are all willing to talk to me.

If you're just giving an abuser a platform to tell their story about how they were wronged by a doctor who they were not wronged by, and furthermore, in this case with Amanda Czernofsky, giving her a platform to continue to blame her two-year-old, who is now six or seven,

for separating their family because she allegedly tossed the baby out of the bassinet, where I'm like, well, are you able to confirm that that's what happened? How that is not enabling child abuse.

And I think the only people that this media coverage helps and this sort of this, you know, the laws, the second opinion laws, the doubting of CAP, the only people that helps.

Well, and they're looking for the man bites dog story. And it sounds like fun, but

it has serious consequences. And,

you know, if you're not going to be serious, you really shouldn't be doing this thing at all.

And, you know,

it's just,

and it's not as if the medical societies at large have already told you this stuff and you just aren't going to believe it.

I mean, you might as well start injecting Clorox under your skin for COVID or doing one of the other kind of crazy things we hear in the world.

Yeah, there's all kinds of people that question science now, right? And it's like, I think like

what I'm really wanting people to understand is that this is an argument that is in league with anti-vaxxers, not abolitionists. Like

this is not a system reform argument. This is an anti-science argument.
I agree.

Every day we're still going ahead and doing the right thing for kids, you know, not calling it child abuse when it's not.

Occasionally we say we're not sure. and then other times we are sure and the system keeps moving along.
And so you hear about these isolated cases, but that's not the norm.

You know, for the most part, the doctors are doing a great job. The

lawyers are doing a great job. And they're moving ahead and doing the right stuff.
And I think that gets overwhelmed. You hear a case or two and you start thinking that's what everything is.

And it's not. It's not how it normally is.
And so I have faith in the fact that we're moving ahead on stuff. It's so discouraging that we have these contrarians that

have to kind of keep pushing the thing but as you said there's an anti-science movement that is going on and this I think is part of it. Yeah agreed.
Well Randy thank you so much for being with us.

It was really such a pleasure to get to have you on the show. It's nice talking with you.

This is our last episode on The Preventionist but it's not the last we have to say about all of this. We're hard at work making season seven, so stay tuned for that.

And next week, as we close out the year, we're catching up with some friends from season 6.

Nobody Should Believe Me is produced and hosted by me, Andrea Dunlop. Our editor is Greta Stromquist, and our senior producer is Mariah Gossett.

Research and fact-checking by Erin Ajayi, administrative support from Nola Carmouche.

Tu mereces distrutar tus favoritos por menos. Ja sel na Big Mac, McNuggets, or a sausage, egg, and cheese, McFriddles, bidet one to hocamoon meal, and a horra.

Oof, nava comodarte un gustaso por tam poco. Los extra value meals están de regreso.
Gana por la mañana con el extra value meal, sausage, mcmuffin with egg, hash browns, and a cafe,

poros eyes dolaris. Bara, ba-ba-ba.
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