The Preventionist - Ep. 2

Speaker 2 After that emotional public meeting in Lehigh County, when all those families shared their stories about misdiagnoses and forced separations, what became clear was that the problem was big.

Speaker 2 The families blamed one hospital network, and the same doctor's name kept coming up again and again. A pediatrician, Dr.
Deborah Esernio Jensen.

Speaker 4 This mess was created by Dr. Jensen's false allegations.

Speaker 5 I'd like to see this council, this county, this state get rid of this Deborah Jensen.

Speaker 4 Please assure Dr. Jensen is removed.

Speaker 5 Deborah Jensen and Dr. Jensen.
Dr.

Speaker 7 Jensen. Deborah Jensen.

Speaker 4 I'm going to summarize. Get rid of Dr.
Jensen and fix the system because it's broken.

Speaker 2 Dr. Jensen was named 108 times that night.
I went back and counted.

Speaker 2 By the time this meeting happened, Dr. Jensen had been working for a a hospital system in Allentown, Pennsylvania, the Lehigh Valley Health Network, for nearly 10 years.

Speaker 2 She'd been hired in 2014 to head up their child advocacy center, but she'd been working in the field for decades.

Speaker 2 The current hospital administration declined to talk with me for this story, so I don't know how much they knew about her work history before they hired her.

Speaker 2 All they would say about this is that they would have done a series of background checks for anyone working with kids in a medical setting.

Speaker 2 I don't doubt they did those, but surely someone bothered to Google her, right?

Speaker 2 If they had, they would have found multiple complaints. They would have found lawsuits alleging misdiagnoses and unnecessary child removals based on her findings.

Speaker 2 Dr. Jensen would not talk to me for this series either.
She did not answer my emails or letters requesting an interview.

Speaker 2 So I've pieced together her history from talking to people who encountered her along the way. Former colleagues, doctors, lawyers.
Plus, I've read lots and lots of documents.

Speaker 2 The reporting took me into court filings and workplace dramas in several states, from New York to Florida to Pennsylvania, and raised a new question.

Speaker 2 Did anyone ever stop, look around, and ask, what are we doing?

Speaker 2 What I learned is that Dr. Jensen's career aligned with the rise of a new kind of specialist, the child abuse pediatrician, or CAP,

Speaker 2 and that the power of a CAP's opinion can be incredibly difficult to counteract.

Speaker 2 From the New York Times and Serial Productions, I'm Diane Neary, and this is The Preventionist.

Speaker 2 Just to set the scene, Dr. Jensen was starting to specialize in child abuse pediatrics in New York City at a time when caseworkers there were on high alert.
There'd been this horrible case.

Speaker 2 It happened in 1995, the day before Thanksgiving.

Speaker 8 Police say she is a brutal killer who systematically tortured her own daughter to death.

Speaker 2 Some believe Elisa slipped through bureaucratic cracks. A six-year-old girl named Elisa Isquierdo was beaten and sexually abused by her mother and stepfather for years.

Speaker 2 Various people had reported their concerns to the city's child welfare agencies, but none intervened. The caseworker assigned to Elisa's case didn't do the home visits he was supposed to.

Speaker 2 One night, Elise's mother slammed the little girl's head into a concrete wall, killing her.

Speaker 2 Lurid coverage of the case shocked the public and prompted a major shakeup in the city's child welfare system.

Speaker 2 In response, the city hired more caseworkers, beefed up their training, and created a whole new child welfare agency.

Speaker 2 Rudy Giuliani was mayor at the time, and he encouraged caseworkers to remove kids from the the homes when there was any question about their safety. A kind of better safe than sorry approach.

Speaker 2 Better to risk an unnecessary removal than to risk another child's death. Caseworkers even had a slogan for it.
When in doubt, pull them out.

Speaker 2 So that was the mood in New York when Dr. Jensen began working on child abuse teams at two hospitals in Queens.

Speaker 4 I would not say I was initially drawn to the field of child abuse pediatrics. It kind of fell in my lap.

Speaker 2 Again, I haven't spoken to her, but this is from a 2023 podcast interview Dr. Jensen did about shaken baby syndrome.

Speaker 2 She's nearly 70, a known figure in the field of child abuse pediatrics, a regular speaker at conferences.

Speaker 2 In this podcast interview, talking about her early career, she comes across as frank and confident.

Speaker 4 And then I just... fell into the role.
But as I fell into that role as my responsibility, I found that I really, I can't say I enjoy child abuse. Of course, no one enjoys child abuse.

Speaker 4 But basically what I'm saying, it's never boring. Child maltreatment and evaluation of children who have been victims is just never boring.

Speaker 2 Back when Dr. Jensen started, she was a general pediatrician.
She said at her hospital, they had a team who worked on possible cases of child abuse.

Speaker 2 If a child came in with suspicious bruising or bone fractures, that case would get flagged and an assortment of doctors, nurses, and social workers would assess to see if it was a case of abuse.

Speaker 2 A spot on the team could have gone to Dr. Jensen's boss, but then.

Speaker 4 He said, okay, I don't want to do this, so you do this. And so basically, he sent me to every American Academy of Pediatrics training involving child abuse.

Speaker 2 Soon, Dr. Jensen was being asked to give her medical opinion in case after case.
Ultimately, more than 100 cases during her time in New York. And sure, that was her job.

Speaker 2 But according to people who knew Dr. Jensen during her New York era, it's fair to say that even in this better safe than sorry atmosphere, Dr.

Speaker 2 Jensen gained a reputation, not just for vigilance, but for excessive vigilance.

Speaker 2 As one pediatrician who worked on some of the same abuse cases as Dr. Jensen told me, she felt like she had to, quote, save the children.

Speaker 2 At least five different New York families ended up suing her in state and federal courts. A sixth family named her, but didn't sue her directly.

Speaker 2 The lawsuits claimed malpractice or that she'd misdiagnosed their children. A couple examples.
There was the baby with a burn on her chest that doctors thought was chemical, but Dr.

Speaker 2 Jensen argued was thermal. Thermal burns are more likely to be abusive.
And the baby was separated from the family for two months.

Speaker 2 There was the sick infant who died due to injuries Dr. Jensen said were abusive.

Speaker 2 His parents were barred from his bedside during the last days of his life, and their other child was removed for nearly three months.

Speaker 2 An autopsy later revealed the baby suffered from a rare heart defect.

Speaker 9 She found child abuse where no other doctor found it, and she went way beyond what other doctors did.

Speaker 2 That's David Lansner, a family law attorney in New York, who represented some of these families. To be fair, Lansner's claims against Dr.
Jensen in particular weren't successful.

Speaker 2 Still, he came away from these lawsuits with the strong impression that Dr. Jensen was too quick to find child abuse.

Speaker 9 New York City caseworkers knew that she was a zealot, what's one of the words that they used in describing her, and yet they would accept her analyses instead of saying, let's get a second opinion.

Speaker 2 You've heard caseworkers describe her as a zealot? Yes. Wow.

Speaker 9 Yes, and there have been printed decisions about Jensen.

Speaker 9 I don't know if you've seen those.

Speaker 2 I have seen those. They're opinions not from Lansner's lawsuits, but from family court judges in New York City who were ruling on different cases.
Dr.

Speaker 2 Jensen testified frequently as a medical expert in family court cases. We don't have recordings from these cases, but from listening to Dr.

Speaker 2 Jensen in interviews, that podcast on shaken baby syndrome, for instance, I can imagine her confidence on the stand.

Speaker 2 In these opinions, one from a Kings County judge and two from judges in Queens County, the way they write about Dr.

Speaker 2 Jensen, you definitely get a sense that they found her headstrong, let's say, not afraid to go it alone. And also, that they think she's an unreliable expert.

Speaker 2 In 2009, one judge noted that three other experts in a case diagnosed a child with a form of meningitis, while Dr. Jensen diagnosed shaken baby syndrome.
The judge agreed with the other experts.

Speaker 2 In a 2005 case, a judge called Dr. Jensen argumentative and defensive, said Dr.
Jensen rejected alternative medical opinions, came to questionable conclusions, and seemed to overstep her expertise.

Speaker 2 Quote, The court takes note of the fact that Dr. Jensen is a pediatrician, not a psychiatrist or psychologist or qualified social worker.

Speaker 2 Also in 2005, a judge found Dr. Jensen's diagnosis in a different shaken baby case of a three-month-old overwhelmingly wrong and called Dr.
Jensen unreasonably judgmental.

Speaker 2 Another doctor testified in that same case, a pediatric neurologist named Dr. Ram Khiram.

Speaker 2 The judge found him, quote, highly competent and quote, clearly much more knowledgeable in the area of childhood brain diseases than Dr. Jensen I called him to see if he remembered the case and Dr.

Speaker 2 Jensen

Speaker 2 what a blast from my past

Speaker 2 he did remember

Speaker 2 I kicked myself and I said Chiram you wished you had more balls

Speaker 2 because I should have attacked her more publicly for what she had done at that time.

Speaker 2 Dr. Khiram didn't remember exactly how many times he appeared for the defense in shaken baby cases.
This would have been well over a decade ago.

Speaker 2 But he thinks at least a dozen and more than half of those cases, he said, involved Dr. Jensen.

Speaker 6 Well, clearly, she was judgmental too quickly and arrogant.

Speaker 11 She was not willing to listen to additional explanation.

Speaker 9 And

Speaker 6 she held a powerful position.

Speaker 11 Therefore, in my opinion, she should have spent a little bit more time

Speaker 11 asking for neuroradiology opinion, call the neurosurgeon in to say, hey, what do you think it is? And ask the neurologist. She did not do that.

Speaker 2 Dr. Khiram told me, working on these cases, he'd sometimes ask himself, wait, am I being fair? Am I just being a zealot for the defense? So he'd be extra cautious, he said.
But he felt like Dr.

Speaker 2 Jensen, she never seemed to have doubts.

Speaker 6 She was

Speaker 11 confident of her judgment.

Speaker 11 She did not know how much science she did not know.

Speaker 2 I asked David Lansner, the attorney who filed multiple lawsuits, what he made of the judges' opinions, why he thought they went into such detail about Dr. Jensen.

Speaker 9 I think they went beyond because they wanted to warn other judges about it.

Speaker 2 About Dr. Jensen.

Speaker 2 Whatever the message, it didn't seem to penetrate beyond the courthouse. And Dr.
Jensen's career did not seem to suffer. In fact, her career would flourish.

Speaker 2 Because during Dr. Jensen's tenure in New York, there was a movement afoot to give experts like Dr.

Speaker 2 Jensen more clout in hospitals, to make them not just an expert, but the medical expert when it comes to determining whether an injury is abuse.

Speaker 2 A small group of doctors was arguing that child abuse research had outpaced what a general pediatrician could be expected to know, and that hospitals needed a specialist on hand, preferably someone who could give expert testimony in court.

Speaker 2 The American Board of Pediatrics agreed, and a new subspecialty was born, the child abuse pediatrician, or CAP.

Speaker 2 Dr. Jensen was among the first to take the board certification test and pass.
CAP credential in hand, she left New York to take over a new team at a new hospital down in Florida. Where, well,

Speaker 2 you'll see.

Speaker 2 That's after the break.

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Speaker 2 In 2011, Jesse Santiago brought his four-month-old son to Shannon's hospital in Gainesville, Florida. The baby had been vomiting for days.

Speaker 2 Jesse and his wife had already taken him to the emergency room once because of the vomiting, and his exam there was normal. The hospital thought, maybe the flu.

Speaker 2 The baby's primary care doctor also took a look and thought, maybe an allergy to the formula. The family went home, got new formula.
But Jesse says, a few days later, the baby was still sick.

Speaker 17 Didn't want to eat much.

Speaker 17 My sister-in-law was feeding him, and then she started noticing that he started to throw up, and then

Speaker 17 his eyes just started to roll, like just start rolling around.

Speaker 2 It was the baby's right eye, and it was crossing inward toward his nose.

Speaker 17 And so we panicked, and we brought him a chance

Speaker 2 emergency room doctors did a head ct and saw a collection of fluid behind his eyes the fluid had built pressure on his brain enough so that the soft spot on the top of his head where his skull had not yet formed was bulging doctors told jesse his son needed emergency surgery We're trying to figure out like

Speaker 17 what's going on because one hospital says that he had the flu and then this hospital saying that he has to have surgery for some reason, you know.

Speaker 2 How did you feel?

Speaker 17 I don't know, just like confused and just shocked, like, you know, what's what's going on, like, why, like, what happened, you know?

Speaker 2 Luckily, the surgery went well, and the baby recovered. But Jesse and his wife couldn't leave just yet.
Because the doctors had questions, namely, what caused this fluid in Jesse's son's son's brain?

Speaker 2 No one could say for sure. A radiologist suspected the baby's condition might have been caused by abuse, but a neurosurgeon thought there might be a different explanation.

Speaker 2 They had ordered an MRI to get a more detailed picture.

Speaker 2 Meanwhile, the case was referred to the hospital's child protection team, headed by Dr. Jensen.
She'd been at Shannon's for about a year by then, as medical director of the team.

Speaker 2 Jesse and his wife were both interviewed, separately, by Dr. Jensen and a case coordinator on her team.

Speaker 2 At the conclusion of her exam, based on the existence of the fluid on the brain and the lack of an explanation for what caused it, Dr.

Speaker 2 Jensen wrote that the findings are, quote, consistent with abusive trauma.

Speaker 2 The hospital ran a couple more tests to look for other symptoms commonly associated with abusive head trauma, but those came back normal. No eye injury, no bone fractures.

Speaker 2 The MRI came back too, the one doctors had been waiting on, and it showed no evidence of blood in the brain, which can be an indicator of abuse.

Speaker 2 But the surgeon's notes had mentioned a bit of blood-tinged fluid, and it was Dr. Jensen's opinion that no blood in the brain at the time of the MRI did not mean there was never blood in the brain.

Speaker 2 It could have cleared up by the time they did the MRI. or during surgery, she said.

Speaker 2 So Dr. Jensen held firm.
This was a clear-cut case of abusive head trauma.

Speaker 2 But was there really enough known to make that call?

Speaker 2 We spoke to the pediatric neurosurgeon who operated on Jesse's son 14 years ago. He told us that Dr.

Speaker 2 Jensen mischaracterized his notes, that the blood in his report referred to blood caused by the incision during surgery.

Speaker 2 We also spoke to an outside forensic pathologist unaffiliated with the case and to two different child abuse pediatricians.

Speaker 2 All four doctors reviewed the baby's medical file, and the one thing they agreed on: this was in no way a clear-cut case of abusive head trauma.

Speaker 2 Both caps agreed the case was definitely gray, one called it as gray as it can be, and both said the literature did not support the degree of certainty offered in this case.

Speaker 2 But Dr. Jensen's diagnosis was certain.

Speaker 2 In the end, she recommended that the baby, quote, be placed in a safe, protective environment until the investigation is completed. In other words, taken away from Jesse and his wife.

Speaker 2 What happened next was swift. A caseworker from Florida's child welfare system took custody of not only Jesse's son, but of his daughter too, a toddler.
Dr.

Speaker 2 Jensen had examined her and found 28 bruises. She was an active kid for sure.
That was noted in her file, quote, extremely active. But Dr.
Jensen thought some of the bruises were suspicious.

Speaker 2 The sheriff's department opened an investigation. After all, a diagnosis of abusive head trauma implies a perpetrator, and Jesse was the one home when the baby's symptoms started.

Speaker 2 Jesse was stressed. His kids were placed with relatives, but he assumed that would be temporary.
And that's when Jesse says their lawyers gave them what sounds like horrible legal advice.

Speaker 17 They started talking about,

Speaker 17 you know, order for this to kind of, you know, stop and nobody will be charged and stuff like that

Speaker 17 uh

Speaker 17 it would be best to sign our rights over

Speaker 17 well we didn't know nothing about that like you know who to sign rights over we don't know how to

Speaker 17 what to do or anything like that so

Speaker 2 was this the termination of parental rights yes for the two

Speaker 2 I was shocked when I heard this. The termination of a parent's rights is what's known in family court as the civil death penalty.

Speaker 2 I'm really still trying to wrap my head around that. It's such an extreme measure to happen so quickly.
At the time, did you understand that it would be permanent?

Speaker 17 I don't know.

Speaker 17 We didn't know nothing about it.

Speaker 17 We thought it was probably just something

Speaker 17 short period kind of deal. We didn't know it was going to be for good.

Speaker 2 After Jesse signed the paperwork, he no longer had any rights to his kids. No right to see them, no right to make any any decisions on their behalf.

Speaker 2 Six months later, he found out he was being criminally charged with aggravated child abuse, a first-degree felony. He was arrested and put in jail to await trial.

Speaker 2 While there, Jesse got a new lawyer who looked into Dr. Jensen's work history and sent Jesse what she found about the lawsuits, the judges' opinions from Dr.
Jensen's time in New York.

Speaker 2 Jesse could hardly believe it.

Speaker 17 Because it wasn't just one or two, it was was just so many, you know, papers of just different cases.

Speaker 17 I'm looking, I'm like, these are real cases.

Speaker 17 And I'm like, wow.

Speaker 12 Like,

Speaker 18 how's this person keep going?

Speaker 2 After 14 months in jail, Jesse agreed to pre-trial intervention, meaning he'd be on supervised release for another year.

Speaker 2 If he complied with all the conditions of the release, the assault charge against him would be dropped. And that's what happened.
So from first-degree felony to nothing, essentially.

Speaker 2 His lawyer's still pissed about it. She told me she thinks Jesse never should have been arrested, never mind charged.

Speaker 2 While he was in jail, his wife divorced him. I did try contacting Jesse's ex-wife for this story, but got no response.
Jesse's remarried now and has stepchildren. His own kids live 40 minutes away.

Speaker 2 He ran into them just once. Brandy, his current wife, told me about it.

Speaker 19 We were shopping. We were school shopping for our kids.

Speaker 2 For back to school. Back to school.
They were in Walmart in the shoe aisle when his ex-wife and the kids walked by. His daughter and son, they were looking at Jesse.

Speaker 19 So now they're peeking around and he's holding a pair of child shoes.

Speaker 19 And immediately, like you could see,

Speaker 19 he kind of

Speaker 19 changed. His whole demeanor just, like, almost defeated.

Speaker 17 My body just felt like it froze, like, seeing them. Like,

Speaker 17 I don't know, just felt funny inside, like, nerves and

Speaker 17 emotions and stuff like, like.

Speaker 2 It wasn't clear whether the kids recognized him. No one spoke.
The main thing Jesse remembers is how big they were. They'd been taken away so long ago.

Speaker 17 She was... She's a lot taller now.

Speaker 17 They're grown up.

Speaker 2 The moment probably lasted a few seconds. Jesse put the shoes he was holding in the shopping cart, and then they left.

Speaker 2 Dr. Jensen's not the one who told Jesse to relinquish his parental rights.
She's not the one who left him in jail for more than a year on charges that never materialized.

Speaker 2 What she does is make a diagnosis, a finding. And there are those within the field of child welfare who respect her work.

Speaker 2 We spoke to a former sheriff in Florida who told us she was impressed by Dr. Jensen and found her to be direct and knowledgeable.
A forensic pathologist, also from Florida, said she thought Dr.

Speaker 2 Jensen was very, very passionate about her work and importantly, had a sense of urgency about alleged child abuse cases and felt that law enforcement and the courts, quote, moved way too slow.

Speaker 2 In reviewing court records from Dr. Jensen's decades-long career, it's clear there were multiple times Dr.

Speaker 2 Jensen was responsible for accurately identifying abuse and, one hopes, saving kids from future harm.

Speaker 20 I think she's one of the best child abuse pediatricians in the country.

Speaker 2 This is Dr. Randall Alexander, who was Dr.
Jensen's boss in Florida. In fact, he says he recruited her for the job at Shan's hospital.

Speaker 2 At the time, he was in charge of all the child protection teams across the state, and he reviewed all of Dr. Jensen's cases for the first six months.
Dr. Alexander doesn't remember Jesse's case.

Speaker 2 It happened after that six-month review period. But he said he never saw a diagnosis of hers that he disagreed with.

Speaker 20 Everything she wrote, I looked at and edited and everything, and I couldn't find anything. She did great work.

Speaker 20 We would joke about it, I said, Deb, someday, if there's a case where I think you're wrong, I'm going to tell you that. I don't have a problem with that whatsoever.

Speaker 20 And I never had that case.

Speaker 2 Child abuse pediatrics is a small subspecialty. There are only about 350 practicing CAPs across the country.
Dr. Alexander's been at it a while and is influential in the field.

Speaker 2 He's published articles and books. He lectures at medical conferences.
So I wanted to ask him, how does he reconcile all the complaints levied at CAPS? Because they do seem to get a lot of complaints.

Speaker 2 An organization called the Family Justice Resource Center, which helps families who say they've been falsely accused of child abuse, they've logged complaints against more than 120 CAPs in 43 states.

Speaker 2 Dr. Jensen, she's in the top five.
And there are CAPs who have records similar to Dr. Jensen's and who've also been sued in at least half a dozen states.

Speaker 2 Dr. Alexander told me he doesn't take complaints all that seriously because of course we get complaints.
First off, caps have to testify in court all the time.

Speaker 2 So they're the face of abuse allegations. And also, you're accusing people, parents, of hurting their own kids.
Nobody's going to thank you for that.

Speaker 2 So child abuse pediatricians get picked on, he said, disproportionately.

Speaker 20 I'm sure I've had complaints

Speaker 20 and

Speaker 20 they've never launched a formal investigation on me but who knows maybe tomorrow you don't run that risk when you're doing cardiology so much and I would also point out that and picking on cardiology if cardiologists makes a diagnosis they don't get challenged about is their diagnosis right or wrong but we do

Speaker 20 by others it's not a completely compare comparable thing but there's a certain degree to which when you do this field you have to be prepared that

Speaker 20 that social services and the courts believe believe that they're

Speaker 20 as good at some of the things that we consider a little more medical.

Speaker 2 Caps do seem to feel embattled, I'd say. I noticed it at a shaken baby syndrome conference that I attended in Utah last year.
There was an us versus them atmosphere.

Speaker 2 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, the media.

Speaker 2 That battle, Dr. Alexander Alexander said, is real because child abuse is actually underreported, vastly underreported, he said.

Speaker 20 We're looking at the tip of an iceberg, and we're never under any illusion we're seeing the whole iceberg.

Speaker 20 You know, some estimates that would put you in the 40% of all adults in the United States have had some sort of

Speaker 20 bad child abuse experience. Some estimates are a little higher or lower.

Speaker 20 Child abuse is more common than ADHD or asthma or a lot of those things.

Speaker 20 And

Speaker 20 it's not as common maybe as diaper rash or sore throats or earaches, but child abuse is 40% or so.

Speaker 2 But not of the general population.

Speaker 20 Or the general population. Really?

Speaker 21 Yeah.

Speaker 2 That's high. That's almost one in two children.

Speaker 21 Yeah.

Speaker 20 It's a common human condition. We always treat it like it's special and it doesn't happen, but it does.

Speaker 20 And there's lots of studies on that.

Speaker 2 I don't know where Dr. Alexander got this 40% child abuse stat.
I emailed asking for the studies he was thinking of, but he didn't get back to me.

Speaker 2 My best guess is that he was referring to this one study published a decade ago in JAMA Pediatrics.

Speaker 2 It used data from the National Survey of Children's Exposure to Violence, and it found that 38.1% of adults reported experiencing maltreatment during childhood, which is high.

Speaker 2 But importantly, maltreatment is a broad term that in this survey includes emotional abuse, neglect, and custodial interference.

Speaker 2 For physical abuse specifically, the study's findings are nowhere near Dr. Alexander's number.
It's much lower at 18%.

Speaker 2 In fact, none of the experts we talked to could point to a study showing 40% of children in the U.S. are victims of child abuse.

Speaker 2 One CAP told us, quote, not every child has what we would consider an idyllic childhood, but that doesn't mean that close to half of them were abused.

Speaker 2 In reporting this story, my team and I have spoken to 11 different child abuse pediatricians across the country, Dr. Alexander included.

Speaker 2 And I want to be clear, the work that CAPS are asked to do is important and can be life-saving.

Speaker 2 They have medical expertise that caseworkers lack, and they can help identify abusive injuries in many cases.

Speaker 2 They can also identify when cases aren't abuse and act as a safeguard against unnecessary removals.

Speaker 2 The problem is this, many cases fall into a kind of gray area and are harder to diagnose. And some CAPs meet these cases with more certainty than the science supports.

Speaker 2 It's not just me saying this, it's other caps too.

Speaker 2 Some caps we spoke to were critical of those in the field who were quote, exceedingly dogmatic in their approach and in their opinions, too quick to diagnose abuse.

Speaker 2 They worry that this cowboy approach, as one cap put it, could give the field a bad reputation, which could make people skeptical of CAPS even when they make genuine findings of abuse.

Speaker 2 They say it's the job of CAPS to stay up on the science as it evolves, and it has evolved. There's been a deluge of studies about how to diagnose abusive injury.

Speaker 2 The problem, multiple CAPS told us, is that the science has advanced away from certainty in some cases.

Speaker 2 To where some injuries once thought to be definitively abusive, studies now show can be caused by accident.

Speaker 2 And not all child abuse pediatricians seem to be allowing for that, which, some caps say, can and does lead to overdiagnoses of abuse.

Speaker 2 And medical certainty that an injury is abusive is shown to be highest when diagnosing children from poor families and families of color.

Speaker 2 One CAP even acknowledged that, yes, innocent parents do get swept up in the system.

Speaker 2 Another said there were cases in the past where they testified saying this was abuse, but they're no longer certain. Definitely, this CAP said.
I think about it all the time.

Speaker 2 Which is why the system isn't built for the CAP to be the be-all-end-all of the child welfare system.

Speaker 2 In fact, nearly every child abuse pediatrician I spoke to, including Dr. Alexander, stressed this point.

Speaker 2 CAPs don't work alone. Even within hospitals, they don't make abuse findings alone.

Speaker 20 Remember, I have a team of people around me.

Speaker 20 So it's not hardly like I'm doing this in a desert island by myself. Right.
Um,

Speaker 20 and so maybe that's a check and balance, you know, that helps us.

Speaker 2 And anyway, he added, it's not like caps are responsible for separating families. That's what social services and the courts do, he said, not caps.

Speaker 2 What I was learning, though, was that when it came to some of Dr. Jensen's cases, those checks and balances sometimes broke down.

Speaker 2 That's after the break.

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Speaker 2 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.

Speaker 2 Jensen before a family was affected by a separation, an attempted check on her power. The case was from 2012, or maybe late 2011.

Speaker 18 If it wasn't football season, it was just after, so it may have been like late fall, early winter, somewhere in that range.

Speaker 2 That's Andrew Caswell, a former caseworker in Gainesville for Florida's Department of Children and Families. He was a few years into the job.

Speaker 2 His cubicle was decorated with Justin Bieber and Carly Ray Jepson posters. His full title was Child Protective Investigator.

Speaker 2 When a report came in about suspected abuse or neglect, Andrew would go investigate and then decide whether the child could stay in the home or need it to be removed.

Speaker 2 So one day, Andrew got assigned to a case.

Speaker 2 And football season is the memorable detail for him because it was about a high school football player, a teenager who had been complaining of pain in his knees, shoulders, elbows.

Speaker 18 I'll be honest, I read the allegations and I thought nothing of it.

Speaker 2 A report had come through that the child was being abused by his mother. So Andrew had to make a home visit, get eyes on the child.

Speaker 18 When I showed up at the house, they were very surprised to see DCF at their doorstep.

Speaker 2 Andrew interviewed the child about his pain, which had been going on for months. He'd already been to the emergency room a few times.

Speaker 18 He said that it was unbearable. He said that he asked his mother to take him to the doctor every time he went.

Speaker 18 She brought them or she brought him to the emergency room at either Shands or North Florida Regional, which are both hospitals in Gainesville. And

Speaker 18 at the hospital, the child presented with pain,

Speaker 18 you know,

Speaker 18 pain that he couldn't describe other than where it was located. The hospital conducted the tests that they felt were necessary.

Speaker 2 Andrew remembers that those tests, which took place over the course of multiple visits, included blood draws, x-rays, one or two CT scans, and one or two MRIs.

Speaker 2 Unfortunately, the tests didn't help explain or address the pain. Looking at the case, Andrew thought, maybe it's growing pains.
The child was something like six foot three.

Speaker 18 And I'm not saying that I wasn't concerned for the child. I was.
I just didn't feel that it was abusive. I felt that this child was just experiencing pain.

Speaker 2 Andrew also noted that it wasn't just the mother at home, but the grandmother too, and a younger brother. For Andrew, the more eyes on the child, the better.
More people to interview.

Speaker 18 Grandma had no concerns, brother had no concerns, victim had no concerns.

Speaker 2 Andrew says he contacted the boy's father. The parents were not together.
And he had no concerns about the mother. For Andrew, it was open and shut.
No abuse here.

Speaker 2 But because the case involved physical symptoms, state law required Andrew to refer it to the hospital's child protection team, headed by Dr. Jensen.

Speaker 18 I thought they would decline to see the kid because of what I told them when I explained the case to them. I thought they would just decline it.
They didn't.

Speaker 18 When they screened it, they wanted to see him. So we brought him in.

Speaker 18 Dr. Jensen did a medical exam on this child.

Speaker 18 And after reviewing his medical records that she saw in the system, and based on what she saw, she diagnosed him.

Speaker 18 I'm sorry, she diagnosed munchausen by proxy and had the mother as the alleged perpetrator

Speaker 2 to remind you munchausen syndrome by proxy is a rare psychological condition popular in tv miniseries rare in real life i couldn't for the life of me figure out

Speaker 18 where she saw abuse I felt that the 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.

Speaker 18 I would imagine that if at 10 p.m. my 15-year-old comes to me and is in absolute agony, I'm going to take him to the ER.

Speaker 18 I'm not going to wait until the next day to go to my doctor or try to schedule a visit of my pediatrician.

Speaker 18 I think that in this case, the mom did what she had to do to get medical attention as soon as possible for her son.

Speaker 2 Crucially, or at least it should have been crucial, Dr. Jensen wasn't the decider here.
Andrew was. He was the investigator.
He was the decision maker.

Speaker 2 He could either verify the abuse allegations, recommend the child be removed from his home, or he could choose not to verify.

Speaker 2 Andrew told me caseworkers almost never went against the findings of the child protection team, and he'd had no problems with Dr. Jensen in the past.

Speaker 2 But in this case, he fundamentally disagreed with her diagnosis, thought it was irresponsible even, because again, he saw no evidence of child abuse. So he decided not to verify the case.

Speaker 2 After the exam, the child went back home, and Andrew went back to his office, back to his cubicle, sat next to Bieber, and contemplated his next move.

Speaker 2 He knew he'd get questions from his supervisor about why he'd disagreed with the doctor. He worried he'd be overruled.

Speaker 2 Ultimately, Andrew decided the best defense was an offense, so he picked up the phone.

Speaker 18 I reached out to the Inspector General's office. I reported Dr.
Jensen for medical malpractice.

Speaker 2 A meeting with the Inspector General's office was scheduled later that week. Andrew went into it armed with the teen's medical records, ready to make his case.
That Dr.

Speaker 2 Jensen's decision was incorrect and irresponsible, and his decision not to verify should stand.

Speaker 18 I went into that meeting thinking that this Inspector General was going to hear me and was going to side with me and he was going to chastise her and

Speaker 18 that is not what happened.

Speaker 2 Andrew said the meeting took place at the child protection team's office where Dr. Jensen worked.
About a half dozen people sat at a long conference table. While he explained his point of view, Dr.

Speaker 2 Jensen explained hers. The person from the IG's office said he'd get back to them.
But Andrew says he never learned what the IG made of his complaint. He assumes it didn't go anywhere.

Speaker 2 Because in the end, Andrew says his supervisor removed him from the case and the person who replaced him verified the abuse allegation. Andrew can't say for certain what happened to the family.

Speaker 2 After all these years, he doesn't remember the family's name. But he believes they were given in-home services and that ultimately the kids were not removed from their home.

Speaker 2 Less than a year later, he quit working for Florida's child welfare system.

Speaker 2 We did try to find the family. We contacted Andrew's former supervisor several times, but didn't get a response.
Same with the supervisor's boss. No word.
We contacted the Inspector General's office.

Speaker 2 They said they only keep records of complaints going back seven years.

Speaker 2 But we did talk with three of Andrew's colleagues at the time, plus his then-girlfriend, now wife, who were able to corroborate details from his story.

Speaker 2 A couple of people remembered Andrew talking about his call with the Inspector General's office, and one confirmed that he'd been removed from the case.

Speaker 2 And they all remembered Andrew's anger over the case, Specifically, how upset he was about Dr. Jensen's munchausen by proxy finding.

Speaker 2 For Andrew, the IG meeting highlighted the flimsy checks and balances of the system.

Speaker 2 How, even though on paper, he's the one who's supposed to make the call for removal, in practice, it seemed, the CAPS was the only voice that mattered.

Speaker 18 It was almost as if I had no involvement in the case. Like that what I had to say didn't matter.
I was the only person who had met with the mother and spoken to her for any length of time.

Speaker 18 I was the only one who met the grandmother. I met with both children.
I had hours in on this case.

Speaker 18 And there was no concern for that at all. They think that she's a doctor and she knows what she's talking about.

Speaker 18 And it was decided that her findings were accurate.

Speaker 2 You could argue, and many caps do, that it should be hard for a social worker to challenge an allegation of abuse made by a doctor based on a medical finding.

Speaker 2 And if Andrew were the only one complaining, maybe you could dismiss him as a whiner. But it wasn't just Andrew.

Speaker 2 We called around to other caseworkers, investigators who worked in Gainesville at the time, and the stories they shared echoed Andrew's.

Speaker 2 For example, Mary Der Plankenhorn told us about a case where she disagreed with Dr. Jensen's recommendation to remove a baby from its mother.

Speaker 2 Mary told us she refused to testify against the mother in court and was taken off the case.

Speaker 23 It just didn't feel like we were all

Speaker 2 working together for the same reasons. It felt like CPT came, they said what they wanted to say,

Speaker 2 and

Speaker 10 they wouldn't listen or take in what other people were saying.

Speaker 23 It was like

Speaker 8 they were there to kind of flex their muscle.

Speaker 2 Another investigator, Cody Withum, also worked in Gainesville when Dr. Jensen was there.

Speaker 23 Oh, yeah, so I remember that woman.

Speaker 2 He remembered feeling frustrated by his interactions with Dr.

Speaker 2 Jensen and the child protection team because it felt as if, quote, they were always disagreeing with his findings, trying to, quote, run the investigation. He said he interacted with Dr.

Speaker 2 Jensen a few times, and his overall impression was that she didn't like people to question her.

Speaker 2 I feel as if

Speaker 23 whenever someone has that level of power and there's no checks and balances and there's no one that's, you know,

Speaker 23 scrutinizing her decisions. It made me feel as if she

Speaker 23 had free reign.

Speaker 2 Clarkson Cantrell worked at children and youth services at the time, training caseworkers. She said that things under Dr.
Jensen's watch were, quote, a mess.

Speaker 2 Other staff who agreed to talk only if we didn't use their names, citing job and pension concerns, shared similar stories about not being listened to and feeling they were, quote, terrorized by by the child protection team.

Speaker 2 One person said tension among caseworkers mounted over time, that they'd say to each other after validating yet another finding by the child protection team, we are abusing children.

Speaker 2 When I contacted the Gainesville child protection team for an interview, they declined.

Speaker 2 A spokesperson for Florida's Department of Children and Families sent over an emailed statement saying, all findings and recommendations are, quote, discussed during multidisciplinary staffings that are designed to ensure a multifaceted decision-making approach, end quote.

Speaker 2 Dr. Alexander, who'd recruited Dr.
Jensen to come to Florida, told me he knew she'd make waves in Gainesville, hoped she'd make waves. He called her a high-energy person in a low-energy environment.

Speaker 2 She did make waves, though probably not in the way he hoped. Because while Dr.

Speaker 2 Jensen seemed to have support and protection within her profession, I learned that upstream from her, once abuse cases got to higher ups in the child welfare system, that's where her decisions sometimes met with pushback that stuck.

Speaker 2 I spoke with David Abramowicz. He was regional director at the Department of Children and Families at the time and was responsible for all of Northeast Florida, including Gainesville, where Dr.

Speaker 2 Jensen worked. He co-signs what the caseworkers told us about the power imbalance and not being listened to.
He told me that during the four years Dr.

Speaker 2 Jensen worked there, Gainesville gave him the biggest headache.

Speaker 21 Remember, I got a whole region.

Speaker 5 I got all Jacksonville. I got all Daytona.
I was so busy with her kids that Jacksonville, never a problem. Daytona, same thing.
No way, had a great relationship with those doctors too.

Speaker 5 Her, I would just, every week, someone was calling me up, sir, she wants to remove this kid for this. Sir, she wants to remove a kid.

Speaker 17 I'd go, don't remove.

Speaker 2 He couldn't give me an exact number, but he told me he remembers blocking a couple removals during that time.

Speaker 2 Even the local prosecutor remembers how tumultuous the Dr. Jensen years were.

Speaker 2 Bill Servone's retired now, but he spent 20 years as the elected state attorney for Alachua County, where his office regularly prosecuted child abuse cases long before Dr. Jensen was on the scene.

Speaker 2 He told me he was used to getting calls from people pressuring him to prosecute all kinds of cases. Usually the calls were from cops who he felt had gotten too close to a case.
But when Dr.

Speaker 2 Jensen took over the hospital's child protection team, she was the one on the phone, calling his office and pressuring his prosecutors to pursue cases they didn't have the evidence for.

Speaker 24 She and her agency took a very aggressive stance on all cases and that they should go forward. contrary to what we believed the evidence allowed us to prove.

Speaker 2 Bill Servone says he didn't bend to it. He was used to telling people no.

Speaker 2 But he was taken aback. This was beyond her purview, he thought.

Speaker 2 He told me she also lacked nuance, especially in cases that were tragic, but not necessarily criminal, like if a child drowned in a backyard pool or if a baby was left in a hot car.

Speaker 2 He couldn't remember specific incidents, but he said he thought Dr. Jensen didn't consider gray areas, especially when it came to intent.

Speaker 24 And maybe, maybe that's what the bottom line on on your inquiry is, that

Speaker 24 when I say she was aggressive, maybe what I'm saying to you is she was black and white zero-sum.

Speaker 2 In 2014, four years after she arrived in Florida, Dr. Jensen was removed from the team she'd been hired to lead.
After a mother complained about the way her young son was examined by Dr.

Speaker 2 Jensen, She filed a report with Florida's inspector general. The IG didn't find wrongdoing, but Dr.

Speaker 2 Jensen's bosses at the hospital decided she was, quote, not in the right position, and she was reassigned.

Speaker 2 Not long after, she left Florida for good, because it turned out her expertise was in demand elsewhere.

Speaker 25 Former Penn State assistant coach Jerry Sandusky was led away in handcuffs Friday night. A jury found him guilty.

Speaker 2 A few years earlier, there had been an enormous scandal in Pennsylvania. A Penn State football coach, Jerry Sandusky, was convicted of sexually assaulting 10 boys.
By 2014, the same year Dr.

Speaker 2 Jensen was reassigned in Florida, the Pennsylvania state legislature had passed sweeping reforms to its child abuse laws.

Speaker 15 And a set of new laws is now in effect that changes the definition of child abuse.

Speaker 16 Those workers are obligated by law to report any abuse or neglect.

Speaker 2 The new laws significantly increased how many people were now required to report cases of suspected child abuse and increased penalties for failure to report.

Speaker 2 The number of children referred for suspected abuse cases skyrocketed. That's when Dr.
Jensen was brought in as medical director of the Lehigh Valley Child Advocacy Center.

Speaker 2 She was the first child abuse pediatrician the hospital had ever hired.

Speaker 2 And you'll remember what happened next.

Speaker 2 The high numbers of Munchausen by proxy diagnoses, the family separations, Mark Pinsley's report, and the emotional testimonies at the county commissioner's meeting.

Speaker 2 Now, at least 27 families in Pennsylvania are suing Dr. Jensen and the hospital.
Most of those families have gotten their kids back by now. Most, but not all.

Speaker 2 That's next time.

Speaker 2 The Preventionist is hosted, written, and reported by me, Diane Neary. Additional reporting by Ben Phelan and Janelle Pfeiffer.
It's produced by Janelle Pfeiffer and edited by Jen Guerra.

Speaker 2 Additional editing by Sarah Koenig and Anita Battajo.

Speaker 2 Fact-checking by Elizabeth Barber and Ben Phelan. Additional fact-checking by Caitlin Love.
For more reporting from the show, sign up for our newsletter at nytimes.com slash serial newsletter.

Speaker 2 Music Supervision and Mixing by Phoebe Wang. Additional mixing by Catherine Anderson.
Sound design by Jonathan Menhevar and Phoebe Wang. Original music by Martin D.

Speaker 2 Fowler, Dan Powell, and Marianne Lozano. Martin D.
Fowler composed our theme song. Our standards editor is Susan Westling.
Legal review from Dana Green. The art for our show comes from A.

Speaker 2 Mae Hunt and Pablo Delcan.

Speaker 2 The supervising producer for Serial Productions is Ande Chubu. Julie Snyder is Serial's executive editor.
Our associate producer is Mac Miller.

Speaker 2 Additional producing comes from Nina Lossum and Corey Beach at the New York Times. And Sam Dolnick is the New York Times deputy managing editor.

Speaker 2 Special thanks to the doctors who reviewed medical records for this story and to the child abuse pediatricians who shared their expertise with us. And to Pamela Koloff, Dr.

Speaker 2 Johanna Greeson, and Viveg Sankarin.

Speaker 2 The Preventionist is a production of Serial Productions and the New York Times.