One of the occupational hazards of being a lawyer is the family reunion. Or more specifically, being pinned into a corner at the family reunion by a third cousin once removed who, under the guise of needing “legal advice,” wants to regale you to sleep with a convoluted story involving a case of beer, a golf cart, and a bench warrant. (“I wasn’t really driving, you see….”)
A couple weeks ago, I found myself pinned down yet again at such a function. But this woman really needed advice. I was able to offer some – not because I’m a lawyer, but because I’m well versed in true crime – and I only pray she takes it.
I’ll call her Aunt Bea. She’s worried about her son – let’s call him Cousin Jim. (Jim is something else. He’s listened to more short-wave radio than is good for a person, and two tours in Iraq were not helpful.) The story in a nutshell (much, much shorter than Aunt Bea’s version):
Jim came home and met a girl in a laundrymat who is 15 years his junior (let’s call her Susie), and within a few weeks, Susie is pregnant. Then Cousin Dinglefritz – um, Jim - finds out a bit about her background. It seems she had two children taken away by the state not all that long ago. But she blames the troubles on her ex-boyfriend.
Now that Cousin Jim is in the picture, Susie wants to try to get her kids back from foster care, then they’ll have her new baby in July, and they’ll be one big dumb happy family. So Aunt Bea wants me to find a lawyer in her home state who specializes in parental rights cases. Aunt Bea will pay the bill.
I tell her I could look around, and that depending on the circumstances, Susie might be successful. So why were they taken away in the first place?
Well, that’s the weird thing, Aunt Bea says. The social worker said that Susie got much house approximately.
Aunt Bea: Much house approximately. I don’t know.
Me: A housing problem? She can get them back if that’s all there is.
Aunt Bea: No, they had some doctor look at some records. He didn’t even talk to Susie. He just said that she had some kind of disorder. What they really are doing is punishing her for some things that happened years ago. I mean, she was 19 when all this happened. Now she’s 21, for crying out loud. How can they judge her for things that happened years ago?
Me: Well, doctors base their opinions on records alone all the time. It’s called a record review. But what was this disorder – much house approximately – oh – oh, Aunt Bea, did they call it Munchausen’s by Proxy?
Aunt Bea: Yeah, that’s it.
Me: (Slow gasp.) Oh no.
Aunt Bea: What?
Me: Whose records did this doctor review?
Aunt Bea: Well, the kids’ records. E.R. visits and stuff. They said she was taking the kids into the E.R. too much. But kids swallow stuff all the time. My kids did. And just because a mom witnesses a seizure and nobody else does, doesn’t mean that there wasn’t a seizure.
Now, you students of true crime out there, you know why I gasped. You know why Aunt Bea’s confusing story is clanging the alarm bells. You know that there is no worse a diagnosis in a prospective daughter-in-law than Munchausen’s syndrome by proxy, called “MBP” in the literature.
Famous British pediatrician Sir Roy Meadow first named the phenomenon in this article in The Lancet. In the last couple of years, MBP has become extraordinarily controversial. In fact, many say that Dr. Meadow “invented” MBP. Groups like MAMA, Mothers Against Munchausen Allegations, call Dr. Meadow “the inventer of this label/diagnosis.”
Was MBP the “invention” of a quack? Suspicious hospital personnel have videotaped mothers suffocating their children.
In a well-publicized case in 1979, in Houston, an all-woman jury convicted a mother of child abuse when she was caught injecting her three-year-old daughter with fecal bacteria and disconnecting her antibiotics. Doctors who are absolutely convinced of abuse have been known to seize children in the hospital. And in many cases, an ill child’s symptoms disappear when the mother is placed under supervised visitation or upon removal from mother’s “care.”
The very first published appellate decision involving a case of Munchausen’s by proxy came out of California in 1981. In People v. Phillips, the mother, Priscilla Phillips, was convicted of murdering one of her children and endangering the life of the other.
She was the last person anyone would suspect -- a social worker who volunteered for the local child abuse agency!
From the opinion:
By nearly all accounts, Priscilla Phillips was a kind, helpful and loving person, a dutiful wife to her husband and a devoted mother to their two sons, who at the time of trial were nine and six years of age. Highly educated, with a master's degree in social work, she was employed in the Marin County Health and Human Services Department. After the birth of her sons, she turned her attention increasingly to religious and civil volunteer work, and became active in a variety of community organizations. ….
After the birth of her second son in 1973, appellant developed physical symptoms which led to a hysterectomy in 1975. Deeply upset that she could not have another child, especially a daughter, appellant and her husband decided to adopt a Korean infant who had been found abandoned on the streets of Seoul.
They called her Tia. Little baby Tia soon developed many infections. She was repeatedly hospitalized with terrible bouts of diarrhea and projectile vomiting. The doctors were stumped. Lab results showed bizarrely high levels of sodium in the baby’s blood. After repeated hospitalizations, the baby died.
Mom and dad then adopted another baby girl from Korea. Then this baby, Mindy, came to the hospital with the same bizarre symptoms and high sodium levels.
The attending physician, Dr. Taniguchi, was deeply troubled. “Thinking about it as objectively as possible, I realized that these two girls were not related in any way,” he said. “It just seemed incredible that they could even possibly have the same type of problem.”
The doctor and his colleagues began to suspect the child was being poisoned. "Again, I was faced with the puzzling finding of an elevated sodium; and for the first time [I] began to look at it in terms of what was going into the patient and what was coming out of the patient. And, it did not add up. There was much more coming out than was going in."
The next day, one of his co-workers gave Dr. Taniguchi a copy of Dr. Roy Meadow’s article from The Lancet.
Then, from the opinion:
On February 24, around 2:45 p.m., Leslie McCarcy, a pediatric nurse at the hospital, arrived on duty and received a report from Cathy Place, the outgoing nurse. The question of Mindy's formula came up. Appellant was in Mindy's hospital room at the time. According to Nurse McCarcy, "Mrs. Phillips came out to the desk and Cathy asked her if she had made up the formula and Mrs. Phillips said yes, she had. It was in the refrigerator."
The next morning, February 25, the pediatrician on duty checked Mindy's intake and output charts. "I found that indeed, there was a large amount of unaccountable sodium in Mindy's stool and urine. . . . She was losing about five times the amount of sodium she was receiving."
The doctor then went to the nurse on duty and asked her where Mindy's formula was kept. He took a sample of the formula and had it analyzed. The sodium content was 448 milliequivalents per liter. According to the manufacturer's specifications, the sodium content should have been only 15 milliequivalents per liter. The doctor had Mindy's formula replaced and transferred her to the intensive care unit.
Appellant was forbidden to feed Mindy, and was forbidden to visit the child except in the presence of a nurse. She was told that sodium appeared to be the cause of Mindy's illness, and that some sort of laxative salt might be a cause of the diarrhea. Appellant said, "I don't know anything about things like that," and asked what the doctor was going to do. When he told her that under the circumstances it was his obligation to call the Child Protective Services, appellant became downcast and said, "Then I'll be a suspect."
And she sure was. As soon as Mindy was taken from her mother’s care, she made an immediate and full recovery.
The prosecutor’s expert testified (over the defense objection, based on part on the fact that he never spoke to Mrs. Phillips) about the syndrome suffered by Mrs. Phillips: "The mother will flourish on the ward. She seems to almost to blossom in the medical drama of the hospital. . . . The concern, competence and intelligence of these mothers . . . makes it hard for the doctors to suspect them as the possible cause of their child's illness. . . . When the mother is confronted with evidence that she in fact is responsible for the illness, [she] cannot accept responsibility, even when the evidence is incontrovertible. . . . The literature describes some mothers who are frankly psychotic. . . . But a great number of mothers who do this to their children are not overtly mentally ill."
The article that Dr. Meadow wrote was key to uncovering the murder and attempted murder committed by Mrs. Phillips. But the truth is that this phenomenon was known before he wrote the 1977 article.
In April 1976, the British Medical Journal published an article by Rogers, et al., entitled Non-accidental poisoning: an extended syndrome of child abuse. The authors, physicians, psychiatrists and researchers at the Hospital for Sick Children and the poisons unit at Guy's Hospital in London, reported in detail six cases of nonaccidental poisoning of children by their parents. One of these involved a trained children's nurse who had administered small doses of salt to her two-month-old infant in her daily feeds. Referring to earlier studies involving such phenomena, the authors cautioned: "This manifestation of child abuse may be commoner than previously supposed."
And back to Aunt Bea. And Cousin Jim. And Susie. Hopefully Aunt Bea will heed my advice: don’t hire her a lawyer. The state will appoint one. And probably pay for some experts, too. And do tell the social worker that she’s expecting. There is a loving set of mother’s arms waiting for that little baby, but it’s probably not her biological mother’s arms. That’s the last place anyone would want their grandchild to be.
For more interesting reading about Munchausen’s, see: Injustice Busters on Munchausen (this is an interesting website devoted to the stories of people who are wrongfully convicted; it calls Dr. Meadow a “Dangerous UK Quack”.)
I found very moving and compelling this account of a Munchausen’s by proxy survivor.
The FBI Law Enforcement Bulletin On Munchausen’s by Proxy : “High risk of injury or death exists while a child remains in the care of the perpetrator.”
There are a few true crime accounts involving this syndrome, with a noteworthy contribution to the subject made by Gregg Olsen in his book Cruel Deception. Another interesting book is Sickened : The Memoir of a Munchausen by Proxy Childhood by Julie Gregory.