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Blame Mom by Proxy
November 5, 2007 permalink
Diana Owen took her sick baby to the hospital repeatedly. Instead of finding the problem with the baby, the doctors diagnosed the mother with Munchausen Syndrome by Proxy and social services put the baby in foster care. It is a convenient way for doctors to dispose of difficult cases. Even after the baby's symptoms persisted in the foster home, child protectors continued to harass the family for a year.
The article says Munchausen is rare, but goes on to say that one hospital reported ten cases in a year. Multiply that by the number of hospitals to see that accusations of Munchausen are not at all rare.
The American elite press is now following the British press and reporting on child protection from the innocent parent's point of view. The Boston Globe is owned by the New York Times.
A mother's battle to be believed
After diagnosis, woman fights doctors and DSS for daughter
Diana Owen had not slept in days when the hospital staff summoned her to a meeting down the hall from her baby's room.
Four-month-old Bryanna-Rose had spent more than a week in Hasbro Children's Hospital in Providence for tests and observation. Owen had told doctors her daughter's projectile vomiting was getting worse, the contents of her stomach drenching her mother's clothes. While sleeping, the mother had said, the child sometimes skipped breaths. Owen worried that her only child might die of an undiagnosed condition.
But some doctors and nurses had dismissed her as a jittery first-time mother, she recalled. One nurse had rolled her eyes when Owen worried aloud, she said. Owen had responded angrily, telling some staff she used to work as a health aide and was not overreacting.
"I do not have New Mom Syndrome!" she once snapped.
As the 38-year-old mother from Fall River walked into the meeting room on June 26, 2006, Owen noticed all eyes on her.
A half-dozen people, seated in a lounge area, announced their conclusions: Bryanna-Rose had no symptoms if her mother was out of the room. The child would remain in the hospital without Owen present. The baby would be placed into the protective custody of the Massachusetts Department of Social Services.
Owen came to the chilling realization that she was being accused of making up - or even intentionally causing - her daughter's ailments. From her healthcare background, she had heard of the diagnosis the doctors pinned on her: Munchausen by Proxy, a rare mental disorder in which caretakers fabricate or induce illnesses in their children to gain attention from doctors.
She could not believe it. She knew some medical staff had seen her daughter's symptoms - and taken notes. Through sobs, she pleaded, "You can't take my baby!"
Owen was escorted by security out of the hospital. As she left, she kept telling herself: I will get my baby back.
This marked the start of one mother's odyssey to prove her sanity, a task that would require painstaking persistence as authorities clung to their original judgment of her. It is a case where hunches about Owen's mental state rapidly escalated into near-certain conclusions, and contradictory evidence was ignored, medical records show. On multiple occasions, hospital staff recorded seeing the very symptoms that Owen was accused of fabricating, yet they continued to disbelieve her.
In the coming months, even when three mental health specialists would question the agency's assumptions about her, DSS would maintain its view that Owen was unfit to be alone with her child.
Hasbro and DSS officials defended their actions against Owen, saying they had a duty to protect a baby from a mother whose repeated false reporting about symptoms triggered unnecessary testing.
At the center is a loosely defined and disputed disorder. Some psychologists say Munchausen by Proxy is an underdiagnosed condition with serious, sometimes deadly, consequences. Typically, mothers are accused, their drive for attention so intense that some even poison their children. Many of these mothers have backgrounds in medicine, helping them fool doctors.
Other psychologists say the disorder - named after an 18th-century German baron who exaggerated his military exploits - is overdiagnosed and applied to mothers who simply clash with their doctors over the seriousness of their child's condition.
Eric Mart, a New Hampshire psychologist, has testified nationwide in defense of mothers accused of this disorder: "All you have sometimes is an overanxious Mom," he said.
A happy addition
Owen calls Bryanna-Rose her "miracle baby," conceived after she and her husband, Robert, assumed they would be childless. Owen suffered from polycystic ovarian syndrome, which often causes infertility. But after ovarian surgery a few years ago, Owen happily learned she was pregnant. On Feb. 16, 2006, she delivered a healthy baby in Orlando, Fla.
Owen had yearned for her own happy family. The youngest of 10 children, she has many bitter memories of growing up in a working-class family in Fall River. She remembers being sexually abused by a relative. In her 20s and having barely graduated high school, she supported herself through low-wage jobs. Her first marriage ended in divorce, and she was twice treated for depression. Marrying Robert, and having a baby with him, seemed too good to be true.
The euphoria over Bryanna-Rose's birth soon gave way to alarm over her frequent vomiting, with the baby's lips sometimes turning blue. She also seemed to skip breaths while sleeping. But doctors ruled out anything serious. In May 2006, with her husband busy finishing school to become a marine technician, Owen left him in Orlando to show off their daughter to relatives.
In Fall River, Owen's concerns about her baby grew. Twice, Owen and family members took the baby to the emergency room of nearby hospitals. Doctors said the baby had gastroesophageal reflux, a relatively harmless condition that she probably would outgrow. They suggested nonmilk formulas to reduce the vomiting and ordered follow-up tests, which came back normal.
On June 16, after Bryanna-Rose had an intense bout of vomiting, Owen's older sister suggested they drive to Hasbro's emergency room. Bryanna-Rose was admitted for yet more tests.
Early on, staff at least once witnessed projectile vomiting, and on another occasion blueness, or cyanosis, around the lips, according to medical records that Owen provided to the Globe.
On June 22, a nursing student also observed an episode of the baby "not breathing with eyes becoming red and becoming blue around the lips," though the student noted no troubling drop in blood oxygen levels.
Despite those notations, the medical staff on that same day began to raise concerns about Owen's mental state. Owen had reported that her daughter's eyes had become fixed for about a minute, prompting a neurological examination that found no serious problem. The three-page report on the exam ended with the suggestion that the problem might be with Owen: "(?) Munchausen by Proxy," it said.
The next day, Owen was asked to undergo a psychological evaluation. The staff member who questioned her said the mother presented an "inconsistent and fantastic history," including recounting heroic roles in aiding foster children and giving conflicting dates for past events.
Over the next few days, Owen was alternately open, then suspicious. At times, she angrily demanded to know why staff questioned her credibility, once telling a nurse she thought a skeptical doctor was an "ass." She initially concealed her past treatment for depression.
"Everyone is asking me a lot of weird questions," Owen told a nurse, according to the records.
Allegations of abuse
In fact, the hospital's child-protection program had opened a file on Owen, and on June 26, just hours before Owen would be escorted away, the staff filed a suspected case of "medical child abuse" with DSS. Of the 700 cases the hospital refers to state authorities each year, about 10 are related to Munchausen by Proxy.
Dr. Carole Jenny, director of Hasbro's child-protection program, said hospital staff treated Owen with respect, but over time, "we had reasons to believe we couldn't trust her."
Owen came under scrutiny when, on numerous occasions, she reported her baby having symptoms that "no one else" observed, said Jenny, who agreed to a Globe interview with Owen's consent. When told about records confirming some of the baby's symptoms, Jenny said they were considered "clinically insignificant."
Hospital staff also examined the baby's prior medical records, and concluded that a healthy baby was becoming the victim of many unnecessary tests.
After Owen left the hospital, however, Bryanna-Rose remained for 10 more days and continued to have symptoms, according to records. Hasbro staff recorded vomiting or mouthfuls of spit-up about a dozen times, as well as several occasions when they noticed the girl's lips were blue.
Yet the hospital's discharge summary for the baby said that, apart from what the mother reported, "no other episodes of apnea or vomiting were documented during her stay in the hospital."
On July 6, 2006, Bryanna-Rose was released from the hospital into the home of a foster mother.
Foster care stay
Staying with her sister, Owen was inconsolable. She kept replaying the day when she left the hospital without her daughter.
"It was the emptiest feeling I've ever had," she recalled.
The baby's stay in foster care, however, would prove a pivotal event. Days after being with Bryanna-Rose, the foster mother called DSS: "It's not the mother! This baby does have projectile vomiting!" she said, according to a psychiatrist's report.
Owen hoped the foster mother's observation would mean DSS would drop the case. Instead, two weeks after placing Bryanna-Rose in foster care, DSS released the baby into the joint physical custody of the father, who had abruptly quit his schooling in Florida to return to Fall River, and Owen's sister. The agency insisted that, at all times, one of them had to supervise Owen if she was with the baby.
Humiliating as this was to Owen, she was ecstatic to be living with Bryanna-Rose again. Still, with the family needing income, Owen assumed the role of breadwinner, piecing together part-time jobs as a health aide and a retail clerk while her husband cared for their daughter. Her sister's two-bedroom condominium became their cramped home.
DSS required Owen to undergo a psychological examination to gauge whether she was a fit mother, and in late summer, a psychologist interviewed her and found no basis to conclude she had Munchausen by Proxy. He noted, among other reasons, that most mothers with this disorder seek the medical staff's approval for their conscientiousness, while Owen had "alienated" many of them. Still, he advised DSS to get another opinion.
As the autumn leaves fell, the couple traveled with Bryanna-Rose to Arlington to see Dr. Lee Birk, a psychiatrist and associate professor at Harvard Medical School. Owen wore her best pair of black slacks and a brown shirt, hoping to impress Birk, who had warned her by phone that if he believed she abused her child, he would be her worst enemy in court.
Not long after entering Birk's corner office, the couple found themselves in a familiar scene: Bryanna-Rose threw up on the office floor. Birk watched the couple clean up after their daughter, impressed at how they "did not panic" and seemed to lovingly care for her, he recalled. After the visit, Birk interviewed Owen alone, talked to relatives, and reviewed DSS documents. The more he learned, he said in an interview, the more he thought the child abuse allegation "was ridiculous."
He concluded that Owen's belligerence was triggered when she felt disrespected but that she did not have Munchausen by Proxy. He noted that a Boston sleep specialist this year confirmed that Bryanna-Rose skipped breaths in her sleep, and though it was not serious, that her parents were right to be concerned.
Birk said authorities got an idea about Owen, and refused to let go.
"They weren't interested in finding the truth," he said.
Last November, Owen saw a neuropsychologist, who concluded that her reasoning and communication skills fell in the "lower half of the average range" but that she had no significant limitations. Owen and her husband were hopeful that DSS would finally accept that she was a fit parent. But instead, the agency ordered Owen to sit through another psychological exam, by a Harvard specialist on Munchausen by Proxy.
On April 26, 2007, Owen's lawyer, James Harrington, fired off an angry letter to DSS.
He called its actions "truly shameful," and urged officials to get out of Owen's life instead of requesting "repeated evaluations until it gets an opinion that meets its interpretation of the facts."
The letter appears to have swayed DSS. On May 25, the agency dropped the supervision requirement, allowing Owen to be alone with Bryanna-Rose for the first time in 11 months, though DSS waited another four months to ask a judge to dismiss the case.
Although DSS believed its involvement with Owen's family had been appropriate, the agency "doesn't want to stay in people's lives forever," a spokesman said in an interview last month.
On Sept. 24, a juvenile court judge restored full custody of Bryanna-Rose to her parents. Sitting on a bench, Owen wept in relief.
The family plans to return to Florida, where Owen's husband hopes to resume his schooling and find a job in the boating industry. They have dozens of bills to pay, including thousands of dollars in medical costs not picked up by Medicaid.
As Owen watches over Bryanna-Rose, now an energetic and thriving 20-month-old, she remains bitter.
"It is myself and my family that will face the consequences of this nightmare," she said. "They did not treat my child or myself with dignity."
Patricia Wen can be reached at firstname.lastname@example.org.
Source: Boston Globe