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Home / US / Doctors who have been trained to detect child maltreatment can save lives. But when they do something wrong, families are torn apart.

Doctors who have been trained to detect child maltreatment can save lives. But when they do something wrong, families are torn apart.



"We've known this young man for a long time," Rodney Vickers told the social worker, "and he's one of the best people."

That was apparently not the answer the child abuse pediatrician team was looking for.

Thereafter, Girardet wrote an updated report for Child Protective Services, stating that Tristan's blood tests for coagulation disorders, which can mimic abusive practices, were negative and concluded that the baby's injuries were "safely inflicted". However, the doctor offered more than just her medical opinion. She also warned that Tristan may still be in danger after being kidnapped by his parents.

"Grandparents do not believe that Tristan was shaken," wrote Girardet. 1

9659002] For Ann Marie, the message was an appeal to bring her baby into a foster home, or worse, to convince her parents to turn against her husband. For some legal experts, the comment raises broader concerns about the dual role of child abuse children and medics, who are also involved in the child welfare system.

The Timmermans were surprised to hear from a reporter that Girardet's work is being funded by the state agency overseeing child protection. According to a 2018 grant agreement with UGealth's McGovern Medical School, Girardet spends 62 percent of her time on matters related to her medical school contract with the Texas Department of Family and Protection Services. 19659007] The doormat in the house of Rodney and Laura Vickers in Houston. Elizabeth Conley / Houston Chronicle

The salaries and benefits of several other Texas-based pediatricians, nurses, and child maltreatment social workers are funded through a similar agreement. The medical teams review cases of suspected abuse on behalf of Child Protective Services As part of a program known as the Forensic Assessment Center Network, the Girardet conducts medical sub-specialty, which usually loses money for hospitals. Some programs are funded by state law enforcement agencies such as Virginia or by public health agencies such as Michigan.

Girardet has defended the Texas Agreement. For example, when a defense lawyer asked for one of the state subsidies in 2017, she argued that the university would continue to pay her if the money went away. When she testified before Texas legislation in March, she said the financial support had no bearing on her decision-making.

"I'm being paid by the University of Texas," Girardet said. "My salary does not change a iota, whether I say the child was abused or not."

But just as crime labs are biased when they are directly supervised by law enforcement agencies, doctors risk losing credibility when Laut Keith Findley, a professor at the University of Wisconsin Law School, co-founded the Wisconsin Innocence Project and defended caregivers who are accused of shaking babies.

"If you have a subjective problem As with the doctors who work in these cases of child abuse, you need to go out of their way to make sure that the person conducting the analysis is free from any influence can lead to conspiracies, blame or otherwise, "Findley said. "It seems they did the opposite in Texas."

Diane Redleaf, a lawyer for family law in Illinois, wrote an article on the ethics of medical practitioners' statements in cases of child abuse. Physicians might consider themselves "part of the team" with child welfare workers.

As a result, according to Redleaf, sometimes the statements and comments of doctors "cross the border between medical opinion and the legal profession".

A review of dozens of court records by Chronicle and NBC News revealed that several examples of child abuse pediatricians shared their opinions with absolute certainty, while at other times they shared views that went beyond their role as medical experts. In some cases, they gave advice on what the state should do with children they believed were abused.

A female medical practitioner told a judge in 2015 that she did not believe that child protection services should return a child to a parent suspected of medical neglect, even as part of a security plan: "I do not trust them to do what they say. "In a case dating back to 2017, a child molestation pediatrician advised a mother suspected of abuse to seek court-only permission to visit with her daughter, if at all.

Another female doctor said "yes" in 2011 when she was asked in court if she was considering examinations suggesting that most rib fractures in children are undoubtedly "conclusive." "That a particular child with such injuries had been abused. "

And during a criminal case in March, Dr. Marcella Donaruma, a child maltreatment pediatrician at Texas Children's Hospital, reiterates that she is "100 percent sure" of bleeding and swelling in a baby's head as well as other injuries, including bruises and a healing femoral fracture maltreatment.

"She is an abused child and now safe," Donaruma apparently said in support of the state's earlier decision to bring the child into foster care.

A neurologist who testified on behalf of the defense came to a different conclusion on the child's head injuries after reviewing the medical records, and the child's father was found not guilty.

Few medical opinions are 100 percent safe, experts say, especially in cases where physicians are asked not only to diagnose a child's condition but also its cause. There is no laboratory test to confirm that a baby has been deliberately shaken, or to prove that a child has been scalded.

Donaruma declined to be interviewed for this story. Dr. Mark Kline, head physician of Texas Children's, first told reporters in an interview that "anyone who says 100 percent about anything is immediately suspicious to me."

He said that such statements are justified in some cases, especially when it is clear that the child has been injured.

"If there are extreme signs of child abuse," Kline said in a statement, "it is perfectly understandable and appropriate that the doctor could create 100 percent confidence in the diagnosis."

Tristan Timmerman as a newborn. [19659006] Kelly Garvey

Homage to physicians

Child protection services do not always deprive their parents of children when they seek medical attention.

In a prominent example from 2017, Dr. Suzanne Dakil, a pediatrician on the Children's Medical Center in Dallas, shelter services that a 3-year-old girl I, Sherin Mathews, had suffered several fractures, of which Dakil said they affected her, but in this case, the child protection services left the child in the care of her Parents: Seven months later, the girl was found dead in a culvert, and her adoptive father was charged with murder, later claiming one guilty of minor charges.

Subsequently, the state child protection agency changed its internal policy and instructed the investigators to give more weight to the comments of state-funded paediatricians.

Ultimately, the State's best interests The authorities face the difficult task of determining when the risk to the safety of a child is so great that it can be taken away from his family.

When a referral is received from a hospital, a clerk appears to hear the family's explanation for the injury and see if it matches what doctors see. After talking with the social worker at the hospital and reading medical records, the caseworkers discuss with the supervisor before deciding how to handle the case. In some cases involving medical findings, the opinion of child abuse pediatricians is of paramount importance.

Rhonda Carson, a former regulator of protection services, said a frequent reference in the agency was, "We are not doctors."

Once a doctor gives his opinion, they stop looking for anything. Sherry Gomez, who oversees nationwide child welfare investigations in Texas, said workers are conducting thorough investigations after receiving reports of child abusing pediatricians. To a certain extent, we have to rely on our experts in leave this area.

Faced with a steady stream of new cases, workers said they had little time to decide on a child's complete health records or seek additional medical opinion. Two dozen current and former protection workers reported a congested agency struggling to keep pace with a steady stream of new cases.

On an average day, child protection services receive reports of about 800 children who may have been abused or neglected. Each report is assigned to one of the state's 2,100 investigators. Hospital malpractice accounts for a small proportion of cases and is often the most complicated.

Texas officials have been trying to reduce the number of cases assigned to every employee since the death of a 4-year-old girl in 2016 in a suburb of Dallas, whose caseworker, saddled with 70 boxes, never leaves her home visited. In order to attract and retain more workers, civil servants increased salaries and reduced educational needs, leading to a decline in average case numbers.

Texas lowers the daily number of cases.

The average number of open cases assigned to each child protection officer in Texas has fallen in recent years.

Jiachuan Wu / NBC News / Texas Department of Family and Protective Services

According to current and former employees, however, there remains pressure to channel cases quickly through the system if they fail. Two in-house e-mails – which lasted more than a year – from supervisors who repeatedly set daily closure quotas, a practice that, according to experts, could trigger haste.

"If you have 17 or more, I need the following," wrote a supervisor in an e-mail shared with reporters. "The two cases you close today. The two cases that you close tomorrow. "

Patrick Crimmins, a spokesperson for the agency, said that any pressure to close cases is simply due to the constant flow of new referrals and does not mean workers are taking short cuts.

"By The caseworkers in the courses are expected to handle a certain number of cases – which means cases are closed on a regular basis," Crimmins said. "We acknowledge that there is pressure to close cases because new ones keep coming in."

Even though the guard services may conclude that a child is likely to be safe, the opinion of a child abuse pediatrician may turn the scales against the parent.

In a case in Houston in 2017, a judge refused to return a boy to his mother, although Child Protective Services had determined that she posed no threat to him. The court-appointed lawyer representing the child continued to refuse to return the boy, pointing out the severity of the injuries described in the medical report.

The judge did not even consider returning the boy according to a record by saying that the child was returned and later injured: "Your name would not be in the paper. Mine would.

Controversial Science

Ann Marie thinks she's across the city and meets with Tim's lawyer when Tristan laughs for the first time in June 2016, a few weeks after Child Protective Services took over custody.

The baby was with his grandmother giggling over a silly face she had made, Ann Marie pretending to be upset when her mother shared the news that afternoon, but in truth she was heartbroken. [19659002] It was one in a series of special moments that she says were stolen from her this summer, and a year before, after losing her job in the oil and gas industry, she decided to break away from to release her career in order to stay home with her young.

Now she spent much of her free time with judicial appointments and research into the controversial medical foundations for the Vorw rfe against her and her husband.

She was surprised to learn that doubts emerged about the doctors' ability to make a definitive diagnosis of shake-bovine syndrome, which has led to overturned criminal convictions in recent years and some doctors who once diagnosed it. to turn around.

For decades, doctors have used a typical pattern of internal head injury, including subdural haemorrhages, brain swelling and retinal haemorrhage, to determine when a baby was shaken. Doctors who support the diagnosis say that it has been confirmed by years of clinical observation, research, and confessions from caregivers.

Robin Muccari / NBC News

However, some biomechanical studies have challenged the notion that a person can shake a baby with the power needed to elicit the pattern of internal symptoms, including the neck of one Seriously injure the child or cause other injuries. Other studies have pointed to underlying conditions such as bleeding disorders, which could lead to similar injuries.

Paediatricians who treat children are aware of these conditions and do everything to exclude them before they draw their conclusions. Some of the physicians have denied that there is considerable disagreement about science. For example, while Girardet testified in a criminal case in 2017, no one in the medical community denied the evidence for the Shaken-Baby syndrome. On her insistence she said that only a few "unscrupulous doctors" questioned this.

Nevertheless, some legal experts have asked the National Academy of Sciences to verify the validity of the diagnosis. In a 2016 report on issues with other forensic analyzes, the Presidential Advisory Council on Science and Technology said that concerns over the scientific validity of Shaken Baby's Syndrome were "urgently needed."

However, according to legal experts, skepticism was required. The diagnosis has not affected many family courts, where child protection services do not need to prove their case beyond doubt, as in criminal matters, only to prove that a person with "ordinary caution and prudence "Concludes that a child is likely to be in danger before an evacuation is carried out.

Often the only doctor called in family court hearings is the doctor who made the initial finding of abuse, in part because many families can not afford to hire experienced lawyers or external doctors.

The Timmermans were luckier. The Sheriff's Office of Harris County has investigated but has not filed any charges. Despite the doctor's warning that his grandparents might not protect him, Tristan was not admitted to foster care. And perhaps most importantly, the Timmermen had money to defend themselves.

They borrowed money from family members and tapped savings accounts to pay high-ranking lawyers and a medical expert to review their case. Two other doctors provided comments free of charge.

The three external doctors – each writing articles questioning the diagnosis of the shaken child – concluded that there was reason enough to question the violation of Tristan. All three noted a drastic increase in Tristan's head size in the weeks leading up to the incident, which led to his hospital visit. When visiting a baby one week ago, the boy's pediatrician discovered that his head circumference had jumped to the 99th percentile.

Extreme head growth in the first few months of life is an indication of a benign external hydrocephalus that medical experts wrote, a condition in which fluid builds up between the brain and the interior of the skull, increases in pressure, and may increase after some case studies the types of internal bleeding that are often associated with shake-baby syndrome.

Dr. Marvin Miller, a professor of pediatrics at Wright State University, Ohio, said "it's very unlikely that Tristan Timmerman was a child molestation victim because there is a plausible medical explanation for the findings."

Dr. Julie Mack, a Pennsylvania State University radiologist, said, "There is nothing in the imaging findings that suggests a significant or violent trauma."

And dr. Joseph Scheller, a pediatrician and pediatric neurologist in Baltimore, said Tristan had developed "A very small venous blood clot that caused a seizure, and he recovered quickly and has no remaining brain injuries."

Slowly, it seemed, the fall of the state crumbled against the Timmermans.

Tim and Tristan Timmerman in July 2016, during a supervised visit to the house of the grandparents of Tristan.

In July, two months after the removal of Tristan, a judge ordered the child protection service to return Tristan to Ann Marie after he concluded that it was in his best interest to be with his mother. The Timmermans were allowed to bring Tristan home, but Tim still could not be unattended around the baby.

Four months later, the Timmermans petitioned the court to restore his rights on the grounds that the state had no evidence against him. At a hearing Ann Marie described what she had learned from some of the medical experts.

Girardet was not asked to testify at the hearing, and a few weeks later Child Protective Services filed a motion to drop the case. Seven months after the conclusion, there was "reason to believe" that the Timmermans abused and neglected their child – and after the couple spent more than $ 200,000 to defend themselves – the state went away.

A judge signed a ruling that officially dismissed the matter

The following spring, Child Protective Services reviewed all the evidence in the case and agreed to reverse its original findings. The employee, who was in charge of reviewing her file, said she had seen too many cases like Tristan's, according to the Timmermans and two attorneys present.

There are always enough controls to protect the parents.

Tristan, now 3, has completely recovered from cerebral hemorrhage and has not had serious health problems since. But now Ann Marie is reluctant to take her boys to the doctor for minor injuries because she fears another doctor will see the child abuse allegations that continue to appear in Tristan's medical record and calls on the authorities to investigate.

Despite the overthrow of the State of Record, Tim lost his job as a farmer at a Houston oil and gas company in the months after the case was closed, though he eventually found work elsewhere. He had been afraid to tell his superiors that he had been investigated for child abuse, and as a result had recorded too many unexplained absences while attending state-requested appointments and court hearings.

"The idea that I would hurt my child, my baby, that's ridiculous," Tim said recently. "All it took was the opinion of a doctor, and that almost destroyed my family."


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