S05 Ep06: Human Timebomb
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True Story Media. Before we begin, a quick warning that in this show, we discuss child abuse, and this content may be difficult for some listeners. If you or anyone you know is a victim or survivor of medical child abuse, please go to MunchausenSupport.com to connect with professionals who can help.

Throughout the first year of my nephew's life, things felt increasingly off with my sister. It was just a million small things about her baby's development and especially his eating issues. After being diagnosed failure to thrive, he'd had a nasal gastric tube inserted to help with his feeding. And this tube is in most of the pictures I have of him. And then Megan started talking about him needing a G-tube, which would require a surgery.

It was around this time that my mother went to the gastroenterologist with Megan and heard him say that he didn't think my nephew needed it yet. And this was all happening against the backdrop of a long history of her deceptions. My sister's own questionable surgeries, her faked twin pregnancy, and the dramatic loss of those babies that never were.

I remember going with her to an ultrasound when she was pregnant with my nephew, and seeing the image of the baby with my own eyes, and still feeling unsure if he was real. This makes me realize how much I already knew about the true her, how hard I was working to hide it from myself. But pushing him towards a surgery he didn't need crossed a line. My parents met with their family doctor, and she gave them the words for the pattern we'd been seeing: Munchausen by proxy.

I remember them sitting down to tell me that evening, and I thought, "Our family is over. She'll never forgive us." Because we knew we had to intervene. There never seemed, at least the three of us, to be another option. I only wish that every family saw it this way. People believe their eyes. That's something that is so central to this topic because we do believe the people that we love when they're telling us something. If we didn't, you could never make it through your day.

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When we last left off, we were talking to Dr. Zupontz about age C to better understand this rare condition that C had been diagnosed with. If this diagnosis was legitimate, could it explain all of these other symptoms that Sophie had described? Specifically, the severe and ongoing gastrointestinal issues that had required C to undergo two invasive surgeries?

Is that another thing that might sort of get worse over time as they're having more episodes and they might have like kind of ongoing problems with gastrointestinal stuff? Yeah, it's more the swallowing. It's not really the digestion with these episodes. Got it. Because the vagus nerve is in the brainstem, you know, so there is a...

brain-gut interaction. So if the brainstem is affected and you're having difficulty swallowing, the vagus nerve can be affected and that vagus nerve could slow down the heart rate, autonomic symptoms, they can slow down the heart rate, they can slow down gut transmobility. And so, yes, you can have vomiting as well.

So if it was, as Sophie reported, that C was having such severe gastrointestinal symptoms that she required a G-tube and a psychostomy tube, this would put her in the slim minority, 10%, of an already extremely rare disorder. And she's already in the minority of AHC patients being one of the 20% that doesn't have the gene mutation. And then there were the details that Sophie reported about her episodes.

Something caught my eye when I was in the literature that it was saying there can be this huge duration of time, difference in duration of time for an episode. So you said a few minutes to 14 days. And again, I won't ask you overly much to sort of speculate on what's about this case in particular, but there was a parent report of paralysis lasting 32 days. Have you ever heard of something that long?

No, I have not. And I've rarely seen, honestly, I've seen episodes that last for a day or two, but I've not personally. I've read about it in the literature. I don't think they comment on how frequently that happens. It just says the episodes can last forever.

greater than 24 hours up to three weeks in duration were reported for 38% of subjects, let's say that, of patients. So I think those are the outliers. You know, three weeks is a really long time. I've not personally seen this, and I've probably seen and interviewed patients

at least in the 90s and 2000s and at the Alternating Hemiplegia of Childhood Foundation. The average time is really hours to maybe a couple of days.

It's an outlier to last three weeks or longer. And you were saying how long? 30? 32 days. I think that would be reportable, quite frankly. Yeah, and it seems to me that if an episode was going...

on that long that there would be a hospitalization during that period? Oh, I would. I would personally. Yes. Because I'd want to make sure that, you know, these children can have what I call comorbidities. Let's make sure there's not ongoing seizures. Let's make sure that there isn't vasospasm. That means where the blood vessels are constricting. Let's make sure there's not something else going on.

I would want to have that child be hospitalized. Furthermore, for 32 days, that child would have had to have slept. And when the child wakes up for 10 to 20 minutes or longer, they should be pretty much back to normal. So if it's just continuous and invariable, that would make me question. I'd want to get more details about that mystery. Yeah.

There is a range of symptoms and severity with AHC, as with many things, but consistently, Sophie is reporting severe, frequent, and long-lasting episodes.

And in such a case, an AHC patient would experience significant cognitive decline. And according to the teachers and care providers the police spoke to, C had occasional issues but was more or less developmentally on track with her peers. So the episodes Sophie is reporting are twice as long as any ever discovered in AHC research, meaning this would be one of the most severe cases of AHC ever documented.

The reason pediatricians take parent reports so seriously is that they recognize that we usually know our kids best and are much more in touch with what's normal for them and what isn't. Was it plausible that Sophie was the only person attuned enough to her daughter to understand what was going on with her? With this disease in particular and sort of the presentation of it, is it plausible that given that there were other people around this child pretty frequently, that

that no one else would see this child have an episode? Well, that would raise a lot of red flags to me, particularly because let's take an example of a parent, a grandmother or grandfather would occasionally take care of that child or a daycare center or other observer. These episodes are noticeable, right?

They're not so subtle that nobody else would notice, particularly because I would presume the parent or care provider would say, or caregiver would say, you know, Johnny has these episodes and just keep a log. Like oftentimes parents or caregivers will say, oh,

We've kept a log of these episodes and we always have our babysitter or daycare provider or grandma or grandpa write down when the episodes occur. They're not typically subtle, particularly if they're happening frequently. And you'd want to characterize, were they alert and conscious? Could you get them to smile? Did they have difficulty breathing or heart rate? I would, I'd really, I'd be hard pressed to say,

wonder if that was really totally and completely true. That's what you need to do to figure out, is this something that the parent is just worried about and exaggerating because they're worried and they're afraid nobody's going to believe them? You know, that's plausible. Or is this something that is really a fabrication? You know,

And then that's where I've done my deepest dives is I'll call the daycare provider. I'll call grandma, grandpa, babysitters, extended relatives, because all of those are caregivers for that particular child. Normally a single parent can't, well, particularly a single parent. I personally can't imagine having had four daughters. I can't imagine having

raising them without a partner. No one disputes that a parent's perspective on their child is important, but Dr. Zupontz talks about getting other people who are around the child in the loop as well. And this piece is equally important in a medical child abuse investigation. Detective O'Rourke and her colleagues from Renton PD did one of the most thorough investigations I have ever seen in a medical child abuse case.

They spoke to dozens of people, neighbors, friends, people from Em's gym, multiple schools that she attended, therapists, church members, people from the writing program, doctors, and family members.

Sophie was nearly always with the girls, though reportedly Em would sometimes stay with friends while Sophie took C to doctor's appointments. And when the girls were a little bit older, she would sometimes leave them at the gym under the supervision of one of the coaches. Now, no one other than the doctors in this case who treated C are qualified to determine whether or not she truly has age C. But given that Sophie had proven to be an unreliable narrator of her daughter's health, it was important for the police to talk to as many people who'd had eyes on the girls as possible to

to see if Sophie's reports matched up with, well, reality. "Just kind of explain the paralysis and stuff like that. I've never seen it." "Like have a seizure or any other sort of medical emergency?" "No." "I don't think I did. Did you ever witness having what Sophie calls one of her episodes?" "I did not."

I have not personally seen her in an episode where I would be able to say, "Oh, she's an episode." I saw more of the videos than I did in person. And did she ever have any episodes when you were with her? No. I never witnessed that. Have you ever seen her have a seizure? No. No. Go into an episode of Paralysis or have a seizure? No.

In my research, I watched a short documentary about children with AHC called "Human Time Bombs" in order to better understand the lives of families coping with this condition. They show some video footage of kids having AHC episodes, and it's very difficult to watch. You can see their whole bodies stiffen, their eye movements become erratic, and some of them are just howling in pain. It's heartbreaking, and as Dr. Zupont said, it's not subtle.

The majority of people who were asked said they had never witnessed an episode firsthand. Those who did report witnessing something went on to describe something that does not actually sound like an AHC episode, such as these reports from Sophie's parents. Have you witnessed any of these episodes or these events? Yes, one time when I was...

out visiting my daughter and two granddaughters. My daughter ran an errand and I watched the girls. This is Sophie's father, Art. Had an episode and it's a sad thing when you have that. Yeah. So what did you see her do? Well, she can become a little defiant. She can kind of freeze. She can be in tremendous pain because if you're

If you can imagine when you have, when your body is freezing up, she can sometimes go into dystonia, which is extended cramping. So if you can imagine the worst Charlie horse and not being able to get out of that Charlie horse, then that's the kind of pain that she endures at times. Okay. And so you saw her have like one of those painful episodes or a... I did. I did. Yeah. It's really rough. Oh, man. I'm sure that was hard to see. Does she like...

double over in pain or does she lay on the floor or what do you remember her reaction? Yeah, I mean, I think it's just there's a little bit of everything. She can, you know, she can, you know,

Oh, what's the right word? I think she can be defiant and she can kind of be in pain. She can be aggressive. I mean, you can't control that. And, you know, she has quite a medical history at Children's Seattle. She gets a lot of treatment there and has had multiple surgeries and different scans and everything. So I think what I just...

And this is Sophie's mother, Anne, in her conversation with a Renton detective.

Have you ever witnessed any of these episodes? Yes, I have. Yes, I have. I've been up, yeah. What did you see? Well, it varies. It could be all of a sudden you're in the middle of a conversation with her and then her face just kind of goes blank. Okay. That's kind of a gentle one. She can come in and out. Okay. She does hippotherapy with horses, which often will bring her out of an episode. Okay. So she could have five, six, seven episodes left dead in a day. Okay.

Oh, okay. She could go for a week and not have any episodes like that. Okay. If it's a more severe episode, she could...

I don't know, not so much crying, but she can't speak words, so she might cry in frustration and her hands are gripping and curling in pain and she might swing her arm. Okay. You know, somebody might see her facial expressions and think it's, I don't know, an angry outburst, but she's...

Her brain knows that she can't function and it inwardly upsets her, but she doesn't know how to speak it. Yeah. She can't speak it. I get that. And then the worst episodes, which I have also seen, she is flat on her back on the sofa, curled up her hands and feet and legs for days and days unresponsive. Really? Those are the worst. Okay. I can't imagine as a grandparent seeing that. Yeah.

Okay. Have you attended any medical appointments with Sophie and? I think once when I was out in Seattle, I stayed with Sophie's older daughter while Sophie went in with the doctor. So I've not attended any, but I usually get a good briefing when we have to go to Duke and yeah.

As a reminder, Sophie's parents live all the way in Michigan, so they weren't there on the day-to-day. In fact, they saw the girls pretty rarely. How often do you see the girls? Once or twice a year. These descriptions struck me because there was only one report from a physician of witnessing any symptoms at all in C. During one visit with Seattle Children's, a physician named Dr. Bray reported C having some behavioral issues, something like Art describes in his interview.

Now, behavioral issues can be part of AHC, especially because the disorder can cause severe developmental delays. But behavioral issues alone are not indicative of a child having a rare neurological condition. Dr. Bray also noted that the longer the quote "episode" went on, he had the sense that the child was more aware and more purposeful in her actions. And according to Sophie, C wasn't just impacted by this disorder, she was going to die from it.

I've flat out asked her, like, what is the lifespan of a person with AHC because she always speaks like a...

You know, like a ticking time bomb. And she told me, like, because I don't know, I don't know how many people in the world, if not very many people that have this disorder. And she said, like, the oldest person that has this disorder is like in their early 20s or something like that. And I would say she has used the word terminal.

That it's rare and that kids don't normally live past this whatever age it is. Where she was born, you know, she would have definitely not made it is what she would say. That because she was able to come here, she's had a way better chance. She still might not, you know, live through adulthood. I mean, there's a really good chance she's not going to survive is what she would tell us.

Many AHC children don't live to even 20 years old. Wow, that's going to be a hard diagnosis to end. So I'm just going to say, and this is from a grandmother, I can't even imagine what my daughter is going through right now. If somebody has filed a complaint on this, after everything she did, she's an incredible mother.

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Sophie frequently told people that C wasn't likely to live past childhood, but many of the patients in long-term AHC studies are in their 50s. Sophie nonetheless seemed preoccupied with C's death. She would frequently tell people that she wasn't sure how long they had with her. And she makes many references to C being a, quote, ticking time bomb.

This seems a clear reflection of the language from the film that I mentioned, which I know Sophie had seen as well because she posted about it on social media, and which her sister mentions in her police interview. Do you know what, like, the prognosis? It's not great. I think the hardest part about AHC is that it's...

Having watched this film, the context the parents use this term in is to reference the unpredictability of their children's episodes and the disruptive nature of it to daily life, i.e., that they could have a painful episode any time, not that they could, as Sophie says, leave us at any time.

So this all begs the question, how life-threatening is this diagnosis? So I'm interested in sort of, especially in terms of like children. I mean, is this a fatal or terminal illness? I mean, is this a terminal diagnosis? Would that language be used? Yeah.

I wouldn't call it terminal. I think it's debilitating, certainly, with the advancements in our technology and maybe our ability. You know, there are things that could happen, like gene therapy, targeted drug therapy, that could be transformative. But even with, let's say, our current status, where we're going to treat the seizures, we're

I would call it more of a lifelong condition that with appropriate and attentive care to treatment can be manageable, not curative, not by any means curative.

And this wasn't just talk. Sophie began requesting palliative care for C as early as 2018, but Seattle Children's told the police she was never a candidate for this type of care, which focuses on alleviating pain and discomfort rather than treating an illness or disorder.

In spring of 2019, about a year after C's AHC diagnosis, Sophie began requesting more extreme interventions in C's eating, including getting a central line placed and pursuing TPN, which gives children nutrition intravenously. We were talking about some of those gastrointestinal complications, and I realize there's a huge range here. But have you seen a situation where a child with AHC was put on TPN? Oh, we try to avoid that. No, I have not.

There's so many advances now in gastrointestinal motility where you can promote motility.

TPN carries a whole range of complications. I mean, that's not a long-term solution. They're important. That's why we were meant to eat and digest our food is that we haven't figured out through what I call hyperalimentation, IV fluids and lipids, how to properly nourish an adult long-term. And so...

Gastroenterologists work very closely if there is a GI problem to try to offer what we call enteral GI feeds because the gut manages it much better than we do artificially through IVs.

Dr. Zupontz likewise said she'd never heard of a child with AHC going into palliative care. Now, palliative care is not only used for end-of-life care, but especially in children. When palliative care is brought in, it's because death is a distinct possibility. As Dr. Becks, pediatric hospitalist and frequent contributor to this show, explains here.

So hospice care specifically are those ones that you know have less than six months to live. Palliative care is kind of that expansion on that. For instance, they have a cancer or a life-threatening condition that there is a potential that the child could die. You're not saying that the cure may not still work, but you're kind of trying to help the family transform.

through that time, knowing that the outcome may not be the one everyone is hoping for, but you are concurrently doing the palliative care, knowing that the prognosis is poor, but you are continuing to do the treatment and continuing to be hopeful and to think my child is going to be that one, you know, that gets through this.

The police also asked Dr. McCotty from Duke about Sophie's request for palliative care, and he was surprised by this and stated that, quote, most of his AHC patients would not be candidates for palliative care and would not apply for such a program. Dr. McCotty also told the police that referring to AHC as a terminal illness was very inappropriate. He likened it to epilepsy, where there's certainly an increased risk of death, but many people live to an old age.

He said probably less than 10% of AHC patients die in childhood, and these deaths were due to complications from an episode. So to recap, Sophie insists that C has AHC, despite her not having the genetic marker for it, and the fact that no one else has ever witnessed something that could correctly be identified as an AHC episode. She also claims that C is terminal and appears fixated on the child's impending death.

she is moving her toward last resort interventions such as TPN and palliative care. And by the time she's six years old, C has undergone two surgeries for gastrointestinal issues that Sophie claims are severe enough to warrant them. And in 2020, Sophie begins pushing for a third surgery for a hormonal implant. So was any of this medically necessary? The doctors from Seattle Children's Child Abuse Team had this to say, quote,

The following is a list of problems, symptoms, behaviors, and diagnoses for which there is no documented objective evidence. Excessive vomiting or dehydration, chronic diarrhea, hematomesis, which is vomiting blood,

seizures, prolonged paralysis 32 days straight, prolonged apnea, not breathing, low blood oxygenation, prolonged lack of urine output, speech or language pathology, recurrent ankle sprains, need for any orthotics, wheelchairs, gait trainers or leg braces, and terminal illness.

Following the separation from Sophie in March of 2021, C was observed by hospital staff for more than two weeks. As far as we could tell, this was the longest she'd ever been away from her mother since the adoption.

This separation test is crucial in MVP investigations. If the reported symptoms persist, then you know right away that the mother isn't the cause. And if they don't? Another question, you know, I had sort of asked you, and again, I recognize that I'm asking you to speculate, so only to the degree that you feel comfortable. There was actually a prolonged hospital stay after the separation. It was 16 days, I believe. With an AHC patient, and given that the reports were that the episodes were extremely frequent...

Would it be pretty unusual during that time where a child's being very closely observed that no one would record any signs or symptoms? That would be unusual, particularly if the parent—usually there are well-described precipitate triggers, particularly if they try to precipitate one of these episodes—

If there is a question of the episodes, they could have done video EEG monitoring or careful surveillance because people come in and out of a room. Right, and just actually a question with the EEG monitoring because they sent them for an at-home. And so you were talking about kind of like they look different than the epileptic seizures, but an EEG monitor...

So if a child is hooked up to a monitor and a parent reports that they're having an episode during that time. Okay. Would it, like, how likely is it that it wouldn't catch anything at all? If it was alternating? If it was AHC. Oh. If it was AHC. Highly unlikely. Okay. It should show slowing. Most studies that have captured that, well, if it was an epileptic seizure, you'd see the seizure. The...

If it's an episode of hemiplegia where one side of the body is paralyzed, almost invariably in the contralateral, you know, if it's right-sided weakness, the left side of the brain should show slowing and it should be pretty obvious. It's certainly true that for AHC and seizure disorders like epilepsy, it can be very hard to capture seizure activity during a doctor's appointment because episodes are unpredictable. And this is why doctors rely so much on parent reports.

One of the challenges of MBP investigations is that it can be very difficult to disprove a clinical diagnosis. As Detective Mike Weber always says about these investigations, you never ask doctors if something is possible, because with medicine, almost anything is possible. It's a constantly evolving science. So though these investigations are lengthy and work-intensive, at some point, the picture becomes pretty clear, as Dr. Zupontz recalls from the 10 or so Munchausen cases that she's come across in her career.

I get suspicious when a child has multiple symptoms and no specific diagnosis. And those symptoms change over time and nobody's been able to demonstrate a specific diagnosis. Nor does my exam confirm any abnormalities on the exam that are consistent. You can't take just one little abnormal diagnostic test without looking at the entire clinical picture.

You just can't because you will miss the forest for the trees. And some physicians get so fixated on this one little abnormality that they do. They miss the forest for the trees. You have to be kind of an artist. Look back, stand back. What does this mean?

entire picture look like as opposed to that one tree standing in the corner? Is it labor intensive to get all those details? Yes, it is. But that's, to me, that's what the art of medicine, that's where you have to really dig a little bit deeper and then it becomes perfectly clear.

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By May of 2021, after Sophie had been charged and bailed out by her parents, her daughter, C, who is now in the custody of her grandmother and aunt, along with her sister, M, was seeing dramatic improvements in her health and abilities. And she was back in school several days a week. Meanwhile, Detective O'Rourke was still putting together the immense medical puzzle that had been laid on her desk.

The notes and internal meetings about See at Seattle Children's date all the way back to 2019, with the police investigation starting in 2021.

Even before making a report to the Department of Children and Families, hospitals do their own work of due diligence. These cases are often portrayed by perpetrators and the media who give them megaphones as a hospital rushing to judgment, making it all about a parent whose child has a condition that the hospital just doesn't understand. But in reality, especially in a large hospital such as Seattle Children's, the doctors often have extensive documentation before they report medical child abuse.

This abuse is very different than a child coming to a hospital with a suspicious broken bone because it is a pattern. There may be a single alarming incident that's captured on video, as with my sister's case, but the devil is always in the details. We spoke to Dr. Jill Glick from the University of Chicago to give us some insight into evaluating this abuse so that we could see what things might have looked like behind the scenes at Seattle Children's when they started tracking this case in 2019.

Just a note that the University of Chicago Medical System uses the abbreviation CAPS, or Child Advocacy and Protective Services, and you'll hear Dr. Glick reference this acronym. Talk us through the process for a hospital of investigating a medical child abuse case and then maybe kind of how that is different from some of these other injuries. This is a vetted protocol for when children need to be referred to CAPS. We evaluate children. We don't investigate.

We are medical people that evaluate. And so we put together a very well-designed

documented role and responsibility of who does what and the rollout. Okay. So if a child, if someone has a concern for medical child abuse, it is immediately brought to the attention of the CAPS team. At that point in time, there's a conversation between the attending, both attendings, meaning the senior people. We don't have the residents kind of trying to interpret what's in our brains.

We talk about it and then we do our due diligence of getting data and information, past medical records, reviewing things, that kind of, and we immediately let legal know, okay, and risk management. And at that point, we identify all the different subspecialists that need to review this case to come together. And then we have a multidisciplinary team meeting and each one of us has to present, and this is attending level people, present our findings and then talk about our level of concern for child abuse.

you know, for medical child abuse. And at that point in time, there might be a bifurcation, which is, you know, this is a very anxious mother with a chronically ill kid. And that might be one or this is new to us. And this is mothers going to a lot of other places, but no one has made a diagnosis yet of what's wrong with her child. So she's looking for an answer. Right.

versus shopping. With the doctor shopping thing in particular, can you differentiate for us, what is the difference between someone, a parent who is, you know, because I think any parent can imagine themselves in this situation if you had, if your child was having issues and nobody was able to give you an answer, right? Of going to a doctor and they don't have answers, doctor, what is the difference between that and an abuse pattern where it is what we refer to as doctor shopping? Sure.

You have a child with chronic abdominal pain. Okay. You take this child to your pediatrician. He or she, they does what they can. Says, you know what? Let's get you to a gastroenterologist.

I send you a gastroenterologist and the gastroenterologist doesn't really give you an idea of what to do. Like, just keep what you're doing. I don't see and does a couple of tests. You go back to your pediatrician. She goes, oh, let's maybe go to Lurie or Comer Children's. And you go there and the GI and whatever work and say, you know, this is tricky. Let's try these things because I don't, I've done X, Y, and Z. I've looked at your records. Mom, dad, or them bring the records, right? Right.

and say, we need help. This is what, let's call my guru at Lurie on dysmotility and let's see if we can get you in there to see what he thinks. That's a parent who's working with the system

Being transparent, like being cooperative. Yeah. And, you know, there is a point where when you get a diagnosis, say this is a very unique situation of Crohn's disease, turns out finally manifests itself and the patient's not doing well. Well, you might go to two or three different GI doctors until you find the GI doctor you best suits you. That's appropriate. You have to be an advocate for your kid. And you have to be an advocate these days.

There is no question because the way medicine is done is that people don't pick up and read what happened at the other institution. A lot of times they start over. And that's why MCA, people who are, if you will, are causing MCA. MCA is short for medical child abuse.

They take advantage of a system where doctors just start over and do their own jam. They start over and say, "Well, let's get our own upper GI," or "Let's re-scope you." And they don't look back and see, because doing a medical record review is a nightmare. Because it's going into a website. It's not a paper chart like in the old days. You just read a book.

So we just had a case, which is, it's kind of like medical child abuse and medical neglect at the same time. Very complicated. Well, we've seen, honestly, that's something I've seen quite a bit of. Yeah. And so therefore it took my residence a whole week. It's like 80 hours. We got all the records. I now have 18 pages summary records.

of this child's medical history from the last 10 years put in one document. That took me a week to get that because I had two residents working with me. Thank you, residents. I think them over and over. It was illuminating that we needed no more testing, no more draw the line, meet with mom and move forward. So the red flags are when they don't disclose where they've been, they keep on getting more diagnoses over time. There's no centralization of care, right?

And that starts bringing the question of, is there medical child abuse here? Is this child getting excessive unnecessary care? You answer that, and then you go meet with the family, and then you try to work out the next steps. And based upon that, you know, that's something that is the big lift.

There has been a deluge of press about so-called medical kidnapping, particularly in the wake of the Maya Kowalski case. This is the conspiracy theory that doctors are snatching children away from innocent parents.

And within this corrosive narrative, there is much, I believe, deliberate confusion created about the doctor's role in abuse investigations. They are there to provide a medical evaluation of a child. And listen, if you are, in fact, an innocent parent of a sick child, you want a team like SCAN at Seattle Children's or CAPS in Chicago with a child abuse pediatrician at the helm.

Child abuse pediatricians and the teams who work for them are less likely than their colleagues who are not trained in the subspecialty to make a mistake or rush to a judgment when reporting abuse. And these teams are going to be incredibly thorough. Medical child abuse is particularly difficult for child abuse teams because the question of when to report is incredibly tricky.

If a team reports to DCF too early and without strong enough documentation of a pattern of abuse, it's likely to go nowhere, and the parents will surely then begin taking their children to different doctors and begin the pattern all over again. But if you wait too long to report, the child could be further harmed or even die. In Sophie's case, the doctors at Seattle Children's made an initial report in 2019 and continued to document the patterns of Sophie's escalating requests for invasive treatment over the next two years.

During this time, Seattle Children's was trying to mitigate the harm by not agreeing to invasive procedures such as the G-tube surgery, which Sophie then went to Marybridge to get. It seems that the incident that put things over the top may have been the precocious puberty debacle and the request for yet another surgical procedure.

I was writing some notes to myself thinking about what I would love to be able to tell the world and tell you is that the child welfare system is completely incapable of diagnosing medical child abuse. They need the medical people. Just that was like my first, my first slide in every talk is I see a kid broken arm. I report, they come back and say, you're my expert. You should have an expert. Now, if you're an expert for DCFS, now you're considering conspiracy.

You're considered, like if you hire a cardiologist, you hire the medical examiner to look at a dead body. Is that person trying to find homicide? No. That's my point. These families have driven the court system to think of us as having a conflict of interest.

And we have no conflict of interest. Yeah. And I think what, like, like you said, you know, a medical examiner, that's a neutral person regardless of who's, you know, who's sort of side they're testifying on. I think, and actually to me, like a doctor in the position of a cop, like, you know, once it gets to court, to a court case, you know, you have like,

experts on both sides many times in if the person has resources right if they have money to pay for medical experts and they have the money to pay for people to come in and do their depositions and review records and stuff so right that is like sort of a different scenario where if someone's being paid but if it's a if it's a doctor that was involved if it's either a treating physician or you know someone on the child abuse team that did this evaluation like i

What I struggle to find any even plausible explanation for is what is the incentive for anybody to do that? Why am I trying to find child abuse? I don't get more money, right? So I have a contract with the state of Illinois.

The state of Illinois pays me for my clinical and educational and administrative services to provide expert testimony, but not testimony, expert interdisciplinary real-time case review. So what MPIC does is as soon as a hotline call is made, say there's a little boy with a broken leg at St. Elsewhere, and he's a Chicago resident and he's reported, that will come from DCFS immediately to me, to my coordinator, who will immediately start reporting

Locate the DCFS investigator, the police officer, get the medical records, notify me, and we start talking immediately.

about this case. Okay. So the idea is we do this real time so that we can get good histories, we can get good medical evaluations in the best interest of the family and the child. Because for me to do a paper review two weeks later, and they didn't do all the right tests and didn't write questions, I always say crap in, crap out, right? So we're setting the highest standard and

And like I said, our statistics show us that we find a lot of accidental injuries in these kids. In fact, almost all the kids are accidental injuries in many of these cases. So back to the whole process about who we are. Another nuanced thing that's important to recognize is we are part of the treating team. We are a consultant. There is an attending physician and an attending service that you're admitted to.

General Peds, for instance, or ICU. But we are a big part of the treating team, just like ID or whatever. And that's how they get me to court. Because court says you're a treating physician and therefore, Dr. Glick, you're obligated to come and testify and we don't have to pay you as an expert. Right? Okay. So I am part of the treating team. So literally nothing in it for you. No.

Except doing the right thing and protecting a child. Yes. But like, no, no nefarious motivation. Like, you know, like not, not a good time probably like going to court and testifying for these cases. No. And then be, you know, for me, it's a chess game at this point after years of sitting in court that, you know, people, I know this so well that by the time I go to court, I'm not going to court unless I'm certain. Okay. I'm never going to go and speculate. Okay.

Either I know or I don't know. Or more likely than not, this is abuse or whatever. Right? And...

The reality is because our process for MPIC and our hospitals use the MPIC process, which is mine, which is interdisciplinary real-time evaluation collaboration. We educate police and DCFS about, you know, this is this kind of fracture. This is how this happens. These are the things we would like to know that help us as medical people understand the biomechanics. And we've helped DCFS go in and they will take action.

like real time video now of what happened. And so many times it's completely explainable. Okay. So that's why we love those cases.

While Detective O'Rourke was continuing with her investigation in possible preparation for a criminal trial, this case was making its way through dependency proceedings. So basically, in a child abuse investigation, there are two things happening at once. The police and the prosecutor are investigating whether there is strong evidence that a crime has been committed, and DCF is looking at whether the child will be safe in the home with the parents.

This latter piece of the proceedings happens mostly behind closed doors, and these findings are not released into the public record unless the parent does so willingly. So we don't know much about what the doctor said on the stand. We do know that the police investigation into Sophie uncovered a significant pattern of her making false reports from one doctor to the next.

reporting that a swallow study came back with severe findings when they were mild, saying that the doctors at Seattle Children's had, quote, given her the impression that she needed a G-tube when they clearly told her otherwise, and reporting a diagnosis of cerebral palsy and significant brain damage despite the MRI coming back with only a mild finding.

Then there was the saga that started in July of 2020 when Sophie brought C to a doctor saying that she was concerned that her six-year-old might be experiencing early puberty. Here is Sophie explaining this piece to Detective O'Rourke. So we got into endocrinology. The provider was great. She was like, some puberty signs. Let's go ahead and do some blood work.

Let's go ahead and see where she's at in this process. And we will schedule for her to have an implant put in that would basically delay. And is that what they recommended? So there was two recommendations. They either said we can do a monthly shot. Right.

Like a monthly injection. Or we can put in, like, it's kind of a little, like a bigger needle, but they just insert, like, a little, it's like an inch thing in the back of her arm. Oh, okay. That would then deliver medication. Okay. For an entire year. Okay. So when I said that to them, I said, listen, needles? No.

When we think about her underlying condition that any pain or like big huge emotion, that's going to trigger these other episodes. Right. Even though doing an implant is a little more invasive, it really isn't that big of a deal. Yeah. I think that would be the better. The provider was like, yeah, like that sounds like the right thing to do. Okay. So we were going down that line and she was like, we need to confirm with lab or just to make sure her levels are off. So, right.

Her levels came back. She called me. She's like, they are off. So we will go ahead and move forward. I just want to do one more thing. I want to do...

ultrasound testing just to make sure she doesn't have like an ovarian cyst. So they did the, like it's like a bladder and ovary ultrasound. Okay. And that came back fine. So I was like, great. And so then I thought, okay, let's get this thing on a schedule. And then she's like, oh, now we need to do an MRI because I want to make sure she doesn't have a pituitary tumor.

or mass. And I'm like, "Okay, this is interesting because the plan keeps changing." Like, "You've told me that precocious puberty is common with neurological disorders, but okay, I'm not going to complain about an MRI." But it requires her to be sedated, which that is not an easy thing for a kid with AHC. When C arrived at the doctor, she was in a wheelchair, despite Sophie having been told by physicians that this was both unnecessary and harmful.

In this appointment, Sophie also described C as a, quote, "very handicapped child." Upon examination, there were some modest clinical findings, the endocrinologist told police, but these were discordant with further lab testing. While doctors were in the process of trying to get to the bottom of this precocious puberty question, they requested an MRI, and Sophie told them something shocking: that C had gone into cardiac arrest while undergoing an MRI at Duke.

The Seattle doctor was alarmed and told Sophie she needed to see the chart notes of that visit before proceeding with the scan. Sophie then changed her story, saying actually it had been a different child at Duke who this had happened to.

When asked about this, Dr. McCotty from Duke told the police he was surprised that Sophie had said this, as this was not a published case and that this patient fortunately completely recovered. This incident had happened two years earlier at Duke, and they'd added some additional precautions to their protocols around MRIs because of it.

Sophie continued to pursue a surgical hormone implant for C against the doctor's advice and told numerous people that C was in "full-blown puberty" and that the likely cause was a brain tumor. This is not behavior that can be explained away as anxiety or a parent advocating for their child in a complicated healthcare system. There are legitimate challenges with getting the correct diagnosis for a rare condition like age C, but this odyssey does not include lying to doctors.

Dr. McCotty declined our request for an interview, but we do have extensive notes from his conversations with the police detectives. He told Detective O'Rourke that he'd only seen C three times and was not in the position of treating the child who lived on the other side of the country, but that his role was to advise the doctors at Seattle Children's who were treating her, and that he would defer to them on making the differential between AHC and Munchausen.

Seattle Children's and Duke had been in contact during treatment, and in fact, McCotty knew C's neurosurgeon, Dr. Wainwright, pretty well. Dr. Wainwright had trained at Duke, and McCotty said that he'd once hoped they'd get a chance to work together. McCotty described him as an excellent neurologist.

Dr. McCotty confirmed that he'd never himself witnessed an episode and that the only way to definitively say whether an episode is AHC or not is to have providers witness and evaluate it. This is why they sometimes attempt to trigger an episode when a child is in the hospital, which Sophie describes in her police interview as though it's cruel. Also worth noting that Sophie reported episodes as long as 32 days.

But she never brought C to the hospital during one of these alleged episodes. Most of the people the police spoke to reported never seeing anything like an episode of AHC. And those who did, such as Sophie's parents, didn't really describe anything consistent with what an AHC episode actually looks like. But people did report seeing something.

either behavioral issues, such as what Art described, or just C seeming very subdued and very out of it. As one of C's hippotherapy — as a reminder, that's with horses, not hippos — providers told the police. Have you ever seen the paralysis? I've seen it when I sat at the front desk. What was that like? I mean, she's unable to move.

It's horrible, is what it's like. - Is she, you've seen it more than once? - I've only seen it once fully, yeah. - Was she standing, sitting? - She was sitting, yeah. - And how did that, are you able to describe it? Like does the paralysis make her go rigid and she falls? - I can't remember that well. She definitely was not in a situation where she would fall or anything like that. I think she might have been in her chair.

And like I said, this is when I was sitting on the front desk, so this is way before I was teaching her. It's probably like two and a half years ago or something like that. So I wouldn't say I can accurately recall, but yeah, I'm pretty sure she was either sitting in one of our chairs or in her chair.

And there was one church friend who witnessed some of C's gastrointestinal issues. Especially before she had the stomach surgeries, it was like if she would eat and then be playing like with my son, as soon as she would like bend down where her head was like, you know, lower than her stomach or whatever, she would instantly like puke everything out.

Sophie also took frequent videos of C when she was, quote, in episode, and shared them with doctors, teachers, as well as posting them on YouTube in order to, by her explanation, raise awareness about age C. Here's how one of C's speech pathologists describes watching those videos. They made me uncomfortable. Okay. I had a hard time imagining being a parent and...

videos of those kinds of things from my kid. Right. Um,

And then I sort of thought, well, she's trying to prove that there's something happening with the medical profession. Maybe that was her motivation for doing it. But it was an uncomfortable thing to watch. Dr. McCotty confirmed that he couldn't conclude anything from the videos that Sophie had shared with the team. And Dr. Wiester, who heads up Seattle's scan team, reports that the videos recorded random behaviors and crying that were not demonstrative of anything.

By all appearances, Seattle Children's and Duke were very much on the same page. But Sophie often told Seattle Children's that a particular recommendation was coming from Duke, such as in an email Sophie drafted to Dr. Wainwright in March of 2020, telling him that Dr. McCoddy said they needed to put C on a higher dose of baclofen, which was one of the medications being used to treat her purported episodes.

As far as the precocious puberty question and the findings that didn't quite match up, the charging documents provide one possible explanation, that C was being given birth control pills, which contain estrogen and which would account for the clinical findings in the initial appointments that did not match up with the lab workup.

Presenting side effects of a medication as symptoms is a common thread in these cases, so it makes sense that doctors and the police dug into this. And then there was this disquieting detail from the police interview with Sophie's next-door neighbor, in which she describes picking up some prescriptions for C&M. So I was going to the store every once in a while to Fred Meyer, and I offered one day to pick up anything she needed. So she said, oh, I have prescriptions to pick up.

And I said, "Okay, great." You know, so she said they were, I feel like she said they were both for . One was for and one was for . And they're right in the back, right in my hands. And they asked me if I needed a syringe. And I looked at the bottle and was like, "What is it for?" And it was for . - That's okay. You can take a second. - It said had the G-tube. And she doesn't have a G-tube, as far as I know. She doesn't have a gastro-do-who to eat.

Just to clarify this because the names are bleeped out, this neighbor picked up a G-tube medication that was labeled for M who does not have a G-tube. The neighbor was so alarmed that she took photos of the prescription bottles. I actually took photos of them, the bottles, because I was that bothered by it. And we'd already had some inklings that something was kind of off. So I've been sitting on it for all this time because I just didn't know what to do with the information. But

I have a G-tube. And I don't know if a doctor's office would get that wrong. And there were two different doctors. The other medication was for...

for the seizures or whatever. She supposedly has seizures, right? I just had it because I felt like someday it might be useful. And I gave her the prescriptions. I didn't say a word, thank you, because it wasn't my place. But to me, that was weird. I don't know why a doctor would prescribe the wrong medication, a different doctor to a different child, and that nobody's going to catch it. I don't know how long it has been happening, but it just didn't feel right.

When she was separated from Sophie and admitted to the hospital for observation in March of 2021, C was on a number of medications for her supposed symptoms. This list, along with the list of medications found in the home when police searched it, could give us some insight into the, quote, symptoms other people saw. I can start with the ones that were actually prescribed to her. Here again is Dr. Becks. So she, it looks like, was on atropine sulfate drops, which are eye drops.

And they're usually used in children most commonly if you have one eye that's much stronger than the other.

The thing is, this does have side effects of things like dilating the pupils, you know, just putting drops in a child's eyes before the exam could change. And it may change your diagnosis if you come in and see a child with dilated pupils and you don't have an explanation for it. And then it's in the class of benzodiazepines. So things like Ativan and things that we use in pediatrics,

both to break seizure episodes is probably the most common reason that I prescribe it. And then also for things like increased tone. So children who have cerebral palsy or brain injuries and therefore are very tense or very increased in tone, this medicine helps them to be a little more relaxed. Now diazepam in and of itself is extremely sedating. One of the reasons that

we only give it in specific situations like when a seizure happens or to kids at appropriate doses that are often what we say titrated up, meaning you start at the lowest dose and then you work up so you're sure that they don't have all of those side effects, is it is extremely sedating. And then the extra medicines for C that I saw were flugercortisone and oxcarbazepine

And then the last one actually does worry me just because of what I know about it. So oxcarbazepine is trileptal. Again, it's another seizure medication. With any medicine, we sometimes use it off-label for other things, but this one is definitely a medication used by neurologists in seizures in children. The thing with trileptal is if you are taking too little, you may have seizure episodes that break through. If you are taking too much, you can have...

side effects from taking too much. So, and one of the biggest ones, again, being somnolence or sleepiness. And I have actually had a child come in with toxic levels of trileptal in my career. And I mean, it really looks like a child who is completely out of it. Like you can't, you can wake them up, but they don't seem very coherent. They can't, they aren't aware of their environment. I also asked Dr. Becks about the prescription for baclofen.

Okay, so baclofen is a medicine also similar to diazepam in the sense that we use it in children with cerebral palsy or increased tone to also help them with relaxation. Posturing is just very tight. And so what that does is it helps to release all of the connections so that they can move a little more freely.

The most common symptom people reported seeing, if any at all, was C being really out of it. So the fact that there were multiple highly sedating medications in the house is notable. Becks also mentioned that the side effects of one of these medications is difficulty swallowing, which Sophie constantly reported in C despite a series of swallow tests that showed either mild or no difficulty.

Sophie's explanation for this was that C could simply perform being able to swallow in a hospital setting. Even the manner in which these medications were used sounded off to Bex, such as what C herself told the police about how her mom treated her during an episode. During the police investigation, forensic interviewers spoke to C about her episodes, and what she told them is shocking. Here is my producer Mariah talking to Dr. Bex.

The investigator asked, tell me what your mom says about your episodes. Well, my mom, she gives me baclofen. That is for an episode. And it's really disgusting. So she gives it to me with food or water. Huh. So that is for an episode is what she says. That's what she says. That's what C is recalling, which again, you know, C is five, but. Right.

So baclofen being for tone is kind of what I was saying. So tone is that you either have low tone and you're extremely floppy or you have high tone and you're extremely like stiff and tense. As far as baclofen being like a rescue medicine for something, I mean, that I don't. Diazepam, yes, I could argue we do, but typically it's given either like rectally or through the nose or something, something that if a child was truly in a seizure that you could still give it.

So again, it's odd that you would give it during an episode because during episodes, usually you don't want to put things necessarily in the child's mouth. Um,

And that's just baclofen is more of an every day you take it three times a day or, you know, however many times a day to maintain normal tone. Not that you would give it in kind of a bolus dose like that. So are there other medications on this list that would be given orally that she could remember tasting that would be something you would give during an episode? So diazepam.

We do give during episodes, but like I said, you're usually, you give it in a safe way because during an episode of any kind, children are at risk of aspirating. So you don't really want to put anything in the mouth. So you want to put it somewhere that it can absorb where they don't have to actually swallow. But typically we don't do like an oral liquid medicine in those cases because you would worry they're not going to protect their airway during an episode and that they could choke. Right.

Or like she said, she gets it with food. To me, that would imply you're also maybe eating during that episode. Just something about that timing, that wouldn't be how we would do it.

I am obviously not qualified to say whether or not C has AHC. The person who is best positioned to make this call is Dr. Wainwright, the neurologist from Seattle Children's, who Dr. McCotty himself said he would defer to on the question of whether this was an AHC case or a Munchausen case. This is from Dr. Wainwright's sworn affidavit. Quote,

C. Hartman is a patient of mine since October 2019. At that time, she had been diagnosed with alternating hemiplegia of childhood.

C had genetic testing which had not identified a variant in the gene associated with this disorder, and the diagnosis was therefore made on clinical grounds, including the reports of symptoms made by her mother. Over the course of her treatment, she had hospital admissions, inpatient and outpatient EEG studies, and brain MRIs. These studies were normal or showed only mild abnormalities. These findings were not consistent with the severity of the clinical symptoms reported by her mother.

In addition, her neurologic examination and symptoms during hospitalizations in 2019, 2020, and 2021 did not reveal these symptoms. I have concluded that C does not have AHC, nor does she have the severe and recurrent neurological symptoms reported to the medical teams. Instead, she has a mild static encephalopathy, which does not require the medications she was previously treated with,

nor does she require the other medical devices, including wheelchair, orthotics, and feeding tube. Given my role as the creator of a podcast about Munchausen by proxy, I think sometimes people assume that I go into a given case looking only for evidence of abuse. But what I actually go in looking for is the truth. And in that search, I look for any other possible explanation that could make any kind of sense. And after months of researching this case, I simply cannot find one.

If C really has AHC, it would be in defiance of all known science on the disorder and truly of reality itself. It would appear that the truth was what Seattle Children's observed at the end of C's 16-day hospitalization following her separation from Sophie, that she was a completely normal six-year-old girl.

On March 18th, 2021, the day after C&M were placed in protective custody, Detective O'Rourke got a call from an attorney named Adam Shapiro, who was representing Sophie Hartman. He said he was just digging into this case, but that he'd seen a number of these medical cases. In fact, he'd had one the year before, and it had even involved some of these same doctors. It had all turned out to be garbage, he said.

In that case, Shapiro, an experienced family-independency attorney, had gotten the children returned to the mom and no criminal charges had ever been filed. This case had also been covered on the local news.

Tonight, a joint Kink 5 and NBC News investigation has found some Washington State children were needlessly torn apart from their parents after a Tacoma doctor said they were abused. It was a Mary Bridge Children's Hospital doctor in Tacoma who triggered the removal. She reviewed the case and found Megan had abused since birth. This case was my sister's.

next time. I told Shapiro, this is what I want. You know, I want Megan to get treatment. There's no doubt in my mind she's seriously ill. And his job is to make sure that she gets treatment. Nobody Should Believe Me is written, hosted, and executive produced by me, Andrea Dunlop.

Our senior producer is Mariah Gossett. Story editing by Nicole Hill. Research and fact-checking by Aaron Ajayi. And our associate producer is Greta Stromquist. Mixing and engineering by Robin Edgar. Administrative support from Nola Karmouche. If you or anyone you know is a victim or survivor of medical child abuse, please go to MunchHausenSupport.com to connect with professionals who can help.