Nobody Should Believe Me - Case Files 20: Rady Children’s Part 4 with Dr. Mary Sanders

Episode Date: May 29, 2025

In the 4th part of our Case Files series on Rady Children’s, Andrea and Dr. Mary Sanders from Stanford University deep dive into the emotional and legal complexities of child abuse cases. They unpack how surveillance in hospital settings—while potentially life-saving—raises big questions around privacy and consent. The conversation also explores the difficult dynamics of teenage victims, how hard these cases are to diagnose, and why the trust between parents and healthcare providers is often the first casualty. Andrea and Mary also examine how conspiracy theories infiltrate the courtroom and public opinion, warping our understanding of child welfare. From the strain on therapists to the trauma carried by kids in foster care and legal battles, this episode is a raw, thoughtful look at what happens when the system meant to protect children is itself under pressure. *** This podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. *** Order Andrea's new book The Mother Next Door: Medicine, Deception, and Munchausen by Proxy.  Click here to view our sponsors. Remember that using our codes helps advertisers know you’re listening and helps us keep making the show!   Subscribe on YouTube where we have full episodes and lots of bonus content.  Follow Andrea on Instagram: @andreadunlop Buy Andrea's books here.  For more information and resources on Munchausen by Proxy, please visit MunchausenSupport.com The American Professional Society on the Abuse of Children’s MBP Practice Guidelines can be downloaded here. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Just a quick reminder that my new book, The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, is on sale right now wherever books are sold. The book was an Amazon editor's pick for nonfiction, and the Seattle Times called it a riveting deep dive into MBP. And if you are an audiobook lover and you like hearing my voice, which I'm assuming you do since you're listening here, you should know that I narrate the audiobook as well. If you have already read the book, which I know so many of you have, thank you so much. Please let me know your thoughts and questions at helloandnobodyshouldbelieveme.com and we will bring my co author detective Mike Weber on for a little book Q&A and post retirement tell all special.

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Please play responsibly, 19 plus and physically located in Ontario. If you have questions or concerns about your gambling or the gambling of someone close to you, please contact Connects Ontario 1866-531-2600 to speak to an advisor free of charge. Hello, it's Andrea. And today we have a conversation with a fantastic expert we've had on the

show a number of times, Dr. Mary Sanders, to help us unpack the complicated situation that we have been covering with Reedy Children's Hospital. Mary is one of the very first people I met in the field of child abuse, and I appreciate her perspective and wisdom so much. We will have one more episode on this case next week and then season six is coming June 19th. And just a reminder that if you want to listen to the whole thing on June 19th, you can subscribe on Apple podcasts or Patreon and we will have the whole thing ready for you to binge on that date. I wanted to take a moment and thank you for all of the feedback on these episodes about Rady's and let you know that we hear you.

Nobody Should Believe Me is an independent production and it's an ambitious one. So we always appreciate feedback from our very smart, very thoughtful listeners. We're going to be back after season six with some additional coverage on this case as we get more information and we're going to talk to after season six with some additional coverage on this case as we get more information and we're going to talk to an expert in POTS and EDS

to get a clearer picture of the diagnoses that are central to this case. We are also hoping to get the lawyers from this case on, but that can be complicated when there is ongoing litigation. But please rest assured, we will have a knowledgeable lawyer on here to discuss the legal complexities of this case

because they are legion. If you have specific questions or comments about this case or want to share your own experiences with POTS and EDS as a number of you have done, please do so. The very best way to make sure we get this feedback is to send us an email or voice memo to hello at nobodyshouldbelieve.com. But we also monitor comments on Spotify and socials if you want to leave them there. Thank you so much for listening and for being so engaged with this show. I could not keep making it without you. Now here's my conversation with the wonderful Dr. Mary Sanders. Hi, Mary. Hi, how are you? I'm good. Thank you so much for being with us.

Yet again, you are a frequent contributor to Nobody Should Believe Me, a friend of the show, I would say. For those listeners who have not met you before, can you tell us who you are and what you do, how you come to this work? Sure. I am a clinical professor of psychiatry at Stanford, and I started in the field of child abuse actually in 1974, when the first reporting laws were out. Over the years, I became more and more specialized in

the area of munchausen by proxy child abuse. But I have over the last, since that time, done quite a bit of forensic evaluations and therapy and writing as well. Presentations. Um, well, you are an incredible thinker, writer, speaker on this topic, and you are just a personal mentor of mine. So I always love having you on the show.

Thank you. And I just want to say, I just so appreciate your podcast. It has done so much good and has really spread the word about helping people inform themselves about this type of abuse. So thank you so much. Oh, Mary, you're gonna get me all teary right at the top of our conversation.

Same. Just a little love fest to start us off. Oh, it's nice. Yes, yes, I love it. You know, and it's so interesting when you talk about your, you know, the duration of your career and how long you've been in this field and mentioning that 1974 was the beginning

of mandatory reporting laws, because I think something that's very easy for people to lose sight of, especially if they are an elder millennial like I am or younger, is that these concepts of child abuse being a thing that should be against the law, that should be protected against in a formal way are very new and hence, I think, very fragile. We are only sort of one generation into these being very accepted concepts. And so, even though I grew up with this as the norm, people your age and my parents' age did not.

And so, I think that's something really important for people to keep in mind as we talk about legal challenges to these protections, which is what we are talking about today. And this lawsuit against Reedy Children's, which we have been covering on the show, which is extraordinarily complex and which we are going to continue to cover as it unfolds. I really appreciate you being here to help us just understand really what's going on here and what is the substance of this lawsuit and its various claims and really just help us put some of these things in context. One of the things I wanted to ask you about is this element of video surveillance, because I think this is something that is not well understood by people outside of the

child abuse field. Although it has come to play in many of the cases that we've covered on the show, it is, you know, frequently comes to play, I think, in munchausen by proxy evaluations. But can you just tell us a little bit about how a tool like video surveillance is used in a hospital setting in the course of a child abuse evaluation? Sure. Well, first of all, I've never been involved in a case where we did use covert video, but I like the word tool. It's a tool. And basically when we're trying to determine the etiology of symptoms, and for example, in cases of apnea where there's a possibility that the child is being smothered, then this is

a tool to help us determine if that's the case. Yeah, I've certainly come across it in cases like the one that we're covering for our upcoming season. It's also frequently used as a tool in poisoning cases and can be if they suspect that that poisoning is actually happening in the hospital. My broader understanding of this lawsuit and lawsuits like this is that they are using a lot of very emotionally charged language and emotionally charged concepts to intentionally or not, I guess, obscure what is really going on here and what actually may have happened to this child. I think that the video surveillance, the reason they're focused on it is because I think it has that emotional charge. I think when people have this idea that you would be surveilled in a hospital with your child is very upsetting.

I understand why that upsets people. I do too. Hospitals are an interesting place. And I think that so many of these lawsuits, we really get into some pretty strong differences of opinion on what a hospital is and is not. Is it a building full of employees? Is it a part of a community? What role should it be playing? And I think that this kind of gets to another one of those questions, right? It's like, what kind of privacy can people expect in a hospital? Because obviously, there are a lot of intimate, sensitive, vulnerable things that happen within hospital settings. And it's a setting where you're not necessarily

going to have privacy for a lot of reasons, right? You know, even like the most time I've spent in a hospital, luckily, was when I was giving birth to my children. And, you know, you have people, and I mean, now it's funny because during childbirth, I could have cared less, but I mean, like you have a jillion people coming in and out of the room, you know, at various points in the process. So I think there are some sort of interesting questions about what privacy people are and are not

entitled to in a hospital. What do you kind of, as a person who spent a lot of time in hospital settings, what are your thoughts on this? Yes, a hospital room is not private. It's actually been likened to a parking lot. It could be monitored. It's a public space.

And I feel I do spend a lot of time in a hospital. I work in a hospital. I feel for my kids because they're constantly, they don't have a lot of downtime. With that said, we certainly try to provide as much privacy as we possibly can. Absolutely. Yeah, they're not private. Hospital rooms are not private settings. Absolutely. But yeah, they're not private hospital rooms are not private settings. Yeah. What are some of the risks of changing laws so that

hospitals are more private settings so that you can have more of an expectation of privacy within that? What are some of the costs of doing that from your viewpoint? Oh, you know, that that's interesting to think about. I, I can't even imagine because we need to be able to get in there and, you know, right away, you know, we can't have bathroom doors that lock, you know, if someone is falls or injured, what have you, we have to be able to get to the patient right away for whatever the medical issue is. So I honestly, I can't even imagine it being a private setting.

Yeah, you understand where some of these privacy concessions, I guess, as they were, could be upsetting and not ideal for a person in a given situation, but also that they're necessary because I think there's, you know, I guess I think about this sort of hierarchy of things that are going on in a hospital, right? And especially, I think, with kits, right? The do no harm of it all. I think, obviously, one of the other things that comes up

in a lawsuit like this, and in particular, is highlighted in this lawsuit, is the idea of parental consent to medical procedures. This idea that the child underwent various procedures, diagnostic testing, nothing that they shouted out in this lawsuit sounded particularly invasive to me. I think the most invasive thing they mentioned was a swallow study, which again is not a procedure that has any pain associated with it or anesthesia. But they were saying that this was without the consent of the parents during a time when the parents did not have custody of the child. So I think there's a lot of tension around that too. And even when we were talking about this with Dr. Becks, who is a pediatric hospitalist, she was saying that there's even in not a custody dispute

situation, but when the parents are at the hospital, they make reasonable efforts to get their consent on certain things. But there are certain things that the doctors there, they're doing their rounds, they're doing routine testing. There are certain group of things that it doesn't make sense to have parental sign off on everything. And that there does have to be essentially trust with providers. Right? Like this is a very, this relationship, I mean, this could not be more central to what we talk about on this show, but like, that parents have to be able to trust providers, and providers have to be able to trust parents. And I really worry about the damage that a lawsuit

and the surrounding media coverage of a lawsuit like this does to that bond. And what are your thoughts on that? Yeah, I was thinking I was applying what you're talking about to my setting. And yeah, there's so many things we do with our population. And we don't run everything by the parent. The parent definitely trusts us that we're taking care of their kids.

You know, and we're very family friendly. We want parents there as much as possible, but they can't always be there. And they are trusting us to take care of their child. Absolutely. If it's a particularly invasive procedure that we need to do, we would certainly do everything to get a hold of that parent. But if it's something that's necessary, we would probably go ahead. Yeah. Yeah, so I want to talk about some of the details. And this really gets into another area of your expertise.

And I wanted to talk about some of the details of what we know was covered on this video surveillance. Because again, this is another situation where we have the lawsuit itself and what we can kind of divine from that. And because this has not gone to any kind of trial yet, we don't have Madison, the child's medical records, but I did sort of go through this with a fine tooth comb seeing what details we could pick out. And one of the things that really caught my eye is that they said that they talked about some of the stuff that

was allegedly captured on this video recording. And one of the things that they mentioned was that Madison was allegedly seen tampering with her own feeding tube. The lawsuit also mentions that there was some concern from a number of providers, including those at Rady Children's, that Madison was fabricating some of her symptoms. This is framed on behalf of the plaintiffs as falsification of evidence. I can't totally follow that thread from the information that I have. But if this is what's been captured, sort of looking at these ideas of seeing her tampering, seeing Madison possibly exaggerating or falsifying some of her symptoms,

given the fact that she is 16 and 17 when this whole thing is going on, what do we know about the dynamics between victims of munchausen by proxy that are that age and their parents, because I think there's really a lot to sort of unpack here. Sure. Yeah, so basically it sounds like there was evidence on the tape that the child had been tampering with their feeding tube. Again, I have not been involved with a case of covert video capturing this, but I have had cases in which a child was presenting there, was basically falsifying their own symptoms or engaging in illness behaviors. I work with eating disorders and sometimes the children are not, you know, allowing all the feed to go in or what have you, and maybe stopping the feeding and that sort of thing

because of their disorder. And, you know, and if a parent is in the room when this is happening, that's more concerning because, you know, is this parent colluding? Is this parent promoting illness behavior? Is this, you know, or is this, or is a parent just not letting us know that the child is interfering with treatment? So, so these are things that we've definitely seen happen with our teen population.

No doubt about it. Yeah. Yeah. And, you know, I think this really brought up, you know, some of these other cases that we've talked about on the show, like the Mike Kowalski case and the Justina Pelletier case, where when you're talking about munchausen by proxy abuse with very young children, they really are not old enough to be part of the dynamic in an active way. And then it gets a lot more complicated when kids get a little bit older,

I think especially once they get to be 9 you know, nine, ten, and then on into their teenage years. And I want to be really precise about how we talk about this. And I know this is something we've talked about quite a bit on the committee of how to sort of frame this behavior, because I think it does and has been in this case, you know, labeled as factitious disorder behavior. This is one of the diagnoses that the lawsuit says that HHSA, which is the Child Protective Services in California, and Reedy Children's gave her, which was conversion disorder, factitious disorder, somatic symptom disorder, post-traumatic stress disorder, and anxiety disorder. We can unpack those a bit further,

but just to call out this factitious disorder right? So factitious disorder imposed on self, that's when someone, you know, fabricates, exaggerates, or induces illness in themselves for the purposes of attention. And I think that this diagnosis when applied to someone who we suspect is a victim is not quite right. I understand why it's used because it's naming the behavior. The other thing that we know about a lot of perpetrators is that they began these, I mean, thinking back on my sister, thinking about a lot of the people where we've talked to their family members, a lot of times these behaviors do start as teenagers. And in a situation that's not an abuse situation, a parent is very concerned by those behaviors and doesn't co-sign that behavior. In this case, the dynamics appear from what we know to be quite a lot more complicated.

I think in a case where you're suspecting that that parent is abusive, that is very different because if a child is participating in it, it's because they've been co-opted by the parent, not because they're necessarily intentionally doing it in the way that we would think of someone doing this just of their own accord. Can you kind of help us tease that out a little bit? Yeah, absolutely. I like the word co-opted. The other word that I've heard recently that also kind of fits as groomed, you know, that they've been groomed to this type of behavior

and or co-opted into illness appearing ill. And it may have started very young. And so, you know, this is also, this is maybe what they know in their family. This is what they do. And it's something that they are supposed to do. It's part of surviving in the family that they need to be ill.

And so, yes, we definitely are concerned when we see a child producing their own illness, but we do, we wanna look back. Is this a behavior that's being encouraged or not intervened? So basically, yeah, we wanna know is a parent involved or not intervened. So basically, yeah, we wanna know is the parent involved or not involved. And so in a case of where the parent is co-opting the child,

then that would be factitious disorder and post-homone-other or child abuse. I was very struck by some of these diagnoses because the family is saying that the diagnosis this child has, Ehlers-Danlos syndrome, POTS, and CRPS, all very real diagnoses that can be very complex and difficult to get to the bottom of, in their own right, but also frequent fliers in these cases, it has to be said. And we have heard actually from so many people. We're going

to follow up on this and hear some of these stories coming up, but I've heard from so many listeners that suffer from a couple of those conditions, but in particular, elders Danlos and Potts, who have had some real difficulties with doctors and also are very aware, and seemingly there are people in those communities that are very aware of the way that these diagnoses have been co-opted by people engaging in fictitious disorder behaviors or in munchausen by proxy behaviors, which is just such a mess and so horrible for the people that are suffering from those conditions genuinely. And so it was very striking to me though that the diagnose, you me though that you have these two sides saying

that, okay, that's what the parents in this lawsuit are saying. Then on the other side, you have this conversion disorder, fictitious disorder, somatic symptom disorder, and then these two mental health diagnoses of post-traumatic stress disorder and anxiety disorder. That's certainly- Can I just yes, yes please. Yeah, I just wanted to say also you can have Aylur-Stanloss and be a victim of munch house and by proxy. Yes, thank you. Thank you for saying that. The perennial reminder that we always put

that the presence of a genuine diagnosis does not mean the absence of abuse. Exaggeration, fabrication, those things can all come up. And so actually, interestingly, as opposed to the Mayakovsky case, where once we had really done all of the research, that diagnosis of CRPS appeared to be very much fabricated. She had gone to three world-class hospitals

that had not given her that diagnosis. So that very much appeared to. She had gone to three world-class hospitals that had not given her that diagnosis. So that very much appeared to be a fabrication. In this case, I'm not so sure, because this was actually diagnosed by a proper hospital, and it does appear to fit the diagnosis of CRPS, stemming from an initial injury, etc. So, and it's not really as much the focus of this more about the Ehlers-Danlos and POTS. But yeah, that's just to say that like, things happen to children all the time. People have medical stuff. It does not negate abuse. Correct. Yeah. Yeah. I'm very glad you pointed that out. But so this list of diagnoses that we get sort of from the other side of what the hospital and HHSA is saying,

I mean, this looks very recognizable to me. And I think that this conversion disorder, do you happen to know the difference between conversion disorder and somatic symptom disorder? Because I actually realize I don't. Those feel pretty interchangeable to me. Yeah, I think they have been used pretty interchangeably, you know, in both situations. Well, and especially in conversion, you know, it's an unconscious production of symptoms. It's not

intentional. And so that's a big difference between like a somatiform disorder versus fictitious disorder, where in fictitious disorder, the intentional production of symptoms. In conversion and somatiform, it would not be a conscious production. Yeah. That actually makes sense that I have started to wonder if our entire population of victim and survivors doesn't suffer from some form of conversion disorder and or somatic symptom disorder. Because something that we hear from survivors all the time is that once they had the revelation of abuse that it took them quite a long time to figure out what was real about their health and what wasn't. I've heard from Joe talks about who's a survivor that's been on the show a number of times and is doing a lot of work in advocacy space. He

talked about how up until a couple of years ago, they thought they had asthma, and it turns out they don't. And, you know, it just really, it's so sad how confused it makes victims and survivors about their own bodies. I agree. Yeah. So I want to talk about this conspiracy element of this lawsuit, where I feel like this element is present in every one of these lawsuits that we've talked about. That's the thing it really leans on, right, when we talked about Sophie Hartman's lawsuit, my sister's various attempts at lawsuits,

certainly the Kowalski v. Johns Hopkins lawsuit, there's this central idea that a bunch of people from the hospital are collaborating in this conspiracy to take the child away from the parent for question mark reasons. This is particularly elaborate in this lawsuit where it's saying, you know, more than two dozen people, both named and unnamed, so they do this like medical dose one through 10, so 10 additional people at the hospital that we don't get named. But you know, it's like more than two dozen people from the hospital, HHSA, and even this residential treatment center that eventually gets involved in this thing

are all conspiring against Dana Gasquet and Bill Maier, the parents, to remove custody of this one teenage girl from these two people. Number one, do we know of any situation where anything like this, like on this level of people has ever happened? No, and it never will. Because it's just nuts. Yeah, I can't even imagine. Yeah, I know.

It's really, I will tell you, I will tell you, I'm trying, especially because we have such limited information about what happened in this case, I'm trying to stay somewhat even-handed in the way that I present this. And yet. I tried to too, but I can't. But this is nuts. I mean, you cannot pretend this is not nuts.

It's like the allegation here, when you strip out all of the, and again, that's why I kind of made that point about the emotionally charged language, because I think that that's meant as a distraction so that we don't look at the actual charge that's being made. And it's been effective, right? Because the media coverage, a lot of it

is about like, these parents were secretly surveilled and like da-da-da-da-da-da, and this whole thing. They had their child ripped away, and they were given procedures without her consent. And you're like, you are being told a sliver of the story. Do you know what this lawsuit is saying happened here? They're saying that all of these people got together across a period of more than a year

and fabricated evidence and knowingly took false reports to the court and coordinated with each other. Why? They give no reason. I mean, and actually the reasons that they give are upside down reasons. They say, oh, this was to cover up for their own incompetence and their own unlawful behavior.

Because they're saying that because they conducted this video surveillance without obtaining a warrant, that that was against the law. It's not, to be clear. Now, I think the point of this lawsuit is to challenge some of those laws around video surveillance and parents' rights and some other things. But it is not against the law. I mean, this covert video surveillance is legal. And every hospital has kind of different policy on it. But they're saying to cover up for their incompetence, to cover up for the fact that they were wrong about this child's diagnoses, to cover for their reputation,

they're also making this broader claim that these are just deep systemic issues that pervade these various agents. The hospital and HHSA, that's part of their, I can't remember the name for it, but there's a specific allegation that, oh, these are systemic issues that come from the way these organizations operate on a whole, not just the specific case. And that is so wild to just like, like, I think people just need to sit with that

for a minute and just be like, why would a group of pediatricians do this? Why would they do the time? Why would they go to medical school and to vote their lives, to taking care of kids? And you make a good point. Those are just hot words. Surveillance, conspiracy, you know, yeah, those are those are headliners. So I see, I see what you're saying here. And yes, just nuts. Just nuts. It's a wild allegation. And I think you really need to put a conspiracy theory lens on it, of like, OK, so you're saying all of these people coordinated.

So it's like, it's an implausible number of people to coordinate. I mean, you can't get people to coordinate on anything. Like, hello, has anyone else done a group project? You can't get this many people to coordinate on something for regular reasons. I mean, one of the reasons that sometimes people react to these lawsuits in such an emotional way

and why they make sense to people is because people have had terrible experiences with the health care system. But I think you need to think about what is bad about the health care system. It's not these things. It's not a bunch of doctors conspiring to snatch children away.

It's actually because a lot of times care is not coordinated the way that it should be, and it's fractured, and you get these sort of like, you know, potholes everywhere. And like, it's exactly the opposite. And in terms of the reputational thing, if I'm a doctor who wants to keep myself out of court and out of the media and my reputation squeaky clean, I'm not reporting abuse.

And we know that that's happening. I mean, I have had married so many people whenever I'm doing something where there's medical professionals there or even just if I'm doing something out like book event or somewhere out in the world. Like I have had many medical professionals pull me aside and tell me that they attempted to report abuse and risk management told them not to. So that is not, yeah, which is bad. I mean we are suffering from the opposite problem, but it's like yes the risky position always. I can't tell me if you can find an argument otherwise, but the risky position always is to report. That's the thing that's gonna end up damaging your reputation. That's gonna that's the thing that's going to end up damaging your reputation. That's going to that's the thing that's going to potentially make

you the villain of a Netflix film. That's the thing that's going to potentially drag you through a lengthy lawsuit, right? So absolutely. It makes no sense. The last thing we want to do is is a find abuse. We don't want to, you know, not only do we not want the child to have gone through that, we know it's upsetting, we know people are going to be angry with us, and we know as mandated reporters we are going to have to report. We will be liable if we don't and also feel terrible if abuse continues and we knew about it and didn't do something. So absolutely if there is abuse, we will report. If there's reasonable suspicion, we are mandated reporters who are going to do it.

Do we want to? Absolutely not. Yeah. No. Yeah. Quite the opposite of this. Yes. Yeah. And I mean, again, we hope we hope doctors report. You know, You look at cases like the Olivia Gantt case in Colorado, where the family members ultimately sued that hospital because they had suspicions and there was disagreement amongst the team, and it eventually got shut down, and they didn't report, and that child died. And that is a tragedy. And I think by and large, when I have talked to both people

on the medical side and people on the child protection side, so people who work for HHSA or CPS or whatever it's referred to in your state, they all recognize that to a person from who I've talked to, they all recognize that when you separate a child from their parents, that's a tragedy. Even if it needs to happen, I don't know anybody that relishes doing that.

Everyone recognizes that that is harming the child also, right? It may be necessary, but it is not something that people take lightly. And I feel like I'm a broken record with this one, but I also just always want to point out, this is the children's hospital that had a child abuse pediatrician. She is named in this lawsuit. She has made a centerpiece of this lawsuit. Child abuse pediatricians find abuse in less than 50% of the cases they evaluate, and they are less likely to have positive findings of abuse than their less well-trained colleagues. Because they are better trained, they've been made into this absolute scapegoat and bogeyman

in this whole system, but they are not. They are doctors who do a medical evaluation. Truly cannot say that enough. One of the really explosive claims in addition to, you know, that really is a continuation of this conspiracy claim is what comes up in this first amended complaint to this lawsuit. This lawsuit, like many, it's in its third amended complaint. In this case, the lawsuit of the parents and Madison herself have now been combined in the first amended to complaint in this lawsuit. Not the original lawsuit. The parents originally filed this lawsuit while things were still sort of actively happening and while the child was still underage. So this was not in their original complaint. This is in the amended complaint.

They make these, to me, just explosive allegations about the hospital's conduct. And they mention this element and we don't get a lot of information about the substance of this disclosure, but they bring in this element that they are alleging that the hospital staff implanted false memories of sexual assault in Madison that then led her to, if I'm following their logic, believe that she had been sexually abused by her parents and led to her attempting suicide in order to not be reunited with them. Because a judge originally, after looking at the Munchausen by proxy reports, originally returned custody of Madison to her parents. And then not long after that,

she attempted suicide and she wrote a note that said that she would rather die than return to her parents. And you know, we can glean from this lawsuit that at some point, again, we don't know when, we don't know what the exact details of this were, but that she had made a disclosure to the hospital that she was being sexually abused by her parents. So I want to just unpack this piece by piece, especially in context of this concept of implanting false memories of abuse. So can you help us understand, you know, and just give us some context of this, the so called memory wars and the 1990s and kind of this whole idea of, you know, psychiatrists or

psychologists implanting a false memory. Absolutely. As you may surmise, I was around during that since I started this in the 70s. So yes, I'm very aware of the memory wars. And this was a debate around whether child trauma memories could be recovered, like pristine memories that had been repressed from childhood up until adulthood. And sort of the pivotal case was the Ramona case. And this was a case, I think it was 1994, in which an adult went to therapy

and was having eating issues. And it was suggested that, suggested or asked, you know, have you been a victim of sexual abuse or any abuse? And the patient, you know, searched their memory and didn't think they were, but then kept looking and kept wondering and kept, you know, examining, gee, have I been a victim of abuse? And actually wanted, requested to go through a sodium amytal interview to try to determine. And in that interview, I guess, had said, yes, I was abused.

What is this sodium amytal interview? I guess under the influence of this drug sodium amytal, that like truth serum basically. Anyway, and then believed that she had been abused by her father and her father successfully sued the therapist or I don't know how many, but sued the therapist for suggesting and leading his adult daughter to believe that she had been abused. So this was sort of a pivotal case. And what came from all of this, the memory wars basically was some really great research into, well, can we do this? Can we actually implant memories?

And, you know, certainly what we know about memory is memory is not just a videotape of what happened in our lives. It's affected by so many things. And also this was going on in the context of, I don't know if you know about the preschools like the McMartin Preschool. So basically, recognizing that children, preschool children,

can easily be led by inappropriate leading questions. Can you actually walk us through the McMartin trial? Because I think that is probably where I think this is maybe the best known, this concept. Yeah. I only think of them as a compilation because there was a lot of them, the Fells, the McMartin. But basically what happened is a child in a particular preschool, wet his pants, the preschool worker, you know, cleaned him up, changed his pants and you know, went on life. And then later on, I guess,

I don't know whether he was asked or just said, oh, so-and-so touched my private parts. And then what happened from that was inappropriate interviewing, you know, leading the kids, you know, not asking open-ended question, but you know, you can tell me or the puppets what happened to you and I know something happened. So definitely, you know, almost coercing these kids into making false

statements and people went to jail for decades. Wow. Yeah. And this is part of the satanic panic, right? Where, exactly, yeah. And of course, what came from that is a lot of good research into what is memory and also from psychology point of view, how best to do interviews and to not leave patients, to be very careful in how we ask questions, never suggesting, not using imagery to lead a patient

to create a false memory. And so can it be done? Absolutely. You can, through suggestive questioning, through imaging, through manipulation, you can implant memories, not in everyone. And that's another interesting thing as well. But certainly some people are susceptible

to implanted memories. And therapists are extremely cautious in how they question and the type of therapy that they do. As a result of some of the research that came out of the 90s. What's interesting to me in this case, and tell me if I'm reading this right, but I read in the complaint that Madison, the child,

made this report that she had been, that this was ongoing abuse from age 11 to 15 or, you know, until she was hospitalized. This isn't a repressed memory. This is, it sounds like this is a report that she's making, true or not, of abuse that is ongoing, not something that happened way in the past that had to be pulled out of her. Yeah. Yeah. I mean, basically therapy is a place to certainly explore your memories, but the therapist is very careful

not to like, you know, imagery or what have you, to do any sort of suggestion to kind of lead a memory forward. So we're asked for talking usually if we're talking about memories, we're talking about an adult looking back at you know early early memories that they can't recall. And I know when I've worked with abuse victims that wanted to know more about their abuse, I had them go back and talk to people that were there. So it's not so much that we explore recovering memories in therapy.

If they want to know more about what happened in their childhood, going and talking to people that were also with them. Yeah. So more of almost like an investigation, or even we talk to a lot of survivors about getting their medical records, like that kind of thing. Yeah.

Exactly. Yeah. Exactly. So yeah, I don't work with patients in like, let's sit and try to figure out what's happened to you. The other thing is whatever your experience is, it's just your experience. And that's being able to try to validate anyone's memory is,

you know, unless they're going to go back and talk to someone who saw something or or it was written down, like you said, in the medical record. Yeah, it's just not going to happen. So it's interesting what you said about sort of this time period, right, that she's she's making a disclosure. We can glean that she made a disclosure about ongoing abuse. So, it's interesting what you said about this time period, right? She's making a disclosure, we can glean that she made a disclosure about ongoing abuse. And in these situations, like the ones that came up in the satanic panic and those trials and even in this other case that you were talking about, it sounds like that was more

like a false memory, not a memory that somehow, like, it doesn't sound like it would be very viable to implant a memory that spans four years of someone's life that just happened. Oh, yes. That's, you know, yeah, that's not what was considered a repressed memory because it's happening. It's not, it's not way in the past, it's been just buried. Yeah, so yeah, I mean, I think to call this claim suspicious

is probably too light of a word. You know, honestly, when I read that, I've been thinking, you know, are they just trying to find any possible way to explain any issue and blame it on the doctors? I think so. And I mean, I will tell you, so a couple of reflections I had had about this. I think the reason that this wasn't listed

in the original complaint and that it got added, my suspicion is because if you hear this story, okay, so you have this child who is being you know, the hospital suspects she's being abused. They present evidence to the court, and then the court, unfortunately, which is, again, something that we know really well, but that maybe people don't know as much, that the courts do not, by and large, have a strong understanding of munchausen by proxy abuse.

There is this idea put forth by lawsuits like this that doctors, it's just so easy for them to make up claims of abuse because the courts will believe them every time. And I'm like, well, you're not watching the same case as I'm watching. Because what we know is that judges frequently do not consider the opinions of doctors, or they will weigh the opinions of like, you know, paid consultants that have not treated the child the same as they will weigh, you know, opinions of doctors who are treating the child and who are much better, you know, much more trained.

So that is just not an assumption that you can make that the courts are going to take what doctors have to say seriously. That really depends on the judge. And I think I can pretty confidently say by and large that more often they don't take this abuse seriously than that they do. We don't have the full copy of the judge's order, but a couple of the quotes that were included leads me to believe that he maybe has some strong biases in the plaintiff's corner. But he does say that this covert video surveillance was a horrible invasion of privacy.

So I think he then maybe has some different ideas about privacy in hospital settings than you or I do. Maybe they really did. Maybe their rights were violated. Maybe this family did get treated badly. Maybe there are some systemic problems here. If you then hear this next chapter of what happened and said, OK, after custody was returned to the parents,

this child who had also made a disclosure to the hospital staff that she was being sexually abused, then attempted suicide and left a note that said, I would rather die than be returned to my parents. Whether or not you think the Munchausen by proxy allegations were true, most people, I would guess, are going to say, wow, okay, something awful is happening in that house. That is clearly not a safe home for that child if she is attempting suicide and saying she would rather die than return to her parents. That's a pretty tough thing to get past. And so I think my guess is that this is an attempt to get ahead of that and say,

oh, actually, this whole series of events was just a continuation of the conspiracy of this doctor. So not only did they falsify evidence of munch has and by proxy abuse, they, I guess, what they're insinuating happened is that they brought in a psychology team to work on this child and make her believe that she'd been sexually abused for a period of four years by her parents. That's what they're saying happened. That's wild beyond wild. I mean, we've just gotten a few levels deeper into the conspiracy theory. And you know, one of the hallmarks of a conspiracy theory is that the narrative evolves to encompass any new information.

that the narrative evolves to encompass any new information. So that anything that you throw out as evidence, they can just say, yep, that's a look, the conspiracy is even bigger than what we thought. And that might sound hyperbolic, but I mean, that really is what is happening here. It's just like anything that shows up that's not on the plaintiff's side, they're like, what, that treatment center,

they were in on it as well. And- You know, that was my take. That was my take. I don't think I've even heard. I haven't come across any sort of allegation of implanted memory in decades. Yeah. Wow.

Yeah. It just seems like a, like just stretch, just like, whoa. You know, it's a very third rail thing, I think, this idea, just broadly, this idea of false allegations of rape or sexual abuse or assault, right? So I think it is a really challenging thing. And again, it's like, okay, why would Madison do this if it wasn't true? So they're not saying that she lied. They're saying that this was implanted in her. And I just, just to sort of like step outside the lawsuit,

I mean, this poor girl, I just, I can't even fathom sort of what's going on with her psychologically. And I think it's, I wonder if you have any theories because I think this is like this idea of like, okay, her being, you know, obviously she did not want to return to her parents at that point where the suicide attempt happened. We don't know much about what happened between then and now. There's several years have passed. Eventually she files a lawsuit of between then and now. There's several years have passed. Eventually she files a lawsuit of her own and now they've combined the two lawsuits. But we don't know anything about what her relationship is with her parents.

How can we sort of look at her behavior and sort of what might be going on with her? Because you said something to me the first time I ever met you when we were in San Diego five years ago, that has always stuck with me, where you said, children want their parents to be good. And I've seen so much evidence of this. And it's one of the most heartbreaking things in child abuse scenarios, regardless

of the form of child abuse, is that you do see children defending their parents, even when they are that you do see children defending their parents, even when they are abusive. You see children defending their parents. You see children wanting to be with their parents still, even if their parents are not providing a safe home. So can you help us understand just a little bit how complex these dynamics are for a child who may very well have been. I have to say, I think the evidence at this point points to that she probably is a victim of abuse. I think this idea that this hospital and HHSA and all these other people conspired to cook this up is completely bananas.

I don't think there's nothing going on here. I think that would be, it would be a complete legal situational precedent setting case if this actually happened. It is never that we know about happened like in the history of anything that you know about child abuse. So it's like, there would be no legal precedent for this kind of conspiracy. So that was just worth saying like in American history, no legal precedent of this ever happening. So if true, you know, then we are in a different world than we thought we were. But like, you know, if Madison is, is a victim of abuse, just like, you know, what, what can we sort of speculate about?

Like what, what her motivations might be for going forward with a lawsuit like this? You know, I, of course, I always think back to cases that I've had. And when I just see, and as you've said, we don't know all the pieces of this case. So scenario number one, that Madison is a victim of munchausen by proxy. Let's just take that scenario.

Then of course we would want to get the medical records. We would be looking for a falsification. We would be looking for intentional falsification on the part of the parent. So I don't know, we don't know yet. Along with that, we do see that there's some indication that Madison is either co-opted or maybe intentionally creating her own symptoms, right?

So is the parent involved or not? I guess we don't know very much about that at this point. The other possible- Well, I will say actually just to break in, Mary, I mean, I think when we look at Madison's medical trajectory up until the point where she was, they call it detained in California, which is like, I think you guys need to maybe have a better verb for that.

Just sounds very law enforcementy. But when she was separated from her parents, if you look at her trajectory up until that point, which like, she's a child, her parents are making medical decisions for her. I will say that that to me, in particular, which we're going to talk about this doctor, Dr. Boulogne, say in New York, them taking her to that doctor who has been sued so many times for a really horrifying malpractice. Again, we're going to break this all down. But I mean, looking at that as a parent, I'm like, I wouldn't walk into that man's office, let alone let them see my child. So I think that trajectory and just the sort of how far outside

of the standard of care her treatment appears to be and this piling on again of the elder stainless, CRPS, pots, again, all real things. But like, why was this child on a feeding tube? Why was she again, it just sort of the the most extreme, the most extraordinary. I mean, it fits so many hallmarks that I think like, again, I don't have the evidence in front of me to say whether or not this is my type has my proxy, but there certainly are a parade of red flags that would leave me to believe that if you know that that is more likely than a factitious disorder imposed on self-scenario. Okay. Because yeah, the third scenario would be, well, third and fourth, I guess there's a number, that she was abused and that she is reparting it and she is scared

to go back to her family that what she's saying is true. Another possibility is that she's falsifying that abuse occurred in the family because either she is at this point wanting to be in the patient role, you know, wanting to be taken care of in the hospital setting, and or, you know, things are going on in the house that she doesn't want to return to. I mean, it is a conspiracy. But the other scenarios, I don't know. Yeah, yeah. I think anybody looking at this, even if you do believe it's a conspiracy, I think we can all agree that this young woman has been through a lot and certainly is going to face some serious mental health challenges. I think

the worst possible thing for a person in that situation is to go through a big public lawsuit. One of the things that really to this day just turns my stomach about Kowalski v. Johns Hopkins is the fact that it has dragged to already traumatize children through years and years and ongoing litigation, media attention, reinforcement of them as their story being a tragedy and sort of being pawns in this lawsuit. And so I don't know, I guess I will just say this. I think if you're sort of like, and not to be glib about it, but if you're sort of putting like, okay, if we're weighing with the information we have what looks bad for the parents and sort of what looks like

maybe there is something there, there's an awful lot in this column that doesn't look good for them. I think it might be construed that Madison now joining this lawsuit is somehow in their favor, somehow speaks to, okay, this was a conspiracy. I don't think that's an assumption that anyone can make because- That's a good point. I think it's the same thing with Maya Kowalski testifying on behalf of her family. And some people who believed that Johns Hopkins was on the right side of things, were pretty critical of the role that they saw her playing.

And I did not agree with that at all. I was like, this is a young person. She turned 18 while that whole thing was happening. I was like, this is someone who has been, no matter what you think happened here, so traumatized by her mother's death, by this whole situation, by being separated from her parents again.

There are situations where both of us agree, where I think most people agree, there are situations where parents cannot provide a safe home for their children. That's not a safe place for that child. The removal separation needs to happen. It's still gonna be traumatizing. Can I say something about that? Yeah, absolutely.

Because one thing we do know about the munchausen by proxy literature is that there is more positive outcome if there has been removal. And, you know, and I do in working in my work with, with perpetrators as well as survivors, that, you know, being able to have a space, a safe space to, you know, to be able to recognize this as abusive behavior, even including on the part of the perpetrator, has been a useful piece. But absolutely, we always try not to remove a child, but there is some evidence that sometimes removal does,

you know, does help the family move forward too. there is some evidence that sometimes removal does, does help the family move forward too. Thank you for saying that. And I think it really is important to remember that it is traumatic to be removed from your parents, but what is the alternative? And what kind of life is that child gonna have? It's not one.

Right, because they're only to do it in a situation where it truly needs to happen. And I will say, in abuse cases, neglect cases are just an entirely other ball of wax that accounts for 76% of child removals. There's so much resource stuff going on there where, unfortunately, that is an easier thing to remove children for because it's more straightforward

than an abuse investigation of any kind where you may not have evidence or it might not be strong enough or the prosecutor might not want to move or what have you. Whereas I think if you're just evaluating, oh, there's not enough space in this place where these people are living or there's not enough food in the cabinets or what have you. So that I think is just a totally other kind of conversation. Yeah. And hopefully in cases of neglect, certainly ones that I've been involved in, what happens is we provide resources instead rather than removal. Yeah. One hopes. But I think that's certainly sort of a flaw in the system that's like pretty separate in my estimation from abuse cases. I heard actually when I was presenting

at the Stanford Child Abuse Conference last year, I listened to another presentation and she was talking about the foster care system. And I think that's something that people have a lot of fear around or that gets a very bad sort of reputation. And she was talking about actually that, that data is so skewed because of sort of

when you talk about like ACE scores, you know, adverse childhood experiences, that like a child that's in the foster care system has already had some bad things happen to them to get there. But they're going to have a often have times have a better outcome being in the foster care system than they would have if they had stayed in that home. So I think it is really like, it's a recognition, like I think this whole conversation is a recognition of there being better and worse options, but no good, no perfect options

once a child cannot be raised by their parents. You know, and it's interesting that, you know, the Hippocratic oath of do the least amount of harm is really what the oath is. Yeah, yeah. It's not do no harm, but do the minimal amount of harm is really what the oath is. Yeah. Yeah. It's not do no harm, but do the minimal amount of harm. Right. Right. I just think about this all the time, having gotten to know some of these people, child abuse pediatricians in particular, because I hope that we will move beyond this period of demonizing them in short order. Because to me, I think their work is heroic.

Because these are people who have chosen to look at something, a part of humanity, that very much exists and unfortunately is much more common than most people would like to think. And they have chose to look it in the face and be part of making those impossible, hard, but necessary decisions. And right now they're being villainized for it.

And I'm like, that is a job that most of us would not last a day in. I have to tell you a story. So I had a pediatric fellow following me, shadowing me one day, and I'm asking him about what his plans are and does he plan to go into adolescent medicine? And he says,

well, I really wanna be a child abuse pediatrician. And I said, what? Whoa. And people had overheard him and people came rushing into the room and said, oh my gosh, you are so brave. Yeah. And that's how we should be training it. I know.

For this upcoming season I'm working on, I talked to a number of people who worked in pediatric and infant hospice care. And those were some of the saddest conversations I ever had in my whole career. And I just thought, God, it is so special that there are people who are able to do this work, that there are people who are able to go and be with parents

in that scenario. Because we should count ourselves lucky that we have people who are willing to do this. And in the case of child abuse pediatricians who are willing to do it in the face of basically being told they're monsters. And it is so backwards. And I think eventually we are gonna look back at this period

the way that we look back at the satanic panic. And we're gonna be like, what were people thinking? How did we ever, how were we ever in such a backwards scenario that we were looking at people who are so... There's just nothing for them to be motivated by. It's not a well-paid position. You don't make money. It's like UA. They do a lot of work. I've never looked at one of these positions where I'm like, oh, you're just actually doing a lot of work that you're not being paid for at all, much more likely than this is well paid. And, you know, they're putting themselves just on the firing line. And I mean, I think it is like, I hope we get to a place where more people understand

that they should just be in deep, deep admiration. Because I think this always comes back to you for me, you know, much like it did in the in the in the Kowalski case, where like, if you are lucky in this country, if you are lucky, you live in a place where there is a well resourced, trusted Children's Hospital. We have one here Seattle Children's Hospital is, you know, not far away, and I can drive my kids there if they need to go there. And you are lucky if you have a community that supports that. And they are a part of the community. Like this idea, and I think this is like where it gets to this core debate that we're having right now as we rehash all of the societal gains that we made in the 70s. Apparently

we're just doing it all over again. Good times. is this idea of, do we think children are the property of their parents, or do we think they're human beings that have their own individual rights that are a part of the community? And are we trusting other people in the community to also be part of raising our children? Obviously, parents have rights to their children.

I have kids. I don't, I'm not arguing that parents shouldn't have decision-making capabilities, they shouldn't have rights of their parents, that they shouldn't be able to choose what school to put their kids in or what have you. But it's like, I think there's a real fundamental question here of like, I want to live in a world where I can trust other adults around my children.

So I want abuse to be investigated because I don't want those adults just wandering around, around my children, around their my children. So I want abuse to be investigated because I don't want those adults just wandering around, around other, around my children, around their own children. Like I don't want child abusers just going scot-free in our community. Call me crazy. So it's like that also means trusting other people that are not in my household, right? That means trusting other family members. That means trusting my kid's teachers and the people she interacts with there. That means trusting child care professionals. that means trusting my kid's teachers and the people she interacts with there. That means trusting child care professionals. That means trusting doctors at the hospital

that they're gonna have my child's best interest in mind. And I just feel like we've lost sight of the fact that if we don't have that, society just sort of crumbles. Yeah, what is society then? Yeah. Yeah. So no small things being debated with this case. And you know, I think that when people go after hospitals, you know, just thinking about how, like you were talking about the headlines here, you know, this family being abused, being surveilled,

what have you, you know, let's go get that hospital. You know, these are this isn't a hospital. These are doctors that dedicate themselves. These are these are caring people that have dedicated their lives to taking care of kids. This isn't a building. So I did want to ask you about this. I know we got into some bigger philosophical questions, but this is another kind of layer again of this conspiracy thing is what they're saying is so that when this whole thing sort of comes out, so there's the suicide attempt and then the child, so then there's a second complaint filed against the parents, a second complaint for removal. This one is ultimately accepted and she is in this center for like a treatment center called Milestone Treatment Center.

The lawsuit is alleging that this treatment center said that if the petition didn't go through, that if the parents didn't agree to have custody of her removed, that they would kick Madison out. And so the lawsuit is alleging that the parents agreed to let the state have custody of Madison so that their daughter would not, in their parlance, become homeless and disabled. So I just wanted to talk.

I mean, again, just on its face. I don't understand that. It's very hard to parse. I mean, it took me, it took me quite a bit of research to even figure out what they were saying happened. If I have misread this, please listeners weigh in because this was a bit of legal jargon that like, sorry, I did not go to law school. You know, but basically they're saying that there was this threat that Madison would be kicked out of her residential treatment center if her parents tried to get custody back. Now, I don't know if the parents got custody back.

Why wouldn't she just come home? We do not get an answer to that. So I just wanted to evaluate this a little bit. I mean, again, I feel like it's very hard for me to take this claim seriously at all because I can barely make sense of it. Custody was ultimately removed. Madison was ultimately, they then at that point terminated reunification services after the second complaint. They removed Custody and were like, we're no longer going to be on this reunification path. This is done.

Again, she was almost 18, so I don't know how much that played into it. this is done. Again, she was almost 18, so I don't know how much that played into it. My estimation is this milestone conspiracy piece is an effort to explain that, right? Why her parents didn't continue to challenge the removal. They're then saying that this, I know, it's next to impossible to divine what they're even saying happened. But it doesn't, I guess it doesn't seem very likely even on its face, but that a residential treatment center would somehow have a dog in this fight. But just knowing centers like this, I mean, what like, does this seem equally as wild

to you? It makes no sense. You know, sometimes we will have in the hospital, in my setting, an unsafe situation for a child to return to. And so we will keep the child longer, even beyond medical stability, that's our discharge criteria, if they don't have a safe disposition.

So we will help look for a safe disposition, but we would never kick someone out for no. Right. I mean, the way I read it was like, oh, if you don't agree that she was abused, then we're just going to say, okay, I guess there's nothing wrong with this child, so she doesn't need to be in residential treatment. So we're going to show her the door. I mean, that just, I just don't think that's nothing wrong with this child. So she doesn't need to be in residential treatment. So we're going to show her the door. I mean, that's just don't think that's how that

works. No. Yeah. I guess another scandal, scandalous and precedent setting if true, right? I mean, I don't like either these people have, have discovered just truly the most wild conspiracy that has literally ever taken place in the United States of America or the world. Yes, I was just saying, I haven't studied international law to know enough, but I would assume that this is a conspiracy. I mean, this is like a Dan Brown novel of a different stripe if any of this actually happened. Yeah. Yeah. So, yeah, I think. well, thank you so much, Mary.

Is there anything else you just want to say about this lawsuit, about this situation, about our understanding of these things? This was so helpful to talk through all of this with you. I really appreciate it. You know, this is just such a wild case, Andrew. And thank you so much for helping us try to understand it. Because I actually do feel like I understand things a little bit better after, you know, talking with you and listening to the podcast. And again, just thank

you for everything you do. I actually, the pediatrician that is hopefully still going to become a child abuse pediatrician, I told him about the podcast. So I said, listen to this, because I think, hopefully it will help you continue forward. I hope it does. Yeah. I hope so too.

I mean, thank you for helping so much. Oh, well, I really appreciate that, Mary. And I just, yes, I know we have many child abuse pediatricians that listen to the show. And I'm sorry you are not more widely appreciated, but you are always appreciated here. And, you know, I try not to be I try not to be hyperbolic too much on the show. But I don't if that's not heroic work, then I don't know what is. Thank you. Thanks, Mary. Thanks so much.

This episode of Nobody Should Believe Me Case Files was hosted and executive produced by me, Andrea Dunlop. Mariah Gossett is our supervising producer, Greta Stromquist is our producer and editor, Aarun Ajayi is our fact checker, and thanks also to Nola Karmouche for administrative support.