Nobody Should Believe Me - Unabridged Conversation with Bea Yorker

Episode Date: August 31, 2023

In Andrea’s full conversation with law professor and nurse Bea Yorker, they discuss the complexities of medical child abuse, their work with survivors, and debunk some of the most common misconceptions about Munchausen by proxy/ medical child abuse. *** Follow host Andrea Dunlop on Instagram for behind-the-scenes photos: @andreadunlop Buy Andrea’s books here. To support the show, subscribe on Apple Podcasts or go to Patreon.com/NobodyShouldBelieveMe where you can listen to exclusive bonus content and access all episodes early and ad-free.  For more information and resources on Munchausen by Proxy, please visit MunchausenSupport.com Download the APSAC's practice guidelines here. *** Click here to view our sponsors. Remember that using our codes helps advertisers know you’re listening and helps us keep making the show! Learn more about your ad choices. Visit megaphone.fm/adchoices

True Story Media But one piece of news that I am excited to share is that the wait for my new book, The Mother Next Door, is almost over. It is coming at you on February 4th from St. Martin's Press. So soon! I co-authored this book with friend and beloved contributor of this show, Detective Mike Weber, about three of the most impactful cases of his career. Even if you are one of the OG-est of OG listeners to this show, I promise you are going to learn so many new and shocking details about the three cases we cover. We just go into so much more depth on these stories, and you're also going to learn a ton

about Mike's story. Now, I know y'all love Detective Mike because he gets his very own fan mail here at Nobody Should Believe Me. And if you've ever wondered, how did Mike become the detective when it came to Munchausen by proxy cases, you are going to learn all about his origin story in this book. And I know we've got many audiobook listeners out there, so I'm very excited to share with you the audiobook is read by me, Andrea Dunlop, your humble narrator of this very show. I really loved getting to read this book, and I'm so excited to share this with you. If you are able to pre-order the book, doing so will really help us out. It will signal to our publisher that there is excitement about the book, and it will also give us a shot at that all-important bestseller list. And of course, if that's simply

not in the budget right now, we get it. Books are not cheap. Library sales are also extremely important for books, so putting in a request at your local library is another way that you can help. So you can pre-order the book right now in all formats at the link in our show notes, and if you are in Seattle or Fort Worth, Mike and I are doing live events the week of launch, which you can also find more information about at the link in our show notes. These events will be free to attend, but please do RSVP so that we can plan accordingly. See you out there. Calling all sellers.

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Yeah, we did. All right. Well, let's dive right in. Hi, Bea.. All right. Well, let's dive right in. Hi, Bea. Hi, Andrea. Do you want to start off by giving us your full name and your description sort of of your title in regards to this work? So whatever you would like to say about you have such an interesting background. Hi, I'm Beatrice Yorker. I'm a child and adolescent psychiatric nurse, and I also have a law degree. And I've spent my career mostly teaching nursing and also doing research to become a nursing professor. You have such a fascinating job. You have such a fascinating background. You are semi-retired now, right? And you are teaching at Cal State LA, right?

So, yes. I taught for the last 15 years at California State University, Los Angeles. And I'm currently a professor emerita, which means I'm a retired professor. So mainly what I'm doing now is I am doing training and I'm consulting. And I'm helping you, Andrea, with our website, munchhousensupport.com, and staying in touch with the field. I'm also very active in the American Professional Society on the Abuse of Children, APSAC, and contribute articles and review articles and best practices for what we're doing in the field of medical child abuse, munchausen by proxy, fabricated illness, anxiety, factitious disorders, all the various terms that we call this. I appreciate you so much, and you really are a mentor of mine, so we're happy to have you here with us. Can you tell us about the role that you

play when you are working as an expert on medical child abuse cases? Well, I'd like to start with my very first case. So this was in 1983, only six years after Roy Meadow published his article giving this a term. His article was Munchausen Syndrome by Proxy in The Lancet. And I was working in Atlanta, Georgia, in a large pediatric healthcare system on the child and adolescent psychiatric consultation service. So I would see kids with all kinds of mental health issues, and I would also attend weekly abuse rounds. And one abuse rounds, our child abuse pediatrician assigned me to evaluate a case of possible Munchausen by proxy. She gave me Roy Meadows' article. And this was a little boy, 18 months old, who kept coming in because his ears were bleeding. And most ear infections, the kid has pus coming out of their ears. But this little boy had blood coming out of his ears. And he had a red

flag. His older brother had died at the age of two. And absolutely no idea why this child died. So I evaluated the mother the best that I could. She was not medically fluent. She was very simple. She was concerned. She was very sad. She was still grieving the loss of her other child. And the pediatrician said, well, maybe she's poking something in his ears to cause them to bleed. So we went ahead and did the separation test. And we put the child with his grandmother for a month. Bea, can you back up and can you explain what a separation test is? So the least invasive way to determine whether or not a parent is fabricating or exaggerating or inducing an illness is to separate the child from the primary caregiver for a sufficient

length of time. So in the case of the little boy with bleeding ears, we had him live with his grandmother. We ensured that the mother would not have any unsupervised physical contact and his ears kept bleeding. So at that point, the pediatricians, the team, went deeper. And they started running more tests. And it was a very sad case. It was not Munchausen by proxy. It was a rare genetic disorder that caused bleeding out of orifices. And it turns out the older sibling who had died

also had that rare genetic disorder. So this is one of the cautionary notes. That's why we have guidelines, because we don't want to just assume that if there's no determinable medical cause that we're at the end of the road. Sometimes we really do need to do more tests. Sometimes it's a disease that hasn't even been discovered yet. I'm so glad you told that story because I think one of the things that I'm hyper aware of as we talk through this is that there are children that have inexplicable medical issues. And there are parents that get treated poorly by the medical system. And those things are real. And I don't want to dismiss them. It's my feeling that legitimate cases look overall very different than abuse cases once you sort of peel back a layer or two, which is what you're talking about. And now, of course, I don't want to say that doing a separation test, being separated from your

child for any length of time is very upsetting. I don't want to say that that has no consequences, but usually the cases I've seen, that happens pretty quickly, right? It becomes pretty obvious whether the issues start to all resolve themselves in the absence of the parent or the issues continue. That usually becomes apparent. I mean, within how much time would you say? Well, it depends on the disorder. If it's autism or if it's hyperactivity or if it's a psychological or educational fabrication, it could take quite a while. And I don't want to minimize the trauma that the separation test might cause. For some children who have been infantilized, who've been kept in a very sick

and dependent position, who may have been poisoned, who may have feeding tubes, when they're separated, that could cause them to really go into a tailspin if they don't know that they don't have legitimate illnesses. And it can be traumatic by the same token, case after case. Those of us who do do the separation test, we often find kids who embrace their health. Once they're separated, all of a sudden they realize they can eat normally. They realize they don't need those medicines and they feel so much better. And they're in normally. They realize they don't need those medicines and they feel so much better. And they're in a nurturing environment where they can get therapy. And so those are the ideal circumstances where fairly quickly, within three weeks to a month, you can determine.

But I have been involved in cases that are so complicated and the kids are so enmeshed that the separation test just compounds the whole picture. I think that it's just worth talking about all the nuance and complexities here. One of the things that drives me crazy about a lot of the media coverage of this topic, in particular on the subject of, quote, false accusations, is that they leave out a lot of the nuance and complexities of these cases. And so I don't want to do that. We interviewed Jordan Hope, who you know well. And one of the things that they talked about was how psychologically enmeshed they were with their mother and how they didn't understand for a long time into early adulthood that they were not

sick. They were having these somatizing behaviors or pretending to be sick, but they didn't even realize they were pretending because any parent can kind of understand that how much your reality is shaped by your parents when you're a small child and how much you're just going to believe them and trust them automatically. And so I think that makes a lot of sense that you say that these, it can take more time to resolve because of some of the psychiatric things that are going on with these kids. You know, you shared that story about your first case and that's so interesting that it was so close to that time when this term was even defined. So obviously everyone was very new to this. Now we've come a long way in the last 40 years on the issue. I wonder if you can talk about how, maybe give us a little compare and contrast with that case to a case that you

worked on that did turn out to be a legitimate case of abuse? One of the worst cases that I worked on was when I was in law school. I was working part-time on the child psychiatry service, and I was also going part-time to law school. And Scottish Rite Children's Hospital in Atlanta had had three cases where they were apnea suffocation cases. And they had read that in England, they had put hidden cameras in the pediatric rooms. And that was really good clear-cut evidence when they caught the mother smothering. So they said to me, Bea, you're in law school. Why don't you do the research to let us know? Is it violating the Fourth Amendment? Is it violating a right to privacy to have these hidden cameras? So I wrote a law review article, and there is no legitimate right to privacy from

being surveilled when you're in a pediatric hospital. I mean, cameras are ubiquitous. And if it's for the purpose of diagnosis, then it's really good to have cameras. Parents should expect that there are eyes and monitors on their kids. So a little boy, again, 18 months, had been admitted to the rural hospital with a temperature of 105. And when they drew a blood culture, they found E. coli in his bloodstream. And the doctor said there's only three ways that that could happen. Either he's got a leak in his bowels and E. coli is leaking to his bloodstream, or he has an immune deficiency like HIV and he can't fight

off a few cells, or somebody is deliberately putting it in there. And all three possibilities are equally rare. So the least invasive thing is to transfer him to the covert video surveillance over at Scottish Rite. So within hours of arriving at Scottish Rite Hospital, the video shows mother taking a dirty diaper into the bathroom, filling a syringe that she pulled out of her pocket with murky liquid in the sink from the diaper, going to the child's IV line, disconnecting the stopcock, inserting the syringe, and injecting that murky fecal liquid into the child's IV line. Now, we had hospital security that was watching

the video cameras. Immediately, they walkie-talkied the nurse who was in charge, and they said, you've got to go in there. Mom is tampering with the IV line. So the nurses went in. Mom realized at that point that she had been seen. Hospital security apprehended her in the stairwell as she was escaping the hospital with the syringe, realizing she'd been caught. So they called me in to do an evaluation of the mother of the father and they instantly separated the child from the mother because they had caught her in criminal

behavior. But then Child Protective Services came to me after they were into a few months of foster care and they said, Bea, this is a sick woman. She was raped as an adolescent. She only did it that once. When can she be reunified? And I was just, if that had been a father who had beaten his child to within an inch of their life, we would not be discussing reunification. And I realized what a gender bias that we do have. They were going, this poor mother, she knows that she shouldn't have done that. But when I interviewed the mother, her biggest concern was how this had messed up her life, how she was the victim, how the nurses were out to get her. She couldn't explain why this got caught the only time she ever had done this.

And we all knew that that wasn't the first time. How did the E. coli get in the blood? So her inability to acknowledge what she had done, I actually testified in her criminal case, and she was sentenced to two years of probation, which is, I think, very lenient, given that the child would have died had he not been already in the hospital. Then I testified in her termination of parental rights case. And she appealed the termination of parental rights based on the fact that I was a nurse and I could not diagnose munchausen by proxy.

The Supreme Court of Georgia upheld my expert testimony and upheld the termination of parental rights. Wow. That story is about as dramatic and clear-cut of a story as I've ever heard in this because I think what makes these cases so complicated is we're talking about some of these sort of methods for determining abuse, right? So separation test is one, as you mentioned. Video surveillance is

another sort of gold standard one. It's usually not quite that clear cut as you have someone filling up a syringe with feces and going to inject it into their child, right? Because there's a lot of other ways this abuse can be committed. I mean, that's interesting that you brought that up because we are in this season discussing the Alyssa Phillips case, another one where there was a blood infection, a quote, mysterious blood infection that happened in the hospital. Like that's a case where you have a quote, smoking gun, right? You have something where it's immediately obvious what she's doing to where you have hospital staff running in the room and she's running out the back door with like the weapon of choice. That's a very, that's a very sort of straightforward.

And even to your point, even in that straightforward of a case, you still have people saying, but she's sick. She should be reunited with her child. A lot of times it's more of this sort of pattern throughout the entirety of the medical records. So I think one of the trickiest things in this field is the question of, are there any of these cases where it's appropriate to reunify the child if abuse has been determined? And what are the circumstances under which a child can be safely reunified with their mother? Yes, there are cases where the child can be safely reunified. I had a case, again, caught by video surveillance, where the mother kept bringing the smaller of her two twins. She had three children under three and six month old twins. The smaller one, she kept presenting doctor shopping, urgent care, doc in the box. Finally, she gets to Scottish Rite Hospital and she said

the baby's vomiting, the baby's throwing up, the baby has diarrhea, and the nurses said the baby looks hydrated. We're not seeing it, but we're going to admit the baby for a workup, and they, at this point, with so much doctor shopping and not seeing any verified conditions to cause the vomiting, they put the baby in the video room. And as the video slowly rolled for the next 48 hours, they saw a pattern where the mother would ignore the baby, be on her phone. The baby was fine. The baby would sleep. The baby was drinking the bottle. The baby was having normal amounts of stool. Mom was on the phone, obviously talking to friends. And as soon as the night shift came on, mom would leave the hospital. You could hear her talking to her friends, arranging them to meet at a bar. She was entering a wet t-shirt contest. She said, if you can hear buzzers going

off, it's because I work at Scottish Rite Hospital. I'm at work right now. So she was a fabricator. She was using the hospital so she could step out on her husband and get a break from this needy six-month-old. And so then the nurse said, this is after two days in the hospital. And they're pretty sure mom is fabricating. The nurse goes, look, we're going to have to weigh the diapers because the mom said, yeah, the baby continues to have diarrhea and the baby's vomiting. And the nurse says, we have to do intake and output.

We know how much is going in from the bottle. We need to weigh the vomit. We need to weigh the diapers. And if the baby is vomiting, which they had not seen on video. So mom goes into the bathroom with an emesis basin. She puts her finger down her throat. She throws up into the emesis basin. She takes the vomit, pours it on the baby, rings the nurse and says, get in here. We've got to weigh the vomit. So she had not induced illness in her child. The child was actually doing pretty well. She had fabricated in order to get the child medical care because she had another agenda.

So what we did in that case is we said, look, mom, you're overwhelmed with your kids. Dad needs to be the one to make all the medical decisions. We need you only go to your first pediatrician, no more duck in a box, no more urgent care, that all three kids, dad needs to quit his second job. Mom, you need to get a job. And let's see how this goes for a few months. And then maybe we can reunify. And sure enough, mom cooperated. She was doing it because she was overwhelmed and needed a break. And once dad stepped up into doing a lot of the child care, and we made it really clear, you can only go to your primary care pediatrician,

and dad is the medical decision maker. So those are the kinds of cases. We have cases where it's malingering, where the parent is actually faking symptoms so that either they get SSI disability benefits or so that they get in-home care benefits. If the motive is because the parent is really anxious, if it's malingering, it's a lot easier to reunify once you get to the root of the problem and you get the parent to sort out how to get their needs met more appropriately. And you point out that it's abusing the child to over-medicalize them or to treat them as disabled when they're not. If, on the other hand, the reason for the parent engaging in this behavior is because they want

the medical attention. It's an interesting nuance that we're talking about this mom who that sounds to me almost like it fits more in malingering, right? Because she had this other agenda and it wasn't just getting the attention. So you're talking about a case where the behavior is abusive, but it's not, it sounds like there isn't the underlay of factitious disorder imposed on another, which is. Correct. Yeah. Because we've been talking about sort of the separation of medical child abuse as a behavior and that there can be these other reasons underlying it sometimes, but then factitious disorder imposed on another being the diagnosis of that disorder that makes someone do it specifically for attention, not so that they can go have an affair and go out with their friends, not so that they can get money from a

GoFundMe, although that may be involved, but that's not seen as the primary reason and they'll do it in the absence of any material reward. That's excellent, Andrea. You definitely do understand the nuances between behavior that is abusive versus the primary dynamic of the parent is to get medical attention. So if we sort of separate those two things. So for these cases where you see it's not just fabrications, it's induction, it's making symptoms worse. It's giving kids medications they don't need.

It's getting surgical interventions they don't need, where it really does more fit that pattern of factitious disorder imposed on another. Do you think there are circumstances where, when that is the case, a parent can be safely reunified with their children? Yes. And we have a few documented cases where parents, and sometimes it's parents who've been put in prison because it was that criminal behavior. As long as they work the accepts model, which is acknowledging the behaviors, first of all, the behaviors that got you caught,

and second of all, all the behaviors you were doing that didn't get caught. Then you are able to develop empathy for how that not only harmed your child, it harmed your whole family, it harmed the system, it harmed the medical providers that you tricked. Then you develop better coping mechanisms. We kind of treat it like a 12-step model, which is admit that you have a compulsion to do this and take it one day at a time like you do recovery. It's like anorexia. It's similar to other high shame, high denial disorders like substance abuse. And so the recovery model is really to stay on top of recognizing when you're vulnerable to wanting to get your needs met through that abusive behavior and catching yourself and building yourself a support system

where you can say to people, look, I feel like I'm falling off the wagon here. I feel like I'm reverting to needing my child to be presented to providers. You're going to have to help me here. Maybe take a bit of respite, take a break, get somebody else to be involved for a while. Do you think that that kind of recovery can happen in the absence of a criminal conviction? I haven't seen it myself. I am hoping that sometimes it can happen in the context of the child being removed and that reunification is dependent on the parent genuinely and authentically working the steps of the accepts model and in a protective environment to either the separation test or with a non-custodial parent, we give them custody. If it's a biological family member who would be the first resort when Child Protective Services step in and want to try and keep the child with a biological relative. But if once it's determined

that yes, the child is thriving outside of the primary care of the offending parent, then I would say reunification should be contingent on the perpetrator working the accepts model. And I will say, unfortunately, that I have lots of cases where they continue to fight it. They continue to litigate. And I have just several sad cases where the moms are no longer having contacts with their kids because they're unwilling to admit to what they did, which is the first step. Yeah. And we talked to Mary Sanders about the accepts model and that opportunity for rehabilitating the situation. And she mentioned that it's probably a very small percentage of offenders that are going to take what we consider full accountability, which is not saying the only time I ever did it was the time I got caught.

Or one thing that Hope Ybarra says, and she served a 10-year prison sentence, and she says, I don't remember. I had this diabetic coma and lost my memory, which is another factitious disorder thing. But, you know, that's not what we consider full accountability, right? Full accountability means I did this. I accept that I did this. I'm owning what I did. I'm not trying to obfuscate and continue to deceive around my behavior. And because of all of the tricky factors that cause someone to do this behavior in the first place, it's a small percentage of offenders we're looking at that could take full accountability in that way.

Do you think that's – do you agree with that? Yes, I do. And from my experience doing hundreds of these cases is that there's only been a handful that I would call successful reunification. What do you think makes the difference in those cases? Is it that the abuse was caught before it escalated to something so severe that it could have been deadly? Is it the person themselves that just has the ability to heal? Is it the support system around them? What do you see being a factor in someone successfully recovering and reuniting with their child?

Well, the successful cases, it really has been the support system around them. The more eyes there are on the child, the more it deters people from engaging in the abuse. So if you can get the kid into a school system where the teachers are aware and the teachers know the warning signs, if you've got a different family member doing the medical decision making, yes. And the sad thing is, in not reunifying, is that all children want to be with their parents and they want their parents to step up and fly right and do the right thing and be a good parent. And that's ideal. Every child wants that. We recognize that in a lot of these cases, that's too high a bar to set. But if we can at least deter them from engaging in this behavior, I think it's great if the kids can at least have some kind of a relationship with a perpetrating parent. Or as

long as they have stopped the behavior, they don't have to fully admit to everything. They can still say, well, I was confused, or I lost my memory, or, and not do a full accounting. But at least if they have stopped the behavior, then, you know, that's what we want. Yeah. So as you mentioned, in some cases there's a criminal investigation. And a lot of times these cases end up with CPS and in family court. I'm assuming you've dealt a lot with family court. Do you find them to be knowledgeable in general about this form of abuse? What I find is that the family courts are designed to uphold what we consider one of the most fundamental rights under the Constitution, which is the right to be a parent. And the courts are driven to reunify and to do that first and foremost.

The courts also, whenever they appoint a guardian ad litem who's there for the best interest of the child, or they appoint a psychological evaluator. And in California, it is the law. You have to look at the strengths and the weaknesses of all custodial, all legally entitled parents. And so unfortunately, in cases of medical child abuse, and particularly if it really is a factitious disorder on the part of the parent, is that when you look at the strengths, I'll read these psychological evaluations where I've seen that the mother has hemorrhaged blood out of the child at children's hospital and denied it, and the mom's sitting there in court, and yet the psychological evaluator will say, well, the mom's strengths are that she genuinely cares about this child, that she understands that the child does have some special needs. The mom's strength is that she understands

schooling. Now, yes, there's this weakness. She almost killed her child by hemorrhaging out a tube. But they put it in this couch term of looking at strengths and weaknesses. And I sort of consider it along with sex abuse. At some point, there's a zero tolerance. And if you bleed your child out, they almost die from that. Then we don't really look at the strengths of the parent. Yeah. To your point, if a child ended up in the hospital because their father had beat them almost to death, you would not have someone sitting up there saying, well, the dad does take him to baseball practice. And that's, I mean, you just, it's, it's unfathomable,

right? And yet we put this in, somehow we just put this in a really different category. And I think to your point, a lot of that does have to do with gender bias. What are your thoughts on that? Because it is a high, high percentage of these offenders are mothers. 95% of the perpetrators of this type of abuse are mothers. So yes, as a society, and I spend a lot of time thinking about this in law school, especially when I studied criminal law, is that as a society, we have a lot of laws that criminalize masculine forms of violence. That is bludgeoning, raping, strangling, gunshots, what garden variety serial killers do, stabbing. We recognize it.

We are much more aware as a society that that is abhorrent. We make laws against it and we put people in prison for it. What we as a society are less aware of are feminine forms of violence, which is suffocating, poisoning, killing with kindness, infantilizing, and they're just as lethal as those other forms of violence. Because of that, the entire legal system tends to be sympathetic, especially towards articulate and caring parents. Now, I'm not saying... Should we say, like, the appearance of caring?

Because I think, like, when you were talking about that psychological evaluator, what I was thinking is, this is a person who's been manipulated by this mother. Because I think, like, you can't... I don't feel, and this is my opinion, it's hard for me to imagine how someone who could bleed their child almost to death feels any empathy for that child. So I don't know how you can describe someone who would almost kill their child for the purposes of getting their own emotional needs met as a caring parent. I believe someone who could do that could appear for a small period of time spent with a

psychological evaluator to be a caring parent. But I think that that sort of speaks to the problem with bringing in like the idea that you could diagnose factitious disorder imposed on another in the course of a psychological evaluation rather than with a full investigation of the records. Can you talk a little bit about that? Yes. That again and again, I have encountered in particularly the family and dependency courts where the entire system really does not understand Munchausen by proxy. Very often they have been intimidated, threatened, or reversed when they try to see it for what it is. They're intimidated by Munchausen by proxy and by factitious disorder imposed on another. And so they defer to the psychological evaluators. And a psychological evaluator is no better than the average Joe Blow on the street at detecting lying.

So the psychological evaluations are notoriously unable. Sometimes they'll say something like, yeah, we saw a little bit of psychopathy or yeah, we saw high score on the need to look good index, but this person is not crazy. This person doesn't have a disorder that would cause them to be a child abuser. So, that is a real problem. It's the medical record review. Every time I interview a new case and a new mother, I am just snookered. I believe them. I feel their sense of concern. I feel how they haven't been heard by the medical system. I believe that, yes, other people are missing these signs and symptoms. Then I do a record review. And then I talk to other people. That is when I start going, oh, my gosh, I was completely snookered by this mom. So even you, even you, with all of your decades of experience even you sitting in a room with one of these women you're fooled essentially snookered fooled very many

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In each episode of the show, Cilicia brings a personal, deeply insightful lens to the crime that she covers, whether it's a famous case like the Manson murders or Jonestown, a lesser known case that needs to be heard like the story of a modern lynching. She covers these stories with a fresh and thoughtful lens helping listeners understand not just the case itself but why it matters to our understanding of the world. Her long-awaited second season is airing now and the first season is ready to binge. So go check out Truer Crime with Cilicia Stanton wherever you get your podcasts. Occasionally, I will interview a perpetrator or a questionable perpetrator, and it will be quite apparent. We had one mother who was taking too much of her Adderall, and she was verging on psychosis.

And when this would happen, she'd bring her kid to the emergency room. She would say things like, the kid was drinking lemonade from the Wendy's. And the next thing you know, he must have swallowed something that implanted in his brain because he's acting outside of his head. Look at him. So sometimes we have parents who are clearly delusional. Yes, they're abusing their child by taking them to the emergency room and whatever is going on at home with a delusional mother, but

this is easier to treat. You know, we were easily able to let the kid go home with mom once we got her psychiatrist to recognize the impending mania and the impending psychosis from taking too much Adderall. Right. So that's not a person that has factitious disorder imposed on another. That's someone who's having a psychotic episode. If they really are doing this for the medical attention, if they are meeting their psychological need to be in the healthcare arena and create crises, then I don't think I've ever done an interview with one of these folks where it was obvious that they weren't really genuinely caring for their child. Wow. I mean, yeah.

They're able to come across that way so well. Right. It's the manipulation. And I think you said that when you were talking about the problem with psychological evaluations. They say, well, this mom's not crazy. Right. She's not. Very organized, actually. You're not sort of, quote, crazy. And you're not suffering delusions. It doesn't meet the definition for criminal insanity.

It's a known behavior. It's characterized by intentional deception. And so that doesn't, that's not crazy in the way that we think of someone looking or seeming crazy and disorganized and all over the place. It's the exact opposite, actually. That reminds me of a conversation I just had with Randy Alexander and Kathy Ayo about the fact that the DSM really needs to come up with a category for pathological lying because it is such a feature of the real factitious disorder imposed on another. They don't just lie about their child's illness. They lie about all kinds of things.

Right. We've seen this across all the cases we've looked at that there's, you have these stories of really rampant infidelity that gets uncovered, financial fraud, lying at work, just all kinds of things. It's not lying about their own health. It's not isolated to the child's medical issues. I want to talk about one of the trickiest cases, I feel like, for anybody around this issue, which is the Jennifer Bush case. Can you tell us about that? I was not involved in that case. What I do know from following it is that Jennifer is one of those children where the separation test was crystal clear. She was separated from her mother. They could remove the feeding tubes.

She ate fine. She started to thrive. She was embracing her wellness. And this was a child who'd been subjected to numerous surgeries. She was on a feeding tube. Anyway, she was separated. And then when she became an adult, I saw a videotape of her. Basically, I'm not sure if it was a press conference, but it's searchable on YouTube.

And Jennifer said that her mother never abused her. And she said that she is going to become a social worker because of how bad the system is. And because she believes that what happened to her was not a good thing. And she suffered as a result of being removed from her mother. And this brings me to the realization that I have whenever I work with kids who have been removed by CPS, is that for many children being removed from an abusive home, it's the devil you don't know. It's the devil you know. And a lot of these kids will recant, like in sex abuse situations. We've learned for years now that when children do somehow disclose that they're being sexually abused and they get removed, a lot of them then

say, oh, I lied about it. It didn't really happen. And we're seeing this because for some kids to remove them from their abusive mother who's perpetrating medical abuse on them, for some of them, it is a worse situation. And it's more traumatic than just staying and going along with their mother. Which is so complicated. about this abuse and that they still have trouble feeling anger at their mother because of that attachment is still so powerful. And I just think that sort of speaks to what you're saying of it, just that this is going to have a different effect on everyone who's been victimized. And I've seen even the split within families where there's one child, we talked to a survivor, and their siblings were also abused and their siblings absolutely refuse to acknowledge that that abuse happened and they

can't accept it and they just seem like they can't go there. And this is even in cases where there is so much documentation or there was a removal or it sort of doesn't matter what like how strong the evidence is. It's really not about the evidence. I mean I think this is what I've come to about how people just in general react to these cases whether it's spouses or the victims themselves or family members. It's not about the evidence. It doesn't matter how strong the evidence is. It's like an emotional belief of whether or not that person is capable of doing that. And if someone refuses to believe it, it does not matter what evidence you put in front of that person.

Exactly. And we don't have a perfect system. So it's not like we can give the kids we remove a happy ending. Yeah. I do want to say, though, we have some wonderful, happy endings. We do have kids where their mother's new husband who catches on and the mother's in jail, the new dad adopts that child and the child starts opening up and saying, I'm so grateful to be with you. Are you going to protect me? And they just, they're just very, very grateful to be out of that situation. So we do have

some happy endings for these kids. But in general, what we really, really want is for parents to be able to put their kids' needs ahead of their own. And this is often hard. There are a lot of broken people out there. There are a lot of people who don't have the capacity to put someone else's needs above their own. They're just so broken and needy. Yeah. I mean, to your point, most of the cases that we've talked about on this show are cases with happy endings, where they either ended up with their father who was loving and who understood what was happening, or in the case of the Weyburns, where they were adopted by family members and had very good outcomes. And I think it's important to me to acknowledge this uncomfortable side of those are the cases with happy outcomes.

Those are not the only cases, which I thought was important to talk about Jennifer Bush. So there is a lot of pushback in the media now. There's been a couple of sort of a spate of huge pieces in the last year about, quote, false accusations. And really that often when I see this issue discussed in the media is described as an exotic condition, Munchausen by proxy, extremely rare, basically painted as this is not something we need to watch out for because it's happening so rarely that we do not need to be, that doctors are just over-diagnosing this and they're raising the flag unnecessarily and they're separating all of these innocent parents from their kids. And that is the prevailing narrative that I've seen in the media. What do you have to say that actually, from all of our experience, that medical child abuse, munchausen by proxy, and FDIA are underdiagnosed, vastly, vastly underdiagnosed, especially

when you start getting into the mental health and the educational arenas and you look at kids with complex IEPs and parents who are demanding. Sorry, can you explain what an IEP is? An individualized educational plan and accommodations for kids with special needs in the educational system. So where it gets so complicated is that the type of parent who would use their child to get their emotional needs met by over-medicalizing or over-pathologizing them is also the kind of parent to be extremely vocal when questioned. And so that makes it really difficult because, like in the case of the bleeding years, that mother didn't go to the press. She didn't question us. She said, you do whatever you need

to do. I lost one baby, and I trust you doctors, and so it's unfortunate because of the nature of this type of abuser. We're going to have so much pushback. Right. Now, of course, I want to say that if someone felt as though they had been really mistreated by the system, it's not wrong for them to raise the alarm to the media. Right. One of the functions that media is supposed to serve, how well it does this is another question, but, you know, is to be a check on systems, right? So if you were a parent who had a bad experience with the system, you would be well within your rights to go to the media about that. What we're saying is that because of the nature of, because we feel this is underdiagnosed, meaning that most people who are doing it get away with it. If someone has been through the system and has been through an investigation and does not end up being held

accountable, that person's desire for attention to be seen as heroic and grandiose, all these things that go along with that actual disorder, that person is going to be the most likely to pursue media attention for how they were falsely accused and go on a sort of vendetta in the media. Not to say that every single parent that's ever talked to the media about being falsely accused is guilty, but we're saying that the nature of this and the way that it plays into things like social media and traditional media, right, is very complex because that need for attention sort of spreads its antenna everywhere. that I never would fault a parent who kept pursuing medical attention because they genuinely, they know they can feel that their child has something wrong and it's not all in their head. And they get angry when they're told it's all in your head or all in your child's head.

The critical difference is the fabrication. Parents who are genuinely concerned and their child has genuine distress, those parents should not and would not induce or fabricate to cause more medical attention or diagnostics or treatments or medicines. And that's why we do the record review. Because if you see the difference between a mother who says, my child has stomach aches, and they do all the workups, and there's nothing found between that mother and the mother who says, and the mother says, well, I don't believe you. I'm going to go on and go to another doctor. Fine, go to another doctor. It's when that mother crosses the line and is administering Ipecac or is administering

milk of magnesia and not telling the doctor. And when you get a toxicology screen that shows that the mother is doing things to make the child's stomach hurt,. And when they were able to go through their medical records as an adult, they found that they had had multiple negative tests for that specific disorder. So that's not saying we can't get to the bottom of it. That's a doctor saying, this is not it. And then it's not the mother going and saying, okay, if it's not that, what is it? It's the mother lying and saying, my child has this thing that they have tested negative for. It's things like that where you have those markers of, right, intentional deception, induction, and that's only going to be accessible in the medical records review. That's right. That's right. For the most part, sometimes we can get that from school records.

Sometimes we can get that from police records because, again, some of these perpetrators work in multiple venues. So you said something about your first or about one of your earlier cases where they had a blood infection and they were on where the perpetrator was caught on camera. And when she appealed the court's decision, she said that you, as a nurse, were not qualified to diagnose Munchausen by proxy. That's something that's come up a lot in the media, of like who is and is not able to determine whether abuse has happened. So who is required to report

and who is able to determine whether abuse actually happened? Who is qualified to do those things, in your opinion? Well, that's a good question, and it's more than just my opinion. Every single state has a law that identifies mandated reporters. And in most states, it is doctors, nurses, teachers, even veterinarians sometimes because sometimes abusive children and abusive animals goes hand in hand. Anyway, there's a list. I'm a nurse. I am a mandated reporter. I am required to report suspected abuse. I am not required to verify abuse. That's the job of CPS, Child Protective Services, or law enforcement. As a mandated reporter, I have immunity for reporting if it's done in good faith, if I happen to make an error and it wasn't abuse. On the other hand, to diagnose

someone with a DSM-5 or an ICD-10 or 11 diagnosis, I would need to be a physician, a psychiatrist, a PhD psychologist, or somebody within whose scope of practice it is to diagnose. As an advanced practice nurse, it's my scope of practice to do nursing diagnoses. But believe me, factitious disorder imposed on another is not in the book of nursing diagnoses. So I always say to the court, I am a mandated reporter. I am qualified to identify and to confirm because of my advanced practice training. I am qualified to confirm whether abuse has occurred to this child or neglect or sex abuse. That I am qualified to do. What I'm not qualified to do is to diagnose why the perpetrator is doing it. And so I defer. I say, yes,

in this case, the child is being medically abused and over-medicalized and the mother is fabricating and exaggerating. And it's up to somebody else, hopefully, who understands that the record review that I performed is the most illuminating for diagnosing factitious disorder imposed on another and looking for fabrication. But sometimes they need to determine, is it malingering? Is it anxiety? Is it delusion? Is it factitious disorder imposed on another? And FDIA should only be diagnosed when you both interview the suspected perpetrator and review the medical records for fabrications. Is it important to have that diagnosis in terms of dealing with the medical child abuse itself, or is that beside the point to the why?

Because when we talk to people, you know, we talk to a prosecuting attorney, we talked, obviously, to Mike Weber, they're less concerned with any kind of psychological diagnosis on the mom. They're concerned with the behavior and finding, again, that pattern of deception, falsifying, inducing, which is in a different category to your point than someone having delusions or anxiety, right? Those are not sort of, those wouldn't be likely to be prosecuted in a criminal context in the same way, right? So it does make a difference when you are going to determine reunification.

It does not make a difference when you need to protect the child. The cause of the parent's abuse is irrelevant if they have not stopped and the child needs protection. The cause of the parent's abuse is relevant when you go, is it safe to reunify this child with this parent? Got it. So it's relevant, but it's the second line of relevance. And I think what we're all just talking about is you have to put that child first because this abuse can be either extremely physically damaging, it's obviously extremely psychologically

damaging, and it can be lethal. Right. Right. So it doesn't matter what the reason is when you need to protect the child. Over the last year or so, you and I have been doing some work with survivors. This is work that hasn't really been done before, and I think it's been really revelatory and hopeful. Can you tell me what you, as someone who's been in the profession for so long, what has that shown you working with this population specifically? It has been revelatory and it has been very powerful and it has been hopeful. So as we

actually hear the lived experience of adult survivors who have endured this, who have figured this out, who have gotten themselves hopefully to a safer place, they don't always go no contact. They are not always completely safe. But they are in a place to start processing it, to talk about it, and to get their lives on track. And what we're finding is that this is another form of complex trauma. And it just speaks to the resilience of human beings and of the majority of children who can have horrible, life-threatening, mind-bending, mind-destroying things happen to them, and somehow or other, either just one safe person or an encounter that gives them a dose of reality or something that they can connect to that helps them overcome

all the, you know, it's disabling to have complex trauma for a lot of people. But we are finding that adult survivors are so much more capable and are able to heal from this trauma. It's an ongoing, probably a lifelong process, but it sure is making me hopeful. Me too. So lastly, we just thought we would get some sort of myth busting from you. I'm going to say some statements and you can tell me whether or not you think they're true and you can give me a response. Okay. So first statement, you have to be a child abuse pediatrician to determine that a report of abuse should be made. No, that is absolutely false because all the list of professionals, teachers, child care providers, nurses, any kind of physician, all of us are mandated by the law that if we don't report suspected abuse, it is either a felony or a misdemeanor depending on your state.

It is easy to get a child removed from their home based on the suspicions of one doctor alone. Absolutely not. It is a very, very high threshold to get a child removed from their home. In Los Angeles County alone, we have several huge high-profile cases where the Department of Children and Family Services is being heavily blamed and scrutinized for not removing children who later died at the hands of their abusers. Overall, child protection agencies would say that the hoops they have to go through, the safeguards, the procedures, the processes in order to remove a child are very onerous and they have to do everything right in order to do that. Doctors tend to rush to judgment about Munchausen by proxy when a child presents a complex medical

issue. Absolutely not. As a matter of fact, I continue to be amazed, although I can relate to it because I said I am so easily snookered when I meet one of these parents, but I continue to be amazed that my colleagues who understand this, who have identified many, many cases, still miss them and still continue to prescribe based on nothing but what the mother tells them. COVID has brought this out so much because of virtual medical and pediatric visits. What we're finding is that this just is a breeding ground for parents who want to get prescriptions based on their report. And as we know, pediatricians particularly, well, all doctors are trained to base diagnosis,

treatment, and prescription of medications partly on the history provided by the person, the patient, or by the parent of the patient. And then sometimes tests can verify that. But a whole lot of it is based on history. And we're trained to rely on the history that people give us. If a child turns out to be genuinely ill, that proves the parents are not abusing them. Absolutely not. If the child has a genuine illness, it might even be part of the dynamic that gets them to be a victim of fabricated or induced illness, because that's often the gateway

for the parent to recognize the thrill or the gain that they get from being in a medical environment with a sick child. Thank you so much, Bea. I want to tell you about a really wonderful organization we're supporting this month. Equality Texas has been working for full equality for LGBTQ plus Texans since 1978 through political action, education, and community organizing. Texas is not my home state, but it is near and dear to my heart. Several of our team members are based in Texas, as are many of the people you've heard from on

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