Nobody Should Believe Me - What “The Preventionist” Left Out with Dr. Randy Alexander

Episode Date: December 12, 2025

In this episode, we close out our coverage of Serial’s The Preventionist with Dr. Randy Alexander, one of the most experienced child abuse pediatricians in the country and the former supervisor of both Dr. Deborah Jensen and Dr. Sally Smith. Randy explains how the media’s portrayal of CAPs as all-powerful fundamentally misunderstands how these cases work and ignores the layers of oversight built into the system.  We also revisit the Amanda Saranofksy case, which The Preventionist casts as uncertain despite multiple conflicting stories and medical findings that simply don’t match the explanations given. These selective narratives don’t bring accountability. They undermine child safety by elevating fringe theories over decades of established research. This is our final episode on The Preventionist, but we’ll continue examining its consequences as we move into Season Seven. * * * Try out Andrea’s Podcaster Coaching App: https://studio.com/apps/andrea/podcaster Order Andrea’s 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

True Story Media Over the past several weeks, we've been talking about Serial's new podcast, The Preventionist, and the significant issues with their reporting on child abuse pediatricians. And the harm this reporting does is very real, first to the children involved, but certainly also to the doctors who are tasked with protecting them. Dr. Stephen Booth, a child abuse pediatrician we spoke to at length for our upcoming season, said in an interview with journalist Naomi Riley last month that his colleagues are the subject of so many threats that many have had to install security systems.

He also notes a concern about attracting young doctors to the profession, and Dr. Sally Smith spoke to us the other week about the death threats and harassment she's received as a result of misleading media coverage that she's been the subject of. Which I dare say may very well be the point. of all this. And it can be pretty challenging to unring the bell here. For example, there was endless media coverage of the Kowalski's lawsuit against Johns Hopkins all children's, mostly extremely favorable to them. However, the appeal in the hospital's favor, not so much. And while we can't speak to Dr. Jensen at the moment because of the pending litigation, as we've

been discussing, the people who should actually be evaluating whether child abuse pediatricians are doing their work properly, are people with expertise in the field. And thankfully, there's almost no one in the country with more expertise than today's guest, Dr. Randy Alexander, a professor of pediatrics, and notably the one child abuse pediatrician whose voice was featured in the preventionist. Not only does Randy have a wealth of experience in the field, he also knows both of journalist Diane Neary's targets Dr. Deborah Jensen and Dr. Sally Smith quite well. That's right. It was actually their boss. And so Sally was, I was this for 10 years, 10 half years, I was the statewide medical director for all the child protection teams in Florida. And Sally was one of my medical directors. So she reported to me. And I got to see her work. I've looked at many, many of her reports through the years on other cases. And the same thing with Deb Jensen. She was my medical director. And she was a station in Gainesville.

And what I did with her, because she was somewhat newer. Sally had been around for more, for a lot of decades. Anyway, I looked at everything she did for about six months. Everything she wrote, I saw. And then thereafter, with both of them, I would, you know, they would call me up about cases and all that. So I reviewed their work. And in essence, I'd say I know them quite well in terms of what they were doing.

I always challenged the community, as I did with them. with other people, I said, if you think they did anything wrong, just send it to me and I'll look it over. And I also would somewhat tease them. Some, that wasn't completely tease. I would say, if you ever do anything wrong, I'm going to call you out on it. And they said, sure, go for it. Because in medicine, we're used to that. When we first start out as a medical student, we expect that our work is going to be critiqued. And all the way through our training, there's always somebody that's going to look it over and always give us some critique one way or the other. And so it's not anything new. It's just kind of part of your normal life that you think that way.

And you don't take any offense about it or anything. And they were both wonderful that way. And then, of course, in Sally's case, I did testify in that trial. You testified in the Kowalski trial. Yeah, they didn't go along with it. But I said she operationally did all the right stuff that I expect of a child protection team person to do. And yet, apparently, that wasn't entirely the way that everybody else in the trial saw it. Right. Well. I was right, nevertheless.

Yes. Well, actually, you know, the appeals court of Florida entirely seems to agree with you as this recent decision that came down a few weeks ago. And we were able to, we had this other, another interview with Sally scheduled just to talk about the preventionist and low. We ended up being able to talk about the appeal as well. And, you know, what that court decided, it was quite a strong. strong decision in favor of the hospital and basically said that the stuff regarding the doctor's actions and protective actions should never have even gone to trial. Well, and the thing I said at trial and, you know, something I believe for anything is she did the things she's supposed to do.

She followed procedure. She followed the law. She did exactly the right stuff. I mean, you would want someone to follow up on your child and see, you know, when somebody says there's this possible case coming up. You want someone to look in that and help you. That's what she did. There's not only is nothing wrong with it, but her job as medical director was to do that very thing. Yeah. Having known these two doctors, is it a surprise to you the way they're currently being represented in the media? Because if you were to look at the media coverage of these two doctors, you would think that they had had, you know, these very fraught careers where there'd been all these complaints about them and that they are committing, you know, malpractice of some kind and that they are extremely

arrogant and don't listen to anyone else. And I mean, that's the way they've both been portrayed. Does that match up with the reality of what you know of these two doctors? Never my experience. And actually, I never did have a complaint about them, which I would have been happy to look into. I would have been happy to argue it with them if I thought there was something to it. But that situation never came up. I think if I had a child and I was looking at primary care, these would be two great pediatricians to have, you know, take care of your particular child. There's a little bit that I don't want to sort of suggest something that, you know, goes beyond its bounds. But I wonder if they're, because they're women, if they're a little

more prone to being picked on, you know, I think it's kind of approval. The field has more more women than men. So, you know, just statistically, you know, if you're going to pick on anybody, you'd probably pick on a woman. But nevertheless, you know, would they pick on a guy quite the same way? And I'm not so sure. So I wonder if there's a little bit of bias that way. And, you know, it's kind of unprovable, you know, that sort of thing. But, you know, it concerns me a little bit, you know, that that might be an element. I have absolutely clocked some misogyny in the media coverage. and certainly in the comments about both doctors,

their supposed arrogance, their unwillingness to be challenged, even their hand gestures and facial expressions are presented as evidence that they're too powerful. And it's not a huge leap to say that people frequently bristle at certain qualities in women that we might admire in men. Both of them are the types that upset the apple cart a little bit. They will be persistent in pursuing a case, I mean, if you had a child that had some infection and they were persistent and trying

to, you know, get the right antibiotic and take care of, you'd say that's a, that's a wonderful thing. And on child abuse things, they're persistent, but they stay within their lane. I mean, they're not out there prosecuting cases because they're not prosecutors. And, but they're doing the medical stuff they're supposed to do. But for some people, it's like, it's inconvenient that you're calling out and saying, well, you know, we have to do, you know, do something about the case. We just recently, my institution, we had a thing where department chow and families kind of wasn't paying a lot of attention. Kid adult bruises all over. And you take one look at it and you gasp it's like, what?

And so we had to kind of prod them to bring the child in and then do our evaluation and all that sort of stuff. And when you have people that do that, sometimes you make a little bit of waves. And it was both Sally and Deb, I think, you know, at times they did that. But as always, if I had done it, it would have, I think it might have been better, you know, just as a male and older. That, you know, all that stuff is a cultural stereotype. And I think that was one thing that's a little harder. Having said that, they've done this stuff for decades. And, you know, these couple things that come up is not the same as all the hundreds and hundreds of cases they've done that they've not had these issues with.

And so, you know, we can speculate about all the various cultures. cultural factors that, you know, occasionally work against them. But in point of fact, imagine that somebody says, I didn't do it, I'm innocent. It's like, well, I think the jails are full of people that say that. And there might be one or two people where that's true, but, you know, most of the time, it's not. Hello, I have exciting news. I am officially taking this show on the road next year. I'm going to be doing a series of Nobody Should Believe Me.

live shows next March. I will be in Los Angeles on March 7th at the Regent Theater. I'll be in my hometown, Seattle, at the Triple Door on March 18th. Then I'm headed to New York City for a show at Sony Hall on March 25th. And I'll be wrapping up in Chicago on March 26th at the Den. Tickets for all shows are on sale now. You can find a link in the show notes or on our website. We're going to have special guests, meet and greets, and more at these shows. We're going to have a great time. So go get your tickets now. Hope to see you out there. Hey, it's Andrea. It's come to my attention that some of you have been served programmatic ads for ICE on my show. Now, podcasters don't get a lot of control over which individual ads play and for whom on our shows, but please know that we are trying everything

we can to get rid of these by tightening our filters. And if you do continue to hear them, please do let us know. In the meantime, I want it to be known that I do not support ICE. I am the daughter of an immigrant. I stand with immigrants. Immigrants make this country great. I think one of the ways that they construct these stories is that they make it sound simultaneously. They sort of collapse the entire process of getting criminal charges or a child removal. They collapse that all into this one moment when a doctor is making. the diagnosis and they do they do this thing where they both they make it sort of like this double-edged sword where if a doctor if a conviction goes through or if charges go through

or if something happens that's an evidence that's evidence of the doctor having too much power however if there's any challenges to her along the way then that's an evidence that she then that's evidence that she got it wrong so it just completely negates, you know, everything that goes into actually having any kind of action from the court on a child abuse case, which is not just based on a doctor's diagnosis. And also, like, something not going through charges is not evidence that that doctor got it wrong. Can you just kind of talk us through this willful misunderstanding of the process that's being put forth in these media pieces? Well, first of all, it's, um, that kind of stuff does occur. It doesn't occur. It doesn't

occur on all the cases by any means, but it does occur. And it's a basically a defense attorney strategy of sorts, or if it's not conscious, at least is what they're unconsciously doing. And their job is to try to get their client off. And we're interested in the child. I mean, as pediatricians, guess what, that's what our job is. So we're going to look at it that way. So, first of all, when we get a case, we have to decide, is this a case we're going to see? So that's barrier number one. Then we decide it's a case that we are going to see. Then we have to see it and see what we think is going on.

We make some sort of determination about the case. But let's say it's a case that you think it's going to be bad and it's probably going to go to trial. Well, then you have to convince the child protective services worker or the police to pursue it in some ways and get their verification. of it. They then take that to the prosecutor and they have to say that, yeah, they think there's enough to go on. And then they have to present it to the judge. So there's all these multiple barriers in essence that the child has to overcome if they want their story heard. And their story certainly doesn't end with the child abuse pediatrician. It's really part of the beginning. And they have to get through all these other sorts of things. Then there comes

the trial itself. And then the question is, you know, what are they going to decide during the trial? And then what's the determination the judge is going to make? And it's almost kind of something we laugh at. We wish that we had that much power. The child abuse pediatrician, oh yeah, we can make the world shake and do all these things. No, we don't. That's not our job. We can't do the prosecution. I have never won a case. I've never lost a case. They're not mind to win or to lose. I'm just there to report on the medical stuff and, you know, what I think is a determination about health and safety. But the prosecutor's got prosecute the case. That's not me. And I think that, you know, portraying that it somehow otherwise is wrong.

It's not how it works. And they're doing it for some sort of agenda purposes, trying to make us out the bad guys. So if eventually they say, well, let's the child abuse pediatricians have too much power, let's make them all go away. Then you're going to have the forensic pathologists. What are they doing, making decisions about, you know, what went on? And they decide, well, it's a homicide. Well, who are they to say? And you can imagine all the different specialists, radiologists. Let's pick on them. Let's pick on all of these people, particularly in complex cases. You have, you know, it would be very common to have six or seven different kinds of doctors involved in the case. And then you're saying, well, let's just pick on one kind of those.

I even had a case where there were three of us child abuse pediatricians involved, and the media decided to pick on one of us, one and not the rest of us. And it's like, wait a minute, particularly me, because they weren't picking on me. And it's like, I was involved in that case. Why didn't you come after me? And that's because they had a female doctor to pick on. I don't really buy Serial's explanation that this series is meant to be only about Dr. Jensen and not all caps.

mainly because Neri broadens the scope to include all caps as she lands her closing argument in the third episode. But even if we take them at their word, that this is just about Dr. Jensen, I wanted to ask Randy if they made a case for that. Is there anything in particular that Deborah Jensen does that is outside of the standard of care for child abuse pediatricians, that's where she goes way outside her lane? I mean, do you, is there anything that you've seen that would substantiate that as someone who's known and worked with her? Not at all.

And remember, I've seen hundreds and hundreds of her cases and reviewed them, read her reports and had the chance to talk to her about even more cases and all. And, you know, so I can't say on a given case on a given day that I wasn't there, I don't know. But that is not the pattern I've ever seen. In point of fact, her work is excellent. And I would hold out as being one of the top people in the entire United States. So, you know, when you're picking on somebody and you say she has all this power, no, we don't have power like that, but are you going to pick on the doctor who says you have cancer and say, well, that's a lot of power, you know.

We need, you know, lots of other opinions and all that sort of stuff. I mean, it's kind of ridiculous when you sort of try to apply it across other disciplines because we have the power in the sense that we evaluate you. Yeah, we reach a determination. Sometimes you don't like that determination. Well, then, like, don't hit your kid or something, you know, whatever the situation is or sexually abuse your child or whatever, you know, got you in the first place. We reflect what has gone on, but we don't have power in the sense that we don't jail anybody. We don't have any of that power.

That's the court that doesn't. Now, the fact the court believes us, well, they believe all kinds of doctors for all kinds of issues. you know, none of which have to do with childbirth necessarily. And that's just the way it goes. I mean, why do you have doctors if you're not going to ever listen to them? Why, indeed, an excellent question in the year of RFK Jr. Now, according to Serial's communications with me, Neri only formed her opinions about Dr. Jensen's work after speaking with other caps, and the evidence she uses to counteract

Jensen's opinion in the one case she goes into detail about is that she showed anonymized records to several other caps who didn't share the opinion that the injuries were abusive. I asked Randy for his take on this. I'm one of the doctors, maybe as much as anybody else in the country, I have for a long, long time reviewed cases from around the country, testified cases around the country. And when I get a case, like somebody calls me up, say, from Arizona, you know, and I'm in Florida, I'll say, okay, here, you know, they tell me a little bit about the case. I said, here's all the records I want you to send me.

So I go through the records and I read them. It may be thousands and thousands of pages, not all of which have to take a tremendous amount of scrutiny, but it's not, you spent hours, you know, kind of going through these things. And I want to see what the raw data is in the first place. You know, I want to see what the EMS people saw when they went out to the home and got the child originally. I want to see what the radiology is.

I want to see a bunch of these other things. And it's by going through that sort of stuff that I've been. might have formed an opinion on something like that. But I would be very wary of somebody said, over the phone, they said, well, here's a few details about the case. What do you think? And say, well, I think I need to see more data in the first place. You know, you can sort of say, I wonder if it's in this area, but I certainly wouldn't

want to commit to that without, you know, knowing more facts. It's really important that we'd be factually correct. And one of the things that I teach my trainees that I've taught for a long time is about accuracy. And so you're working a lot in accuracy. None of us wants to see an innocent person go to jail. And we're not super happy about somebody that's a threat to children not going to jail. But, you know, obviously the whole system is geared so that we don't convict that much that, you know, that the bear is quite high to convict somebody. And that's the way it is. And, you know, I think that's something, a truism that's been true way beyond medicine. And it's true in all

kinds of areas. And for the most part, that probably seems to work. I think that sometimes people find these cases interesting because the perpetrator says, I didn't do it, which, you know, they do that in a lot of things. And then sometimes they get off on that because they only hear one side of it, you know, from perpetrator. And then HIPAA and all these other things confidentiality stops us from talking about what is it in the first place that they start thinking, you know, well, we're just going to believe the one thing that we're being told. And you don't know what all the other stuff is. I mean, I've had cases where the media went crazy about these doctors were terrible and blah, blah, blah, and then the parent admits to it. You know, take these with a grain of salt, you know,

it's one thing to say, the parent said that they didn't do it. That's great. You know, I mean, that's a fact. But then when you start to pick up on that as an agenda in reporting on it, and you said, well, they must be innocent. No, they said they didn't do it. That's a fact. That's a fact. what you know. You don't really know all the details of it. The other thing is, do you really think that doctors who've got busy schedule and are working hard, do you think we just sit around and make things up because we have nothing else to do? I mean, I'm sorry, what insanity has gripped you that, you know, you think that's how we run our lives. We don't get up in the morning and, you know, hit the alarm clock and say, well, let's go out and you get, you know,

somebody in trouble. We don't do that. And in particular, again, we're going to be child centered. And so we want what's best for the child. And that might be stay with your parents. That might be that it's a bad situation and you need to go someplace else. We don't know to start out. So we're going to work off on the facts. And then if even if we reach a conclusion, this child's unsafe, we still have to, as you said, work through all the various layers of things, you know. Does everybody else in the system agree or not? The media coverage about caps often make it sound as though they are the single deciding factor in everything from CPS to court decisions to police investigations. And Amanda Surinowski's lawsuit attempts to lay legal responsibility

for everything that happened to her and her children at Dr. Jensen's feet. The introduction to the lawsuit reads, quote, this case is about a remarkably dangerous pediatrician Dr. Deborah Assyrano Jensen. And it goes on to say that Dr. Jensen had been intentionally making false allegations of child abuse against innocent parents like Amanda for decades. Under the claim of intentional infliction of emotional distress, the lawsuit posits that rather than the prosecutor, CYS, and the courts acting independently, Jensen was intentionally aggressive with these entities in order to knowingly cause Amanda and her children distress. And though much of the story Amanda tells on the show has to do with custody decisions and dealing with CPS, Serial also points it all back to being an issue with Caps. Neri stops short of saying Dr. Jensen is purposefully falsely accusing parents. as the lawsuit alleges, and instead says that caps might be, quote, mistaken.

But it's hard not to see a through line, especially as serial appears to rely on much of the same evidence that the lawsuit presents as being indicative of Dr. Jensen's wrongdoing, such as context-free excerpts from family court judge decisions about other families, and, of course, the complaints of parents whose children were diagnosed by Dr. Jensen. And according to Randy, this is a misrepresentation. Well, first of all, I suspect the critics don't really know how this works because the way they're portraying it and the way you described it. That's not how it goes. So I'll just personalize it.

So I'm sitting in my office, how am I going to know if there's a kid in the hospital that we should look at? That means somebody at the hospital, some other doctor, not a child abuse pediatrician, some other doctor has, seeing this child, made an evaluation, probably done various testing things, maybe not. Some things are so obvious, you know, you see right from the beginning, but they would have made an, their own evaluation said,

I think something's going on here. Or maybe they actually think it went on there. They're not really in doubt about it. And that's when they get us involved. So we're number two on the scene at the best. We're not there to begin with. We're not watching them come through the ER door and seeing it that way.

So this notion that, The child abuse pediatrician is primary. We are not. There's already other physicians that think there is an issue there. And so guess what? There's going to be at least several of us that think this, if not more. And then we've got all this other specialists that get involved in various cases. So this, again, it gets back into the somehow we're these all-powerful people. And then we get criticized that we have no power. And you know, which way is it? And pick one. And let us know which way you think it is, but we're only involved when somebody already has a concern for this, and that's when we hear about such cases. I mean, we don't go walking around

at school systems and say, let's check all the kids on, see what's happening with them. How would we even know any of these things? And so it's a misunderstanding the medical system. In essence, we're like a consultant that somebody has to, you know, do something that would get our services. To say that Diane Neary is misunderstanding the issue at hand is, of course, charitable. Neri and the serial team spent two years on this story. They were certainly exposed to accurate information about child abuse medicine and abusive head trauma throughout the course of their reporting, even if they chose to disregard it. Serial even reports on a trip they took to a medical conference on the subject. She's putting this in the context of how arrogant, you know, some of these unnamed

people have found Dr. Jensen to be, and she said, I noticed it at a shaken baby syndrome conference that I attended in Utah last year. There was an us versus them atmosphere. Lots of panels devoted to fighting the naysayers, defense attorneys, medical experts who disagree with them, science, the questions, the validity of shaken baby syndrome. So I wanted to ask you about the us versus them. and the science that questions shaken baby syndrome because shaken baby syndrome is different than munchausen by proxy, which we've spent so much time in that we have a lot of data and an extremely broad medical consensus on the science behind abusive head trauma. So can you just talk us through some of that?

Well, if she'd listen to my keynote at that conference, she would have, I laid out how it all works and where we stand over the, I think it was a 20-year retrospect. in terms of things that stood. In point of fact, yeah, we do have a lot of data. We have, I don't know, I'd say 15, but I think it's more than that. Organizations, international organizations that all line up and say the same thing. And she's right in the sense that there are sessions, I wouldn't say a lot of sessions, but there are some sessions where they're talking about what are some of these defense witnesses out there,

and what kind of theories are they saying. And, of course, part of it is, well, let's listen to what they have to say. But as it turns out, their stuff is garbage. And so some of the sessions talked about that and why it doesn't line up. And why do all these organizations around the world say otherwise? And then you have these couple, handful of people, I don't know, maybe 20 people or something, that go around and say these things. Joseph Scheller is one who comes to mind who just believes that shaking is not a way to cause that brain injury.

Right. And he has a tendency to say the same thing. And he's had a couple courts that are not happy with. them and not let them do things and yet they still go on and keep doing this and they would be an example of somebody who perfectly well knows you know what the mainstream medicine says and all these other things they probably reviewed testimony that i did and a hundred other doctors did as well so it's not that they're uninformed they just have an opinion that um is counter science you know i always wonder if they think they're galileo or they think one way and the rest

of the world thinks another and i would just remind them that guys Galileo did science and the world wasn't doing science. And the difference is that nowadays we're the ones doing science. And so it's not at all the name analogy. It's the analogy is totally wrong. And they don't even agree a lot of these people with each other. But the key thing is, yes, some of the session is devoted to that in part because when we get to court, we have to put up with, you know, hearing about these things and dealing with these things. And they're not particularly successful, but they keep coming up because there's nothing else they can do. These defense experts are an important piece to dive into, because in fact, these are the

second opinions that are actually being advocated for when Neri points to second opinion laws that she posits could be a solution to the professed problem of crusading child abuse pediatricians. In this context, second opinion does not mean bringing in a fellow child abuse pediatrician who has equal knowledge and expertise, someone like Randy, who provided innumerable second opinions in his role as statewide medical director. It also doesn't mean bringing in someone like Dr. Jensen, who was the second opinion in Amanda Serenovsky's case. More likely, it means bringing in someone like Dr. John Galasnik, the expert witness whose findings are excerpted in Amanda's lawsuit. Dr. Galasnick found Amanda's report that her baby fell,

or was tossed or was pulled, defending on the version, from the bassinet to be completely consistent with medical findings. The lawsuit claims that Dr. Galasnick concluded that, quote, Dr. Jensen's opinion that the baby was abusively shaken by his mother, plaintiff Amanda Sironovsky, is not supported by the current experimental biomechanical and animal and human research data. With the caveat that I obviously don't have the baby's medical records, I shared the near-death report, which summarizes the injuries, with both Randy and Dr. Sally Smith and asked them if Dr. Galasnick's opinion made any sense with what we know about the story Amanda is presenting and the injuries the child sustained. The short answer is no. It's possible

for babies to sustain a head injury from a fall, yes, but not the type or severity of the injuries recounted in the near-death report matching Amanda's case. And Dr. Galasnick is a well-known defense expert. In fact, he exclusively testifies for the defense. Though Dr. Gillesnick appears to be a board-certified pediatrician, he has treated college students in the student health clinic for the past 30 years, and has not actually treated an infant or young child since 1980, despite the fact that he nearly always testifies in cases involving physical abuse of children under the age of two. Importantly, not only has Dr. Gillasnick never evaluated a case of suspected abusive head trauma as a He's never evaluated a child with a head injury, period.

Dr. Galasnik's CV includes just two peer-reviewed studies. The first is a case report based on the observation of a single subject, and the second is a lab experiment featuring infant mannequins and a live infant wearing motion sensors. The latter study was published in the Journal of Forensic Biomechanics, whose publisher has been widely criticized and lost a $50 million lawsuit against the last lawsuit against the FTC for its lax review standards and deceptive publication practices. In a 2010 court deposition, Glasnick also notes that he's done many, quote, home experiments on his own. In this same court deposition, Glasnick explains that his interest in child abuse medicine

was inspired not by his clinical practice, but by an experience he had serving on a jury in 1999. He is well known for opining in court that medical findings typical of abusive head trauma could have instead been caused by minor accidental household injuries. He frequently posits that you can't diagnose A.H.T. based on medical findings because another explanation could always be possible. This is well outside the prevailing medical opinion on abusive head trauma, which is, by the way, the subject of extremely broad consensus in the medical community, including the American Academy of Pediatrics. Glasnik is not a credible expert, and his opinion is frequently disregarded in court. His

testimony was the subject of a Dober motion, which is used to exclude or limit expert testimony, in a New Mexico case just within the last month. In this case, the judge ruled that Galasnik, quote, will not be permitted to testify about any controversy regarding abusive head trauma or shaken baby syndrome. Even when the, quote, second opinions come from defense experts like Gulasnik, the media often portrays them on a par with people with decades of experience evaluating these injuries. A quick Google search will come up with in new, numerous articles about the questions around the very robust science of abusive head trauma. It's a manufactured debate, but it doesn't stop people like Neri from framing child

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I want to talk just a little bit more about kind of this idea of, of how Dr. Jensen is framed because she has this, you know, and sort of this, again, this like flattening of the system. And they used this quote from her in the second episode where I just thought it just was, which I found very frustrating, where she is talking about how she got into child abuse pediatrics. And so she says, you know, and then I fell into this role and it's an interview with her from a podcast.

But as I fell into the role as my responsibility, found that, you know, I really, I can't say I really enjoyed child abuse. Of course, no one enjoys child abuse. But basically what I'm saying is it's never boring. Child maltreatment and evaluation of children who have been victims is just never boring. And, you know, they left out what came directly next in the interview where she talks about this whole interdisciplinary process that they have. And I was like, oh, I know exactly what they're doing with that specific quote, right? they're trying to make her sound like, oh, this is such exciting work for me and like, this is such a good time.

You know, it just, I found that to be quite a telling editorial choice. Well, and again, a total misunderstanding by people that don't do practice medicine. So, for instance, what if a cancer person who's on a cancer word says, I don't find it boring, you know, what are we going to do, you know, say there's something nefarious about them? I mean, they're doing the cancer stuff. Now, that's not everybody's cup of tea, but you assume that they enjoy that work in the sense of being able to help people or doing what they can, you know, relieve things as best and all. And to say that it's not boring, that's what I want, you know, if it was me, that's one of my cancer person to say. So, and Dr. Jensen is saying the same thing.

Well, that's what you want. It means that they're engaged in what they're doing. And it's sort of like in an ER, when we work in the emergency room, every day it's not boring. There's always these little different things that come up. A lot of times, little quirky things that you never heard of before. Not necessarily wildly different, but just different how it looks. And the same thing's true in child abuse. We say that.

And Dr. Jensen is not alone in that. I think just about everybody has said that at various times. And part of that's because people aren't the same. and so there's always a little bit of difference with each individual person and we try to get to know people a little bit if we can sometimes we pretty well sometimes not so much um and that's what makes it interesting and you know what if it was just putting out widgets on a conveyor belt no that's not what that part of medicine is it's not boring it's it's got some interest to it and i'm sure that there's at least for all of us there's some days that are more than others you know

Yeah. Well, I mean, I think this quote really struck me because I say that about my job all the time, you know, where because people are like, oh, well, is that hard working on those cases? And I say, yeah, like, there are some really emotionally challenging aspects to doing this work and looking exclusively at child abuse cases. And I always said, I was like, but I'm never bored. Like, it is, it's fascinating work. That doesn't mean that, like, I'm glad it's happening. And like, hurrah, I get to be a true crime podcaster because, you know what I mean? It's like, it's just such a, it's such a disingen. It's such a purposefully. ingenuous. Well, and for her, I don't know what she's suggesting that life should be boring. I mean, if it was boring, she should quit her job. I'm sure she would say, no, she finds it interesting every day. And I think most people that like their job well enough, you know, find some sort of interest every day. There's something especially troubling about vilifying child abuse pediatricians, because to my mind, it's kind of a miracle that you can find doctors to do this work at all. It's emotional. emotionally grueling, it's not especially well paid, and now they have to deal with being

excoriated in the press and tied up in court with lawsuits. And we need them. According to the National Institute of Health, 18% of children will experience physical abuse. An abusive head trauma is the leading cause of death from physical abuse in children under two. And the job of a child abuse pediatrician isn't to, quote, find abuse, as it's often portrayed, but to determine abuse. And on average, they have positive findings of abuse in only about half of the cases they evaluate. And there's no reason to believe that we're actually catching every case.

Child abuse is much more common overall. Now most victims of child abuse aren't going to end up in a hospital. And most victims may never be identified during their childhood. And so we have all these studies of adults where we're asking retrospectively, you know, what happened to you during your childhood and everything? But in point of fact, child abuse is not a rare diagnosis. It's not always picked up on, but it's something that's out there. And the point isn't so much about arguing that.

The point is what can we do about it? And you know, how can we prevent these sorts of things? And that's one of the works that child abuse pediatricians who they're trying to vilify. You know, we're particularly interested in about prevention ideas. What can we do to help this out? this is, we want kids to have a great childhood. Can you imagine if everybody by 18 had a terrific childhood, the chronic diseases, all the other stuff that go along with, you know, having a bad childhood. We could have the internists, you know, have a lot more time on their

hand, you know, if we could really get kids off to a healthy start. Yeah, I mean, and I think it's so striking, again, in having these conversation with people who are abolitionists, And that's why I'm so kind of hammering that at the moment to sort of draw these arguments out from each other because I think this conversation that this is involved in is about parents' rights and whether parents have the right to do anything they want to their children or not. And I think that's what's essentially undergirding this argument, not, you know, this abolitionist argument where it's about what if we had, you know, what if every child had enough food and their parents had enough support and like how could we, you know, these things that there's a lot of robust data that would help prevent so many situations from getting to this point. And like to me, child abuse pediatricians, to your point, are engaged in that conversation about

prevention. You know, mileage may vary about how to accomplish that, but that is essentially a good faith data-backed, science-informed conversation, whereas this is not. This is a minimization and denial of how frequent child abuse happens. And I've noticed, Randy, in these pieces by people like Neri and Hicks and Bog that I have spent way too much of my one precious life thinking about, they really avoid, for the most part, talking about child sex abuse. And I think There's a reason. It's because people's reaction to that is so strong that they know they will not find the same sympathy and the same mileage if you are talking about child abuse pediatricians diagnosing child sex abuse. Because we've had our sort of cultural revelation about that. That is like reached a cultural acceptance that, you know, Munchausen by proxy certainly has not. And I think it's really like abusive head trauma now is in a back. slide from, you know, this, again, it has a broad medical consensus, but you would not know that from the media. So I think they're really being choosy about which pieces they're pushing back

on for a reason. No, I think you're right. I think that some things they're more susceptible on doing. You don't get defense witnesses arguing about sexual abuse particularly. And so not much of an industry there. So they pick the ones that are, of course, the ones that you have a major felony exposure to, you know, those are the ones you're going to fight more. And so I understand that, you know, and that's where you're going to see it. And imagine you're a defense attorney. If you don't find a defense witness somewhere to testify that it's not shaken baby or something like that, they're going to hit you for inadequate defense.

And so you've got to drum up somebody. And that kind of, in the legal system keeps that alive. And it's an artifact, if you will, with the legal system that they do such things as opposed to say, well, gosh, I guess we can roll over because all these medical people say this is what it is. But I assure you in medical schools around the country, we're teaching about that, about the shaken baby stuff, and we're teaching about the munchaus and bi proxy stuff. And there's not a big counter stuff in the medical schools going on in the United States that I'm aware of, and I don't believe it exists. So this stuff is pretty well accepted and everything.

And we even have some studies, particularly with the abusive head trauma, shaken baby stuff. We have studies that the acceptance is really high, but that doesn't mean they're not going to argue the case, or they'll say, well, this is the exception in court. And if they've got a case for it, go for it. I mean, I don't have a problem with that. But, you know, a lot of these things we would work out before it ever got to a court. Court is not the discovery stuff. Discovery stuff is done, you know, back when we deal with it, you know, on the scene when we're seen with it. And I think sometimes people forget that.

You know, they're used to seeing Perry Mason or Matt Locke or I don't know which ones they're looking at, depending how old you go. And somehow in the court process, that's when they discover things. And it's like, that's not how the world works. That stuff's already been done. And now you're just going to court and arguing, you know, other issues. Despite the preventionist's claim that this series is solely about Dr. Jensen, It's forwarding the idea encapsulated in so many other stories that the real problem isn't under-reporting of child abuse, but overzealous and crusading child abuse pediatricians.

And this idea is always presented without any data or evidence that it's actually happening, other than in this series the existence of angry parents and the report of a county controller. I wanted to just ask you about this notion of cowboy caps. Do you think there's just, I mean, there's not very many caps in the country, right? It's a small, and I'm sure it's going to be harder to build on that number, given how they're being treated in the media, and that's a problem I worry about. But, like, can you just respond to the cowboy cap, defense, I suppose, because this is one I've seen come up a lot. Well, is there one individual out there in the world that's acting crazy? I don't know. That's probably true for anything in the world.

You know, so, I mean, to generalize that against everybody is ridiculous. I don't think that that's true. I mean, I don't get up in the morning. I don't know anybody gets a morning and says, oh boy, I hope I see a Munchausen bioproxy case. I mean, if there's anything, I get up in the morning and say, I hope I don't see a Munchausen by proxy case. Because first of all, it's going to be contentious. It's going to be an amazing amount of hours. I mean, I spent, like, in the Kowalski case, I spent 82 hours going through,

tens of thousands of materials and things. I don't want that. You know, I mean, I could be doing a lot of other stuff during that time period and get a better result, you know. So this isn't anything that we particularly want. We have a system where we look in Florida, we look at all the reports that go to the hotline. They're medically seen. That's over 200,000 reports in the state of Florida. And every day in my particular child protection team, we get a stack of paper. It's like a REMA paper that's just in all these different cases. You know, it's two or three pages that talk about this case that got reported. And then we have to go through it and make a decision, but is that a case that we're going to see in our clinic or at the hospital?

And that is a lot of cases. We actually physically look at about 20,000 plus cases per year. You know, if I could make that all go away and retire, that would be great. And I'm sure the cancer people are thinking the same thing. you know, for what they do and orthopedic people or, you know, whoever we are in medicine, we want this stuff to go away. It's not like we need it for job security. We could do other pediatrics. At the drop of a hat, it'd be so easy. So that notion that we're doing that is it's malicious. It is insulting. And if a medical student said anything along those lines,

we'd have to flunk them or something. I don't know. You know, it's like, how could you be so wrong? I mean, they never say that because they're smarter than that. But, but, you know, it's like this is not a job security thing. It's just nuts to say something like that. And, you know, I don't know what the motive is that somebody would talk like that. But it's not a good motive. Yeah.

And, you know, I think having talked to child abuse pediatricians and, you know, like Sally and others who, you know, have been engaged in this work for a long time, you know, they realized that this was work that they could do that a lot of other people just couldn't tolerate. And certainly seeing children who've been beaten, sexually assaulted, you know, who've been tortured by Munchaus and by proxy abuse, this is, you're looking into something that happens too commonly in society that most people, you know, who've been tortured by Munchaus and by proxy abuse, this is, you're looking into something. that most people would much prefer to just live their lives and never have to think about. Sally has talked to us about how one of the things that really kept her sane doing this work

was keeping up with her general pediatrics practice because then she could just see, you know, children who were happy and healthy and thriving. And, you know, that that was something that really brought her a lot of balance. And, you know, it's so baffling to me to choose people that have, taken on something so difficult and villainize them. I have seen stuff that a human shouldn't have to see. Now, it's, you know, police have sometimes had to do that and others as well. And I can't tell you how a discouraging that is.

And I get the thing from other medical professionals for years. They've said, I'm really glad you do that. I couldn't do that. I don't know. They do some stuff that isn't always my favorite thing to see, you know, medicine's full of stuff that, you know, it's difficult. But in point of fact, when we go to the hospital and we're, you know, to see some kid that they brought in because they got a child abuse case or they think they have one, they welcome us. They are so happy to see us because we're going to come in and

help them deal with the case and everything. The people in the hospital, they love us, you know, from that point of view, kind of like we're the cavalry coming in, you know, to save the day or something. And of course, we don't always, in our outpatient clinic, we have looked at our own one. There's literature on the subject, somewhere between about 35 to 50% of the time, you don't call it child abuse. Now, what happens is people suspect it might be, and so they make a child abuse report, and they should do that by law. And then we look it over and we say, well, is that really child abuse or not? And then it may not be, or we may not quite have enough evidence to say for sure. And that's okay. If we don't have it, we don't have it. And so again, the numbers are

depending on what you're looking at about 30 to 50 percent or so. So we don't call everything child abuse by any means. In fact, one of my favorite things, and I know this would be true for Sally Smith, Deb Jensen, and every other child abuse pediatrician in the United States, one of the favorite things is you walk into a room and it's some other condition. And it kind of, you can see why they thought about child abuse, but it's not child abuse. Now, by and large, you're hoping that other condition isn't something that's even worse, you know, like, oh, my God, you got a fatal disease, you know, that kind of thing. But sometimes you get that, and I've had that experience a lot in my life, you know, that there's something else going on. And yet I understand why someone thought there's child abuse, and they come to us to figure out, you know, what's going on and all.

So we're not a rubber stamp. Everything's child abuse at all. And people characterize it that way, you know, they must think that in medicine, anytime you go to a doctor with a concern about something, they're always going to diagnose something that's always this one thing. And it's like, come on, that's not any part of medicine. That's ridiculous. What do you think we went through all that college and medical school and training and everything else just to be, I don't know, even worse than AI would be on such stuff? Right, yeah, all those oncologists that are staying in business by just anybody who shows up, they diagnose them with cancer. right? Exactly. I don't do that.

That's why you get into like plastic surgery or something, you know, then you can really, then you can give someone something every time they walk through the door. I mean, and we get all kinds of different kinds of diagnosis we have to think about. Now, there's a lot that, you know, at a trial they bring up that are ridiculous type of things. But then there are some things that come up, for instance. There's some called ITP. And I bring that because we just recently had a case. It wasn't an ITP, but I was having my training.

you know, talk about it and everything. And I've seen a number of those cases where they show up and they have these blotchy bruises on their skin and they have a bleeding disorder because they have very low platelets. And you take a look at that and you say, well, that's not child abuse, but you've got to go to the hospital because we've got to do a few things with you anyway. And you'll eventually get better from it, although it might take months and months, you know, to do various things. There's other conditions.

There's something called phytophododermatitis, which we're a little bit prone to in Florida, maybe. And that's where you get, like, say, lemon juice on your skin, and then you're out in the sun, and then you get this reaction, and it kind of look like a bruise. And so I've seen those, and my colleagues have seen those, you know, you take a look at it and say, well, it doesn't quite look like a bruise now that we look at it really, really carefully. But I understand why someone thought that, and then you send it, go out the door and have a good life, you know. and it's not an issue. And those parents don't call the media, though, and say, hey, this wonderful child that used pediatric can just, yeah, they're happy, but they're not going to, like, take that to, you know, Netflix.

But we've helped them understand something, a condition that's going on. And they appreciate that like with anything in medicine, you know, I mean, they could go to their primary care doc and get that diagnosis too, perhaps. You know, we're all trying to pull together here to figure out what's going on. And we have no incentive. whatsoever to have it be one way or the other we don't we don't care when you walk in now the other thing is we try not to be swayed whether we like the parents or not you know because sometimes what will happen is not very often but you get people to say

well they were nice parents so they wouldn't do it and you go well what are you saying that if you don't like the parents they must be bad i mean that's pretty biased um in point of fact you should decide it on the data, not on whether, you know, the parent's nice to you or you're warm on optimum. Otherwise, you're going to introduce bias, and bias is wrong, and that's not how you decide things. The end of the year is a good time to take stock and figure out what changes you can make that would make your life easier in the new year. And I am telling you right now, if you don't love your bank, and most people don't, you should consider switching to

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Results may vary. See Chime.com for details and applicable terms. My name is Sarah Turney. I spent years fighting for justice for my missing sister, Alyssa attorney, before an arrest was finally made in her case after nearly 20 years. But after my experience with the media, law enforcement, and the court system, I knew I couldn't stop with Alyssa's case. I know what it's like to fight for media attention, for answers, and for justice. After I stopped telling my sister's story, I knew I wanted to help as many other victims, survivors, and families as I could. On my podcast, Voices for Justice, I provide unique insight into these tragic cases, because I know what it's like to not just listen to these stories, but to live them. And more importantly,

how to help them by being a true voice for justice. Listen to Voices for Justice in your favorite podcast player today. You can be so much more than just a passive consumer of true crime. You have the power to help. In addition to being an experienced child abuse pediatrician, Randy is also one of the most well-respected experts in the country on Munchausen by proxy abuse. I know Randy from the Upset Committee that we both serve on, so I wanted to ask him about serial's handling of MVP.

But in the second episode, they talk about this caseworker from Florida, who had had a case with Dr. Jensen, who he, importantly, could not remember the name of the family, so did not have a ton of information. But, you know, this is how, his name was Andrew Caswell, this is how Diana frames this case. She said, I want to tell you about one more case from Florida

because it's the clearest example I found of someone trying to challenge Dr. Jensen before a family was affected by a separation and attempted check on her power. And so the case was from 2012, 2011, again, there is no details about who this family was, anything, any information about them, just this caseworker's recollections. But I could tell, by the way, this caseworker describes it that he has no idea what he's talking about. For instance, he says, you know, I couldn't figure out why she was calling this abuse. And he said, where she saw abuse, I felt that abuse would have.

have been medical neglect if she hadn't taken him to the hospital. I don't have a teenager, so I don't know what it's like to have a teenager. So he's saying, this mom was taking her child to the hospital. So how could this be abuse? Can you just kind of help us address the misunderstandings that this caseworker appears to have about what Munchausen by proxy abuse is? Well, first of all, that's a really common thing we get. People that overuse the medical system can be abusive. if every day you got poked with the needle. And so I said, well, you're getting poked with needles, that's good. We'd say, no, it isn't.

You know, at some point that's not good. You know, so one of the things is that when you have a type of thing where it presents is overuse, people fall back on that. Well, they're going all the time to a doctor. Well, you know what? That can be wrong. And so, first of all, that's a total misunderstanding. Second of all, it's not a psychological diagnosis, period.

yet. Never was. There's always a pediatric diagnosis. So the fact that they're trying to find a mental health issue, it's not about mental health issue. It's a child abuse thing, you know, where you're doing something to the child, maybe you have a pattern of things that are wrong. The child suffers. I had a case once in Nebraska where they were saying that same kind of thing, you know, about the overuse thing. And I said, every time that we poke somebody with a needle or we do something for him. That's in the medical record. So I said, get a big box together of all the needles this kid ever endured and all this other stuff, put in a big box and put it in front of the judge and say, if we assaulted somebody on the street with all that, how do you think that would

be? You know, you'd think it was assault. In point of fact, you think that doctors were nice and safe. And one of the discouraging parts for me has always been when you give a kid a shot, or actually our nurses give the shots, but you give a kid a shot. And, you give a kid a shot. And the mom will say, thank the doctor. And it's like, they just gave the kid a shot. Don't make them thank the doctor, you know. Come on, it hurt. They didn't like it, you know.

Let's not be a hypocrite, you know, to the kids, you know. I mean, you know, it's nice enough to say goodbye, but, you know, let's not try to pretend it's something. But they're thinking the doctor is a safe place. In a lot of ways we are. But when you think about it, particularly say somebody's hospitalized, we hurt children. We put IVs in them.

draw blood from them, we do a lot of that. We do it for a much better reason, you know, we're trying to save their life or, you know, try to help their condition or diagnose them or something. And so when you see a doctor, to the child's point of view, it's not completely safe, but we certainly hope in its elements is safe. And we hope that in the long run, we're doing really good for them, despite, you know, the discomforts that they have along those lines. And I think in a certain sense, people don't understand that overuse of doctors can be a problem. Like, for instance, if you drew a lot of blood on somebody that never needed it, if you did a lot of other things, those hurt and their things. Now, maybe they're not all life-threatening, but still,

there can be a problem there. So this is a person that misunderstands. I have to say that as a medical provider, medical providers kind of get it. They understand, you know, well, what's this going to mean, you know, to doing this. I mean, I don't like doing things to kids that they don't need. And I don't know any other pediatrician that would. I mean, we try to be as minimalist as need be. But then we know there are things that we have to do, you know, if we care about the child. And so anyway, that person doesn't really know. Second of all, if he really had a concern at the time, he could have brought it to me as a statewide medical director. I never heard it. Well, it sounds like it did go up the chain for review and then basically he was

come to me like he was told yeah gentlemen is wrong I'm the I'm the I'm the supervisor so um yeah and there'd be nobody else to judge because it sounds like that happened and they took him off the case and he was mad about it and like I just as a journalist I mean as a journalist this just wouldn't pass muster as an anecdote because you've got someone that can't remember any of the specifics of the case they're not presenting you with documentation had he brought it you know up to me if it'd come up the chain, I would have looked at it. If I thought Jensman was wrong, I would have told her in a flash. I had no problem with that. And she would have had no problem in receiving that information. She might, you know, want to argue or discuss the case. So that'd be fine. That's what you do as

medical professionals. But it never happened. And so, you know, just throwing out these accusations that I didn't agree with something somebody did that was medical that I didn't understand. It's like, well, you know, I don't know what to do with that, you know? Yeah. And then there was one of their anecdote that she, you know, this is again, I'm sort of including these because this is all she found in two years of reporting on this case, or all she found that suited this narrative. She certainly found many other things, as we've had sort of evidence of. But so she said, I spoke with David Bramowitz. Is that a name you recognize? I guess he was the regional director of Department of Children and Families at the time. She said he was responsible for all

Northeast Florida, including Gainesville. Will Dr. Jensen work? He co-signs what caseworkers told us about the power imbalance and not being listened to. Several things. One is. yes, he could disagree. He was the DCF head in that region of the state. Apparently, he didn't agree with some of the things that she said. Again, could have brought it, you know, up the supervisor chain. And DCF can do that. It's the way we do things.

It's our operations. And if he disagrees, that'd be fine. And I would say, bring forth your medical data. And let's deal on that basis. But don't go on your feeling. You know, well, I think Dr. Jensen pursues something, and that makes me feel uncomfortable. You know, well, yeah, as medicine, we're going to pursue something. We're there for the child.

That's what we call pediatrics. And one of the things that we do is we're an advocate for the child. And if we think the child needs something, we're going to pursue it. Now, we won't do it endlessly. At some point, that's not our, you know, that gets outside our lane. But of course, we're going to want to see things done in certain ways. And in DCF world, child protective services, more known generically, sometimes they don't do what we want them to. And I'm sure there are times that they don't agree with us either.

And we have staffings. We actually sit together and say, if you've got a problem, we're all going to get in the room, we're going to talk over the case. And we can do that. And in fact, we do that on a fairly regular basis about things. And it's not always because of disagreements. But we talk over the case and what have we got, where are we going to go, and everything else like that. as you would want someone to do. And that means then you have a bunch of professionals that are involved in the case,

medical and non-medical professionals. And, you know, that's the forum. If you have an issue with any of our medical docs, you know, let's do that. And let's talk it over and see what you've got. We don't have a vested interest in this for the most part, you know. If somebody's got a better argument, let's hear it. Yeah. I mean, and I think I'm really struck by this.

you know, by these episodes that like any person who'd been doing this work for this long, you would be able to go back and find, you know, a defense attorney, a former caseworker, you know, like, you're going to be able to find a couple of people that didn't like them or didn't. I mean, it's like that, that to me is just not evidence of a bad doctor. And I asked Sally Smith the same question and I wanted to put it to you because I don't want. want to get into, you know, I'm always trying to check for my biases and my lens. I come at this work from a certain angle, of course. And, you know, we all, everyone, every journalist does. Any journalist that pretends they're not is being disingenuous. But like, I'm always trying

to account for that. And I don't want to sort of build this argument of like, child abuse pediatricians are perfect. And there's nothing you could ever tell me about a child abuse pediatrician that would convince me that they're doing a bad job or that there are, there are problems of their work. So help me understand, like, how should we be better consumers, being better consumers of this media, like, how should we evaluate whether or not there is a problem with not just child abuse pediatricians, but any doctor who's in, because most places don't have them, most places are not lucky enough to have someone that knowledgeable on staff. How should we be evaluating this role and whether or not a doctor is doing it well? Well, for one thing, um,

Nowadays, not so much in my day and Dr. Jensen's day, but now if you want to be a child abuse pediatrician, you have to do a three-year fellowship. And then at the end of that, you have to pass a test, a national test that's given. And then you can be a board-certified child abuse pediatrician. And then we got grandfathered in in our day back in 2009. And then we had to show that we'd been doing

child abuse pediatrics for, I think it was five years or something, at least half time. And then we had to have letters of recommendation. And then we had to pass the national test to be able to say that we were that. And then I just completed the cycle, but we get every quarter, we were getting tests online tests.

And we had to pass these questions and everything else. And it was only after five years of doing that, that they gave me what's called maintenance of certification, which is basically kind of like saying your credentials are continued. But guess what, you're gonna get it again? And so this is something where, you know, where they're constantly,

testing you on these things, you know, and make sure that you're up to speed. And that's true for many other specialties as well. I don't know if it's true for everyone, but for a lot of them, it is. And so it's sort of a quality control that is being done nationally on all that. And of course, you're getting your feedback from your colleagues that, you know, are in your office or you're in your hospital or wherever they are. I mean, you know, you certainly hear from your colleagues And they tend not to be shy when you get a bunch of doctors together, they talk. And if they had a big worry about you, you'd know pretty quick, you know, that they had concerns about you.

And then we go to conferences, various child abuse conferences. And most everybody's a child abuse pediatrician goes to at least several conferences a year or so. And we discuss various things that are going on and well. And, of course, we have the literature and all that. So there's really a pretty big educational component. that goes on to something like this. And it's not trivial by any means. And I guess I just noticed that, you know, people that aren't in the subspecialty aren't doing that. So, you know, it's not that they are necessarily wrong, but they certainly don't have quite as much

proof that they've been working at it as the people that do this. And that's what you want. I mean, I want my doctor that's in some sort of a special. I want them to be really good at it. You know, keep getting continued education and do all these sorts of things. And that's something that the child abuse pediatricians, much less pediatricians in general or anybody else, you know, to keep up their licenses and things they have to do. You know, the state has it too. In my particular state, I have to have 20 hours of training per year, 20 hours of training per year. To do child abuse work, I have to have eight hours training and child abuse per year. now that's pretty easily accomplished when you work in a field you know you get that with

almost at a blink of an eye because there's so much stuff you're doing but um in point of fact people are pretty good at this stuff and um and i would have a fair amount of confidence if i you know in general if i was anybody in the public about you know how good how good this is going yeah and that's i think that's one of my um that's one of the other real fears i have about this kind of reporting is that it makes parents afraid to bring their children to the hospital, completely unnecessarily, in my opinion. And I would say, like, if I'm a parent that brings my child in with an injury that might look suspicious and I'm innocent, I want a child abuse pediatrician to evaluate it. They're the best person to make that evaluation. Well, you know, kids have accidents and physical injuries and this and that.

Even some kids will get a couple of broken bones. And, you know, and a parent will say, oh, my God, you know, you're going to think I abused the kid and then you'll laugh about it and we laugh about it and then nobody thinks anything about it afterwards you know I mean we're aware of that you know many of us have had kids of our own and we kind of know what some of these things are about and so what you're looking for is a deviation outside of the norm sort of thing now it's interesting you mention about being scared of doing it sometimes people are scared because they have a history you know that's been a little bit checkered and so I appreciate that um burns are actually one of the ones that we get into sometimes a kid will get a bad burn and the parent says, well, I'm not

going to take them in because they'll want to take my kid away or something, which it might well be true. And then they wait until it gets infected. So about three days later, we see when they bring in their infected wound. And now we're for sure going to see to it their kid gets taken away because it's medical neglect now on top of whatever the problem is in the first place. And so I'm with you. I think, you know, if you've got something and it's an accident or something that's not, you know, really it's not an abuse issue, you know, feel comfortable. Come on in. We're not going to, you know, we know, we're, we know about these things, you know. We're sympathetic and we'll be on your side. I asked Randy about the Amanda Sarnovsky case featured in Serial's third episode, which neary positions as being, quote, obscured by a giant question mark, end quote. There was a history of abuse in this household and positive abuse findings by doctors and child welfare. services. Not to mention that Dr. Jensen wasn't the one who even made this diagnosis, but rather the

doctor who confirmed it. That is not a great case, no. And you get to cherry pick which doctor you see. I'm glad that, you know, from your description anyway, it's like changing stories is one of the hallmarks of child abuse. Now, it's not absolutely certain that it is, but it certainly the red flag. Because most people, if there is a true accident, there's only one story. You know, and they tell you what the story is. And when you start hearing different versions and everything, it's like, what's going on here? Yeah, and the stories were markedly different. She says to the paramedics, apparently, she said to the paramedics that she, you know, this happened really early in the morning at like 5.30 in the morning. She said that she heard screaming and crying and

went into the room and found the baby on the floor. In the version she tells in serial, she said she was woken up by a thud when the baby fell to the floor. I mean, those are two quite different stories. You know, it's not a matter of like one sort of element. Need to, yeah, so what we would do then is we go and we probe that history a whole lot more. And, you know, we would keep each of the histories that the paramedics or whoever the initial admitting to the hospital people might be. We'd certainly look at their histories, but we would also go in and try to get a really detailed history of our own. We wouldn't interrogate them in a sense of challenge them and have like a, I don't know,

whatever the movies have, you know, a bright light on them or something like that. That's not what we do. But we want to say, we're trying to understand what's going on here and, you know, try to get real detail, make sure there's no misunderstandings, you know, in the history. Because sometimes when you ask people to do something twice, it's slightly different. We're not looking for slightly different. We want to hear, as you mentioned, you know, if it's quite different, then what's that all about? And then, you know, she heard a thud that her child fell on the floor.

How does she know the child fell? I mean, she could say that she heard a noise and the child was on the floor, but how would you know that's a fall? And so, you know, you'd be trying to, you know, flesh this out, get a much better picture of what's gone. And then you go back to say, could that mechanism account for the injury? And you see, now you said there was a two-year-old that picked up a small child? Yeah, so she, you know, she claims that she. was I think asleep on the couch and it's not it's not totally clear from description where the bassinet was but you know it was a very young baby was seven week old so the baby was in the bassinet

um and then says that her she awoke to this noise and that the baby was on the floor next to the bassinet and then her two year old was in the bassinet and so she was saying you know she i guess is painting this picture and and it made me very uncomfortable how much she took pains to blame this situation on the child throughout this episode. And that's sort of a whole separate thing. But like, you know, that the two-year-old had, I guess, thrown the baby. I mean, it wasn't like that the bassinet tipped over with both of the minute, like that the two-year-old had sort of, I guess, chucked the seven-week-old out of the bassinet, which again, you know, having little kids in this time of my life being really relatively recent, I don't know if that's

impossible, but it's a strange story. It doesn't sound developmentally possible. If you recall that a two-year-old, when they are trying to get a baby, first of all, they don't throw them, that takes arm muscle strength they don't have. So typically what they do is if they hold onto a baby, they're doing it like this. They're grabbing them against their body, and they're in no position to hold them at arm's length and throw them. So right there, I'd have a problem with that.

You're asking people to have a development that's not. It's not appropriate for that age. So now, if they said somehow they tipped the baby out of the bass, and that'd be fine, but then would that be enough to cause a fracture? And you'd have to know some more details about that. Every once of all, a shortfall will cause a broken bone. Usually not, though.

And so you'd have to probably give a scene investigation and see more what that looks like. Just after my interview with Randy, we obtained a copy of Amanda Sernovsky's lawsuit. And in reading Amanda's account of this incident, caught yet another discrepancy, giving us a total of three versions of the story. According to news reports from the time, Sarnaski told paramedics that she was out of the room when the fall happened and came in when she heard crying. The story Amanda tells in the media

is that she awoke to a thud and found the baby on the floor with its onesy undone, and that her toddler was sitting in the bassinet, which would indicate that the baby was pushed or tossed out. In her lawsuit, however, Amanda includes what appears to be a direct quote from the hospital, which says that an RN determined that, quote, mother has been consistent in her reporting that the two-year-old pulled the baby out of the bassinet. A toddler pulling a baby out of its bassinet is more developmentally possible than a toddler throwing a baby out, but it's not the same story. If the toddler pulled the baby out of the bassinet, why did Amanda find her toddler in the bassinet afterwards. It just doesn't make any sense. I wish cereal would let me know

how they decided that this case was in a gray area, but sadly, they declined my invitation to speak about it. They did make a gesture at hearing out the other side by publishing a roundtable discussion with a number of child abuse pediatricians on their paywalled newsletter, not on the podcast. And I wanted to ask Randy what he thought of this attempt to balance Cereals reporting. Well, the, um, That particular chat and everything else, my impression is that, first of all, I know most of those people that they had. The, what they were talking a lot about was process, the way that it was shaped. They were talking about the process and saying, you know, you really have to think about what you're doing here and, you know, what's going on and all that stuff. And that's true. You absolutely do.

You don't want to jump to a conclusion. You want to think it all the way through. But that doesn't mean at the end of the day, you don't end up having a conclusion. that you know you don't have a diagnosis from this whole sort of thing and I don't think they were saying that now a couple of my colleagues seem to say that more explicitly than some of the other ones who are talking about more of the process of thinking it through which is right of course you want them to think it through I wouldn't want any diagnosis to be arrived at real quickly I will tell you that there are times where it's obvious and you don't have to spend

any time thinking it through I'm sorry I just saw a kid that was all beat up the day and it didn't take any time to know that I mean you know it's like how hard is it and it was more like it's sad it's not a diagnostic challenge and so I think that in that sense I'm not sure if that completely came through because they're kind of focused on the operations of doing this which was right but I don't want there to be the sense that there's ambiguity in this or that we're you know these things are so hard we can't reach diagnoses. So we do it all the time. And they testify about it all the time as well. So, and they're called by other doctors to come see the kid because they already decided

that there's child abuse issue going on, probably. But they need us to help confirm it. So, so in that sense, I think it was okay, but I wouldn't want anyone to walk away, you know, interpreting it in such a way as to say that a couple of the people were talking about great ambiguity. That's not really the case. Yeah, and I think it's like there is this presentation where, you know, because people like Diane Niery and my kicks and bog, I sense, this is my just editorializing, I think they know they won't be seen as credible if they just outright say, we don't think Munchausen by proxy abuse exists and we don't believe the science behind abuse of head trauma, right? So they really do this other sort of roundabout thing of just saying, well, these cases are so gray and how can we know? And I'm like, but you can know. And like, furthermore, as a journalist, you can know a lot about the case by doing a foyer request.

It's like they act like the only way they could get to the bottom of it is if they could get Dr. Jensen on the record about the case. Now, listen, they could do that in some cases if they got the parents to sign a hip release. refuse to answer that question of whether or not any of these parents had signed hip or releases. And furthermore, you know, half the time, you look at these cases, because I've dug into a lot of these that have been covered in the media, you look at these cases and they're like sort of present this and they say, well, doctors disagreed about, you know, this diagnosis. And then you look up the records, you know, the court records and you find that the doctors who disagreed are one of these, you know, defense experts.

that is way outside the medical consensus on something like abuse of head trauma, you know, and furthermore, like the story the parents are telling about how these injuries happened don't make sense to anyone who's spent time with a human child, let alone, you know, a pediatrician of any kind, right? So it's like, it's not like these are unknowable, especially if you have the cooperation of the parents and the parents are presumably willing to be transnational. parent with you. And if they're not, then you should wonder why they're not. You know, it just it's just such bad faith. I think it's just evidence of bad faith. I can't take it as anything else at this point. Well, I think you're right about the bad faith. And, you know, there are

instances where you'll have one of the parents that isn't in on the abuse of something. And so they'll tell you a different story. It's not always like there, there's collusion between parents. Now, in my child's and bi proxy, as you know, often one of the parents is sort of silent. The usually is mostly silent. And so you're really hearing from the mom for most of it. I mean, that's not going to be true 100% of the time, but it's true most of the time. And going back to your head trauma,

I've had people tell me they did it. I mean, I'm sorry, what are we going to do with that? You think the doctors made that up and the laboratory people are just, you know, fantasizing about it? I mean, some of this stuff is just incredible to believe. And I just wonder why they are enablers of child abuse. You know, right now we have a big thing going, on about sexual abuse, you know, and Jeffrey Epstein and, you know, all these people that in essence

are the enablers of sexual abuse. Well, if the New York Times and all these other people, if they push the boundaries too far, they're enablers of child abuse. Oh, I think they are. I think this, I think this falls into that category. I want to be clear because I think they, you know, and I don't want to say that every journalist is participating in this, but this journalist is. I really feel strongly about that because she knows better. She does. I listen to people tell her. I've told her myself. I've spent two years trying to get, you know, get information to this journalist. She willfully misrepresented this case and she willfully misrepresented the Kowalski case. And when you are saying, you know, that's the thing. It's like, again, this is utterly separate from those

arguments that are being made by people about systemic reform and how we can prevent child abuse and how we can, you know, make life better for families, that those are such legitimate critiques. And those people, by the way, are all willing to talk to me. If you're just giving an abuser a platform to tell their story about how they were wronged by a doctor who they were not wronged by, and furthermore, in this case with Amanda Sarnovsky, giving her a platform to continue to blame her two-year-old, who is now six or seven, for separating their family because she allegedly toss the baby out of the bassinet where I'm like, well, are you able to confirm that that's what happened? How that is not enabling child abuse. And I think the only people that this media

coverage helps and this sort of this, you know, the laws, the second opinion laws, the doubting of cap, the only people that helps. Well, and they're looking for the man bites dog story. And it sounds like fun, but it has serious consequences. And, you know, if you're not going to be serious, you really shouldn't be doing this thing at all. And, you know, it's just, and it's not as if the medical societies at large have already told you this stuff. And you just aren't going to believe it. I mean, you might as well start injecting chlorox under your skin for COVID or doing one of the other kind of crazy things we hear in the world. Yeah, there's all kinds of people that question science now, right? And it's like, I think like what I, what I'm really wanting people to understand is that this is an argument that is in league with anti-vaxxers, not abolitionists.

Like, this is not, this is not a system reform argument. This is an anti-science argument. I agree. Every day we're still going ahead and doing the right thing for kids, you know, not calling it child abuse when it's not. occasionally we say we're not sure and then other times we are sure and the system keeps moving along and so you hear about these isolated cases but that's not the norm you know for the most part the doctors are doing a great job the lawyers are doing a great job and they're moving ahead and doing the right stuff and I think that gets overwhelmed you hear a case or to it and you start

thinking that's what everything is and it's not it's not how it normally is and so I have faith in the fact that we're moving ahead on and stuff, it's still discouraging that we have these contrarians that, you know, have to kind of keep pushing the thing. But as you said, there's an anti-science movement that is going on, and this, I think, is part of it. Yeah, agreed. Well, Randy, thank you so much for being with us. It was really such a pleasure to get to have you on the show. It's nice talking with you. This is our last episode on The Preventionist. But it's not the last we have to say about all of this.

We're hard at work making season seven, so stay tuned for that. And next week, as we close out the year, we're catching up with some friends from season six. Nobody should believe Meek is produced and hosted by me, Andrea Dunlop. Our editor is Greta Stromquist, and our senior producer is Mariah Gossett. Research and fact-checking by Aaron Ajay, administrative support from Nola Karmouche. Thank you.