Medical child abuse: Making sense of the Boston Globe stories on Children's Hospital
The Boston Globe caused quite a stir with its two-part story on Justina Pelletier, a 14 year-old girl taken from her parents and kept at Children's Hospital in Boston for months after doctors there suspected her parents of "medical child abuse" and got the state child protection office to take emergency custody. The stories ( part I and part II) are well documented and disturbing, but I've been around the media and health care long enough to know that you can never be 100 percent sure of the real situation just by reading about it.There are a couple points that stand out for me, however:
- It is concerning that Dr. Mark Korson, the referring physician from Tufts --who is a knowledgeable and level headed guy-- was not allowed to take part in the process after Justina was confined and that the patient did not get to see the gastroenterologist Korson referred her to. Children's really needs to explain that part of the story
- There are definitely cases where child abuse is wrongly asserted by physicians and the consequences for kids and parents can be absolutely devastating. When a child is seriously ill, some parents may lose it and act somewhat crazy, adding to the suspicion that they are causing the problem in the first place. I can empathize with the families while at the same time understanding where the doctors are coming from
Child abuse is real, but there are also physical illnesses that look like child abuse. And there's no guarantee that physicians will sort out the true diagnosis. There is a helpful article (The Differential Diagnosis of Child Abuse) by Michael Segal, an MD PhD pediatric neurologist. It should be required reading for anyone in a position to make allegations of abuse. The article covers findings including lethargy/coma, bleeding and bruising, failure to thrive, immunodeficiency, high muscle enzymes, broken bones and recurring odd complaints. For each finding there is an explanation of potential underlying reasons other than child abuse.However the Pelletier story comes out, I'm glad that we still have an independent, local newspaper that puts real resources into these investigations.-----By David E. Williams of the Health Business Group.