Munchausen Syndrome by Proxy exists, and we’re terrible at dealing with it

As a resident, I saw more than one case of suspected Munchausen Syndrome by Proxy. Munchausen Syndrome, named after Baron Munchausen who supposedly told many tall tales about himself, is a mental disorder where a patient makes up symptoms or problems in order to get attention. People with the syndrome will go to extraordinary lengths, and undergo very invasive care to keep the story going. Munchausen Syndrome by Proxy refers to a guardian who makes up those symptoms about someone in their care. In my world (pediatrics), it’s usually a parent who creates them in their child. In the worst cases, they will even cause those problems in their child in order to back up their case.

Brad Flansbaum sent me this horrific case in Texas and then Minnesota about a mother who allegedly had her child put on a large number of medications, and then had him operated on repeatedly, all, potentially, for nothing:

“It’s been awful, Duke lost three or four years of his young life,” his father said.

Welch said his son had a nasty fall in 2008 that hospitalized him for four days. Doctors expected a full recovery, but nothing was quite the same afterwards. Feeling numerous hospitals in Texas were unresponsive to Duke’s needs, his mother Mary brought him to Gillette Children’s Hospital in St. Paul, Minnesota.

Over the course of two years, doctors at Gillette performed a number of surgeries on Duke. Surgeons placed an intracranial monitor in his skull to monitor pressure, inserted a spinal fluid drain, put a shunt into his brain, and performed a Nissen Fundoplication – basically a surgery on his esophagus. They also inserted a feeding tube into his stomach.

One of the experts called the affidavit “the most powerful document I’ve ever seen in a Munchausen Syndrome by Proxy case.” More:

Mike Weber, an investigator with the Tarrant County District Attorney’s Office, wrote the affidavit accusing Mary Welch of “doctor shopping” her way across the Dallas/Fort Worth area. The allegations are that she provided false medical history to obtain unneeded medical procedures and medications for treatment of made up ailments. The investigator states in the affidavit that a review of medical records shows Duke’s fall that landed him in the hospital for four days was just for “observation.” But the investigator claims Mary began telling everyone Duke had been on the “brink of death” was in “a coma” and as a result developed a “myriad of neurological problems.” Those problems Included epilepsy, migraines, and seizures.

“He was on a variety of drugs, some 13 to 14 different drugs,” says Doug Welch. One of the most powerful, Risperdal. Risperdal is an Autism/bi-polar drug. It was prescribed for Duke despite a neuropsychologist claiming to investigators that she directly told Mary, “you can’t ‘catch’ autism from a head injury.” Among the drug’s side effects are sedation and cognitive blunting. Doug Welch now believes all the medications were the cause of Duke’s troubles in school. “He was drugged,” said Welch.

While some Texas doctors prescribed medications to treat the symptoms Mary says she observed in her son Duke, investigators claim medical records show all of the boy’s tests came back “normal,” indicating no surgery was needed.

And because kids almost always seem to get the shaft, it turns out that nothing may happen:

Prosecutors in other Minnesota jurisdictions tell KARE 11 a case like this can be nearly impossible to prosecute in Minnesota because state laws don’t have anything that directly addresses this type of child abuse. They give the old analogy of a round peg in a square hole. If the surgeries had taken place in Texas where the laws are different, sources there claim Mary Welch would be facing up to 99 years in prison if convicted.

Meanwhile, weaned off all of his medications, and freed from the cumbersome leg braces, Duke Welch is playing little league and getting good grades in a public middle school.

There are so many things wrong here. If we had a decent infrastructure for medical records, Minnesota doctors might have seen a red flag earlier. So might Texas doctors for that matter. If we had better laws to protect children, we might be able to do more about this. Go read the whole piece. Get angry.


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