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What MSPs Need to Know in Cases Involving FDIA

By Teddy Durgin

Media and pop culture, in general, can’t get enough of stories involving Munchausen syndrome by proxy, the mental health disorder in which a caregiver creates the appearance of health problems in another person, typically their child. Perhaps most famously, there has been the case of Gypsy Rose Blanchard, who endured years of abuse in which her mother faked her having muscular dystrophy. Eventually, Gypsy Rose came of age, became involved with an unstable boyfriend, and together they plotted the murder of the woman.

Her story was made into an eight-episode mini-series in 2019 that starred Joey King and Patricia Arquette and streamed on Hulu. Earlier this year, the Lifetime network garnered some of its highest ratings ever with the airing of the six-part docuseries, “The Prison Confessions of Gypsy Rose Blanchard.”

In October 2022, The Cut published an article titled “What Happened to Maya,” which followed Maya Kowalski, a 10-year-old girl who went to the emergency room complaining of mysterious, excruciating pain. At one point, ER physicians at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, questioned Maya’s earlier diagnosis of advanced complex regional pain syndrome and her subsequent treatment with ketamine. Instead, they suspected Maya was possibly a victim of Munchausen syndrome by proxy and contacted child protective services.

Her story became the basis of the Netflix documentary, “Take Care of Maya.” On Nov. 9, 2023, after suing the Johns Hopkins facility for more than $200 million — alleging everything from false imprisonment and medical negligence to fraud and intentional infliction of emotional distress, among other harms — a Florida jury awarded the child’s family $261 million in total compensatory and punitive damages.

With so much spotlight on these and other cases, medical service professionals (MSPs) need to be particularly mindful if they find themselves embroiled and possibly even called to testify. Dr. Jon Burroughs is a healthcare system expert who has participated in more than 230 legal cases, including some involving the more up-to-date term for the disorder, factitious disorder imposed on another (or FDIA).

He says, “This is a tough diagnosis to make, because you always want to give the parent the benefit of the doubt. And the majority of the time, by the way, it involves the mother. That was the problem in ‘Take Care of Maya.’ The fatal mistake that Hopkins made is that they jumped to a conclusion that wasn’t true. That’s a very dangerous thing to do. You don’t do that in medicine. And you don’t do that in what is really a psychiatric condition. This isn’t a medical condition. You need to have a lot of evidence before you can make the diagnosis. You can’t assume anything, because the kid may actually be sick and require medications. In this case, it was ketamine. You must give the parent the benefit of the doubt until you have clear and convincing evidence.”

He also asserts that clinicians, physicians, and healthcare systems should not be faulted for giving a parent the benefit of the doubt. “Obviously, when a parent does suffer from this, she or he is seeking to gain attention and manipulate physicians,” Burroughs states. “She is looking for control. From my experience, it’s pretty rare because most moms are in that gray zone. They’re overreacting, but they are overreacting in good faith.”

So, what if you are an MSP ordered to testify in a court case involving FDIA? What are some things to keep in mind before taking the stand? Burroughs was quick to answer: “I would say that this falls in the realm of complex medical decision-making and that the physician should be given wide discretion to make a medical judgment based on the clinical evidence. It’s a psychiatric disorder, so you have to use a lot of subjective inferences. It’s a very challenging diagnosis to make or not make. If I was an MSP, I would support a physician’s right and obligation to do that.”

While seemingly rare, the cases do keep coming. And when they do, they make big headlines. In February, for instance, a lawsuit was filed against Pennsylvania’s Lehigh Valley Health Network and its doctors. According to ABC 6 Action News in Philadelphia, the network is accused of misdiagnosing families with medical child abuse. In all of the cases, one or both of the parents were accused of FDIA.          

In all four cases, the courts never adjudicated and ruled. And when the families fought to regain custody, the counties closed the cases and returned the children. Lehigh County Controller Mark Pinsley later released a report finding an alarming number of FDIA cases in the Lehigh Valley. He called for a county investigation after finding one-third of all cases in the state during a five-year period ending in 2021 were in that region.

Burroughs is the right person to comment on such cases considering he has been an emergency physician and healthcare administrator and is now a healthcare attorney. More specifically, he is president and CEO of The Burroughs Healthcare Consulting Network Inc., which provides best-practice training and solutions to healthcare systems across the United States.

“I wouldn’t want over-reporting, and I wouldn’t want under-reporting,” he states. “The problem is, again, it’s such a challenging diagnosis to make. You have to have really solid evidence before you make it. It’s not one you want to make an intuitive leap. It’s like pronouncing someone incompetent or insane. Those are not diagnoses you can take lightly. The same thing is true with this. You’re looking at having a child removed from a home, so the consequences are incredibly serious for both the parent and the child. You can cause permanent damage to the child by separating him or her from their parents as cited in the Maya case, which led to the mother’s suicide. So, it’s not something where the doctor or the system should be blamed for taking their time.”

In summary, Burroughs stresses that there are no short cuts in such matters. “There is no way to make this easier or to prevent,” he concludes. “There is a good reason why there is a lengthy process that physicians and personnel have to go through, because the consequences are so significant. You’re taking away somebody’s freedom. And freedom of parenting, in the Constitution, is called a ‘strict scrutiny fundamental right.’ This means the court has to have a very, very compelling reason to interfere with the parents’ right to parent their child.”