With the recent, negative media attention focusing on the sub-specialty Child Abuse Pediatrics, Dr. Bruce McIntosh, the statewide medical director of nearly two dozen child protection teams in Florida, has broken his silence to speak out in defense of these Child Abuse Pediatricians (CAP’s).
“We do not set out to diagnose abuse; we set out to find out what happened.”
Katie LaGrone reports,
“This is the first time Dr. McIntosh has responded, on the record, after their investigation found several families were wrongly accused of child abuse by child abuse pediatricians who work for the state as experts on abuse.”
The response was the result of questions posed by WPTV regarding a 2017 training video they found on the state child welfare website. (Full video below.)
The video includes 62 minutes of Dr. McIntosh and state legal experts presenting common defenses in child abuse cases and why those defenses are false.
Dr. McIntosh claims these false defenses are often made by hired witnesses to offer alternative explanations for the child’s injuries.
What McIntosh and others fail to mention is the fact that child abuse pediatricians are paid by the prosecution to testify in these cases as well. They are paid because most of them are “hired” or contracted with the state to consult on suspected abuse cases and testify for the prosecution.
Often times, the Child Abuse Pediatrician is the primary and/or only expert witness for the prosecution. This is never told to families when they are being questioned by the Child Abuse Pediatrician in the hospital.
Horace L. Bomar, Jr., author of The Compensation of Expert Witnesses, points out how and why experts are paid by the prosecution, which includes medical doctors.
Bomar also brings up the fact that expert witnesses who are contracted with the state, as most (if not all) CAP’s are, are paid the amount listed in the contract to testify against the defense. He writes:
“The constitutional argument more frequently used is that an expert’s opinion is his property, the taking of which without adequate compensation is a deprivation of property without due process forbidden by both federal and state constitutions.”
So despite what McIntosh and prosecutors say in regards to the hiring of expert witnesses by the defense, it is the constitutional right of any expert witness to ask for and be compensated for his work and testimony, whether they are testifying for the defense or the prosecution.
The real issue isn’t about defense witnesses being paid for their time and testimony, but the fact that families and individuals are put in the position to have to seek out, hire and pay an expert to review medical records, provide these “alternative explanations for a child’s injuries” other than abuse, and testify at trial.
Child Abuse “Medical” Diagnosis: Second Medical Opinions Not Allowed
Child abuse pediatrics seems to be the only specialty where individuals are not allowed to seek a second opinion.
According to WebMD.com, second opinions are encouraged and even covered by most health insurance plans.
An article by Jay MacDonald, “The 6 questions every patient want to ask about getting a 2nd opinion,” Dr. Martin Makary, Professor of Surgery at Johns Hopkins Medicine, answers the question “why get a 2nd opinion?” by saying:
“Easy: 20% to 30% of second opinions differ from the first opinion”, says Makary.
“When you’re dealing with something serious, what’s the downside of getting one?”
MacDonald’s article also brings up another option which is to talk with your Primary Care Physician.
Niran Al-Agba, MD, a pediatrician in Silverdale, Washington, and a regular columnist for the Kitsnap Sun, wrote an article published November, 2019, on Kitsapsun.com, describing exactly how her opinion as a primary care physician, and the opinion of a seasoned law officer, were disregarded by CPS.
In one case, Dr. Al-Agba describes:
“The CPS caseworker ultimately disregarded the opinions of a veteran police detective and the child’s pediatrician, resting a determination on the outside doctor’s observation. On the basis of a single piece of evidence, CPS decided the allegations of abuse were “founded” — meaning the state believed it was more likely than not that a father or mother had intentionally inflicted harm on their 2-year-old.”
According to Dr. Al-Agba, these allegations were deemed “founded” when an outside child abuse pediatrician reviewed only photos provided by CPS. These photos were the only thing used by the child abuse pediatrician to make her determination that the child was abused.
Two cases were mentioned in this article, “both involved overzealous child abuse pediatricians who made mistakes,” wrote Dr. Al-Agba.
Dr. Niran Al-Agba suggests:
“Washington state lawmakers should implement stronger safeguards to protect families when Child Protective Services defer to contracted ‘child abuse experts’ whose opinions may at times be at odds with those of primary care physicians. Keeping families intact should always be a top priority.”
These contracted physicians are paid by the state to testify against families, something Dr. McIntosh fails to make the audience aware of in his 2017 training video. WPTV reports Dr. McIntosh and other legal experts describe,
“some witnesses hired by the defense attorneys as carnival people who travel around the country making six-figure incomes offering explanations not backed up by science or medicine.”
Again Dr. McIntosh is attacking the character, agenda and knowledge of physicians who testify for the defense, this time going so far as to call them “carnival people” and again, failing to mention child abuse pediatricians, who are contracted with the State, as mentioned by Dr. Niran Al-Agba, are also paid by the state to testify against the families.
Dr. McIntosh also claims the explanations used by these physicians are not backed up science or medicine.
This too is false. There have been countless studies done by physicians that are peer-reviewed and published, meaning they have been objectively verified and accepted by peers of the author in the medical community.
There is a multitude of peer-reviewed articles and studies that have found alternative explanations for the common “injuries” and findings, used by CAP’s to diagnose abuse. Not to mention the slew of rare and sometimes common diseases known to mimic abuse.
The studies show concrete medical and scientific evidence that support the fact that many injuries deemed abuse by child abuse pediatricians do in fact have other causes. They are not just theories.
Shaken Baby Syndrome Theory Lacks Scientific Consent
The only “explanations NOT backed up by science and medicine” are the theories used by child abuse pediatricians to claim abuse; theories that, till this day, remain just that, theories. Some of which continue to be theories for almost 50 years, as is the case with Shaken Baby Syndrome (SBS)/Abusive Head Trauma (AHT).
Shaken Baby Syndrome, now known as Abusive Head Trauma and other names that are constantly changing, was popularized in the 1970’s. So for almost 50 years, this theory is still unproven.
In fact, there is more evidence disproving the theory, yet it is still being taught in the medical literature, is still used by child abuse pediatricians to diagnose abuse, is used by prosecutors to charge individuals with felony child abuse, and is still convicting people of child abuse and sometimes murder.
Family (civil) courts have the lowest burden of proof which is “preponderance of the evidence,” but in criminal court, the burden of proof is the highest at “without a reasonable doubt” which, according to Investopedia.com, means the evidence presented by the prosecution establishes the defendant’s guilt so clearly that it must be accepted as fact by any rational person. A theory is just that, a theory, and has yet to be proven and supported as fact.
The “triad” or “constellation of findings” is what is used to make the diagnosis of SBS/AHT. Sometimes it only takes just one or two of the findings for a CAP to claim a child has been shaken. An independent study conducted by the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), concluded:
“There is limited scientific evidence that the triad1 and therefore its components can be associated with traumatic shaking (low quality evidence).
There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low quality evidence).”
Even with the overwhelming evidence discrediting the theory of the SBS/AHT and other common theories used by CAP’s to claim child abuse with such certainty, it is still being defended by its supporters and taught as fact in the medical literature.
In a paper by Jay Simmons, “Ironic Simplicity: Why Shaken Baby Syndrome Misdiagnoses Should Result in Automatic Reimbursement for the Wrongly Accused,” Simmons points out several times the prominent supporters of the theory acknowledge it is a theory, one even claiming “the triad” is a myth.
WPTV asked Linda Shiflet, a former State Prosecutor in Hillsborough County, Florida, to watch the training seminar and interpret it for them.
Shiflet’s opinion on the training session is:
“In my opinion it’s a training session on how to be a good prosecutor.”
Shiflet goes on to explain:
“They weren’t saying that all defenses are false, they were specifying certain defenses and how the medical science doesn’t support them as, in fact, true defenses.”
While McIntosh makes claims that families and individuals are using “false defenses” conjured up by these alleged “carnival people,” the real question remains: How can families use a “false defense” if the child abuse pediatrician tested for these underlying conditions and ruled them out?
McIntosh and other child abuse pediatricians are attacking families, many later deemed by the courts to be innocent of their charges, who have fought to find out the truth about their child and attacking the physicians who are more qualified to diagnose these types of conditions.
If it wasn’t for the negligence of these child abuse pediatricians’ biased opinions and being under-qualified in genetics, radiology, neurology, orthopedics, and other specialties, families and individuals wouldn’t have a defense because anything and everything that could cause or mimic the findings to diagnose abuse have been tested for and ruled out.
It is clear this is not being done. Child abuse pediatricians continue to rely on the circular reasoning surrounding the many theories regarding common factors that are indicative of abuse; they fail to consider, which means they don’t test for, other conditions and diseases.
Once “Abuse” is Diagnosed Families Left to Themselves to Find True Medical Causes
This leaves the burden of finding the true cause of a child’s “injuries” to the family and/or caretaker. A burden that is financially and emotionally devastating.
This doesn’t include the burden placed on CPS agencies to investigate cases that should have never been referred to CPS, taking up their time and resources that need to be used for true cases of abuse and neglect.
The courts and taxpayers then have to waste time, money and resources on lengthy and expensive trials, all due to the medical negligence of one physician who failed to perform their due diligence and has also failed to uphold the ethical oath they took when they became a doctor.
Child Abuse Pediatricians Violate the Hippocratic Oath
The modern version of the Hippocratic Oath, according to MedicineNet.com, translates “Do no harm” as:
“I will not be ashamed to say ‘I know not’, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery”.
“…this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God.”
Child abuse pediatricians continue to defy the very oath they took when they became physicians by continuously jumping to a conclusion supported only by theories and never testing for, or even considering, other possible causes.
CAP’s also fail to involve other medical specialists with more knowledge and experience in rare diseases and neurology before rendering their conclusions.
“’Out of control’ child abuse team that is too quick to report minor injuries to authorities and that is too closely aligned with state child welfare investigators.”
Hixenbaugh also reported:
“Three of the doctors recalled being pressured by child abuse pediatricians to alter medical records, removing passages where they had initially reported having little or no concerns about abuse.”
It seems to be common in cases involving a child abuse pediatrician where they fail to consult with other specialists.
Medical Doctors Speak Out Against Child Abuse Pediatricians
Now with the investigation conducted by Mike Hixenbaugh, CAP’s are going so far as bully other physicians.
According to The Becker Law Firm,
“medical records are legal documents that may not be falsified or altered in any way. Knowingly falsifying medical records is a felony crime with a potential fine of $250,000 or five years in prison.”
In a medical malpractice case, “falsification of a medical record with any kind of alteration or destruction is considered as tampering with evidence,” also a felony.
In an episode of “Diagnosis Murder” – Broadcast date, Friday, January 13, 2012, Dr. Patrick Barnes was interviewed.
Dr. Barnes is a Pediatric Radiologist and Pediatric Neuroradiologist who has been practicing for over 41 years. His experience also includes being a past Chair of the Child Abuse Task Force of the Society for Pediatric Radiology.
In the past Dr. Barnes was an expert witness for prosecution and would testify against individuals accused of shaken baby syndrome. After seeing the credentials of the physicians who were expert witnesses for the defense and speaking out against the theory, he decided to go back and research the science and studies used to back up the theory that continues to be taught to medical students.
He learned through his research and explains in the interview it was found out from other experts you can’t diagnose shaking based on the “triad.” There are lots of other causes. They also found the whole theory about the amount of force being equivalent to throwing a child out of a third story window
“has no basis in science whatsoever and in fact the prosecution witnesses admitted it was somewhat anecdotal and it was concluded children can sustain the same findings by falling off small pieces of furniture or playground equipment.”
In regards to “the triad” he says,
“This was a theory. A theory that made sense with no other theory to replace it which means it was taught and accepted dogma. You can’t shake children to test the theory, which makes it hard to prove or disprove making it accepted.”
Dr. Barnes made it clear the theory is,
“being questioned now quite widely. Science is always contingent and changing and developing.”
“The point is, if the prosecutions witness is saying short falls can’t kill, and you have evidence a short fall did kill, you have disproven that theory. It only takes one,” he says.
In regards to his opinion on the science used to back the shaken baby theory is:
“Very skeptical about the science of shaken baby theory. You can’t identify shaken baby syndrome as the cause of most, if any of these injuries based on the medical science today. It’s just not there.”
Finally he states:
“The medical and scientific community can’t agree that the theory is the cause for a child’s death.How can we expect a jury to decide beyond a reasonable doubt?”
Which Doctors Are Using False Theories and Hiding Behind HIPAA Laws?
So again this begs the question: Who is using false theories? The prosecution who brings in paid experts to testify about a theory as if it is fact when modern science has disproved it, or the defense who brings in experts to testify to the various other causes of a child’s injuries, causes that were never considered or tested for by the child abuse pediatrician prior to concluding abuse?
WPTV reported McIntosh as saying he would not discuss any single case due to HIPAA laws, but was quoted as saying:
“Families who have abused their children are free to go to the media and proclaim their innocence. The Child Protection Team, however, is constrained by Florida statutes and Federal HIPAA regulations. Therefore, it is easy for the public be provided a slanted impression of the accuracy and value of CPT medical provider’s work.”
This is a common excuse used by hospitals defending their child protection teams.
It’s not clear if this statement is true under HIPAA regulations, but it seems if the family has made the records public, there would be nothing obstructing them from commenting on the case or at least making the public aware of the testing used to prove a child was in fact abused.
Yet, this never seems to be the case. Instead HIPAA privacy laws are used as an umbrella to hide under when the conduct and medical practices of a CAP are called into question, and more importantly proven to be wrong in the courts.
According to WPTV, the Florida’s Chapter of the American Academy of Pediatrics, sent a letter to at least two lawmakers. The letter was defending the work of the state’s child abuse pediatricians.
Dr. Paul Robinson, Chapter President responded to the WPTV investigation and other media outlets who have been reporting on this topic stating:
“Recent news reports have contained inaccurate and misleading information about child abuse pediatricians.”
Dr. Robinson and Dr. McIntosh make this claim, but continue to hide behind privacy laws, avoiding a true response and failing to provide any sort of evidence to back up these claims.
It seems the only inaccurate and misleading information in these cases are the reports and opinions given by child abuse pediatricians.
Judges and juries are hearing all of the evidence from both sides. They are hearing the claims of abuse based on theories and opinions not supported by medical and scientific evidence, along with other “true” causes that can and do result in the same injuries.
Are Dr. Robinson and Dr. McIntosh now claiming all of these judges and juries are getting it wrong? Are they willing to publicly say this while attacking the families that have been proven innocent, therefore proving the child abuse pediatrician was wrong?
Furthermore, if these child abuse pediatricians are so firm in the science used to make their diagnoses with such certainty that it can’t possibly be anything else, why are they so opposed to families seeking a second opinion from an independent physician or specialist?
With the recent push for legislators to make changes to the law to provide families the right to a second opinion before CPS steps in and removes their children, Dr. Robinson also mentions in his letter,
“Some cases already can [get a second opinion] by seeking the opinion of the state’s medical director Dr. Bruce McIntosh.”
How can a family get an unbiased opinion with this type of proposition that uses the same doctors who believe the same child abuse dogma based on circular reasoning?
Last year the Florida Department of Children and Families reported nearly 37,000 cases of child abuse and neglect, among the top five reporting states, according to WPTV. More than 15,000 cases were reviewed by child abuse pediatricians during fiscal year 2018/2019. The finding of abuse was confirmed in “roughly” half of cases.
It needs to be pointed out there is no mention as to how the cases were confirmed as abuse, but even “roughly” half is not a good statistic when it comes to medicine. If the “training,” studies, and scientific and medical evidence is sound and accurate, shouldn’t these physicians should be getting it right a lot more than just “roughly” half the time?
Child Abuse Pediatricians Held to the Lowest Standards of Accuracy?
No other specialty in medicine is held to such a low standard. No other medical specialty is immune from liability if they get it wrong even one time.
Why are child abuse pediatricians put on a pedestal with no oversight and accountability?
McIntosh ends his 2017 training seminar by warning the audience of experts to be more thorough when evaluating a child for abuse.
“It’s not really sufficient anymore to look at a child. Look at x-rays and say this is abuse,” he said.
Is this the type of negligence that has been used in the past, and most likely currently used to diagnose child abuse? Simply look at an x-ray and say “this is abuse?”
And how is a child abuse pediatrician able to make such conclusions without having specialized radiological training and who does not consult with other physicians in that specialty?
How many families have been falsely accused by this type of negligence?
Conclusion: Oversight and Accountability Needed for Child Abuse Pediatricians
Oversight and accountability is long overdue for this growing sub-specialty. Law makers must step in and govern how these “doctors” are practicing medicine and the methods being used to “diagnose” crimes.
Families and children deserve to remain together and not be torn apart based on flawed medical science and studies, the true “false theories,” and biased opinions of child abuse pediatricians.
By Allie Parker
Allie Parker is a Family Advocate and mother. She is a surviving victim of a false Child Abuse Pediatrician’s accusation. Read her story here.