Part 1 of 4
Two out of every 100,000 patients suffer medical child abuse (3). The treatment of medical child abuse is complex but does not require involuntarily hospitalization. Involuntary hospitalization, particularly of a child, in psychiatric hospitals, increases the risk of #suicide and other high-risk behaviors.
Medical child abuse is a form of child abuse that leaves the physical and emotional stigmata of abuse. Over 82% of child abuse cases occur in children under four years old. Justina Pelletier is 15 years old, and she had no signs of physical abuse or neglect. Medical child abuse implies Munchausen by proxy and the two are used interchangeably. As there are no tests to make a diagnosis, Munchausen by proxy can only be proven when(as is the case with most psychiatric diagnoses) an improvement of the child’s condition follows transient separation from an abusive parent.. This did not occur with Justina; she got worse and now cannot walk while she skated a week earlier.
In the case of Justina Pelletier, treatment plans based on the diagnoses of medical child abuse and somatic symptom Disorder (SSD) were inappropriate and deviated from standard care. Traditional paternalistic medical approaches are outdated and not in keeping with current times. At one time, most female problems were due to hysteria. It looks like we have slipped back to overusing psychiatry in order to dismiss medical problems, and more importantly, in order to label and defame and patients.
The ACA was supposed to change the culture of medicine, value the patients through patient engagement, and participate in their care. Boston Children’s Hospital, the nation’s preeminent provider of medical care to children, practices cruelty rather than healing, exposing youngsters to greater abuse and risks to ensure indelible nightmares.
Part 2 of 4
At any other hospital, Justina Pelletier would be free by now; unfortunately, the laws on forced seizure of children and parentectomy were made in Massachusetts and at Harvard’s Boston Children’s Hospital. The power structure is on full display as Harvard Boston Children’s Hospital ignores Justina, her family, her community, and we the people. A power structure that defies the integrity, quality, and science of medicine. It is a power structure where illegal activities are enforced by systems meant to protect the people. Furthermore, we pay for these systems with our tax dollars. Now we the people see where those dollars eventually end up: not with the poor as victimized and as previously imagined.
Much of the literature on medical child abuse centers around child abuse. For Boston Children’s Hospital to take such drastic measures without signs of physical abuse or neglect (traditional meaning) and without reviewing patient records or even consulting Dr. Korson beforehand, is not only cavalier and arrogant but unusual that such a preeminent institution would deviate from the standard of care and continue to do so. Surely, there is big monetary gain and an upward rank in the near future for participants. As the result of a hasty call by Boston Children’s Hospital’s doctors, without appropriate or standard evaluation, 14 months have passed and Justina Pelletier remains a ward of the state of Massachusetts.
Harvard’s Boston Children’s Hospital carries much weight and influence in Massachusetts as well as the world. A new and ill-defined psychiatric diagnosis, Somatoform Disorder, was made by a new team of doctors unfamiliar with the patient who made no attempt to be thorough or understand her as a patient. This team summarily dismissed mitochondrial disease, which is rare and genetic. ( Justina’s sister had mitochondrial disease. She was treated by Dr Korson and appear tedo be doing well except for the fact that her little sister was snatched away.) and is associated with findings on physical exams and muscle biopsy diagnostics. Mitochondrial disease has more hard findings, yet it was targeted by the team of doctors at Boston Children’s Hospital.
How to proceed when the child’s diagnosis is in dispute? Communicate and coordinate care always, with the intent of doing no harm and healing. Boston Children’s Hospital’s actions were not in keeping with ethical health care. The doctors violated patients’ trust without much evidence to back up their arrogance.
Are victims of child abuse who are evaluated at Harvard’s Boston Children’s Hospital Emergency Department routinely admitted to a locked unit , Badr 5, for ten months? Is this a new approach to medical child abuse? Or is this a new approach to the treatment of severe somatic symptom disorder? How do you select patients for this treatment plan?
Part 3 of 4
Justina is of the age where, in family court, she can choose which parent she wants to live with. Does Justina not have that right? Why and how was that right stripped? Justina should not have to fear revealing her feelings of violation and abuse. What kind of psychiatry is practiced at Harvard’s Boston Children’s Hospital? As parents, we warn our children not to keep secrets, but Justina is being punitively conditioned to keep secrets and deceive. What kind of parent is the State of Massachusetts? I say it is a very abusive parent. Moreover, signs, symptoms and physical evidence confirm my belief.
Child neglect and physical abuse represent over 80% of fatalities. Victims of medical child abuse, or rather Munchausen by proxy, often show signs of physical abuse or neglect. Unneccessary surgery does not yield large bands requiring removal. Justina was referred by Dr Korson—a Munchausen by proxy parent deceptively seeks care secretively from multiple providers. These parents have a profile that plays out over time, and this has not occurred with the Pelletiers. In addition, Justina did not improve, and is now worse, essentially eliminating the claim of medical child abuse as well as the threat to Justina’s health and life.
Why is she still a ward of the state? Why isn’t she at home with her family as she desires to be? Why is she not allowed to speak?
Involuntary inpatient hospitalization (incarceration) for either medical child abuse or SSD is not medicine, it is not standard treatment and it is a dangerous deviation from appropriate care. Within the literature on child abuse and psychiatric conditions, particularly SSD, adverserial relationships with parents are to be avoided and involvement of a trusted physician could have averted this nightmare, if that had been the intent.
Boston Children’s Hospital’s pre-eminent staff chose to ignore their own literature, choosing the most dangerous, ill-advised and most expensive path of treatment. Justina occupied a bed that could have been used by patients with severe mental illnesses, who had an acute risk for self-harm or whose judgment was impaired making them unable to provide for self.
Criteria for 51 A and involuntary admission:
1. At risk to herself
2. At risk of harming others
3. Unable to care for self
Many deserving patients were turned away because of Justina’s inappropriate admission to Bader for five to ten months. Patients in need of inpatient psychiatric care wait in emergency departments all over this country for psychiatric beds. They are routinely kept in the ED for 72 hours and sometimes up to 7 days before a bed is available, or those patients are discharged directly from the ED. And here we have Justina, inappropriately placed without thoughtful planning, inadvertently using services that could be better used for those who truly need this kind of placement. These patients meet the criteria and have nowhere else to go. Justina has a family who wants her and are fighting for her to come home. How does the state of MA justify this wasteful use of resources?
Part 4 of 4
Psychiatric hospitalization dramatically increases the risks of suicide, with studies stating that the risk of suicide to mentally ill patients post-discharge after inpatient psychiatric care is up to 100 times greater. The risk of suicide attempt is even more disturbing, with three in four patients attempting suicide within 1 month post-discharge. (This increase risk was independent of pre-existing suicide risks). Suicide attempts cause severe morbidity associated with severe disabilities.
Research in this area is scant. Most studies focus on the first 72 hours to one week post-discharge after inpatient psychiatric hospitalization. Long-term risks are not well-documented, but the risk of suicide never disappears.
Child abuse is complex making treatment an art. However, treatment plans recognize that child abuse often stems from stress, culture and history of abuse. Child abuse often stems from stress associated with an acute event, such as the loss of a job, especially among single parents.
Supportive services that help identify underlying reasons for the abuse also help families find alternative methods to cope with stress and improve parental skills. The safety of the victims is the primary goal, along with the preservation of the family through reunification with counseling, etc. Massachusetts receives many grants and allegedly has these services. Are they (MA) providing this support to the Pelletiers?
Why did Harvard’s Boston Children’s Hospital choose to follow a path that clearly jeopardized Justina’s health? If #JustinaPelletier was abused by her parents, BCH’s treatment exploited and victimized her further.
In medicine, classic cases are easy. The art of medicine is diagnosing atypical presentations. With Justina, this is made simple because she has a sibling with a similar diagnosis. Why is that point lost in the shuffle?
Dr. Korson should have performed a muscle biopsy, but did not. Did Boston Children’s Hospital perform a muscle biopsy? Were the results negative? An initial assessment should be done on all patients before making premature, unsubstantiated allegations and accusations of child abuse, or reporting the family to the Department of Children and Families (DCF).
What were Harvard’s Boston Children’s Hospital’s reasons (motives) for hastily invoking these diagnoses (Somatoform disorder and Medical Child Abuse) that resulted in the infamous parent-ectomy?
Fourteen months is a very long time for a teenager to be forcibly separated from the family and friends she loves, as is evident from pictures and notes she secretly wrote asking her family to take her home.
What is the next step? Judge Joseph Johnston has granted permanent custody of Justina Pelletier to the state of Massachusetts. Will Justina remain a prisoner at Wayside Youth & Family until age 18? No other facility will accept Justina in transfer from Wayside, and if one does, beware.
In addition, will her providers at Harvard’s Boston Children’s Hospital continue providing medical care to other children? Our medical delivery system should heal and not do harm. These providers should not be allowed to continue to do harm.
Will their research be published? Will the NIH continue to give Harvard’s Boston Children’s Hospital grant money to imprison, molest and conduct medical experiments on children? Will sponsors continue their support of Boston Children’s Hospital?
Finally, who is calling the shots? Will that person step forth, be a leader, and communicate their intent?
This case shows that the state of Massachusetts is blatantly violating human rights, parental rights and patient rights with impunity. The will and voice of the people were ignored and gagged. The people are powerless in Massachussetts, a state known from its preeminent institutions, hospitals and leaders. The people of Massachussetts are powerless to free Justina. Petitions and phone calls fall on deaf ears or no ears at all. Evidence of wrongdoing, harm and criminal activities are obvious. This impotent response does not get the job done.
Equally apparent and shocking is the lack of accountability of those who provide medical care and services. A problem we, the people cannot ignore if we value our health. The lack of accountability of hospitals, and Harvard’s Boston Children’s Hospital in particular, (and in my case Tufts Medical Center) compromises the public’s health. Many parents fear the same could happen to them. The worst is knowing there are no laws to protect against such forced seizures. These seizures are unethical and are not healing, and they cause enormous harm. Rights are trampled under the guise of so-called medicine. This occurs at moments when people are most vulnerable and in need of the healing powers of doctors and other medical providers. These medical providers are like priests who exploited their powers and hid behind the Church; these providers still practice and care for children.
Harvard’s Boston Children’s Hospital has demonstrated that healing is not a priority for them; neither is doing no harm. The acquisition of knowledge to maintain power and financial gain entices many who rise to senior leadership positions. The bottom line is that Boston Children’s Hospital did not need to place Justina in a locked unit (Bader 5). The average length of stay for psychiatric admission is 10 days, with the longest being about 300 days, making Justina Pelletier’s stay the longest in modern times. Justina Pelletier was forcibly seized from her parents, her friends and her community—everything she knew and loved—and forced to live in another state, surrounded by strangers who deny her basic rights to practice her religion. There is no reason for her to be in such a setting; furthermore, it is medically not recommended to cavalierly place patients, particularly victims of medical child abuse.
We need studies to determine the impact of a lack of accountability on corruption and cruelty to patients, as well as rising health care costs, poor health outcomes and mounting, unprecedented dissatisfaction of patients.
No child abuse means that Justina Pelletier should be free! When will Massachusetts #FreeJustina?
Failure to Listen to the will of the people will cost the election….don’t you think?
Of the children who experienced maltreatment or abuse, over 75% suffered neglect; more than 15% suffered physical abuse, and just under 10% suffered sexual abuse.
5. YOUR RIGHTS REGARDING ADMISSION TO AND DISCHARGE FROM A HOSPITAL UNDER MASSACHUSETTS MENTAL HEALTH LAW