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What’s in the Water in Tarrant County 

Andrea speaks to Deanna Boyd, the crime reporter who broke the Hope Ybarra case and discovers that Hope’s was one of many Munchausen By Proxy cases in Tarrant County that Deanna unearthed; all of which had flown under the radar. What’s going on here? Why are there so many cases in this one area? 

As Andrea interviews Deanna and meets with Detective Mike Weber, as well as Dr. Jayme Coffman and Dr. Karen Shultz–two doctors involved with the Ybarra and many other MBP cases–she makes a chilling discovery. It’s not that there are so many cases in Tarrant County, it’s just that they’re catching them. If the systems meant to protect children were functioning, every county would look like Tarrant. 

Andrea can only guess as to what truly went on behind the scenes in her own family’s case, but she begins to grasp what the systems involved–CPS, the police, the doctors–are up against and why so many cases are destined to fail. Meanwhile, Andrea continues her maddening back-and-forth with Hope. 

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Show Notes

Host Andrea Dunlop:

For behind-the-scenes photos: 

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For information and resources:

The American Professional Society on the Abuse of Children’s MBP Practice Guidelines can be downloaded here.

About Mike Weber: 

Read Deanna Boyd’s original reporting:


Andrea: [00:00:00] Nobody should believe me is a production of large media. That’s L A R J Media. Before we begin a quick warning that in this show we discuss child abuse and this content may be difficult for some listeners. If you or anyone you know is a victim or survivor of medical child abuse, please go to munchhausen’s to connect with professionals who can help.

Andrea: People believe their eyes. That’s something that actually is so central to this whole issue and to people that experienced this, is that we do believe the people that we love when they’re telling us something. If you questioned every, everything that everyone told you, you couldn’t make it through your day.

Andrea: I had developed a really good relationship with the Butcher family at this point, but I just really wanted to hear from Hope. I really wanted to sit down with her and hear what [00:01:00] her experience about. What her experience of this had been like because that was still the biggest mystery. So I got her number from her father Paul, and I sent her a text message asking her if she’d be willing to talk to me, and she told me she would think about it.

Andrea: When I came across Hope You, Barr’s Case, it really stuck out to me and resonated with me because of some of those similarities that we’ve been talking about with my own family’s story. But it was far from the only case in Tarrant County, Texas that was in the media at the time. The cases of people like Cecilia Rand’s bottom, Kristin Shreve, and Elizabeth Honeycutt were also making headlines at that time, and I started to wonder what’s going on here?

Deanne Boyd: The cases are out there. I’m not trying to say that they’re common, but they’re out there, but so many of them just go undetected and unreported. I’m Deanna

Deanne Boyd: Boyd,

Deanne Boyd: a former investigative reporter for the Fort Worth Star Telegram. What I found out about Tarrant County, but I don’t think this happens [00:02:00] in a lot of counties or a lot of states.

Deanne Boyd: It’s all about the investigation. Tarrant County seems to do it right. They don’t do it alone. They get CPSs involved. They get Cook Children’s Medical Center involved there. There is a team of people who are involved in this investigation and going through medical records and going through social media records, and these are long, drawn out investigations.

Deanne Boyd: From my research, it was most law enforcements aren’t gonna. Dedicate the time. Most law enforcement officers in CPS PS don’t even have the training in these kind of investigations. Here again is Detective Mike Weber. He echoes Tiana Boyd’s. Thoughts on why there are so many cases in Tarrant County?

Mike Webber: How come we have so many that’s easy?

Mike Webber: The criminal part is me, right? Cuz no one else can do that. But we have, we have a system set up to, to catch these offenders, our pediatricians that cooks Children’s feel comfortable. Reporting this abuse. I mean, that’s a real issue for physicians. There are physicians that have been [00:03:00] followed home. There are physicians that have been harassed.

Mike Webber: There are physicians that have been sued by these offenders. For physicians to feel comfortable reporting, knowing that something is going to be done is important for them to be educated on. What this is, is important to me. And Dr. Kaufman have done two grand rounds at Cook’s Children’s Hospitals to make sure that the physicians there have an understanding of this and know and will feel comfortable reporting this abuse.

Mike Webber: And it also goes to the hospital legal staff. Are they, are they gonna be more concerned about self protection? Because it’d be real easy to ignore this and never have to deal with a headache. And just let the child suffer or are they going to do the right thing and be supportive of their doctors whenever they do report this abuse, which Cooks Children’s has been, and I can tell you 100% that all children’s hospitals have not been,

Andrea: the more I got into these cases, the more I realized what a huge lift this was for hospitals and doctors to [00:04:00] investigate these cases.

Andrea: And I wondered how Cooks seemed to be accomplishing this. For hospitals between HIPAA and their various liabilities and their, you know, bills to pay and whatever else their staff has to do. You know, it’s just a lot of work to try and get everything that you need together to move forward with one of these investigations.

Andrea: I got a chance to meet with Dr. Jamie Kaufman. She’s the child abuse pediatrician at Cook Children’s Hospital, and she frequently does trainings with Detective Mike Webber. Dr. Kaufman told me about their care team at the hospital, which she is the head of.

Dr. Jayme Coffman: So the care team is actually our child abuse program for our medical system.

Dr. Jayme Coffman: So we have an outpatient clinic and uh, we have a pretty big staff that’s full-time, which we’re very fortunate for that we don’t have to do any general pediatrics or any other, uh, types of clinics. So there’s myself, I’m at. Board certified child abuse pediatrician. We also have advanced [00:05:00] practice providers, nurse practitioners in our case, as well as sexual assault nurse examiners.

Dr. Jayme Coffman: And so we all work full-time in this clinic along with social workers as well. We see children concerns of any type of abuse, so it can be sexual abuse, severe neglect. To physical abuse, medical child abuse, um, whatever the issue is. But we also do inpatient consults in the hospital. We have a lot of experience, uh, with dealing with the different types of abuse, but also dealing with the system.

Dr. Jayme Coffman: So whether it’s the criminal system or the civil court system,

Andrea: does every children’s hospital have some version of this?

Dr. Jayme Coffman: They all look very different. There’s a huge variety on, um, staffing and in a lot of children’s hospitals, the, uh, child abuse pediatrician may have to do other types of pediatric work as well, and not just child abuse pediatrics.

Dr. Jayme Coffman: So they may be doing some general pediatrics. They may be doing some emergency medicine. Um, so it, it varies.

Andrea: What [00:06:00] occurs to me listening to Dr. Coffman talk about these discrepancies in care at various children’s hospital is just that I can’t imagine that you could ever catch one of these cases without dedicated staff because the number of pages of medical records that you have to review in order to.

Andrea: Detect this abuse. You know, that’s what it comes down to. It comes down to the records. The hallmark of these cases is that the parent is taking their child to the hospital all the time to different hospitals in different counties with different systems, and they’re creating this. Immense paper trail that could completely overwhelm the staff of, of any hospital.

Andrea: And so it’s, it’s hard to imagine that without some kind of really direct focus, you know, o of the staff to be able to, to do that medical record review. I mean, that’s what it [00:07:00] comes down to in these cases. Dr. Kaufman talked to me about the importance of everyone involved in these cases, talking to each other, and how much trust plays a huge role.

Dr. Jayme Coffman: Our system really fosters a collegiality amongst staff because we have relationships and I think that’s what everything basically comes down to is relationship between providers, between departments there. I’ve worked at a lot of different places and I have to say, I. Have the cell phone numbers for a lot of people, um, that I can call for different specialists or investigators or whatever.

Dr. Jayme Coffman: Um, that if I’m want an opinion or I need help, they’re a phone call away. Um, they’re an email away. They’re an instant message away, and they respond. Right. It’s not like I’m gonna send an email to an orthopedic surgeon with a question about an x-ray and he’s not gonna get back to me, or she’s not gonna get back to me.

Dr. Jayme Coffman: They get back very quickly. Right? And so we have that [00:08:00] relationship and expectations that’s fostered by everybody.

Andrea: I’ve become really familiar with Dr. Coffeman’s’ work, uh, via Mike Weber. I came to find out that she wasn’t the only one who has been working really hard to make this system work to protect kids.

Andrea: Here’s Dr. Karen Schultz. She is a pediatric pulmonologist at Cook children’s.

Dr. Karen Shultz: Cook is a unique place. Our main focus is taking care of patients, not education for students and residents. So if I have a concern about my patient, I pick up the phone and I call directly to the attending physician, and we don’t have layers of students in residence that everything gets filtered through.

Dr. Karen Shultz: There’s a lot more direct communication.

Andrea: So despite all of the strong working relationships amongst the various colleagues at Cook Children’s Hospital, investigating these cases of medical child abuse is still anything but easy. Even with a dedicated child abuse detection team. [00:09:00] At the same time, it really seemed to me like Cooks is doing something right here.

Andrea: And I wondered if we just couldn’t replicate this model all around the country.

Dr. Jayme Coffman: Well, it is a complicated issue. Um, it’s a. Complicated for medical professionals, much less laypeople, even when you’re well informed. These are such entangled, complicated medical kinds of situations that I think even for medical professionals, it’s oftentimes hard to disentangle fact and fiction, right.

Dr. Jayme Coffman: Because the perpetrators are so manipulative and have enough knowledge base that they’re really good at putting enough truth with the fiction that it gets very difficult to differentiate

Andrea: sometimes when there is a suspicion of medical child abuse specifically, what does the record review process for that look

Andrea: like?[00:10:00]

Dr. Jayme Coffman: You can’t make a diagnosis of medical child abuse without, uh, reviewing all medical records. And that’s not just your own institution because many of these perpetrators, uh, doctor shop and hospital shop, and, um, we’ve had, um, children that not only use different physicians within our town, uh, but also travel among different cities and among different states, uh, to get that medical care that they’re trying to seek.

Dr. Jayme Coffman: So it’s important to review all those records because that’s where you find the discrepancies between what, um, the caregiver is saying versus what is actually documented in the record. And so when you start seeing those discrepancies where they’re saying, oh, this child had a brain bleed, for example, and then you review the records and they’re saying the brain bleed was found on.

Dr. Jayme Coffman: This hospitalization. You review that and you’re finding, oh, there was a normal head CT scan. There was no brain bleed. Um, so there you find that’s a falsified report of a medical condition that isn’t true. And so you’re looking for [00:11:00] those kind of discrepancies in the record. And then once you start looking for that, um, then you let the medical providers know, uh, This is a discrepancy that this isn’t really the truth because these diagnosis get perpetuated in the medical record.

Dr. Jayme Coffman: So if a mom says that, or a father or whoever the perpetrator is, it gets put down as one of their diagnoses, and then that just gets repeated throughout the medical record, and it’s not true to begin with. And there’s difficulties in reviewing medical records outside of your own institution because unless a, uh, legal guardian gives you consent, you can’t see those records.

Dr. Jayme Coffman: And so, number one, they have to be truthful to tell you they went somewhere else, which if they don’t tell you you don’t know to look. And two, they have to give you permission to look. So if you don’t have those two things, you’re not gonna even know the care that’s done elsewhere. And to review these records is usually thousands of pages of [00:12:00] medical records, cuz you can’t just review the doctor’s notes, right?

Dr. Jayme Coffman: There is so much within the nursing notes, uh, telephone calls, all those things have to be reviewed. It’s every single notation and it can take well over a hundred hours to do all that. And of course, insurance doesn’t reimburse for any of that time. So how do you. Do it right? How do you have time to do it?

Dr. Jayme Coffman: How do you fund something to where people can review those records and then find out is this just an anxious parent who comes to medical care for every sniffle, right? Which that happens, especially new moms and things. You don’t know what’s normal, what’s not normal. Um, and. Obviously there are anxious parents out there.

Dr. Jayme Coffman: There are children with truly complex medical problems, um, that are getting appropriate care. And then there are situations where a caregiver is lying or inducing illness and. In [00:13:00] all that quagmire of information, you have to figure that

Dr. Jayme Coffman: out.

Andrea: Do you think that it’s as rare as most people believe?

Dr. Jayme Coffman: No. When I first started in this role 21 years ago, we looked at maybe one or two cases a year as being muncha and by proxy or medical child abuse.

Dr. Jayme Coffman: And over the years when we’ve really. Kind of developed better system for looking and not being siloed, right? That’s one of the problems is siloed medical care. So once we started looking at getting out of those silos and really looking and, and having a system for other medical providers to speak out and notify.

Dr. Jayme Coffman: That there may be an issue. Um, we started looking at 30 or 40 cases a year, and out of those cases, there’s some that aren’t, that are truly a true medical condition or an anxious parent, but out of those, you know, we’d have 20 that c p s validated. [00:14:00] Now, where they got removed was a whole nother thing, but, but that c p s did validate and substantiate as being abuse.

Andrea: Technology also plays an increasingly important role in these cases.

Dr. Jayme Coffman: How many of those were abused and didn’t get validated? That is another thing that we can’t really. No, for sure. And I think the number’s growing as we have a computer in our pocket to Google everything and to look for symptoms, um, that you can falsify.

Dr. Jayme Coffman: Um, so I, I think it’s going to get worse, not better. And also as our society, um, is all about social media and how many likes you have and how many people watched whatever, um, You know, I think that kind of feeds into it as well, um, that attention seeking. And so I think it’s gonna get worse, not better.

Andrea: I really wanna make sure that this moment in Dr.

Andrea: Kaufman’s interview lands, because I think this is really genuinely [00:15:00] a terrifying thought. We know that this abuse is underreported to begin with. It’s incredibly difficult and time consuming to investigate. And the way that this collides with the. Attention economy of social media, it means that it’s primed to get worse.

Andrea: And this is the access to the drug that people who have this disorder are looking for has increased so many times over as social media has permeated our society. And so I think looking at this intersection and really absorbing what Dr. Kaufman’s saying here is really important.

Andrea: The reality is modern tools make this crime much easier to commit. After all, we know that this is a crime of opportunity. Here’s Dr. Mark Feldman, a psychiatrist and one of the world’s leading authorities on munchausen by proxy.

Doctor Marc Feldman: Years [00:16:00] ago, before the advent of social media, people who wanted to falsify illness had to trudge to medical libraries to find medical textbooks, decide what ailment they were going to depict, bring their child to the emergency room or doctor’s office or hospital, or go there themselves and do a fair amount of.

Doctor Marc Feldman: To convince the doctors that there really was a severe problem, when in fact there was none at all. That’s time intensive and laborious. But now you can become an expert in a medical illness or a mental illness in about 20 minutes by reading Wikipedia. And you don’t need to go to the medical libraries.

Doctor Marc Feldman: Similarly, you can just click to a support group devoted to illnesses of various types, and they exist to be unquestionably supportive and perpetrators count on that. Uh, so they’ll go online and say either that they’re sickly or that the [00:17:00] child has cystic fibrosis or asthma. Or some other dread condition and there’s no verifying it really, that makes it hard, obviously, to dispute it on the other hand, and they get all sorts of attention and feel a sense of control over other people.

Doctor Marc Feldman: By having manufactured all of this online,

Andrea: what would you say to people who say, this isn’t a real thing?

Doctor Marc Feldman: Fortunately, it’s getting a little bit more common for people to acknowledge that it exists, but we get into conflict over how common it is. One of the biggest myths is that Muha BI proxy is extremely rare.

Doctor Marc Feldman: And I counter that. It’s not rare, it’s just we’re failing to recognize it, that if doctors and health professionals and the public were better informed about maches and by proxy, we might see an explosion of cases, not because people are suddenly [00:18:00] abusing their children, but because we’re now recognizing the risk factors for cases.

Doctor Marc Feldman: So again, it’s not true that it’s very rare. It’s also not true that. People who engage in munch chasm by proxy abuse, the perpetrators are crazy. If they were, if they were flagrantly psychotic, we would be able to tell right away that they’re not credibly reporting on the child’s symptoms. The fact is that even in court, they present as utterly normal people, loving parents, for whom this kind of behavior would be sh totally alien.

Doctor Marc Feldman: So we can’t tell from just chatting with an alleged perpetrator whether or not she is in fact a perpetrator based on the apparent normality of her responses to questions. I think also another myth is that Muhas by proxy is about financial gain. So that if somebody is not [00:19:00] getting disability support or opioid medications as a result of what they’re doing to their children, it can’t really be, uh, munch chasm by proxy.

Doctor Marc Feldman: That’s a complete misunderstanding. We call that malingering by proxy and it, or just plain malingering. The aim there is to acquire attention, sympathetic concern. They want intangible satisfaction and they get very deceptive in order to obtain it. That’s what munchausen on my proxy is all about.

Andrea: Yeah, I really like that point you made about them not seeming crazy because I think that that is one of the things that has persisted a bit in some of the.

Andrea: Media around it, and I’m thinking actually more of the dramatizations, where in some ways those perpetrators come across as so obviously creepy, that it does run the risk of making it seem like this is something that anybody would be able to [00:20:00] spot and that, you know, these women are so, so odd and so sort of either have, you know, this.

Andrea: Really heavy, sort of southern gothic creepiness or you know, or seem sort of deranged, um, when in fact that’s not usually the case and that’s actually what enables them to pull this off.

Doctor Marc Feldman: That’s precisely the case. That’s exactly what I’m talking about. And. Much as a by proxy is an inherently dramatic phenomenon, and I don’t think programs need to go and sensationalize it further.

Doctor Marc Feldman: When you find out the facts of a case, your jaw drops. So why elaborate? All sorts of turns and spins to something that’s so disquieting to begin with, but it’s done for dramatic effect in many of the programs that have recently appeared in which Munch has by proxies, either the central plot or a subplot.

Andrea: You know, it’s a word that comes up all the time when you’re reading about these cases in the news or, you know, [00:21:00] reading about sort of the, the coverage of, of it in the media in any way is the word monster. And even in one of Hopi Barr’s interviews that she did from prison, she described herself as a, as a monster.

Andrea: And I. Understand that because the behavior is monstrous. I think that it’s something that as a behavior, it’s the worst thing that most people can possibly imagine is a mother who would torture her child in this way for the purposes of attention. And yet I think that people have a desire to distance themselves from it.

Andrea: By saying that person’s a monster, that person’s crazy. And in that way it allows them to push it away and say, this would never happen in my family. If it did happen in my family, I would be the person who knew right away. I would not be the person who got conned for 10 years. I don’t think that that reflects reality at all actually.

Andrea: People who are good and loving get pulled into these, these stories and, and I think that in many [00:22:00] ways to characterize these women as somehow this really scary other is a disservice because in reality, I think it is the mom next door. It is your sister, your auntie, your friend. It could be in your family, it could be in any family.

Andrea: Against all odds. Tarrant County is still catching and prosecuting more of these cases than anywhere else in the country. Again, here’s Detective Mike Weber.

Mike Webber: After the first case that I worked on, I went to my chief prosecutor, Atlanta Minton, and I told her, I’m like, you know, I’d seen what it took to work these cases, the volume amount of the amount of work.

Mike Webber: And I told Atlanta, you know, detective with 30 cases on this caseload’s gonna have a hard time working these, why don’t you just give any more of these that come into me? Your bar came in two months later, and that was in April of 2009. When we got the Abar case and from that point until until [00:23:00] 2015, I investigated 16 reports of this abuse and we filed six criminal cases.

Mike Webber: We got five guilty pleas to child abuse crimes and one guilty plea to, uh, Medicaid fraud.

Andrea: So Mike has a really impressive track record and he’s considered the top expert in the country on law enforcement in medical child abuse cases. But the road in Mike’s career has not always been easy for him.

Mike Webber: Um, I went to the sheriff’s office in 2018.

Andrea: And how many more have you worked on since that time,

Mike Webber: since January of 2019? Uh, I’ve investigated, gosh, 12 more of these cases and we filed criminal charges on six.

Andrea: That’s a lot of cases for something that’s just exceptionally rare, allegedly. So, um, right. Is there something in the water in Tarrant County or

Mike Webber: we’re investigating crimes?

Mike Webber: The issue with this is, Police aren’t trained on what this is, they don’t know what it is. They tend to dismiss it as a CPS issue, and the child continues to be unprotected. [00:24:00] We have learned in Tar County, we have a quasi system. It’s not perfect by the stretch of the imagination. But we have a system in place that allows us to address these, these offenses, and we’re working to make that system better every day.

Andrea: So what you’re saying is you’ve got kind of a, a working ecosystem in Tarrant County around this. So what does that look like?

Mike Webber: You know, the first thing in, in, in a good ecosystem is having education. And that starts with the doctors that cooks Children’s. And you know, this can be very dicey for doctors if they report it and nothing is done.

Mike Webber: These offenders are extremely litigious. They can, I have nine no doctors who have lost. Professional privileges because of accusations made by these offenders. Um, you know, there’s a very big case in Boston Theier case where they sued the hospital for falsely accusing the mom. Our doctors at Cook’s Children’s know that this is going to be addressed properly.

Mike Webber: Anyone right with anything, when they know that’s the right thing is going to be done, they’re more [00:25:00] likely to report things, which is what we found at Cook’s Children’s. And you know, not doctors are humans. And that’s another big fallacy here that people don’t understand. There are cases where, uh, reports are made that aren’t true, but we have a system that shows that they’re not true.

Mike Webber: Police investigations do not just convict the guilty, they also clear the innocent. And without that police investigation, there are certain things we can do that CPS cannot do. And without that police investigation, you do not get a full picture of the behavior of the alleged defender.

Andrea: There is a pretty visceral fear as a parent of having some run in with the system where you are falsely suspected of abusing your child.

Andrea: So I think it’s good to point out that actually the behavior of a loving parent, of a parent who’s taking good care of their kid. Does not look like the behavior of a parent who’s being medically abusive. You know, a lot of the perpetrators that we [00:26:00] know about where we know back into their history as teenagers, they started these behaviors.

Andrea: And teenagers, you know, hope’s family told us about. She suddenly fell outta bed and was in a wheelchair in her marching band, and the marching band was pushing her out in a wheelchair. You know, there’s things in, um, in my own family’s history that go back to being a teenager that we look back now and are just, oh my God, I can’t believe we didn’t realize this was going on.

Andrea: You know, we were talking about early, like catching these things early, being a preventative measure. Ideally catching the person when they’re doing it to themselves and getting them psychiatric help when they’re not victimizing anyone else. That’s the ideal time to catch the behavior. Right? Right. So this is like really important on a couple of levels,

Mike Webber: right?

Mike Webber: Is what parents worry about. So if you have police involvement early, it can stop that. You okay?

Andrea: Oh man, it just, ugh, it sneaks up on me sometimes. I think it’s because my sister was around the same age when she started doing some really obvious, you know, [00:27:00] falsifying and, uh, yeah. There was this incident in, um, when she was, I think 16 or 17 when she told everyone at school that she was losing her hair and she had a bald patch, and my mom took her to the dermatologist and the dermatologist pulled my mom aside and said, Your daughter’s shaving her head.

Andrea: I’m just like, why didn’t this dermatologist say she needs psychiatric out? Like right. You know, like, and I think my mom tried to get her to go to counseling, but once you have a 17 year old and you’re not in a situation where it’s as serious as you have a police officer there and they can send you the psych word, it’s so hard to look back at that situation and think, oh my God, if we had known, and I know that that’s just something that like.

Andrea: So stuck with my parents. I know it’s not that they didn’t do the right thing. I just think that it’s like nobody said this could be nch house, and this could be infectious disorder. This could be this psychiatric condition where this is the reason she’s doing it. I just seem like a baffling teenage thing that no one could make sense of.

Andrea: And then it escalated and [00:28:00] escalated and here we are now. You know, it’s just. I mean,

Mike Webber: something that you need to understand and your parents especially to understand is even if you had sought psychiatric help and you know this, there’s every chance that it would’ve been in ineffective. I mean, whoever you would’ve sought it from probably wouldn’t have known how to apply the proper psychiatric help.

Dr. Karen Shultz: My name is Karen Schultz and I am a physician at Cook Children’s Medical Center. Starting out. It just, all of these are just normal kind of cases that a patient comes to you with a problem, you try to help the problem, but as you dive into them and you start having second doubts of yourself, is this really right?

Dr. Karen Shultz: Am I really doing what’s been the best interest of the child? Because that’s my job is to do what’s in the best interest for the child. Not for the parent. For the child. It really makes you doubt where you’re going [00:29:00] and makes you not sleep at night.

Andrea: If you could talk a little bit about how you get to a diagnosis, like whether that’s mostly tests that you can sort of see on a screen, or is it mostly based off of patient history as a specialist?

Dr. Karen Shultz: So it kind of depends on the age of the patient and the problem. Depending on where you can come from, there tends to be less tests you can do on smaller children a lot of the time than you can on some of our older children. And for our younger children, you really depend on the history from the parent or the caregiver.

Dr. Karen Shultz: Because they can’t tell you, my head hurts, my stomach hurts. Whatever else hurts. You depend on the parent to tell you the truth about what is happening to their child. So you can make the best decisions on, is there a test I can do? Is there a medicine I can give? Is there something else that I need to do?

Andrea: And what sorts of [00:30:00] things would make you suspicious that a parent wasn’t being honest?

Dr. Karen Shultz: It’s usually when things don’t quite add up, they tell you about symptoms and you’re like, oh, that is clearly looks like this and your treatment plan doesn’t work whatsoever, and you try a different treatment plan that again, should work and it doesn’t work at all, and you just know that there’s something there that isn’t quite right. I mean, you just, you just don’t feel that it’s right.

Andrea: Are there any patterns that you’ve seen emerging that have helped you develop a way of looking out for red flags?

Dr. Karen Shultz: I think the biggest one that I pay attention to right off the bat is um, whether they’ve doctor shopped. So if they don’t get their answer at one physician, then they go somewhere else and then they end up at me [00:31:00] cuz they, there’s something, they’re looking for

Andrea: a lot of people. If they had the feeling that something was wrong with their child and felt like the doctor they took them to wasn’t being responsive to their concerns, it would be pretty natural to go and seek a second opinion. So how do you differentiate this kind of doctor shopping that you’re talking about from, uh, parents’ more natural inclination to follow their instincts about their child’s health?

Dr. Karen Shultz: I mean, as a parent, if I had any doubt about what the physician was telling me and. I would go find someone else to ask the same question to. I think the big part is they’ve had multiple normal tests or multiple appropriate therapies that families report don’t help, and then they’re switching and wanting all of the same evaluation repeated.[00:32:00]

Andrea: Obviously some things are medically complex. Like what sort of distinguishes that? Like what does that look like? So we can kind of contrast it with what you just described.

Dr. Karen Shultz: You can verbally review the test results with the family and say, okay, these are all the things that I know are normal. And the families who were really looking for a second opinion will go, okay, so what do we do now?

Dr. Karen Shultz: Um, and a lot of my. Medical child abuse families will say, yeah, but I don’t really believe that

Andrea: they’re clearly looking for a yes rather than we’ve ruled out X, Y, and Z. So now what comes after that? The assumption would be that someone would go to something that was really rare and sort of hard to test for, et cetera.

Andrea: But you’re saying that some of these things that parents are bringing their kids in where it does turn out to be an abusive situation are pretty common things. It’s just that they’re. The child response is not what you would [00:33:00] expect.

Dr. Karen Shultz: Yes. Ones that are easy for families to tell you about and hard for doctors to prove they’re lying.

Dr. Karen Shultz: One of the most common, just in general for medical child abuse is failure to thrive the family. Comes in and you go through a whole plan of how you’re gonna feed this child, how you’re gonna get the child to gain weight, what you’re gonna do, you can bring them into the hospital, you can document them gaining weight in the hospital, and they go home and they lose weight again, and you bring ’em back into the hospital and they gain weight and they go home and they lose weight again.

Dr. Karen Shultz: And so that’s really documenting that I can make this child gain weight when they’re there. I am trusting that the family is doing the same thing at home, but clearly they are not. Is the conclusion you come to eventually our training is a patient comes to you, you figure out the problem, you treat ’em, everybody moves on.

Dr. Karen Shultz: I mean, there’s some [00:34:00] chronic illnesses that that have lifelong implications, but for the most part, That’s your goal is to get the patient better and then when they’re not getting better, and then you’re doubting yourself in my, is there some medical diagnosis I’m truly missing? And then to make the leap of is this caregiver not being truthful and that’s why.

Dr. Karen Shultz: They’re not getting better versus I missed something from a medical standpoint. And when you get to the point where you’re thinking, is this really, really more on the medical child abuse side, then you keep going back saying, oh, but if I missed something, then I’m gonna feel even worse because I missed something, rather than thinking that a parent is not being truthful to me,

Andrea: that sounds like a scary place to be as a.

Andrea: Professional. I mean, this is a lot of responsibility that we give to pediatric medical professionals in particular, to put someone in that [00:35:00] position where none of the outcomes are, are good. Right? You’re worried you miss something, or this parent is, is doing this to their child on purpose. Do you think that some physicians are just not even able to make that leap to the possibility of child abuse?

Dr. Karen Shultz: It’s a hard leap to to make, especially that first time or two when you haven’t been exposed to it as much. And I think it’s why a lot of these cases, the children undergo multiple procedures is because the physician’s going, oh, but what if I did miss something? And so you’re really then just playing into the caregivers wants and desires to have the focus put back onto the child and the caregiver.

Andrea: Once you suspect that this may be a case of medical child abuse as a doctor, what happens [00:36:00] next?

Dr. Karen Shultz: Generally, I try to document well that the steps that we have gone through to get to that point. Then I generally call c P s and they’re my first line to get more investigation done.

Andrea: It’s become really clear to me how in order to protect children from this form of abuse, every part of the system needs to be working well and working in concert from the doctors to cps, to law enforcement, to family court and criminal court, and in some ways, This makes me feel a little hopeless because the idea that all of those systems would work together in this seamless way almost seems like an impossible bar to reach.

Andrea: And yet the fact that these systems are working, this ecosystem clearly is developing in this one place in Tarrant County, Texas [00:37:00] where. They’re developing something of a model for what, a successful system that does protect children from this abuse, and that does catch these perpetrators when they’re hurting their kids.

Andrea: What that looks like. I think the really chilling thing that settled into me as I dug deeper into what is working at Tarrant County is just that there’s no reason to believe that there’s something extraordinary about Tarrant County in that they just have a higher rate of munchhausen by proxy than other places.

Andrea: Right now, the way that this issue of muncha and by proxy is presented in the culture when it’s talked about at all, is as being an extremely rare thing. None of the experts that I’ve spoken to throughout the course of this project have told me that they think it’s rare. They don’t think it’s common, but it’s not rare.

Andrea: It’s likely as prevalent as any other form of child abuse, just something that’s interwoven into our communities. We know that right now the various [00:38:00] systems and mechanisms that are meant to catch child abuse are not working. If we were catching it, unfortunately, I think every county would look like Tarrant County.

Andrea: In the next episode, I’m going to talk to three dads who have been through really similar cases, and we are gonna delve deeper into what it’s like to be the non-offending partner in one of these cases. If you’ve been listening to this podcast and some of the details sound very familiar to you from your own life, or someone that you know, please visit [email protected].

Andrea: We have resources there from some of the top experts in the country, and we can connect you with professionals who can help. If you are curious about this show and the topic of Chasm by proxy, follow me on Instagram at Andrea Dunlap. If you would like to support the show, you can do so at should believe me, and if monetary support, it’s not an option for you right now.

Andrea: You can also rate and review the podcast on [00:39:00] Apple and share on your social media. Word of mouth is so important for podcasts and we really appreciate it. Nobody should believe me is a production of large media. Our lead producer is Tina Noel. The show is edited by Lisa Gray with help from Wendy Nay.

Andrea: Jeff Gahl is our sound engineer. Additional scoring and music by Johnny Nicholson and Joel Schock. Also special thanks to Maria Paolos, Joelle Noel and Katie Klein for project Coordination. I’m your host and executive producer, Andrea Dunlop.

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