Bad Medicine

The scene is like something out of Kafka: A young woman named Misty Jones in her 34th week of pregnancy is arrested at her home and taken to a local hospital in handcuffs. Her labor is induced and her baby is taken away from her at birth by Child Protective Services. Accused of manifesting Munchausen Syndrome by Proxy (MSBP) and harming her first two children by injecting them with insulin, the woman is stripped of her third child as a preventive measure.

Jones never got her three children back. But what if she was falsely accused?

That's the question asked by a searing documentary being released this month on DVD. Called MAMA/M.A.M.A: Mothers, Medicine and Madness, the film explores the devastating consequences for mothers accused of fabricating their children's illnesses in order to draw attention to themselves, the purported hallmark of MSBP. The syndrome was the subject of "An Irritating Woman," the Dallas Observer's cover story last week. The story examined the case of Dr. Susan Diamond, who lost custody of her five children after she was falsely accused of MSBP involving her mentally ill son.

Written and directed by journalist Nonny de la Pena, based in California, the film premiered to acclaim at the South by Southwest Music and Film Festival in Austin in 2003. It never received a wide release.

The filmmaker focuses on a handful of cases on both sides of the Atlantic. De la Pena started her research in 1999, when Sir Roy Meadow, a British pediatrician who first defined the diagnosis in 1972, was still at the peak of his pernicious influence. He had testified in thousands of cases that resulted in women losing their children or being convicted of child abuse or murder and sent to prison. In the film, Meadow smugly describes his approach to diagnosing these malignant mothers who fool less enlightened doctors. When he's finally pinned down by de la Pena's persistent questions of his methodology, he grabs her microphone to stop the interview.

Meadow has now been discredited, and 5,000 cases in which he testified are under review. Last week, a British judge issued a ruling saying that "I would consign the label MSBP to the history books."

But Meadow's authoritative descriptions of evil mothers hurting their children influenced many physicians in the United States who began seeing MSBP in their own practices. De la Pena found three cases of women accused of MSBP after they took their children to Cook Children's Hospital in Fort Worth. One case out of Cook Children's was substantiated last October when Shawna Danielle Perkins, 25, was sentenced to 45 years in prison for two charges of injury to a child after the hospital set up a covert video camera and filmed her trying to suffocate her baby.

But most MSBP cases have no such evidence, only a profile of often-contradictory "warning signs."

The most devastating case explored in the film is that of Julie Patrick, a Tennessee mother who was accused of MSBP after taking her infant son, born with congenital defects, to a hospital in Nashville. This powerful segment includes home movies made by the family while the 11-month-old Phillip was hospitalized and heavily medicated with powerful drugs. Though removed from his mother, a month later the baby died a gruesome, painful death. Child protection workers and the hospital refused to let the parents near the baby even as he died.

The film paints a damning picture of doctors blind to their own biases and assumptions.

The medical examiner said that Patrick's behavior "fit the profile of a [Munchausen] perpetrator in some ways...She was clearly pushy to the point of being obnoxious. She frequently questioned the medical staff, their conclusions and treatment options" and took Phillip to a succession of hospitals. But an autopsy revealed the boy died of multiple birth defects related to his gastrointestinal illness.

The Patricks later founded a national organization called MAMA (Mothers Against Munchausen Allegations).

The film makes a compelling argument that many MSBP cases are the result of doctors prescribing powerful drugs, particularly neuroleptics like Propulsid (cisapride) and Reglan (metoclopramide) for infants, and then mistaking the strange side effects for harm caused by mothers. (Neuroleptics are medications originally developed to treat psychosis; they're often used to treat involuntary movements, like spitting up. Propulsid has now been removed from the U.S. market.)

"I found incredible documentation of this issue," de la Pena says. "The child begins the drug, the mom starts recording seizures, the nurses put it in the notes. But the doctors never consider the drug as a problem. Then they start another tier of medications on top of that, with an anti-seizure drug." And one of the so-called warning signs of MSBP is a mother lying about her child suffering seizures.

She contacted dozens of mothers accused of MSBP whose children had been given these drugs. "There was a real problem with doctors prescribing very strong drugs to infants and not recognizing the side effects," de la Pena says. "The moms would complain about the babies having weird spells or seizures. Instead of acting on that, they go after the moms."

De la Pena says that British medical authorities are finally taking steps to stop the false MSBP accusations that tore apart thousands of families and sent hundreds of moms to prison. One prominent doctor, David Southall, a British doctor who testified against hundreds of women accused of MSBP, was suspended for three years for serious professional misconduct after his expertise and methodology came under scrutiny.

The Council for Healthcare Regulatory Excellence met this week to consider taking away Southall's license to practice medicine.

Over the years, Southall has given testimony against hundreds of women, including a Massachusetts welfare mother named Brenda Snyder. Snyder called 911 when her 3-week-old baby had trouble breathing and turned blue. After a doctor accused her of suffocating the child, prosecutors commissioned Southall to examine the case. He wrote a report concluding that Snyder perpetrated MSBP. She was convicted, says de la Pena, despite the fact that an autopsy showed the baby had a tumor on its heart that could cause sudden cardiac arrest.

De la Pena says that Southall's participation in the case is under review by British authorities, but Snyder is now serving 45 years in an American prison.

For more information, go to www.munchausenmovie.com. --Glenna Whitley

Big Idea

Each year, during any thunderstorm, there's a 50 percent chance East Dallas will be flooded worse than all other parts of the city. Why is that? Because of hillbilly unseemliness 70 years ago and governmental neglect today.

Mill Creek flows throughout East Dallas, but it flows underground. It used to flow aboveground, like any other creek, but the city decades ago got sick of residents dumping their waste--be it feces, urine or plain household junk--into the creek. So, in the 1930s a support structure was built around it and dirt was dumped over it, and voilà, Mill Creek was underground.

But 70 years later that support structure is crumbling in parts. The flood of '95, the one that was cruelest to East Dallas, closing Baylor Hospital's emergency room floor for three and a half days, is the support structure's fault, Councilwoman Veletta Lill says. "We have a great deal of inadequate drainage within this watershed," she said at the city council meeting three weeks ago.

To fix the problem, council members want to bring a portion of Mill Creek aboveground again. (They think East Dallas residents can resist the urge to defecate in the creek. Time will tell.)

To bring it aboveground, though, presents problems of its own. Houses and commercial buildings now stand on top of the creek's flow between Henderson Avenue and San Jacinto Street. "It would appear you would have to take down some buildings in the area," Lill says.

Which brings us to the cost. The latest estimate calls for upward of $150 million. "How are we going to find the money to pay for the exorbitant amount of drainage issues...facing this city?" Councilman Ed Oakley asked at the meeting three weeks ago.

Nobody knows. There's talk of tying it to a larger bond package that would also spruce up the Trinity River, but that drives the cost to $350 million. And nobody knows when to hold the bond election. "Maybe 2007 at the earliest," Mayor Pro Tem John Loza says.

But everyone agrees Mill Creek should have been fixed earlier but wasn't because it didn't require a big or sexy idea to fix it. Mill Creek was a basic municipal problem like potholes, which get worse until they require big ideas to fix them. --Paul Kix