Responding to an I-Team Investigation by email only, Florida's Department of Health provided few answers into how some Florida parents were wrongly accused of abusing their children when child abuse pediatricians, hired to be the state's experts, made the wrong call.
"Protecting the health and safety of Florida's children is a top priority," the email, which was provided to us by a department spokesperson, stated multiple times in response to a series of questions we sent last week.
When asked how some of these doctors made determinations of abuse that were later debunked by other experts, the state responded, "CPT (Child Protection Teams) remains open to receiving input from others who are involved in protecting the health and safety of Florida's children."
A recent Contact 5 report found parents around the state have been separated from their babies when they sought medical attention for unusual behavior or health issues with their children. However, these parents found themselves on the defense when the state's expert wrongly determined the child's medical issues were the result of abuse.
"I kept thinking, this is a mistake, this is going to corrected, it's not right," said Nydia Ortiz of Miami.
Her son and girlfriend were separated from their seven-week-old daughter last year after seeking answers for unexplained bruises on their daughter. For weeks they were in-and-out of doctors' offices and hospitals. But during a visit to the emergency room, a child abuse pediatrician determined the baby's 22 fractures and bruises were the result of abuse.
It turns out it was actually a rare genetic disorder that both of her parents also have.
Vadim Kushner of Sarasota County and his wife were also separated from their two children last year when a state pediatrician concluded seizures that his then-33-day-old was having were the, "the result of shaken baby or blunt force trauma," according to court documents.
After fighting back, a judge ruled "there was no abuse" and agreed with the family who had medical records to show the baby had a complicated birth and was born not breathing because the umbilical cord was wrapped tightly around his neck.
In court records, one of the state's doctors admitted he didn't know this information because he "never reviewed all his [the baby's] medical records."
"I have to believe that is the exception not the rule," said Clara Reynolds, President and CEO of the Crisis Center of Tampa Bay.
Reynolds also sits on the state's Child Abuse Death Review Committee and spent a year working with Child Protective Investigators in Florida. We showed her the state's responses to our findings, which repeatedly stated how physicians "continue to operate in accordance with medical standards of practice," and how child protection teams are "open to receiving input from others who are involved in protecting the health and safety of Florida's children."
"In the reporting you have done, you have shown mistakes do happen," said Reynolds, who added that child protection teams are "using the data you have, the info you have and you’re making the best possible decisions. Sometimes even in those situations where you have trained professionals who really want to get everything right, there are still those opportunities for mistakes and things to be made," she said.
It's unknown how often state child abuse pediatricians get it wrong. Records involving children are confidential and so are health and medical records. Often, the only insight into questionable diagnoses can be found in court cases filed by families who can afford the attorneys and experts it takes to the prove the state wrong.
In the last three years, child protection team doctors have conducted more than 44,000 medical exams on kids in Florida, according to the state. Findings of abuse, either positive or negative, were roughly equal according to numbers provided to us by the Florida Department of Health.
The stakes are high and everyone agrees, the costs of getting it wrong are even higher.
"I don't want to be the investigator who got it wrong on either side," said Reynolds. "Either I moved too fast or I didn't move fast enough."
BELOW ARE FDOH's answers to our questions about child abuse pediatricians and questionable diagnoses:
- QUESTION: IS THERE WRITTEN STATE POLICY THAT REQUIRES CHILD ABUSE PEDIATRICIANS (not other members of the CPT including other dr’s and nurses) INTERVIEW PARENTS AND TAKE THE MEDICAL HISTORIES OF PARENTS WHEN EVALUATING A CHILD FOR POTENTIAL ABUSE? IF SO, PLEASE FORWARD THAT SPECIFIC POLICY?
- ANSWER: Each Child Protection Team (CPT) operates under the guidance of a local CPT medical director. When evaluating a child, CPT medical directors collect information from parents or caregivers regarding the alleged abuse, neglect or other maltreatment of a child, as appropriate based upon the case. CPT medical directors operate in accordance with their licensure requirements and standards of medical practice.
- QUESTION: IF A CHILD ABUSE PEDIATRICIAN DETERMINES A CHILD’S INJURIES ARE THE RESULT OF ABUSE, UNDER ANY CIRCUMSTANCES, DOES STATE POLICY REQUIRE THAT CHILD ABUSE PEDIATRICIAN SEEK OUT A 2ND INDEPENDENT OPINION BEFORE A CHILD IS REMOVED FROM PARENTS? IF SO WHY? IF NOT, WHY NOT?
- ANSWER: A CPT physician evaluating or assessing a child may request consultation as needed. CPT findings are provided to the Department of Children and Families (DCF). Decisions regarding the safe placement of children are made by the judicial system.
- QUESTION: WHAT IS THE STATE’S EXAMINATION/EVALUATION PROTOCOL, SPECIFICALLY, FOR CHILD ABUSE PEDIATRICIANS? (not all CPT members)
- ANSWER: Section 39.303(2), Florida Statutes, outlines the requirements to serve as a local CPT medical director. This section also contains the requirements for other physicians who provide CPT services.
- QUESTION: DOES THE STATE HAVE RECOMMENDATIONS OR REQUIREMENTS FOR HOW LONG CHILD ABUSE PEDIATRICIANS MEET WITH THE CHILD THEY ARE EVALUATING FOR ABUSE?
- ANSWER: Medical evaluations and assessments are conducted based on the condition of the child as it relates to the alleged abuse, neglect or other maltreatment.
- QUESTION: DOES THE STATE HAVE RECOMMENDATIONS OR REQUIREMENTS FOR HOW LONG CHILD ABUSE PEDIATRICIANS MEET WITH THE CHILD’S PARENTS WHEN EVALUATING A CHILD FOR POTENTIAL ABUSE?
- ANSWER: The time required for meeting with parents or caregivers varies depending on the nature of the child’s condition and is in accordance with standard medical practice.
- QUESTION: WHAT IS THE DEPARTMENT’S REACTION TO TERMINATION OF PARENTAL RIGHTS CASES THAT WERE DROPPED/DISMISSED OR DENIED BY THE COURTS AS A RESULT OF INSUFFICIENT EVIDENCE OR CONFLICTING TESTIMONY PROVIDED BY CHILD ABUSE PEDIATRICIANS?
- ANSWER: CPT provides DCF with findings. CPT staff provides testimony during court proceedings as required. Protecting the health and safety of Florida’s children remains a top priority. Legal standards and evaluations of evidence are completely within the authority of the courts.
- QUESTION: IN SEVERAL CASES WE REVIEWED THAT WERE DISMISSED, A JUDGE CRITICIZED STATE DOCTORS FOR NOT INTERVIEWING AND ASSESSING PARENTS’ MEDICAL HISTORIES, LACKING KNOWLEDGE IN CERTAIN DISODERS AND NOT REVIEWING A CHILD’S FULL MEDICAL BACKGROUND. IN ONE RECENT CASE THAT WAS DISMISSED, A STATE DOCTOR ADMITTED SHE DIDN’T KNOW THE NEWBORN HAD A COMPLICATED BIRTH BECAUSE SHE DIDN’T REVIEW ALL OF THE BABY’S RECORDS- WHAT IS THE STATE’S RESPONSE TO THESE CRITICISMS MADE BY DIFFERENT JUDGES AROUND THE STATE?
- ANSWER: CPT physicians continue to operate in accordance with medical standards of practice; however, CPT remains open to receiving input from others who are involved in protecting the health and safety of Florida’s children. The Department is unable to comment on the specific circumstances surrounding confidential CPT evaluations.
- QUESTION: WHAT KINDS OF CHECK AND BALANCES DOES THE STATE HAVE TO ENSURE CHILD ABUSE PEDIATRICIANS ARE NOT PREMATURELY OR MISTAKENLY CONCLUDING ABUSE?
- ANSWER: It is within the scope of practice of a CPT physician to determine whether abuse, neglect or other maltreatment has occurred. This decision is often made in consultation with other members of the CPT.
- QUESTION: FOLLOWING NATIONAL HEADLINES AND LOCAL CONTROVERSIES INVOLVING SOME DETERMINATIONS MADE BY CHILD ABUSE PEDIATRICIANS, IS THE STATE TAKING ANY ACTION TO ADDRESS CONCERNS RAISED PUBLICLY?
CPT physicians continue to operate in accordance with medical standards of practice; however, CPT remains open to receiving input from others who are involved in protecting the health and safety of Florida’s children.
- QUESTION: DOES THE DEPARTMENT SUPPORT INCREASED MEASURES TO REDUCE CASES OF QUESTIONABLE DIAGNOSES? SPECIFICALLY, WE’VE HEARD FROM FAMILIES ABOUT THE NEED TO REQUIRE CHILD ABUSE PEDIATRICIANS CONDUCT MORE THOROUGH INTERVIEWS AND ASSESSMENTS WITH PARENTS AND, IN SOME CASES, REQUIRE AN INDEPENDENT SECOND OPINION BEFORE A CHILD IS REMOVED FROM THE PARENT CUSTODY? DOES THE DEPARTMENT SUPPORT THOSE RECOMMENDATIONS? IF SO WHY? IF NOT, WHY NOT?
- ANSWER: Although the Department of Health does not comment on specific cases, CPTs have a successful history of protecting the health and safety of Florida’s children. Decisions regarding the safe placement of children are made by the judicial system. CPT remains open to receiving input from others who are involved in protecting the health and safety of Florida’s children.
- QUESTION: WHAT IS THE STATE’S OVERALL REACTION TO NATIONAL AND LOCAL HEADLINES THAT HAVE RAISED QUESTIONS ABOUT SOME ABUSE DETERMINATIONS MADE BY CHILD ABUSE PEDIATRICIANS IN FLORIDA?
- ANSWER: Protecting the health and safety of Florida’s children is a priority, and CPT remains open to receiving input from others who are involved in protecting the health and safety of Florida’s children.