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IN WAKE OF THE KOWALSKI VERDICT

A CALL TO ACTION

Interacting With a Child Abuse Pediatrician: A Parent's Perspective

The Family Justice Resource Center (FJRC) has encountered hundreds of stories from parents navigating the child welfare system due to a wrongful allegation of abuse. The story below is a condensed portrayal of a typical parent’s encounter with a child abuse pediatrician—a scenario that, unfortunately, is not at all unusual. This amalgamated account is crafted from the true stories of several FJRC client families and the in-depth experiences of our staff, volunteers, and board members. Specific sources are listed in the endnotes.

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Sarah Clark and her 18-month-old son

This is the story of Sarah Clark's encounter with Dr. Johnson, a child abuse pediatrician operating out of the local children’s hospital.

 

Sarah Clark is reading to her 18-month-old son, Jaden, before bed when she notices that he seems to be favoring his left arm when reaching up to help turn the pages. Jaden is a very active child, and clearly a right-handed toddler. Sarah tells herself, “it's probably nothing,” but makes a quick mental note to check his arm in the morning.
 

After waking up, Jaden seems not to want to lift his right arm to dress, but he doesn’t cry out when Sarah puts his arm through the tee-shirt sleeve. When she hands him his favorite wooden toy truck, he grabs it with his left arm—“that’s odd,” she thinks to herself. Throughout the day, she notices he won’t use the right arm at all, even though the truck is a bit heavy and he’s having trouble holding it with just his left arm. Her husband, Darren Clark, also notices and shares Sarah’s concern. Before he leaves for work, they agree that a visit to the pediatrician would be wise.
 

Sarah calls the pediatrician’s office and gets an appointment scheduled after she drops off Devan, her three-year-old, at preschool. The pediatrician notices some faint bruising on Jaden’s arm and orders an x-ray at the local children’s hospital. After the x-ray, they pick up Devan from preschool and head home to wait for the results. Back home, Jaden continues to favor his left arm as he eats his lunch, but he doesn’t cry or appear to be in apparent pain. “Maybe he just bruised it somehow,” Sarah thinks to herself. 
 

Someone from the hospital—with a name she doesn’t catch—calls her back at 2:30 pm to say that Jaden has a fractured humerus and that he needs to come to the emergency room to be seen immediately. Sarah asks a neighbor to watch Devan and then races back to the hospital with Jaden, eager to get his arm attended to as soon as possible. 

She checks in at the hospital at about 3:30 pm. After a brief wait, they are placed in an exam room where Jaden is briefly examined by a nurse. Then, a nurse practitioner comes in and starts asking questions about what could have happened to Jaden’s arm. Sarah has nothing to hide, so she answers all the questions—which she assumes are routine— without hesitation. She shares about how Jaden hasn’t been using his right arm and about how she hasn’t noticed the faint bruising, likely because he’s been wearing long sleeves due to the cold weather. When asked when the injury might have occurred, she answers honestly that she has no idea what happened to cause the injury. The nurse practitioner then asked who else, besides her, has taken care of Jaden, to which she replies, “No one,” forgetting that her mom did watch him briefly four days ago for a few hours. 
 

After the nurse practitioner leaves the room and they wait for another doctor to care for Jaden, Sarah realizes that it’s nearly dinner time. Thankfully, she came prepared with drinks, snacks, and activities to keep Jaden comfortable. She calls her husband to tell him he should pick Devan up at the neighbor’s by 6:30 p.m. and that it’s better if he doesn’t come to the emergency room (ER) so that Devan can get to bed on time. She wonders when someone is going to come and take care of Jaden’s arm. 
 

It's a long wait. Another doctor, Dr. Melissa Johnson, comes to talk to Sarah at about 7:30 pm and introduces herself as a member of the hospital's “trauma team.” Sarah doesn’t know it yet, but a child abuse hotline call was already placed by the nurse practitioner, who reports to this doctor. 
 

Dr. Johnson is, in fact, a child abuse pediatrician who works directly with child welfare investigators, police, and prosecutors. The hospital, which doesn’t directly employ her, refers to her as the director of its child protection team and the hospital’s treating doctors are required to call Dr. Johnson anytime a child presents with findings that could raise suspicions of child abuse. She and her staff— which includes nurses, social workers, and a nurse practitioner—have a contract with the state to conduct medical evaluations for suspected child abuse. She also sits on the multi-disciplinary team at the Children’s Advocacy Center, alongside law enforcement representatives, child welfare investigators, and the prosecutors’ office. 
 

Dr. Johnson does not tell Sarah that her role in Jaden’s care is to assess whether he is the victim of abuse and then report her conclusions to the Children’s Advocacy Center (and the team of CPS investigators and police who will be staffing Jaden’s case). She also doesn’t mention that she may become a prosecution witness against the family if either the State child welfare system or its criminal system decides to bring charges or substantiate a child abuse report in the state’s child abuse register. She doesn't tell Sarah that she’ll participate in the discussion of whether the case should be screened into court (or that if she thinks it should, the state almost always goes along with her opinion). Sarah, who has never dealt with any legal issues, has no reason to suspect that she is talking to someone who is anything other than a treating doctor who is there to help her son feel better and provide the medical care he needs.
 

Naturally, if Dr. Johnson did tell Sarah her true role, Sarah might be reluctant to continue talking openly and she might even consider calling an attorney to find out her rights. But since she isn’t aware of the real reasons why Dr. Johnson has come to see Jaden, she speaks freely with the doctor. Could Jaden have low Vitamin D, as she herself does? Is there a genetic disorder? Could this have something to do with Sarah’s family’s history of Ehlers Danlos syndrome? Could it have happened when he slipped and fell while playing a week ago? Why hasn’t Jaden shown any signs of pain, such as crying or irritability? All possibilities are openly discussed between Sarah and Dr. Johnson. 
 

Dr. Johnson doesn’t answer any of Sarah’s questions, but instead begins questioning Sarah. She asks if Sarah and her husband have had any recent arguments. Sarah thinks this is an odd question, but she has no reason not to answer. Sarah tells the doctor she and her husband had a recent argument about who was going to put the kids to bed after Sarah had a long day of childcare. The doctor also asks about family mental health issues and Sarah responds by telling her that she just started a new medication for mild depression. When Sarah mentions that she hasn’t noticed any bruising on Jaden’s arm or any indications of pain, Dr. Johnson seems unconvinced. 
 

By the time that Dr. Johnson leaves the room, it is 8:00 p.m. and Sarah is confused why no one is tending to Jaden’s broken arm. She and Jaden are exhausted, and they haven’t been able to eat anything but snacks brought from home.  
 

Around 9:15 p.m., a child protective services investigator comes in and tells Sarah that she is there because the child abuse hotline has been called about Jaden’s injury. She doesn’t tell Sarah that the hotline call was made by the nurse practitioner who works with Dr. Johnson. “Maybe it’s just standard protocol?” Sarah wonders. She has no clue that Dr. Johnson has already met with the investigator and reported that there is “no explanation for the fracture other than child abuse.” She also doesn’t know that Dr. Johnson’s contract with the State allows her to assess the validity of her team’s own hotline call. 
 

Still waiting for care at the hospital, Sarah answers the investigator’s questions. No one gives her any notice of rights or cautions her as to the potential use of her statements against her in any kind of legal case. She assumed that all the information she gave Dr. Johnson was confidential, but now she wonders if the doctor told the investigator about the argument with her husband or her mild depression. She doesn’t have anything to hide, but she wouldn’t want that information shared. The investigator never asks for the name of Jaden’s treating pediatrician or about any family history. She also doesn’t ask to talk to any family members or friends, including Sarah’s husband, Darren. Sarah doesn’t know it, but the investigator has already made up her mind that Jaden was abused. While it’s her job to investigate abuse allegations, when an allegation is medical in nature, her agency’s conclusions depend almost entirely on Dr. Johnson’s opinion. 
 

Dr. Johnson comes back to the room and tells Sarah that Jaden must undergo a full skeletal scan, to see if he has other fractures. Sarah is also told that her older son, Devan, will need a full skeletal scan, as well. When Dr. Johnson tells Sarah this, she begins to respond in an irritated tone. She’s exhausted. “Why couldn’t you have told me this right away? You needed to wait until we’d been here all day?! And why do we need to subject Devan to x-rays? Don’t you know that’s not good for kids!”
 

Dr. Johnson doesn’t explain the reason for this additional procedure, and she minimizes the amount of radiation that will be involved. Dr. Johnson leaves Sarah with the impression that the purpose of the skeletal scans is just to ensure the boys don’t have a genetic bone disease. In reality, Dr. Johnson has no intention of ordering any tests to check for genetic conditions or other alternate medical explanations; after all, she is not a member of Jaden’s treating team—she is only there to conduct a medical evaluation for child abuse.

 

At this point, pieces are moving about which Sarah knows nothing: (1) she is now a suspected child abuse perpetrator and skeletal scans are viewed as a mandatory part of the medical evaluation for child abuse; (2) if new fractures are found, they will be used as evidence of abuse (at the same time, if no new fractures are found, it will not help clear her of suspicion); and (3) if Sarah refuses to comply with these skeletal scans, the state will seek a court order. 

At 10:30 pm, a fourth-year orthopedics resident finally arrives in the room. The resident puts a cast on Jaden’s arm and advises Sarah on how to wash Jaden with the cast on. The resident can’t give Sarah any information as to how the fracture came about, nor advise her as to whether Jaden’s bones are more fragile than normal. The resident does say this sort of fracture is quite common in toddlers of Jaden’s age. He calls the bruising near the fracture line “minor.” He even tells her that, to his knowledge, this isn’t the kind of fracture ordinarily seen in abuse cases. That’s the first good news Sarah has gotten all day. The resident does give Sarah his name, but she forgets to write it down. She is exhausted and didn’t think to ask how she can reach him to make sure he lets the investigator knows his medical opinion about this kind of fracture. She mistakenly assumes that the investigator will be reaching out to the orthopedics resident who cared for Jaden’s arm.

After the resident leaves at about 11:30 pm, Sarah assumes Jaden is ready for discharge. Much to her surprise, the investigator comes in to notify Sarah that, since she and her husband are under investigation, they cannot be alone with their children. She’s told that Jaden will be kept in the hospital overnight, and that, in the morning, after both Jaden and Devan have skeletal scans, there will be a meeting about how the state plans to keep the boys safe until the investigation is completed. 

The next morning, Darren Clark takes Devan to the hospital, and both boys are subjected to full skeletal scans. After waiting over two hours for results, the Clarks are told that neither scan shows anything concerning. Despite this, the investigator arrives at the hospital by noon to initiate a “safety plan”. The Clarks are told the “safety plan” will require that the boys stay with a family member or friend. Darren asks, “So our kids will be in foster care?” The investigator responds, “No, safety plans are voluntary.” Darren looks at the investigator and says, “Well, if it’s voluntary, we don’t agree to this!” The investigator snaps back, “If you don’t agree to the safety plan, we’ll have no choice but to put your kids in foster care.” Confused and scared by this coercion, Sarah and Darren sign the safety plan, feeling their hands are tied. 

The Clarks only have one local relative, Darren’s Aunt Linda. Thankfully Linda is recently retired and can come right away to the hospital. Sarah, Darren, and Linda are all made to sign the safety plan, which specifies that the children will reside with Linda. They are all warned that the Clarks can only visit during daytime hours and that all of their time with the children must be supervised by Linda. After Jaden is finally discharged, the boys have to leave with Linda. The Clarks hold back tears while they tell the boys they need to stay with Aunt Linda for a “few days."

 

A few days quickly turned into weeks.

 

Every day, the Clarks go to Linda’s house to visit the boys, trying to make things feel as normal as possible. While the boys love their great aunt, they end every visit by clinging to their parents and begging to go home with them. The Clarks regularly call the investigator, who continues to tell them that the agency is “working on the investigation.” A week into the investigation, Darren asks “Did you talk to the resident who treated the fracture? Or to Jaden’s pediatrician?” The investigator doesn’t answer. She says she followed child protection investigation protocol and that her agency “relies on Dr. Johnson’s expertise”. 

Five weeks later, the Clarks are told that no charges will be filed in court and that the boys can finally return home. They are also told, however, that Sarah will be indicated by the state for medical neglect for “delaying getting Jaden seen by a doctor.” As a result, Sarah’s name will be listed on the State Central Child Abuse Register. This means that she will not be able to volunteer at her kids’ schools or go back to work in any field involving children for at least five years.

The Clarks are confused as to how the state can put Sarah on a child abuse register even though she isn’t facing any juvenile or criminal charges, and they believe there must be some mistake. They find out that they can appeal the register placement, but they have to hire a private attorney at their own expense. Once they retain an attorney, they are told that they need to get Jaden’s full medical records. When they go through the records, they see a note from Dr. Johnson, who wrote a short report that briefly states that Jaden’s fracture is “highly suspicious for child abuse.”

When the Clarks finally get a copy of the full child abuse investigation file, they are stunned to learn the true extent of Dr. Johnson’s involvement in their case. They read that the hotline call was made only an hour after Sarah brought Jaden to the emergency room, just after Jaden was examined by the nurse practitioner who they now understand works under the direction of Dr. Johnson.  

In the file, there are notes of her 9:15 pm conversation with Dr. Johnson that includes her impressions that Sarah was “overwhelmed with childcare responsibilities... deflects questions about supervision of child... expresses anger at husband/may have anger management issues... seeks to explain fracture with low Vitamin D history/questionable Ehlers Danlos connection.” There are no notes of any contact between Dr. Johnson and the resident who put the cast on Jaden. 

They also learn that after Dr. Johnson left the ER exam room, she called the investigator and said definitively that, “There is no explanation other than child abuse. This fracture is large, displaced, and only could have resulted from the parents intentionally twisting the arm.” 

The Clarks are shocked to realize that the investigator relied upon Dr. Johnson without consulting with Jaden’s treating pediatrician or the orthopedic resident who examined and placed the cast on Jaden’s arm, the same resident who stated that this kind of fracture is common in toddlers. 

Both Sarah and Darren are overwhelmed with a sense of betrayal. Sarah tells her attorney, “I can’t believe that the same child abuse pediatric team that called the child abuse hotline was allowed to investigate their own allegation! Dr. Johnson didn’t even tell me who she was. I had no idea that her only role was to investigate child abuse! The state shouldn’t allow a single doctor to put families through this without some kind of checks and balances!”

Jaden is fine now—his arm is fully healed, and after months of delays and thousands of dollars in legal fees, Sarah finally wins her register appeal. However, the Clark’s trust in the local children’s hospital and the child welfare system is shattered, and their children now suffer from separation anxiety. 

See the following published accounts that bear a direct similarity to this amalgamated story: Dupuy v. Samuels, 141 F. Supp. 2d 1090, aff’d in relevant part 397 F. 3d 493 (7th Cir. 2005) (A.H. case); Hernandez v. Foster, 657 F. 3d 463 (7th Cir. 2011) (Humerus Fracture Case), “Linda” case and Chapter 18 story reported in D. Redleaf, They Took the Kids Last Night: How the Child Protection System Puts Children at Risk (ABC-Clio 2023), D. Redleaf, How Faint Bruises on Baby Ava Nearly Destroyed her Family (Reason, 8/6/19).

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