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Jury finds Children's not negligent in Pelletier lawsuit

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I know families who are scared to take their children with complicated medical situation to Childrens because of what happened to the Pelletiers. Too many people think that if something was done by Harvard doctors then it must have been right.

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Voting closed 37

You (and these supposed "families too afraid") didn't sit through that trial and you have no idea what you're talking about. I did. I was a juror in this trial. In a nutshell: The evidence we were presented over the almost five weeks of testimony, medical records, emails, expert witnesses, sidebars, and cross examination made it very clear to me and my fellow jurors that those doctors weren't responsible for what happened to her. It was something far more complicated. There was an established years long history presented of medical records that demonstrated a very clear pattern of doctor/hospital shopping and overmedicalization by the parents, an initial suspicion of pediatric condition falsification (fka Munchausens by proxy) which was noted in medical records by multiple providers going back years before Justina was brought to Children's, a clinical diagnosis of metabolic disease, which was later ruled out after a medical diagnosis revealed she didn't have it, parents who were abusive to staff at multiple hospitals and refused to accept that many (not all) of their daughters symptoms were the result of a somataform disorder (which appeared in records going back before she was brought to Children's), all of which came to a head after the father attempted to remove her from the hospital without a discharge plan and against medical advice (and freaked the fuck out and had to be removed by the Boston Police), and when she was in dire need of hospital treatment. Removing her from the hospital without a discharge plan (not to admit her to Tufts, as the Associated Press erroneously reports) would have resulted in furthering her issues and could have very well have resulted in death (what would these so-called "families too afraid" think of Children's if they discharged and then she died a few days later of dehydration?). Those parents were endangering her safety and only then was a 51A filed and DCF was called in. The plaintiffs' counsel was not able to prove that anyone from Children's was liable, and the defense went way beyond to demonstrate that they met, and in most cases exceeded, the standard of care. Now I am very tired after a long emotional day and have to work in the morning after serving on that jury since January 15th, but please feel free to post your (serious) questions on it here and I will do my best to answer.

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I tried to follow this in the local media. There always seemed to be something left out of this story.

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It's probably the most accurate story and the reporter put out a well written, reported, and fair article.

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Upon reading the previous comment I literally thought to myself "Yeah, but you weren't on the jury..."

Jury duty isn't easy, thank you taking the time to inform us of the context of the ruling. I suspect the conspiracy -minded supporters of the parents won't be moved, but it's good for the truth to be out there for the sake and reputation of the hospital and medical professionals involved.

Also wishing Justina the best.

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For doing your service as a citizen and also for taking the time to respond to obvious nonsense with a factual account of what happened.

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why, if the family had been taking their daughter to many places (medical shopping), that only at Children's did it escalate to a legal fight?
thanks

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Because it was at Children's where they attempted to take her away against medical advice from the critically needed medical treatment she was receiving (a recent inability to walk, talk, incontinence, etc.). She had been released from Connecticut Children's Medical Center against medical advice (as reported to them by the mother, per the notes) a day before she arrived at BCH, but she was sent home with a home treatment plan. When that plan failed, they went from Hartford to Boston Children's via a six hour ambulance ride during a blizzard in February 2013 for emergency admission there, instead of returning to the ER at much closer Connecticut Children's Medical Center. The long term pattern that was established by the medical records was also more or less discovered at Children's when doctors and staff there began calling previous providers for records, notes, and consultation, etc.

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I was on the jury for a similar case a couple years ago, and we also found for the defendants. The dirty looks we got from the plaintiffs and their lawyers were quite something. Fortunately for us it wasn't a media frenzy, despite the plaintiff's lawyers best efforts to make it one, so we didn't have to put up with what you guys are going through right now. People really don't understand the whole story unless they've seen all the evidence that the jury has. I hope you're able to get some rest and de-stress from what I know has been a tiring ordeal for you and your fellow jury members.

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I have long suspected Munchausens by proxy syndrome (and I know that it’s not called that anymore) in this case. It had all the hallmarks.

I’m my career, I have come across it once or twice. It is rare, thankfully, but potentially deadly for the victims.

I am glad that Children’s was exonerated. The parents have put this girl through hell.

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Voting closed 30

Having served on a medical malpractice jury, I know how tough that can be. Fortunately, my trial did not run for a month, but we heard a similarly harrowing tale for a very young girl who has a physical abnormality due to genetics, but the parents were convinced (by whom I'm not sure) that this was the fault of the doctors at Children's and if they'd only diagnosed her properly then a corrective surgery early on would have saved her a lifetime of problems.

We deliberated in about an hour or two but found we had all reached the same conclusion independently...the evidence just didn't hold up in the plaintiff's favor. The doctors did everything based on the scans and lab results that they could do and this was just one of those rare medical cases where her problem developed too late in life due to genetics and not malpractice for the corrective surgery to be much use at preventing the abnormalities.

You really wanted to feel for the parents in our case, because this child is clearly going to have problems in life and the parents definitely cared deeply for their kids, but there wasn't anyone to blame for the situation. Some of us after the trial commented on how it'd be better if there was some sort of state-run pool of money to assist a family, who through no fault of their own, are now having to cope with extraordinary conditions regardless of their background or anything else. Just something to ease the transition and difficulties that life brought them.

It always makes me wonder if we'd see fewer lawsuits like this if medical care was socialized. I wonder if the pressures of mounting bills and strained relationships leads us to more detrimental outcomes than just being unable to afford healthcare for those who need it most.

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Call your state reps and senators. Explain what you saw, and ask them if it might be good policy to have a fund for families in such circumstances. It should be available to children with genetic syndromes that affect developmental progression, too.

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But first, thanks for the sacrifice to perform your civic duty as a juror, and upending your life for the past month.

My question is this: While Justina was in the care of Children's and not with her parents, did her physical symptoms improve at all? I am asking because I read that her colon was removed after her release from Childrens, so obviously another facility found it medically necessary to do so. Do you have any thoughts on that? Thank you.

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So it sounds like there was likely overmedicalization, but I hate for the takeaway in this ruling be that the general public now believes there was nothing going on with this young person. That obviously isn't the case. Psychosomatic issues can cause physiological problems, so psychosomatic concerns aren't "nothing" either.

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Yes. When she was admitted, she was unable to walk, was incontinent, was unable to lift her arms, was lethargic, unable to eat, drink, or swallow, and didn’t make eye contact. After her treatment began, she was able to improve markedly (her somataform disorder was treated by psych staff and her health and socialization began to improve quite a bit -attending school in the hospital, became a caller at Bingo games in the ward, cooked and partook in activities, etc-she also underwent the longest stretch without needing emergency treatment in years while under BCH's care.

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-She did suffer from diagnosed colonic dysmotility, but many of her reported symptoms didn't match up with that condition (IE levels of pain) and had no medical explanation, was attributed to a diagnosed somataform condition (conversion disorder). She eventually had her colon removed and will rely on a colostomy bag for the rest of her life.

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Do you think Children's mishandled this case in a way that fell short of civil liability? I am concerned by the fact that her condition improved once a different hospital removed her colon.

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But we ruled it out completely because the medical records, testimony, emails, and treatment history painted a much different picture than what was presented by the plaintiffs' counsel. We found that the doctors either met or exceeded the standard of care despite the claims otherwise. The records showed that she was being treated at Children's for conversion disorder and she apparently regressed a bit after she was released (she can't walk, and slumps when sitting with no medical explanation, but then is able to bounce up and down and kick when horseback riding -she's clearly not faking of course and no one thinks she is-but that is indicative of a somatoform disorder. Her horseback riding seems to be a wonderful form of therapy for her too). The colon issue was related and there was a diagnosed medical condition, but many of the symptoms presented exceeded her condition and were attributed to the untreated somatoform disorder. Another problem overall was the plaintiffs' counsel's reliance on very unreliable and in some cases, almost unqualified expert witnesses and a lack of evidence to back up their claims. Here's an article from the Globe that was brought to my attention this morning (we were on media blackout regarding this matter during the trial of course), and in retrospect, it makes sense because when I think back to it, the plaintiffs' counsel seemed almost dejected during the last few days of the trial. Knowing this now, I don't know why anyone was surprised at the verdict.

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Why was a woman arrested after an Amber alert because she took the kid to Childrens rather than be ignored at a local ER?

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I am a court evaluator for child welfare cases. I don't know much about the Pelletier case other than things I've heard in passing from colleagues who've been involved. I can absolutely comment on Children's in general though.

Children's is well-known among child welfare attorneys and clinicians for filing reports with DCF in which they portray any disagreement with their providers or any anxious/frustrated parent as having factitious disorder imposed on another/Munchausen's Syndrome by Proxy. Most of the parents and children on whom I perform extensive psychological evaluations do not meet any such profile, and I find various combinations of complicated kids, anxious kids, anxious parents, but usually nothing that warranted a child welfare issue. An attorney in my network has a file of cases in which MSBP was alleged by Children's. These are just cases that either that attorney encountered or that were mentioned by other attorneys or clinicians. The number of cases this attorney has in this file is much greater than what experts state the prevalence of MSBP would be in the entire country over that time period. And this clearly isn't anywhere near even the total number of cases coming out of Children's. Their child protection team is seriously out of control. I have psychology and social work colleagues in various departments there who tell me it's well-known within the organization, and who tell me they have to constantly push back against the pathologizing and parent-blaming culture of the organization. Children's really likes to push this narrative that they know better than the family what's best, and it's harmful.

There has been some good reporting lately, particularly by Mike Hixenbaugh, around the problem with the so-called "child abuse pediatricians." Children's currently employs and previously has employed some scary folks who have deemed conditions to be abuse in complete ignorance of the science around these conditions.

The other thing most members of the public don't know is that DCF does not do a thorough investigation involving skilled clinicians. Their investigation response workers and ongoing social workers are usually bachelor's-level. Very very few have an LICSW/LMHC (the full master's-level independent clinician licenses) and I've yet to encounter anyone there with a doctorate. The decision that something is abuse or neglect and the decision to remove children are made by people with usually a bachelor's degree and sometimes a non-clinical master's. A lot of the investigators are good and thorough, but laws and policies don't require this and literally state that the say-so of an employee of the department equals a fact that something happened, met the legal threshold of abuse or neglect, etc. Removal decisions are eventually heard by a judge (supposed to be within 72 hours, often is several weeks), but the family is not allowed to present a defense, and the laws state that whatever the DCF worker said is a fact. Even if families are wealthy and able to get into appeals court, statements from DCF workers are still facts and the court decides they are not in a position to question fact-finding. Oh, and any action against DCF first starts in DCF's "Fair Hearings" division, which is a hearing run by a DCF worker. The courts view the decisions of the DCF worker in terms of how s/he admits and views evidence to be legally settled. If the bachelor's-level DCF worker said in the hearing that they decided the parent is delusional, then this is generally viewed as a fact all the way up through the SJC. I've seen ones where the DCF worker makes horrendously bogus claims, like where the family doesn't even own such a thing or do such a thing remotely resembling what was claimed, I don't know whether out of malice or by mixing up families or what, but it's gone to court as an established fact.

I have worked on cases where records and interviews with specialists at various places show that they've diagnosed children with various conditions (asthma, allergies, Ehlers-Danlos, autism, developmental delays, Crohn's, etc.) based on extensive evaluation. I then interview the person at Children's who says, "no, they don't have that," but didn't do any evaluation, and is focused on how the parents are crazy. There seems to be a mistaken idea there that a child can't both have a crazy parent and have a medical condition. Many of the providers will file a report with DCF over this, stating as fact that the parent states the child has X but they don't. DCF comes rushing in, because, yes, true MSBP is dangerous, and usually will align with Children's. DCF has this huge reverence for any MD, without looking at the actual training and evaluation behind something. A child can have spent hours per week for months with a speech-language pathologist who performed standardized testing and diagnosed the child with a condition that the SLP is licensed to diagnose. Then a random ER doctor who saw the child once for a sports injury files a report that the parent stated the child has a language disability but the ER doctor saw them and they don't. This is literally an example I've seen. And the system is clogged up with these bullshit cases where parents are criminalized and children are traumatized because a parent pushed back on a cocky doctor. Meanwhile, families who are actually in need of intervention can barely see their worker because there are so many families in the system.

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What upset me and those I know at the start of this was that Children's had prevented the girl's long-time doctor from Tufts from seeing her or consulting. To me, this was a red flag that minds had been made up prematurely and were not going to change.

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I don't think I knew that detail, or didn't recall it if I did, but it's typical of the attitude both at Children's and at DCF. I constantly hear folks from both organizations dismiss another provider saying, "Oh, s/he's aligned with the family." They've completely lost the idea that we are in helping professions and our work is based on relationships and empathy. Of course as providers we need to set limits and talk people out of things sometimes, but this doesn't mean and shouldn't mean that we're adversaries. It's absolutely not any kind of red flag when a provider views a patient as a fellow human being. It's a red flag when they don't. Children's and DCF both frequently like to take an approach to complicated families where you don't empathize in any way, you don't tell them what's going on, and you treat them as criminals. It's traumatic to children, and it makes parents much more protective of their children and distrustful of providers. It's also pretty much the opposite of what experts recommend. Like, why wouldn't you let the family involve the provider they're comfortable with, and you all make the decisions together? Have you convinced yourself that they're a fake doctor who is doing the completely wrong things? And if that's the case, why aren't you reporting them?

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The law did. The metabolic doctor at Tufts didn't have admitting privileges to Children's and therefore was legally barred from treating her there. The Children's doctors certainly did consult with him as is the established standard of care. There were pages and pages of medical records and emails in the case file to confirm this (which, by the way, are all now part of public record, so feel free to look it up at Suffolk Superior Court, it's case 16-474). At a certain point, it became quite obvious to us that he didn't want to continue treating her, and strong indications that he didn't want to deal with this family, hence his suggestion that they take her to Children's in the first place.

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Pediatric symptom falsification (fka Munchausens by proxy) was only listed as a concern (not a diagnosis, which involves a long multidisciplinary process) on the emergent 51A due to reports of the same by multiple previous providers on record going back years that listed it and overmedicalization as a concern. The hospital only got DCF involved when her safety was threatened by the parents' actions: when they showed up unannounced and attempted to discharge her without a discharge plan when she was unable to walk, slurred her speech, was incontinent, and in was need of an nasal gastric tube to provide hydration and sustenance. She could not be discharged from there unless there was a valid plan to bring her somewhere else that could offer hospital care, and they didn't have one. Her safety was severely threatened and the parents' actions triggered the legally mandated 51A report (not to mention the parents' unhinged and outrageous behavior which turned out to be a precursor to their continued obstruction to her care throughout the ordeal). Boston Children's Hospital doctors had no choice at that point but to file the emergent 51A and bring in DCF to perform a 51B investigation (it was the attending physician's first time filing a 51A, despite being there for several years at the time). Custody to DCF was then later granted by the Juvenile Court after a hearing at which the parents were represented by counsel, Justina was represented by counsel, and DCF was represented by counsel (oh and the Juvenile Court hearing notes were a doozie, including records of threats of physical harm made by the father against several parties, including a DCF LICSW).

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Who is this dr in CT going along with this BS?

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I'm guessing that her parents just don't think the same way I do. I would have been worried about subjecting my daughter to a very public trial. I would have also wondered whether I really had a strong case.

They aren't "bad" parents. I believe they really do love their daughter. I just think, at this point, her best interests would be served if someone else was in charge of her care.

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That person is named Justina. She's an adult now.

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After ruminating on this for a few days and letting the experience settle in my mind and as my thoughts get more organized, I can say this: the plaintiffs' legal team did not offer a whole lot of substance in this case. I wanted to give them the benefit of the doubt and I was rooting for them to tell their story, as I was rooting for both sides at the beginning. Most of their experts just weren't credible or even qualified in some cases, and there were inconsistencies and big holes in their narrative and there was no real tangible evidence that made their case. At some points in the trial, it seemed that the plaintiffs were even making the defense's case. I thought to myself at some points "why are they even offering this? Are they trying to get ahead of this evidence that could be damaging to their case by presenting it themselves?" It just didn't make sense. The defense offered a much better story, a clear timeline and on top of that very clear evidence in the form of mountains medical records, phone records, emails, contemporaneous notes, and a slew of very credible expert witness testimony.  

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Voting closed 7

I find it very unfortunate that our legal system favors the party that has money for better lawyers.

I'm not sure what the alternative is. But with the current system, it's really hard to fight a big hospital or corporation, even when the facts of the case should mean you totally deserve to win according to fairness and the law.

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That anons feel the need to chime in with cynical comments on things they clearly know nothing about.

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