Reporting Highlights
- A New Medical Specialty: Little one abuse pediatricians diagnose and doc indicators of abuse. Their work has come underneath rising skepticism for the frequent use of the shaken child syndrome analysis.
- Some Controversial Diagnoses: Dr. Nancy Harper, a Minnesota baby abuse pediatrician, has been criticized by medical doctors, attorneys and even a decide for a way she dealt with some circumstances of alleged baby abuse.
- The Worth of Criticism: Dr. Bazak Sharon mentioned he misplaced his job after questioning how Harper and her crew made abuse diagnoses. Hospital officers mentioned he didn’t comply with applicable protocols.
These highlights had been written by the reporters and editors who labored on this story.
On a February afternoon in 2022, Dr. Bazak Sharon logged right into a distant video assembly from his house workplace in Minneapolis. He propped up his cellphone subsequent to his laptop computer and hit file on a video app.
There have been a number of individuals within the assembly with Sharon, who on the time was a pediatrician with the College of Minnesota. Two hospital leaders, Sharon’s boss and a lawyer had been there, too. However the particular person Sharon was most cautious of was within the lower-right nook of the grid of faces: Dr. Nancy Harper, the director of the kid abuse crew at College of Minnesota Masonic Youngsters’s Hospital in Minneapolis.
Sharon suspected that the dialogue, concerning the care of a 3-month-old named Hank, was going to be contentious. He anxious that sometime, maybe even in courtroom, he would possibly want proof of his position caring for Hank. He was ready to argue with Harper if she challenged his medical judgment, however it was shortly obvious that the standard of the care he offered was not at concern.
Hank was born small and was not consuming effectively or gaining sufficient weight; generally, in keeping with his dad and mom, he simply gave the impression to be in ache. (ProPublica is utilizing a nickname for the kid on the dad and mom’ request.) At an appointment in January, a physician ordered an endoscopy, a process the place a tiny digital camera is threaded by the physique, and in addition steered an MRI.
The scans of Hank’s mind confirmed fluid pooled underneath either side of his cranium. The blood was outdated, presumably months outdated, and Hank was admitted to the hospital. Sharon met him the following day.
A member of Harper’s crew named Dr. Caroline George additionally evaluated Hank that day. In her opinion, in keeping with courtroom data, the bleeding was “in keeping with abusive head trauma.” Sharon had steered different attainable causes, together with an harm from start, an an infection and even spontaneous bleeding. Sharon wrote within the baby’s medical file that it’s “doubtless we are going to by no means determine the precise mechanism that triggered his harm.”
Three days after Hank was admitted, Sharon mentioned he discovered {that a} county baby safety companies employee was making ready to return to the hospital to take custody of the newborn, in addition to his 2-year-old brother, William.
Sharon mentioned that he was shocked that nobody had spoken to him since he was Hank’s main physician. So he did one thing that appeared to place him at odds with George, Harper and hospital management: He instructed Hank’s dad and mom, CPS and police he didn’t suppose the bleeding alone was sufficient proof to say this was abuse.
Sharon was additionally involved that separating a sick toddler from his dad and mom based mostly solely on a suspicion of abuse would trigger extra hurt to Hank. Working with the detective assigned to the case, he admitted William, although the older boy was not sick, in order that the entire household may keep within the hospital underneath the supervision of a nursing assistant whereas medical doctors continued to deal with and monitor Hank.
However 4 days later, in keeping with Sharon, his supervisor instructed him that he was being faraway from Hank’s care crew, and that he shouldn’t talk additional with the dad and mom. When Sharon requested why, he mentioned he was instructed it was at Harper’s advice. “The care,” he mentioned, “modified the second she bought concerned.”
In lower than 48 hours, a decide decided that Hank and William had been in want of kid safety companies and their dad and mom had been pressured to go away the hospital with out them. The identical day, Sharon mentioned, he was summoned to the primary of two conferences with hospital management and Harper. When his supervisors scheduled the second assembly — titled “Evaluation of CPS Affected person” within the emailed invitation — lower than a month later, Sharon got here ready to file it.
Earlier than all this, Sharon had an appreciation for Harper’s formidability and for her affect on the earth of kid abuse pediatrics. She started her profession as a pediatrician within the U.S. Navy earlier than main a baby abuse crew at a hospital in Texas. In 2014, she grew to become the director of the College of Minnesota’s Middle for Protected and Wholesome Youngsters.
An authorized baby abuse pediatrician for nearly 16 years, the 56-year-old Harper consulted on suspected circumstances of abuse for a number of Twin Cities hospital programs, testified as an knowledgeable witness in baby abuse trials throughout the U.S. and lectured on diagnosing indicators of abuse. She was additionally the vp of the Ray E. Helfer Society, a nationwide nonprofit group for physicians who work on the medical features of kid abuse and neglect, and she or he grew to become its president in 2023.
Credit score:
Coburn Dukehart/Wisconsin Watch
Sharon, now 53 years outdated, was additionally well-respected. Initially from Israel, he got here to the U.S. in 2003 to proceed his medical research. He started as a fellow on the College of Minnesota in 2006 and had been on college for 12 years. Specializing in infectious ailments, he grew to become medical director of the college’s pediatric COVID-19 clinic and was a contributing member of the state Well being Division’s Lengthy COVID Guiding Council. Sharon was additionally a hospitalist, which means he directed the look after admitted sufferers like Hank, coordinating with different medical doctors and specialists.
As the net February assembly progressed, it grew to become clear to Sharon that, in a face-off with Harper, his medical experience and the truth that he thought-about lots of the individuals on the decision to be buddies counted for little. The lawyer famous that differing medical opinions may open the hospital or the medical doctors themselves as much as a lawsuit. George added that the variations in opinions had additionally “made issues troublesome for significantly legislation enforcement.”
“I’m not a baby abuse knowledgeable,” mentioned Dr. Sameer Gupta, the chief medical officer of the hospital, on the decision. “However, you realize, my expertise is that this: Attempt to be fully aligned. That’s one story that’s coming from the medical crew as a lot as attainable, to keep away from the potential for, one, litigation, two, to let the consultants actually drive the ship.”
Sharon grew to become more and more agitated through the name, shaking his head. He was offended that the dialog had revolved round protocols and the hospital’s authorized liabilities, reasonably than Hank’s care.
“I believe I did the most effective any physician can do at that time in ensuring that my affected person is getting the most effective care whereas I’m not making an attempt to cover any potential abuse,” he mentioned through the assembly, the video of which he shared with ProPublica. “I felt very uncomfortable that CPS are displaying up unannounced and taking two youngsters away from the dad and mom with out having a dialogue with the medical doctors who maintain this affected person. I hope nobody expects me to not say one thing when that occurs in entrance of me.”
However Harper appeared to recommend that Hank may need been seen by too many medical doctors, and that Sharon had interfered along with her crew’s potential to “body” the case to CPS and legislation enforcement. She mentioned she didn’t think about it her position to be involved about what may occur to a household after a analysis.
“Sadly,” she mentioned, “if I spent all of my time worrying about … what’s going to occur with baby safety and foster care or the associated fee for the authorized stuff afterwards, I wouldn’t be capable of do my job.”
Sharon started to protest. He mentioned he had been studying the scientific literature on abusive head trauma and located it unconvincing, a conclusion an increasing number of medical doctors had been coming to. Harper lower him off. “If I spent two weeks studying the literature on COVID, would you think about me as certified as you’re?” she requested. “I’ve been doing this for many years.”
Gupta abruptly shut down the dialog. He mentioned that Sharon’s plan to maintain the household within the hospital was the “fallacious determination and can by no means, ever occur once more,” after which he ended the decision.
Because the display screen went clean, Sharon set free an extended, deep sigh. Although disturbed and pissed off, he didn’t but understand his actions on behalf of Hank and his household would have an effect on his profession. Over time, Sharon got here to see Harper as the primary driver of a marketing campaign to get him to fall according to the kid abuse crew.
“She’s very black and white, proper and fallacious, no grey space,” he mentioned, “which isn’t the best way to do drugs or pediatrics.”
Harper didn’t reply to requests for remark. She and a spokesperson for College of Minnesota Physicians, which is the medical follow for the college’s medical college college, additionally didn’t reply to an in depth listing of questions. However the spokesperson wrote that the Otto Bremer Belief Middle for Protected and Wholesome Youngsters, as it’s now referred to as and which is led by Harper, offers “trauma-informed medical care and psychosocial help whereas addressing analysis, prevention, advocacy, coverage and training.”
“When healthcare suppliers and group organizations refer sufferers to CSCH, the crew solely makes selections about diagnoses and subsequent medical care based mostly on knowledgeable evaluation of medical proof (e.g., medical historical past, bodily examination, lab and radiological findings, enter from different medical specialists and data offered by caregivers),” the spokesperson added. “Additional investigations and authorized determinations are exterior of our crew’s scope.”
A spokesperson for Fairview Well being Providers, which owns Masonic Youngsters’s Hospital, mentioned in a press release that though Harper is an worker of College of Minnesota Physicians, “we clearly take these issues critically and are actively reviewing the matter.”
“Our highest precedence is the security, dignity, and wellbeing of our sufferers and households — particularly in moments of disaster. We’re conscious of issues being raised concerning the conduct of a College of Minnesota Physicians (UMP)-employed supplier who practices in a UMP-led clinic inside the M Well being Fairview Masonic Youngsters’s Hospital,” the spokesperson added. “We’re in shut communication with our tutorial companions and are evaluating any steps we could must take to protect the belief our sufferers and households place in us.”
Harper’s arrival in Minnesota coincided with the fallout of a high-profile tragedy: the 2013 dying of 4-year-old Eric Dean.
Dean lived along with his household in sparsely populated Pope County, in west-central Minnesota. In line with an investigation by The Minnesota Star Tribune, academics and caregivers reported indicators that Dean was being abused to baby safety employees at the least 15 instances earlier than his stepmother threw him throughout a room, inflicting accidents that may kill him. She is in jail serving a life sentence.
In response, then-Gov. Mark Dayton signed an government order in 2014 creating the Governor’s Process Drive on the Safety of Youngsters. The following 12 months, together with a slew of different reforms, the state Legislature created a $23.35 million grant to provide counties cash based mostly partially on the variety of open baby safety investigations.
She’s very black and white, proper and fallacious, no grey space, which isn’t the best way to do drugs or pediatrics.
The variety of baby abuse circumstances soared. As an example, in Hennepin County, the place Minneapolis is positioned, circumstances of bodily abuse greater than doubled from 2015 to 2016, earlier than dropping over the following a number of years. Little one abuse consultants attributed the rise to what Joanna Woolman, a legislation professor who makes a speciality of baby abuse legislation, referred to as “a second of hyper-awareness round medical baby abuse and baby abuse basically.”
“We had been convening a process pressure that was closely made up of individuals with the view that we would have liked to do extra, have extra eyes on, be extra conscious,” added Woolman, who can also be the chief director of the nonprofit Conserving Households Linked Minnesota, which offers free authorized companies to households going by baby safety proceedings.
A subspecialty of pediatrics first acknowledged by the American Board of Pediatrics in 2006, baby abuse pediatrics focuses on the analysis and documentation of indicators of abuse. A analysis can assist decide whether or not a mum or dad loses custody of their baby or faces felony investigation. In circumstances the place youngsters die, it may well imply homicide costs. Harper was one of many first licensed baby abuse pediatricians within the nation — the board counts over 350 subspeciality certifications nationwide — and is one among seven presently licensed in Minnesota.
“Physicians with much less coaching on baby abuse and neglect each over- and under-identify accidents in youngsters, whether or not they’re bodily abuse accidents, sexual abuse accidents,” she testified in a 2019 trial. “A toddler with a missed harm may come again later with a extra severe harm and even die. And so these are kind of points the place we understand that we would have liked experience.”
Harper was employed as director of the Middle for Protected and Wholesome Youngsters by the College of Minnesota the identical 12 months as Dayton’s government order. In line with testimony she gave in a 2019 felony trial, the college recruited her to construct up the middle and create a regionwide baby abuse session system.
“After I’m on name, I might be overlaying as much as six totally different locations the place youngsters might be seen,” Harper testified.
In 2016, the Otto Bremer Belief, a non-public charitable group based mostly in St. Paul, introduced a $2.5 million grant to fund Harper’s ambitions to develop the middle, which relies at Masonic. Harper can also be program director for the college’s Little one Abuse Pediatrics Fellowship, a three-year coaching program, giving her affect over the following technology of kid abuse pediatricians. A spokesperson for the belief added that it doesn’t have any “position within the day-to-day operations of the Middle.”
Hennepin County has a contract with Harper’s employer, College of Minnesota Physicians, to supply medical session, knowledgeable witness testimony and case session with county attorneys. In line with testimony Harper has given prior to now, she and her crew deal with about 700 circumstances of suspected abuse annually. She has testified that 10% to twenty% of these wind up confirmed for bodily abuse, though it’s troublesome to find out if these figures are correct since baby safety case data are usually not public. She has given totally different solutions on the witness stand when requested if she has ever testified for the protection; in 2021, she mentioned she’d testified for the protection in a “half dozen or a dozen” circumstances. In 2023, she mentioned she’d carried out so twice.
In 2018, Harper’s middle started cohosting an annual Little one Abuse Summit with the Hennepin County Legal professional’s Workplace. In 2022, she acquired an introduction throughout a panel dialogue from Dan Allard, senior assistant Hennepin County lawyer, that illustrated the shut relationship between Harper and her crew and county prosecutors.
“In case you haven’t heard Dr. Harper testify, she does a beautiful job. She is aware of her stuff,” Allard, who can also be the pinnacle of the county lawyer’s baby abuse crew, mentioned on the summit. “We simply barely attempt to sustain understanding what she’s speaking about. So we simply form of let her go.”
In response to an in depth listing of questions, Daniel Borgertpoepping, a spokesperson for the Hennepin County Legal professional’s Workplace, wrote, “Since our workplace represents Hennepin County in CPS issues, we’re unable to remark.”
Earlier than Sharon’s encounter with Harper, he hadn’t given a lot thought to her crew’s practices, which included evaluating and treating a few of the worst circumstances of bodily and sexual abuse of kids. Whereas he mentioned he had referred a dozen or so circumstances of suspected neglect to her crew, he seen their work as a bleak aspect of pediatrics. He was pleased to keep away from it.
“I had a variety of respect for the kid abuse medical doctors, like, ‘Thanks for doing that for us,’” he mentioned.
However for roughly 15 years, the world of kid abuse pediatrics has been roiled by criticism of the analysis as soon as referred to as shaken child syndrome and now categorized underneath the umbrella time period abusive head trauma. A triad of signs — mind bleeding, mind swelling or harm, and blood within the retina — was as soon as thought-about proof {that a} baby had been violently shaken, even when there have been no different accidents and even bruising.
In courtroom testimony, Harper has mentioned that each shaken child syndrome and abusive head trauma are thought-about scientifically legitimate diagnoses by “the mainstream medical group,” and that the controversy is extra of a authorized one than a medical one. She has acknowledged there are medical situations that mimic attainable indicators of abuse, together with bruises, bone fractures and head trauma signs, however she mentioned that her assessments take all of that into consideration in live performance with specialists like neurosurgeons and radiologists.
“We take a really detailed historical past from the household. We do a bodily examination, take a look at previous medical historical past, different medical situations, the preliminary laboratory and X-ray stories,” she testified in 2023.
Sharon readily concedes that he wasn’t an knowledgeable in baby abuse drugs. However as he and the opposite medical doctors tried to know the bleeding in Hank’s mind in addition to his lack of weight achieve, he spent his evenings studying the scientific and authorized literature about shaken child syndrome and abusive head trauma, scribbling notes to himself. He learn a key American Academy of Pediatrics assertion reaffirming its perception within the diagnoses; he additionally learn research that challenged the science underlying them.
“It’s fallacious to fail to advise dad and mom and courts when these are merely hypotheses, not confirmed medical or scientific info,” Sharon wrote on a duplicate of 1 legislation evaluate article.
He examine how the primary neurosurgeon to posit the speculation of shaken child syndrome mentioned in an interview years later that he was “disturbed that what I supposed as a pleasant suggestion for avoiding harm to youngsters has change into an excuse for imprisoning harmless dad and mom.” In line with the Nationwide Registry of Exonerations, over 40 individuals convicted in circumstances associated to the analysis have been exonerated for the reason that Nineties, usually over rising doubts that the three signs might be interpreted so definitively.
Sharon additionally discovered that the subspecialty of kid abuse pediatrics itself has additionally been underneath rising scrutiny. Maybe probably the most well-known baby abuse pediatrician case grew to become the idea for the Netflix documentary “Take Care of Maya,” through which a 10-year-old lady’s ache syndrome was recognized by a baby abuse pediatrician as Munchausen syndrome by proxy. A jury discovered the hospital chargeable for medical malpractice and awarded the household over $200 million; the hospital has appealed. A number of households are suing a Pennsylvania hospital for what they are saying are false diagnoses of abuse by Dr. Debra Esernio-Jenssen, who led its baby abuse crew. A sequence of allegations of overzealous diagnoses of abuse have adopted Dr. Barbara Knox from her job main a baby abuse crew on the College of Wisconsin to comparable positions in Alaska and on the College of Florida.
The kid abuse pediatrician group is tightknit. After Knox left Wisconsin, Harper changed her as an knowledgeable witness in some felony circumstances. Esernio-Jenssen wrote Harper a nomination letter for a Ray E. Helfer Society award, calling her “an unstoppable pressure.”
Esernio-Jenssen and Knox, in addition to the Helfer Society, didn’t reply to requests for remark. In a response to the lawsuit, attorneys for Esernio-Jenssen and her former hospital community wrote that they “are being attacked and demonized for shielding youngsters from abuse and following the legislation,” and that the allegations of bad-faith abuse investigations are “clearly unfaithful.” The lawsuit is ongoing.
Knox was sued by two households in Alaska who accused her of leveling false accusations of abuse in opposition to them. In response, Knox mentioned in an affidavit that she has no say over whether or not baby safety takes youngsters away from their dad and mom, that she didn’t “conspire” with police or anybody else on custody points or felony prosecution, and that she didn’t personally consider one of many named youngsters. The lawsuit was dismissed in 2024 after the households agreed to drop the matter.
In line with a spokesperson for the College of Florida, Knox resigned her job there as a pediatrician with the Little one Protecting Workforce, efficient Aug. 15. He declined to touch upon the circumstances.
From the beginning, Sharon thought what was taking place to Hank — a baby battling consuming and weight achieve, with irregular outcomes on his endoscopy and weeks-old, unexplained cranial bleeding with out every other signs of abuse — match into his wheelhouse treating complicated and even mysterious circumstances greater than it match into Harper’s. After poring by the literature on abusive head trauma, he was much more satisfied.
Sharon adopted his supervisor’s instruction to not communicate to Hank’s dad and mom. However after the couple’s lawyer approached him, he offered a five-page account of Hank’s medical therapy. He included a number of potential different diagnoses.
“It’s clear to me that lacking baby abuse is as severe as lacking bacterial meningitis and needs to be thought-about as malpractice,” he wrote. “But additionally, as a hospitalist, who regularly handle youngsters with out clear definitions of their analysis, I’m used to ambiguity.”
Dr. Matthias Zinn, Hank’s neurologist, agreed with Sharon that the fluid in Hank’s mind, what he referred to as “subdural collections,” couldn’t be definitively tied to abuse. He offered a letter to the couple’s lawyer as effectively. Zinn, who mentioned he’s consulted on a whole lot of circumstances of suspected abuse, mentioned Harper’s baby abuse crew was by far probably the most aggressive he’s labored with.
“It was simply loopy,” he mentioned. “I bear in mind talking to them and saying, ‘What proof do you might have, apart from the subdural collections?’ They usually made it clear that they didn’t respect my opinion.”
Zinn has since left the College of Minnesota for a place in Florida.
Each a CPS investigator and a police detective spoke to Sharon repeatedly, and in keeping with Hank’s dad and mom, in addition they relayed Zinn’s opinion and begged CPS to speak to him as effectively. However the CPS petition alleging Hank was a sufferer of abuse solely cited George’s evaluation. There’s no point out of Sharon or Zinn.
George didn’t reply to requests for remark.
A spokesperson for Hennepin County declined to touch upon particular person circumstances or to answer an in depth listing of questions. However she offered a press release from Kwesi Booker, the director of Hennepin County Youngsters and Household Providers, which oversees baby safety companies. In that assertion, Booker mentioned “baby safety social employees appropriately depend on the subject material experience of skilled medical professionals in conditions involving complicated medical points.”
Unable to let the matter go, Sharon wrote letters to the hospital’s management council about what he referred to as “harmful overreach” by Harper’s baby abuse crew. In response, Gupta mentioned he referred the letter for evaluate to the hospital’s Committee for Skilled Enhancement. Citing privateness legal guidelines, hospital directors wouldn’t inform Sharon the result of the committee’s evaluate.
Individually, Gupta wrote Sharon a “peer evaluate” letter informing him that, in a number of of his circumstances, there have been issues about his conduct, professionalism and a disregard for hospital protocol. Sharon mentioned he was conscious of his fame for being strong-willed and, at instances, dismissive and even impolite to colleagues. The letter warned him in opposition to doing something that might be seen as “retaliatory” towards different members of the workers. Gupta gave three examples associated to Sharon’s purportedly improper procedures for prescribing medicines for pediatric COVID-19 sufferers; he additionally referred to Sharon’s interplay with the kid abuse crew.
“Your documentation within the chart and communication with legislation enforcement was opposite to what was being acknowledged by the kid abuse crew,” Gupta wrote within the peer evaluate letter. “This created confusion with the group employees and with the household in a scenario through which consistency is essential.”
Gupta didn’t reply to repeated requests for remark or to an inventory of questions.
Hank’s household had a restricted view of what was occurring behind the scenes at Masonic Youngsters’s Hospital, although Hank’s mom, Kay, labored within the neonatal intensive care unit there. She acknowledged Sharon and knew of George, although she hadn’t labored intently with both. As a result of Hank’s dad and mom each work within the pediatric discipline and for the privateness of their youngsters, they requested that ProPublica not use their full names.
The day after Hank’s admission, Kay and her husband, Ross, defined to George concerning the child’s problem with breastfeeding, his inexplicable ache and his incapability to tolerate formulation. When George requested her about attainable accidents or accidents, the one factor Kay may consider was a time when she was driving and slammed on the brakes with Hank in his automobile seat.
After she learn the CPS petition alleging her youngsters had been victims of bodily abuse, Kay mentioned that she got here to suspect that George had been making an attempt to gather info to make use of in opposition to her and her husband, to not deal with Hank.
“I believe she was sitting there hoping that I used to be simply going to admit or inform her that I assumed my husband may need carried out it,” Kay mentioned. “And I used to be simply hoping that she was going to assist me.”
Whereas Hank and William had been in foster care, police confiscated the couple’s cellphones, laptops and child displays, and interviewed numerous relations and buddies. In April 2022, Hennepin County determined to not pursue felony costs.
CPS discovered no extra proof of abuse, and after practically 4 months, a decide ordered each boys returned to the couple, although it was on the situation {that a} grandparent stay within the house full time as effectively. In June, simply earlier than a trial to find out if Hank had been abused, CPS agreed to start the method of dismissing the matter, although the company nonetheless made a “discovering of maltreatment” by an “unknown offender.”
In late July, the Hennepin County Legal professional’s Workplace signed off on the dismissal. It had been practically seven months since Hank was first admitted to the hospital.
Across the similar time, Kay and Ross took Hank for genetic testing, which confirmed he carried an irregular gene duplication with unknown results. He was additionally placed on remedy that resolved his abdomen sensitivity points and elevated his urge for food. One among Sharon’s theories was that the bleeding underneath his cranium was on account of poor feeding, dehydration or vitamin deficiency, although nobody has been in a position to determine a definitive trigger.
“He’s simply been our little thriller child, however he’s a lovely, wholesome, thriving little 3-year-old,” Kay mentioned.
William, she mentioned, nonetheless has nightmares about being taken from his dad and mom. At 5 years outdated, he insists on sleeping of their mattress each evening. Defending themselves, Kay mentioned, plus the price of extra caregivers amounted to roughly $100,000 for the household.
Kay by no means met Harper and solely later got here to know the position she performed. As a result of there was no trial, she by no means had the possibility to confront Harper or George, or lay out any of the arguments that she and her husband had been falsely accused of abuse.
However simply earlier than the case closed, Kay noticed an commercial for the 2022 Little one Abuse Summit, with Harper as a featured panelist. She purchased a ticket to the occasion and sat proper in entrance of Harper.
“They do these items and possibly by no means must see the individuals once more, exterior of locations the place they’re in cost,” she remembered considering. “You’re going to must see me.”
Sharon didn’t comprehend it on the time, however he was removed from the one particular person struggling lately to maintain a household from dropping their youngsters after Harper’s involvement. In his job as an lawyer for indigent dad and mom at Hennepin County Grownup Illustration Providers, Scotty Ducharme has handled horror tales and seen circumstances of utmost baby abuse up shut. However when allegations have arisen nearly solely from a medical analysis from a baby abuse pediatrician, which he calls a “CAP,” he has additionally seen indicators that not all of the medical doctors on the kid’s therapy crew are in lockstep.
“In case you learn the medical data written by the CAPs versus the common medical doctors within the circumstances I’ve labored on, you possibly can see the breadcrumbs by the common medical doctors who don’t consider what the CAPs are saying,” he mentioned. “I’ve solely caught, on the file, medical doctors instantly contradicting one another a couple of instances.”
Within the spring of 2023, Ducharme met María Alejandra Ramírez Rodríguez and her husband, Cristian Andrés Guzmán de la Ossa, a pair of their 20s. Current arrivals from Colombia who spoke no English, they introduced their 4-week-old son to Hennepin County Medical Middle in Minneapolis after noticing bruises on his thighs, again, brow and face. That they had taken pictures of earlier bruises as effectively, which they shared with medical doctors. (ProPublica isn’t naming the kid to guard his privateness.) The couple additionally introduced him to the hospital when he was 12 days outdated as a result of his umbilical stump wouldn’t cease bleeding.
Harper examined the newborn and reviewed X-rays of his skeleton. The outcomes had been alarming; he had 14 therapeutic rib fractures, in addition to fractures in his legs and arms in numerous states of therapeutic. Harper wrote that the newborn was “at grave danger for additional harm, morbidity and mortality,” and the Hennepin County Legal professional’s Workplace filed an expedited petition to completely sever the dad and mom’ rights. The newborn was positioned in foster care with a lady who labored as a nurse.
When Ducharme appeared on the medical data, he noticed that the newborn had gone by a variety of blood checks, together with ones to examine for clotting issues. A number of metrics had been marked barely exterior of the conventional vary, together with a studying for a protein tied to a genetic clotting dysfunction referred to as von Willebrand illness. Ducharme zeroed in on a selected notice, maybe a “breadcrumb,” written by the pediatrician who noticed the newborn earlier than Harper; he wrote that the newborn would wish extra comply with up from the hematology division “if extra bruising develops.”
Whereas within the care of the foster mum or dad, the newborn developed new bruises and Harper evaluated him once more. A brand new abuse investigation was opened in opposition to the foster mum or dad, and he was moved to a second foster household — on this case, a pediatrician and her husband. As soon as once more, the newborn developed new bruises, in keeping with his visitation supervisor.
“That is medical, one thing bizarre is occurring right here,” Ducharme remembered considering.
However in keeping with notes from the CPS investigator, Harper declined to vary her willpower or to carry out extra blood clotting dysfunction checks as the primary physician had suggested: “Wouldn’t be any totally different now so they didn’t repeat these checks,” he wrote. He added that in Harper’s opinion, whoever bruised the newborn in April was the most probably offender in subsequent incidents.
In her notes, Harper additionally questioned whether or not the marks observed on the newborn whereas he was dwelling along with his second foster household had been true bruises. As an alternative, prosecutors posited a brand new concept within the case: that Ramírez and Guzmán had been surreptitiously abusing their son throughout visits, although the visits had been supervised by a lady who works as an observer in CPS circumstances. To Ducharme, that strained credulity. He grew to become involved that Harper was too unwilling to vary her diagnoses, and that prosecutors had been reluctant to problem her.
“She has this stage of cachet with prosecutors, it’s like a trauma bond. I’m positive she’s proper greater than 90% of the time,” he mentioned. “They’re unwilling to see her failures.”
However not everyone seems to be. In a number of circumstances lately, judges and juries have discovered Harper’s diagnoses unconvincing. In 2024, a Wisconsin decide barred Harper from telling the jury {that a} baby died as the results of “abusive head trauma, non-accidental harm, baby abuse, or homicide.”
“Dr. Harper sees herself as an advocate, at the least partly, and this blurs her position as scientist and clinician with the position of advocate in opposition to baby abuse, additional calling into query her constancy to the scientific validation of abusive head trauma diagnoses, particularly when it’s a shut name,” the decide mentioned.
In one other Wisconsin case, Paul Marshall was discovered not responsible in 2023 of shaking his 7-week-old son, Fox, to dying. Harper examined the boy at Youngsters’s Minnesota, a hospital in St. Paul. A spokesperson for Youngsters’s Minnesota declined to touch upon the case.
“We had been put by the grinder,” Marshall mentioned. “We don’t get our son again, and we don’t get a variety of the closure that we should always have had as a household. That was robbed from us.”
After Ducharme grew to become satisfied that there was a medical rationalization for Ramírez’s child’s accidents, he ready a memo that identified a variety of attainable contributing elements, together with that Ramírez had gone days with out consuming whereas she was pregnant and touring throughout the U.S.-Mexico border from Colombia and had a troublesome supply in Minneapolis. Ramírez bought her personal medical data from Colombia which confirmed that, as a baby, she’d additionally skilled unexplained bruising.
To problem the prosecutors’ concept that the newborn’s new bruises had been from additional abuse by the dad and mom, Ducharme spoke to their visitation supervisor. She offered a sworn affidavit saying that she didn’t witness any abusive habits from the dad and mom, and that she’d change into so confused partly from the stress to say she had witnessed abuse that she requested to be taken off the case. She additionally wrote that CPS employees had been mendacity to and concerning the couple, claiming that the foster dad and mom spoke Spanish, which they didn’t, and that Ramírez and Guzmán had been unreliable about conserving visitation appointments.
“The dad and mom attended each go to. They by no means cancelled,” the supervisor wrote. “Even when their tire popped on the best way to their first supervised visitations, they bought an Uber and had been solely about 5 minutes late.”
A decide dominated that there was “no proof” that the dad and mom had been abusing their child at visits and ordered a second medical opinion. However earlier than that would occur, the county agreed to drop the termination of parental rights petition after Ramírez and Guzmán agreed to acknowledge that their son “sustained severe harm” whereas dwelling with them, with out admitting guilt. The case was transformed to a daily baby safety matter, which allowed the couple to have house visits. They ultimately regained custody, and the case was closed in April 2024.
“There’s no accountability. There’s no discovering of reality,” Ducharme mentioned. “You suppose: ‘You get your child again. None of the remainder of it issues.’ However it issues.”
The couple discovered your entire expertise bewildering and traumatic. Though they’re now reunited, they missed six months of their new child son’s life. Ramírez didn’t have the possibility to breastfeed after the primary foster mum or dad started feeding her son formulation as an alternative of the breast milk she was pumping.
“We didn’t see him crawl. We didn’t see him flip over —” Guzmán mentioned.
“We didn’t see him sit up,” Ramírez mentioned.
Though they fear about doing something which may draw consideration from immigration authorities, in late Could they filed a federal civil lawsuit in opposition to Harper and the establishments she works for. Ducharme, who left his job at Hennepin County and is now in non-public follow, is representing the couple within the lawsuit, which alleges that Harper acted in “dangerous religion,” and that due to her actions there was no “real investigation” into the newborn’s medical situation.
In line with a spokesperson for Harper’s employer, College of Minnesota Physicians, they haven’t been served with the lawsuit but and haven’t responded to the allegations.
“Why, after they didn’t discover any bodily abuse, did the hospital not preserve doing exams to see if there was one thing medically fallacious with him?” Guzmán requested. “They robbed us of our baby with none actual rationalization.”
In late Could 2023, a 12 months and a half after Hank’s case, Sharon was on his manner house from work when he bought a cellphone name. A brand new case had come into the emergency room at Masonic Youngsters’s Hospital that wanted his session: a 3-month-old boy named Daniel. An MRI had proven fluid on his mind. CPS was already investigating whether or not this was abuse.
“Not once more,” Sharon recalled considering. He turned his automobile round.
On the hospital, he discovered the weird circumstances that had introduced Daniel to the hospital: His mom, a pediatric nurse, had volunteered her son for an instructional examine that wanted the MRIs of wholesome youngsters as a baseline. Somebody on the analysis crew famous fluid in Daniel’s mind, and a report was made to baby safety companies.
After assembly with the dad and mom, inspecting Daniel and reviewing the MRI report, Sharon wrote up a one-page notice. Amongst different issues, he really useful that CPS proceed assessing Daniel for attainable abuse. However after what had occurred with Hank’s case the 12 months earlier than, Sharon additionally put his views on the file.
“One ought to follow excessive warning attributing remoted intracranial fluid assortment to abusive head trauma when no extra medical indicators or signs are discovered,” he wrote, “because the proof to help that is controversial and has been questioned by many authorities (medical in addition to authorized).”
After a day within the hospital, Daniel and his dad and mom, Grace and Paul, had been allowed to go house collectively, though they mentioned the CPS investigation remained open for a month. George, the identical physician concerned in Hank’s case, requested Daniel’s dad and mom to carry him again two weeks later, the place Grace mentioned he screamed as he was pinned down for extra X-rays and to examine for bruises. In line with medical data, George decided that Daniel had skilled an “unintentional trauma” however didn’t attribute the cranial fluid to abuse.
However, in keeping with Sharon, his supervisor referred to as to inform him that, as soon as once more, Harper was involved concerning the authorized legal responsibility created by his notice, and that his opinion concerning the bleeding was “past the scope” of his follow. Struck by the similarities in Daniel’s and Hank’s circumstances, Sharon wrote one other letter reiterating his issues from the convention name in February 2022. He mentioned that he’d spoken to many colleagues on the hospital who shared these issues, and that he strongly believed “our group should acknowledge and tackle these issues in a clear method.”
In late June, College of Minnesota data present that three complaints had been filed inside days of each other in opposition to Sharon. As a result of the complaints had been closed with out self-discipline, they’re protected personnel information underneath Minnesota legislation.
The primary criticism was filed the identical day he mentioned he acquired an invitation to a gathering with Dr. Joseph Neglia, head of the College of Minnesota Medical College’s Division of Pediatrics, physician-in-chief at Masonic Youngsters’s Hospital and one of many individuals included on the February 2022 name. The second criticism was filed a couple of days later, whereas the third got here the day earlier than the assembly befell.
In line with Sharon, an lawyer for College of Minnesota Physicians on the assembly instructed him he was “weaponizing” his notes. Per week and a half after that, Sharon mentioned, Neglia introduced him in once more and gave him a selection: resign or be terminated on the spot. Sharon was shocked. He finally resigned.
Beneath an settlement with College of Minnesota Physicians, Sharon stayed on the job for a number of months with strict tips, together with that he was prohibited from working with the infectious illness division. Neglia warned Sharon in a letter to “preserve a excessive stage of professionalism and decorum” and to not have interaction in “any habits that might be perceived as retaliation,” echoing the language in Gupta’s peer evaluate letter to Sharon.
“You’ll chorus and take away your self from involvement in any circumstances of suspected baby abuse or potential non-accidental trauma,” Neglia wrote. “This consists of any interactions with or communication with dad and mom or guardians of a affected person in such a case.”
Neglia didn’t reply to requests for remark.
On the time of his departure, Sharon was one among solely a small variety of medical doctors within the nation who handled a sophisticated immune illness with behavioral signs in youngsters recognized by the acronym PANDAS or PANS. Dad and mom of Sharon’s sufferers had been so upset by information of his resignation that they went to the native newspaper.
The protection prompted an investigator from the Minnesota Legal professional Basic’s Workplace to achieve out to Sharon, and Sharon mentioned he took the chance to share his issues concerning the baby abuse protocols at his former office. He mentioned he has but to listen to again. A spokesperson on the lawyer normal’s workplace declined remark.
On a latest April afternoon, Sharon arrived at a restaurant in a suburb of Minneapolis. Tucked in a again nook desk was Daniel, now a blond-headed 2-year-old, Grace, Paul and Grace’s mom. Sharon had not seen them since that day within the emergency room two years in the past, and the household needed to thank him for what he’d carried out. (As a result of Grace is a pediatric nurse and since she desires to guard her son’s privateness, ProPublica agreed to withhold the households’ full names.)
Grace nonetheless feels traumatized by the 24 hours she spent at Masonic Youngsters’s Hospital, undecided if she’d be allowed to take her son house. She remembers that the one one who gave the impression to be in her nook was Sharon and the way it felt to learn that single line in her son’s medical report that will have price Sharon his job.
“That was the sunshine within the darkness at that time,” she mentioned.
For the reason that incident, Grace mentioned, she has needed to work with George on circumstances of suspected baby abuse and mentioned she has change into extra understanding of how dad and mom are handled.
For his half, Sharon characterizes your entire expertise as “surreal.” He commutes from Minnesota to Colorado and Wyoming for momentary hospitalist and medical work, however he’s nonetheless in search of a full-time job. He desires to get again to treating infectious ailments and eager about pediatric immunology, and he worries that he might be hurting his personal fame by talking out about how hospitals take care of circumstances of suspected baby abuse.
On the similar time, he mentioned he feels that he has to push again in opposition to the try and get him, and different physicians like him who could disagree with a baby abuse pediatrician, to “fall in line.”
After leaving his job, Sharon bought a tattoo on the within of his left forearm, a quote attributed to Albert Einstein he mentioned displays his considering and his actions at Masonic Youngsters’s Hospital: “Unthinking respect for authority is the best enemy of reality.”
Mariam Elba contributed analysis. Melissa Sanchez and Agnel Philip contributed reporting.
