Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Was It Really Munchausen-by-Proxy?
Some doctors may be too eager to diagnose “medical child abuse,” otherwise (and controversially) known as “Munchausen syndrome by proxy,” according to an investigation by the Houston Chronicle and NBC News.
As part of a larger series on “child abuse pediatricians” — a new but growing subspecialty — reporters reviewed seven cases of mothers accused by physicians at Texas Children’s Hospital.
In one case, Child Protective Services told parents that a medical team didn’t believe their daughter really suffered from a bleeding disorder. The bleeding disorder had actually been verified by medical testing, records show.
In another, a mother was surreptitiously recorded on video when a doctor suspected she would tamper with her daughter’s medical equipment. That recording didn’t reveal anything unusual, and months later another doctor discovered the cause of the girl’s digestive problems and fixed it with surgery.
The story centers around the case of Ajshay James, whose daughter Harper was taken from her in November 2017 after child abuse doctors at Texas Children’s suspected the girl’s medical conditions were manufactured by her mom. Harper had been born 16 weeks early and required much medical care throughout her early life.
More than a year later, Child Protective Services walked away, and James was never charged with a crime. The medical abuse allegation, however, is dragging out a custody agreement with the girl’s father, and James can only see Harper unsupervised for six hours on two Saturdays a month.
“The process for diagnosing what they call medical child abuse is subjective, it’s vague, it doesn’t have a clearly tested error rate,” Maxine Eichner, a law professor at the University of North Carolina who has studied the way medical child abuse allegations play out in court, told the news outlets. “This is a process of belief. This is not a process of scientific testing.”
Experts agree that in rare instances, mothers use medical treatment to intentionally harm their children, but some say the medical child abuse diagnosis is “too broad, poorly defined and, therefore, easy to get wrong,” the outlets reported.
Childhood Cancer Treatment Rationing
The chemotherapy drug vincristine is in short supply and doctors warn they may have to start rationing treatment, the New York Times reports.
Vincristine plays an essential role in the treatment of most childhood cancers, including leukemias, lymphomas, and brain tumors. There’s no appropriate substitute, according to the Times.
“It’s hard enough for any family having a kid with cancer, and having a child with cancer likely to be cured except we can’t give them the drug is beyond the imagination,” Peter Adamson, MD, chair of the Children’s Oncology Group, a collaboration of researchers at cancer centers, told the Times. “How can we do that to families?”
There have only been two suppliers of vincristine in the U.S. — Pfizer and Teva — but that number dropped to one in July when Teva decided to stop making the drug for business reasons. Since then, Pfizer has been the sole supplier, and has run into manufacturing issues.
Drug shortages tend to affect older generic injectable drugs that are difficult to manufacture and don’t pull in big profits, diminishing incentives for manufacturers. Yet these drugs are critical in treating cancer, particularly for the 19,000 American kids and teens who develop cancer every year, the Times reported. (After that story appeared, Pfizer said it will ramp up production, according to FiercePharma.)
Dark Money Fights Medicare for All
Investor-owned hospitals are leading the fight against Medicare for All, The Intercept reports.
Tenet Healthcare, the third-largest investor-owned hospital operator in the U.S., has donated nearly $630,000 to the Partnership for America’s Health Care Future (PAHCF), a dark-money group created last year to erode public support for the universal healthcare plan.
PAHCF’s incorporation records list a lobbyist for the Federation of American Hospitals — the trade group that represents Tenet and other investor-owned hospitals — as one of its authorized representatives. Its membership roster includes dozens of health insurance, pharmaceutical, and hospital trade groups and companies, according to The Intercept.
Earlier this year, the Federation’s CEO Chip Kahn said PAHCF was his brainchild. Kahn is best known for creating the health insurance industry’s advertising campaign against the Clinton administration’s healthcare reform plan in the 1990s. The Federation paid Kahn almost $2.6 million last year.
Troubled L.A. Psych Hospital
The Los Angeles Times reports that lack of oversight led to serious patient harms at Kedren Community Health Center in south Los Angeles.
Inpatient Jacob Masters was strangled in his room in November 2017 by another patient, Francisco Garcia, who was psychotic and suicidal. Garcia was never given a psychiatric evaluation, and the hospital failed to monitor Masters’ room, the newspaper learned.
Other patients have reported harm: one said she was sexually assaulted by her roommate, and another reported being choked by a Kedren employee.
A state inspection that occurred several months after Masters’ death still found serious safety issues that put patients in “immediate jeopardy” of harm or death. It took several more months and a violent encounter between a patient and security guards before Kedren implemented 24-hour psychiatric care, the Times reported.
Employees have also filed claims, with one nurse alleging she was fired after reporting insurance fraud and a lack of basic safety training. Another nurse said she was fired after reporting that a 12-year-old patient was given medication without a prescription. In a lawsuit, she charged that nurses there routinely gave drugs without consulting a doctor, and that physicians would sign off the next day, making it seem they had given verbal orders.
An advocacy group official told the Times that Kedren’s problems are symptomatic of a larger mental healthcare crisis in Los Angeles, spurred by a lack of resources including psychiatrists.