Feb. 28, 1996, was the worst day of Kristi Yuille's life. That afternoon she was led into a small room at Children's Hospital in Seattle and given a few moments to say goodbye to Wyatt, the 6-month-old baby she and her husband Bob were in the final stages of adopting. "I was crying, so he was crying," says Kristi, 42. "I gave him a hug and told him I loved him, and then I told them to take him away."
Since Wyatt's birth, the brown-haired boy had spent more time at the doctor's office, it seemed, than at the Yuilles' 80-acre ranch in Republic, Wash. Wyatt's umbilical cord had become infected. There was a hole in his heart. He had bouts of vomiting, diarrhea, and on one occasion he simply stopped breathing, say Kristi and Bob, 48, both of whom are nurses. But the doctor standing before her at Children's Hospital that day, Kenneth Feldman, said the problem might not have been with Wyatt but with Kristi. Feldman suggested she was suffering from a rare and baffling disorder called Munchausen's syndrome by proxy that causes mothers to intentionally make their kids sick. To win sympathy and attention for themselves, Munchausen's moms have been known to poison their infants or to suffocate them to create a medical emergency. Wyatt, the doctor explained, was being taken from the Yuilles for his own safety, effective immediately.
Devastated, Kristi Yuille vehemently denied ever harming Wyatt. She and her husband successfully regained custody of their older child, Dakota, now 9, who spent 75 days apart from his mother while they battled the child-abuse accusation. In 2001 they succeeded in adopting another boy, Hunter, now 3. Yet Wyatt, put up for adoption elsewhere, is no longer a member of their family. "The pain was so incredible," says Kristi. Says Bob: "This man can take away a child and ruin an entire family, and he's never been held accountable."
The Yuilles are not the only family to feel betrayed by Feldman and his team of experts at the Seattle hospital. Since Munchausen's syndrome by proxy (MSBP) was first identified by a British physician in 1977, Feldman has reported 68 parents to the state's Child Protective Service agency—not an unusually high number, he says, given the five-state area the hospital serves—in most cases triggering the removal of children from their families, at least temporarily. In the last six years, five families have tried, and failed, to sue the doctor after the state found no cause to keep their children in foster care.
It took Kevin and Nancy Grennan more than three months to recover custody of their daughter, Amanda, after they visited Children's for an 11-day stay back in 1995. Amanda, then 5, had been diagnosed with a rare form of epilepsy and had already undergone brain surgery in New York City when the Grennans, who live outside Chicago, took her to Seattle for another opinion. Not only did Feldman and his associates argue against more surgery, they found no sign of epilepsy at all during her stay—and accused Nancy of endangering Amanda by continuing to seek invasive treatments. "You have a sick child," says Nancy, "and the next thing you know you could be in jail. That's a scary thing."
Yet the Grennans, like other families who have tried unsuccessfully to sue Feldman, have all become ensnared in the same bureaucratic catch-22: Since Feldman and other doctors are so-called mandated reporters of child abuse—and therefore legally bound to report suspicious parents within 48 hours—they enjoy legal immunity from reprisals whether the diagnosis is correct or not.
That, says licensed medical assistant Michelle Bateman, 31, is an injustice. The Renton, Wash., single mother lost legal custody of her then-4-year-old son for two years after Christopher's medical records, which detailed countless trips to the emergency room for chronic vomiting, were evaluated by Feldman in 1996. Feldman never actually met Michelle or Christopher; their case had been referred by another physician who suspected her of feeding the boy ipecac syrup, a home remedy for poisoning that induces vomiting. "I had to do something that no parent should ever have to do with their child. I had to leave him with strangers," says Bateman.
But Feldman, a pediatrician who has won the respect of many peers for work at a clinic in one of Seattle's poorest neighborhoods, steadfastly stands behind his assessment of each family. "These are always agonizing cases," he says, "but based on what we knew at the time, and based on what we've learned since, I think we have done the right thing by all of these kids." As one of the nation's most prominent experts on MSBP, Feldman says the condition is far more common than the public realizes, in part because its tiny victims are almost always too young to speak. (In fact, when children become old enough to report their mother's actions, their symptoms tend to disappear.) If mothers aren't stopped, he says, MSBP can even lead to the death of a child. "The courts and the general public may have a difficult time believing what's going on," says Feldman, "but that doesn't invalidate the diagnosis."
For legal reasons, Feldman refuses to discuss in detail the cases he has diagnosed, although he says Munchausen's moms are expert at hiding the frightening truth. Dr. Herbert Schreier, a psychiatrist at Oakland's Children's Hospital, tends to agree. In 17 years of working with Munchausen's he has come to the conclusion that just as disturbing as the harm mothers can inflict on their kids is the damage done by doctors duped into performing unneeded tests and procedures. "There is one case I studied where a child had 40 operations, probably all of them unnecessary," he says. Adds Alabama psychiatrist Marc Feldman (no relation to Kenneth Feldman), who has written three books on Munchausen's: "These mothers tend to be very knowledgeable about the disorder they are creating or feigning in their child, and they are master liars and deceivers." Even when caught red-handed, some Munchausen's moms don't seem to grasp what they have done. "There's a lot of denial," says Richard Molteni, medical director of Children's Hospital.
Indeed, Munchausen's cases are invariably complex, and discerning the truth is nearly always difficult—and open to interpretation. By the time young Wyatt first visited Children's Hospital with Kristi Yuille six years ago, the baby boy had already made 17 trips to other doctors and been hospitalized four times. On Oct. 31,1995, Bob and Kristi noticed he was having trouble breathing. He was airlifted to a hospital in Spokane, where a hole was detected in his heart. "Because we're nurses, we took him to the doctor before he got too ill," says Bob.
Four months later, after being referred to Children's Hospital by the Oregon agency that was handling Wyatt's adoption, Kristi spent the better part of two days being questioned by Feldman and other doctors at Children's, where her responses seemed to raise red flags. According to Feldman and others, Munchausen's moms are typically intelligent and well versed in medical matters; Kristi is a nurse. Other children in the family often also undergo hard-to-explain medical emergencies. In the case of the Yuilles, Dakota, the couple's older son, was accidentally poisoned on five occasions—twice by eating a toxic plant, once by swallowing dishwashing soap, once by an overdose of children's vitamins and once, say the Yuilles, because he ingested dog deworming medicine while in the care of his grandmother. Asked to explain the incidents, Kristi Yuille describes Dakota as "very oral" when he was a toddler.
Yet Dakota's poisonings and other problems he was given medical attention for "dramatically ceased" with the adoption of a new child, according to a report submitted by Children's Hospital in response to a malpractice suit filed by the Yuilles in Washington state superior court in 1999. The report noted that the boys' symptoms occurred "primarily in their parent's presence" and were often "unsupported by clinical findings." The hospital also looked at Kristi's medical past. She had a hysterectomy at age 19 without seeking a second opinion and in 1993 underwent surgery after reporting symptoms of a blocked intestine, although the surgeon who performed the operation found no signs of an obstruction. Interviewed later, Dr. Andrew Frank of Kaiser Permanente hospital in Portland, Ore., recalled that he had operated without conducting exhaustive tests because Kristi had "made such a good case" for the surgery, according to the report.
Because of Feldman's immunity as a mandated reporter of child abuse, the Yuilles' suit against him was dismissed by a judge in 2000. Feldman, a father of two teenagers who likes to climb mountains in his spare time, vows to continue to keep an eye out for MSBP—which some critics have gone so far as to call a "fad" diagnosis—no matter how much bad publicity it brings to his hospital. "This is one of the last frontiers of child abuse," he says. "Wherever we are dealing with abuse, we are balancing risk of injury or death to a child with risk to the family. It's a tough decision all the time, and it never sits lightly on me."
As for the Yuilles, they spent close to $100,000 on legal fees and a detailed psychiatric evaluation to retain custody of Dakota and on their failed attempt to adopt Wyatt. Now living in Estacada, Ore., they vow to take their fight to Washington's supreme court, hoping to spur a change in the law. Says Kristi: "We do not want this to happen to another family."
John Hannah and Johnny Dodd in Seattle and Alexandra Hardy in Portland
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