Lawsuit filed against Neuropsychiatric Institute
Doctors sued for alleged misdiagnosis, patient negligence
By Jennifer K. Morita
Daily Bruin Staff
After living under the threat of prosecution for a year, a
Southern California couple is suing doctors at UCLA’s
Neuropsychiatric Institute (NPI) for alleged negligence and for
misdiagnosing their daughter as suffering from a form of child
abuse.
When Kert and Janet Evans took their 9-year-old daughter Kristen
to the institute in April 1993 with complaints of stomach pain,
itching and having "odd mannerisms," the Evans claimed Dr. David
Beck informed them there was nothing wrong with their daughter.
According to the lawsuit, filed with the Los Angeles Superior
Court last July, NPI doctors diagnosed Kristen as a victim of
Munchausen Syndrome by proxy, a form of child abuse in which the
offender, usually the child’s mother, induces or fakes illness in a
child to gain the attention of physicians.
In addition, the Evans and their attorney Brian Magana, said
Janet Evans is just one of a number of mothers whose children were
institute patients diagnosed as victims of Munchausen Syndrome by
proxy, including a woman in Illinois.
"Dr. Beck told me that he felt … her problem was entirely me,"
said Janet Evans, a part-time dietician in Downey. "He said that I
was somehow able to influence her by a mind sort-of-a-thing, where
if I thought she was going to have stomach problems somehow,
psychically I would make her have stomach problems."
"I was outraged," she said. "I made fun of him and he got very
loud and threatening. He said he wasn’t joking and that I wasn’t
taking him seriously at all, and that he fully intended to
prosecute."
Neuropsychiatric Institute spokesperson Roxanne Moster said
their attorneys declined discussing the specifics of the case due
to physician-patient confidentiality. However, a clinical
psychologist employed by the institute but not involved in the
Evans case, said that hospital officials are legally required to
report any evidence or suspicion of child abuse.
"Technically all you need is a suspicion," said Brenda Bursch,
who was not working at NPI when Kristen was a patient there. "But
it’s difficult when it comes to medical cases."
In normal physical abuse cases, Bursch explained, what
traditionally happens is a child has odd bruises or injuries that
cause the physician to suspect child abuse. That’s all it takes for
the Department of Child Services to investigate.
"It gets trickier when it comes to medical cases," said Bursch.
"It’s tough because, in order for the Department of Child Services
to follow up on the case, the data has to be stronger. For them to
pick it up, the case has to have a medical problem."
And with a Munchausen Syndrome by proxy case, the child does not
suffer from any medical problem. Instead, a pattern of illness is
revealed through medical records such as seizures, failure to
breathe, diarrhea and vomiting, but no medical cause for these
problems can be found. But not all cases get reported, Bursch
said.
"When we don’t have enough data for the Department of Child
Services to pick up the case, then we don’t report. This is
something that drives me nuts," Bursch said.
"In other cases where we’re lucky, there will be some other way
to address the problem such as having another family member who is
aware of the problem so we can put into place some kind of
structure that will guarantee the safety of the child," Bursch
added.
When the Department of Child Services does pick up a case, many
times the child is taken away from his or her parents. In the
Evans’ case, the family’s attorney said the institute did not press
charges. If Kristen had been taken away from her parents, they
would have been unable to file the negligence suit due to a
California civil code that gives immunity to doctors and hospitals
who report alleged child abuse.
Instead, the Evans were told to comply to five conditions in
order to avoid prosecution and keep their daughter. Kert Evans had
to take Kristen to the institute for therapy once every week,
withdraw any medications and agree not to take Kristen back to her
former pediatrician or any other doctor. He also could not to put
her through any other kinds of tests.
"They were assuming my daughter had nothing wrong with her and
that we were giving her medication that she didn’t need," said Kert
Evans. "All we were doing was trying to find out what was the
matter with our daughter and got accused of child abuse."
The Evans had been giving their daughter Tagamet for her stomach
pains, which they said seemed to help. But according to the Evans,
NPI doctors instructed them to stop giving her the medication.
"She went drastically downhill and you could see her get worse.
Every week her stomach would get worse," Janet Evans said. "But I
had to agree to those five commandments otherwise he would
prosecute. We lived under that threat for maybe a year."
In January 1994, the Evans stopped taking Kristen to her
appointments because the Northridge Earthquake had destroyed the
freeway they used to get to UCLA. By that May, Kristen’s weight had
dropped to 50 pounds and she refused to eat because "she was afraid
that germs were on everything," said Janet Evans.
"She wouldn’t talk to you because she was holding spit in her
mouth and she was afraid to swallow it so she’d have to spit it out
into a tissue," she said.
As Kristen’s condition deteriorated, the Evans’ marriage
suffered as well.
"Once NPI made this accusation, I was forced to choose between
the continuity of my marriage – which was going to break down
obviously because they were accusing my wife of abuse – or the loss
of my daughter," said Kert Evans, who opted to take his daughter
each week for therapy.
"Our relationship was getting worse and the communication was
breaking down," he said. "We became more and more distant … There
were suspicions involved. My wife’s position was that I didn’t
trust her because I was following NPI’s instructions and not
standing up for her."
Eventually, Janet Evans stopped being involved with the family
activities and moved out of the house. About a month later, the
Evans went against the wishes of NPI doctors.
"Finally, we decided that even if they came to take her away,
the kid was doing bad, so we ended up breaking the rules and took
her back to her pediatrician."
The Evans took Kristen to the City of Hope Medical Center, where
doctors diagnosed Kristen as having Teret’s Syndrome in addition to
other problems including obsessive compulsive disorder and
Attention Deficit Disorder.
"Teret’s would be a disorder that’s easy to fake because there
is no diagnostic test that can be performed to confirm Teret’s,"
Bursch said.
According to Bursch, patients who suffer from Teret’s Syndrome
display a wide range of symptoms including involuntary vocal or
motor tics and can be caused by stress.
"This is a perfect disorder for a Munchausen family to claim,"
said Bursch, explaining that a child may suffer from Teret’s
Syndrome because of the abuse brought on by Munchausen.
But Bursch claimed that although doctors may have a suspicion of
Munchausen, they don’t really diagnose it. Instead, over a period
of time, their suspicions are confirmed if for example, a child has
been removed from the parent and no longer displays any symptoms or
problems.
"It makes it difficult because time is needed in order to
confirm the suspicion," Bursch said. "It’s very difficult to even
suspect because, by and large, the people who are the perpetrators
are the people who the medical staff really likes. The parents are
nice, articulate, devoted parents and they become friends with the
medical staff.
"There’s nothing not to like," Bursch said. "These are the
parents the staff loves … but what drives me crazy is that their
explanations can make sense. They’re very good at lying and it’s
not obvious at all. They’re often pathological liars."
In addition, as the child gets older he or she may begin to fake
symptoms along with the parent, Bursch said, adding that the
patient’s reality is so distorted that the patient may not realize
he or she is faking.
But the Evans, who also have an 8-year-old daughter, said
Kristen has thrived since she has been under treatment for
Teret’s.
"I met my daughter a year-and-a-half ago," Janet Evans said.
"It’s so nice. Kristen is happy, she doesn’t itch, she doesn’t
ache. She’s doing wonderfully and she’s the picture of health."
Meanwhile, their case is still in its initial stages, Magana
said, adding that it may take up to two years before their case
goes to trial.
"We’re sort of hampered," Magana said. He explained that
portions of Kristen’s medical records are missing and medical notes
that were dictated weren’t transcribed until a year after they were
taken.
"They fictionalized an entire chart on her and wrote it like a
storybook," said Janet Evans, who claimed that medical notes for
Kristen’s first 15 visits at NPI are missing and others have been
rewritten.
The Evans’ attorney is still investigating the scope of
"improper care or skill in regard to the diagnosis, treatment,
tests and care" of Kristen allegedly provided by institute
staff
But doctors said denial plays a large part in Munchausen
Syndrome.
"It’s very rare for someone to admit to this," Bursch said.
"It’s such a bizarre thing that a person can come up with any
reasonable explanation and you start to believe it. Denial is
absolute and 100 percent."
UCLA Medical Center, in particular, sees a large number of
Munchausen cases because other hospitals often refer patients to
UCLA’s medical specialists or NPI when they cannot find a problem.
In addition, Bursch said, NPI has a "very good team of experts" on
Munchausen.
"It’s very common for perpetrators to go to the media and this
is prone to litigation as well, because they seek attention,"
Bursch added.
"They’ve gained the attention of UCLA and it’s like they’re
going up against the big time."
It was because of UCLA’s reputation that the Evans brought
Kristen to its clinics in the hopes that her medical problems could
be solved.
"I’m very surprised that a medical facility of NPI’s stature
completely misdiagnosed this and put us through the damning
conditions that they did," said Kert Evans. "The medical profession
needs to be designed in its entirety to help people and not hurt
people.
"Anybody can be wrong," he added, "… but they should admit it
and fix it. Their mistakes need to be corrected and prevented from
happening again in the future."Comments to
webmaster@db.asucla.ucla.edu