Dr. Bex
Appearances
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
So summer of 2018, two years after that surf camp, she actually got diagnosed with POTS, which is Postural Orthostatic Tachycardia Syndrome, another one of these acronyms that seems to come up time and again.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
The idea being that when these patients stand up or change position, that they can get dizzy, lightheaded, feeling of a rapid heart rate because of the quick fluctuations in the level at which their heart is beating. Some people say, oh, well, everybody's heart rate goes up when they stand up. It's what's supposed to happen.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
But it's that kind of change between your resting heart rate and your standing up heart rate that's more pronounced. The thing with POTS is that it does seem to be one of the things that comes into play when the patients become more debilitated, more where they do start to do less, they're less active, they're unable to do certain things that they were able to do before.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
And it just seems like you can probably speak to this too from your experience, but it's one of those things that once that comes up too, it feels like we're kind of starting down this path. that is similar in a lot of these stories.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
I think that's the hard part with POTS is I think it is there's still a lot that's unknown about it, meaning can it worsen after you get a bad viral illness? And it's one of those things that gets triggered. And then once it's triggered, it kind of never goes away. But the most important thing to know with POTS is it's symptomatic management. So
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
Things like increasing hydration, increasing the balance of salt intake with fluid intake are things that are recommended early in the course. Then there are the kids who do need medication to basically keep that balance correct. So meaning it's about keeping the blood flow going to your brain and to all of the important organs when you stand up and that you don't get so dizzy that you pass out.
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Case Files 17: Rady Children’s Part 1
And so some medications will help that balance where it won't let those fluctuations be so great. And it'll keep your heart rate more in a balanced range. That being said, there are these extenuating circumstances with POTS, which I know POTS experts or people that really focus in this field are trying to find solutions.
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Case Files 17: Rady Children’s Part 1
less invasive ways, you know, rehabilitation and therapy and dietary changes and nutrition changes, because I think there was a push at some point that IV fluids or fluids through an intravenous line is really the way to improve the symptoms quickly. And so this idea of some of these patients needing
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
G tubes or tubes in their stomach or central lines to be able to give themselves fluids versus like you or I would just attempt to always have a water bottle with us, always be eating crackers, balancing it with a water bottle. It's kind of became more invasive very quickly.
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Case Files 17: Rady Children’s Part 1
And I think we're now backing off of that a couple years, you know, like years later to realize what other things can we be doing early on. And POTS, from my understanding, is kind of once you are prone to it, It can keep causing issues throughout your life.
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Case Files 17: Rady Children’s Part 1
But there are times in life where it seems to be more prominent in like the teenage years, probably because your fluid needs and balances and hormonal changes are all playing a role. And it does affect women more than men. So there is that question of kind of.
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Case Files 17: Rady Children’s Part 1
the hormonal connection and I think it's kind of about finding a balance as with anything it's definitely not something that should be debilitating that you can quote-unquote die from it is something that is very manageable got it and yeah I mean then the reason that we become concerned about
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Case Files 17: Rady Children’s Part 1
And I think physiologically, I can understand that if you have Ehlers-Danlos, you're having these dislocations, and then you're going through this period where it sounds like two years of pain or some symptoms still associated, going through doctors, getting put on different medications. It sounds like she became much more sedentary over this time. And I would argue that
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
That if there's a time that she would feel dizzy standing up, right, or that some of these symptoms may show up, it would be now. So that to your question of does POTS always exist? I mean, the question is chicken and egg. Is the symptom and the thing she's describing more related to this underlying symptom? very legitimate change in her lifestyle and in her activity level.
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Case Files 17: Rady Children’s Part 1
And, you know, if we have a kid who lays in the hospital with pneumonia with, I mean, we know it from COVID, you get deconditioned over time just laying in a hospital bed from any illness. And kids have to go to our, you know, rehab unit to physically rehab just after being sick in the ICU because your body weakens. So if someone is more sanitary due to all of these symptoms,
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Case Files 17: Rady Children’s Part 1
By definition, getting up at that point is going to be harder. And so you wonder, once someone is healthy, is it even going to be as much of an issue or an issue?
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Case Files 17: Rady Children’s Part 1
Right. And pain medications, you know, do certain ones drop your blood pressure. And then again, you're more prone to those positional changes whenever you're on those medications. I mean, you know, most people will tell you they feel a little bit woozy or dizzy when they're taking certain medications. And
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Case Files 17: Rady Children’s Part 1
So at this point, we are in August of 2018, and she gets admitted to Kaiser Permanente San Diego. It does not specify anywhere if we're still looking at shoulder, if it's her whole body. I can say there are pictures of her where she is in a motorized wheelchair. I do not know if that is true as of admission to Kaiser. But she also is now presenting with GI symptoms. And...
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
unable to eat and this is kind of that progression that I do start to worry not only about things like Munchausen by proxy or anything like that but I start to worry when the pattern is certain neurologic symptoms followed by certain GI symptoms or certain GI symptoms followed by neurologic symptoms because there is so much interplay between our nervous system and our GI system and
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Case Files 17: Rady Children’s Part 1
And once you're affecting both, it just means it's going to be more life affecting for these children. And often once the GI system is involved, this is when things like tubes and central lines become even more, kind of more that the child becomes at risk of needing these things.
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Case Files 17: Rady Children’s Part 1
And so you're wondering, my biggest thing in all of this right now is where in the story does intervention happen to try to be realistic and have a realistic plan of care and a realistic goal for a family, for a patient, all of them that kind of keeps the escalation in check because you can kind of already feel it starting to escalate at the beginning of this admission.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
She's already now been two years with this debilitating, you know, kind of unrelenting pain. And now we're starting to have GI side effects or GI symptoms as well, which Andrea and I know is often a side effect of medications too. So the question is, did we iatrogenically or did the physicians cause this by medication she was on?
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
Or is this a second symptom, third symptom, whatever you want to say of this overarching story?
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Case Files 17: Rady Children’s Part 1
Well, I can start with POTS. POTS itself does not have GI connections. The idea is the reason tubes and central lines sometimes come into the picture is more of the need for a hydration and hydration status above and beyond maybe what another person would need to drink in a day. And so whether they are able to take all of that by mouth or not, are unable to.
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Case Files 17: Rady Children’s Part 1
And then that's how that door is open into the world of tubes and lines with Ehlers-Danlos. I did a little digging because again, Ehlers-Danlos is often something in pediatrics or in medicine that is a secondary diagnosis, something that you may know the child has, but isn't necessarily the reason they're at least with me in the hospital.
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Case Files 17: Rady Children’s Part 1
But we do always consider those secondary and third diagnoses as, is this playing a role? So it does seem like kids with Ehlers-Danlos, um,
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Case Files 17: Rady Children’s Part 1
which the idea is that they have hypermobile joints so their joints are very kind of floppy but because of that the rest of their body is overcompensating for their they're always trying to balance their joints and the thing is if your joints are floppy or loose then there's ideas that like your pelvic floor is loose which affects your abdominal motility or your gi motility um
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Case Files 17: Rady Children’s Part 1
like your chest between your ribs, everything are affected. Are you more at risk for like getting a bad pneumonia or something like that? And so I think it's all this stuff that is known to be associated. So a lot of these kids have maybe slow GI motility, constipation, things that we see in a lot of kids for a lot of different reasons. It just, again, it's the extremes of it.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
So it's the fact that Ehlers-Danlos syndrome in and of itself does not cause kids to need a tube or need a central line. It may be contributing to some of the symptoms, but these are symptoms that can be managed many other ways.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
It's one of those diagnoses that is much more prevalent than anyone knows. A little funny side story is that I have a colleague who consistently tells me I have Ehlers-Danlos. It is like a running joke at the hospital. Like, oh, you know, Bex, you know, you have Ehlers-Danlos. Ha ha ha. You know what I mean?
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
And it's because of how I sit and how I position and the fact that I can contort into strange positions. And then when I get a massage, he's like, dang, what are your muscles doing all day? And I'm like, probably balancing my hypermobile joints. So again, but I think the point is, I think it is much more prevalent than what is reported because I think people do just live with Ehlers-Danlos.
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Case Files 17: Rady Children’s Part 1
There are, just as a total aside, is there are types of Ehlers-Danlos that are vascular types of Ehlers-Danlos. That's when you get into them having cardiac issues and actual problems because the muscles of the blood vessel walls are affected. And so that you can imagine has a lot more medical consequences.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
The hypermobile type of Ehlers-Danlos is anywhere from you can position yourself in a little bit of weird positions to causing significant full body pain. I think the point is, as we have talked about many times, is there are people that truly suffer and are debilitated by things like CRPS, by things like chronic pain.
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Case Files 17: Rady Children’s Part 1
And I'm sure there is a subset of Ehlers-Danlos that is more severe, and maybe someday we will have a gene or something else that can diagnose that. But the point is when... The pieces of the story just start lining up in a certain way. And Ehlers-Danlos is kind of mentioned or comes out. And then there's just this rapid decline in a child that was otherwise thriving for all intents and purposes.
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Case Files 17: Rady Children’s Part 1
That's concerning because they've had Ehlers-Danlos their whole life. So again. So it's something you either have or you don't have.
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Case Files 17: Rady Children’s Part 1
So they would have been born with it. Now we could go into the whole, there's that sidebar of Ehlers-Danlos with fractures, which it's a whole nother thing, but often you wouldn't know in a little child that they have Ehlers-Danlos or, and yes, I'm sure the pain builds up over time just because as we get older and our joints get arthritic, cause we're old that there's then going to be new problems.
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Case Files 17: Rady Children’s Part 1
The point is that the diagnosis marking is, the point of no return where they become bedridden and wheelchair-bound and needing tubes now to feed, that timeline just is what is so concerning.
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Case Files 17: Rady Children’s Part 1
This is the downward trajectory that is both rapid and never seems to have that where it starts to climb back up the other way again. And if it does, it's this very little just to have it kind of go down again. So it's the pattern. Yeah. So, okay. So where are we at this point? So we are at Kaiser San Diego. That is where the first NG tube is placed. So nose to stomach to help feed.
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Case Files 17: Rady Children’s Part 1
And that's because she was showing signs of malnutrition or weight loss. and pain is still the word that pops up time and time again. So she is actually transferred, are you ready, to Kaiser Permanente LA for ketamine treatments. So what do you think?
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Case Files 17: Rady Children’s Part 1
And I think the one good piece of this is they were at Kaiser Permanente San Diego, which is a very good hospital. They were transferred to Kaiser Permanente LA. So it sounds like it was done within the correct, you know, channels and going to a place where she was actually in the ICU, it seems, when she got it. So getting the appropriate monitoring and all of that.
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Case Files 17: Rady Children’s Part 1
So it sounds like they were probably following more of a protocol of what Stanford is doing. And the thing is, she did not improve at all. They said the ketamine was unsuccessful. But during her time at Kaiser LA, she developed a whole slew of new symptoms, one of which was vision loss. And this comes up time and again in the case because...
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Case Files 17: Rady Children’s Part 1
The parents thought is that it was related to medication she was put on at Kaiser LA, which very well, I mean, there are medications we all know with side effects that could be part of it. According to the documentation by the defendants, there were normal opto exams throughout that time period. And despite those normal exams, the parents were still saying she was having vision loss.
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Case Files 17: Rady Children’s Part 1
So this is a he said, she said of when it came about, what the exam showed. Just to remind us, who are the defendants in the case specifically? Oh, yeah. Oh, there's a lot. So Kaiser Permanente San Diego to Kaiser Permanente LA.
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Case Files 17: Rady Children’s Part 1
Right, but it's going to be the ones at Rady's Children's that come in a little bit later that are the ones that are kind of the bulk of this, the lawsuit component. But I think these parts of the story we have that help us see how we got to where we are at Rady's and why maybe Rady's was thinking what they were And the parents were kind of coming in thinking what they were.
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Case Files 17: Rady Children’s Part 1
So it's kind of a good setup. But at this point, she also developed what are called psychogenic non-epileptic seizures, which pseudo seizures is another name. But the sidebar to that is people were still saying, and you will find it all over TikTok, rabbit hole, that they are still saying, I am having seizures. They are just of the psychogenic non-epileptic kind.
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Case Files 17: Rady Children’s Part 1
Well, I mean, but then they're not, like the word seizure people associate with, It is an actual electric change in your brain that is causing you to have a seizure. So, again, people who truly suffer from epilepsy and seizures using that term even is problematic.
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Case Files 17: Rady Children’s Part 1
this. Right. So it's a version of a functional neurologic disorder, which we covered a lot during the about the hysterical podcast and the story of kind of mass hysteria or mass psychogenic illness.
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Case Files 17: Rady Children’s Part 1
The idea is it's our body's outward manifestation of something that is psychologically troubling or so inside stressors or other things, external stressors that are kind of manifesting themselves with physical physical symptoms. And the thing is, vision loss can be a version of a functional neurologic disorder where all of the testing is normal, but the patient truly cannot see.
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Case Files 17: Rady Children’s Part 1
I mean, in their head, they do not see. Or in their head, they do not feel their left arm or whatever it is. The thing is, there is no physiologic reason for the symptoms. And so that's the idea with these events, these psychogenic non-epileptic events. So psychogenic meaning, again, it's stemming from something within us that is manifesting physically.
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Case Files 17: Rady Children’s Part 1
And then it's non-epileptic, meaning they've been captured on this EEG where you're being put on and it's recording your brainwaves and it was not epileptic. So it is not coming from your brainwaves. And then again, that word seizure is, technically means those abnormal movements, but realistically in medicine, when you say seizure, it is assumed you mean of the epileptic variety.
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Case Files 17: Rady Children’s Part 1
So that's why now we're changing it to events. And I think that is an important distinction too, because even in this story, it's One of the claims made in the report to DCF or to their HHSA in California was that parents are claiming diagnoses that were rolled out. And so continuing to say she had seizures, despite it being explained that these were not true seizures. Got it.
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Case Files 17: Rady Children’s Part 1
And then also at Kaiser LA is when she gets an NJ tube. So now we're escalating nose all the way down into the jejunum or into the intestines to feed her. So that to me implies that something was not going well when they were feeding her stomach.
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Case Files 17: Rady Children’s Part 1
To normal, yep, to treatments. And this is a kid who ate normally before. So again, where did we go? How are we here now? And then her first central venous catheter is also placed during that time. Maybe it was placed for the ketamine and then stayed in. That's, that I don't know because there's not a lot of detail. Okay.
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Case Files 17: Rady Children’s Part 1
So I think we both know that this escalation in GI is a big piece and is very concerning. And even I think Kaiser LA got concerned, wow, this is escalating. And so the ketamine didn't work, which was really why they were brought into the equation. And so she gets sent back to Kaiser San Diego.
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Case Files 17: Rady Children’s Part 1
And it's interesting because when they returned to Kaiser Permanente San Diego is the first report to HHSA, which is Health and Human Services Agency in California, but that's the overlying agency that manages all the child abuse claims or abuse claims. And the reason for that first report was some kind of tampering with an IV line by the mother.
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Case Files 17: Rady Children’s Part 1
Although it's not clear what that was, that's what the statement in the initial report is. And this is where, again, Shaylin Nino comes into the picture because she is the child abuse pediatrician or one of them in the San Diego area. And so when these cases do get referred, then even though she was not at Rady's at that point, she was in a hospital in San Diego County.
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Case Files 17: Rady Children’s Part 1
So Dr. Nino gets involved as the child abuse pediatrician. Um, I just want to take one little sidebar. Cause again, we're going to do this about a couple of the other physicians in the case, but Dr. Nino. Um, and so she actually was a nurse before she was a doctor, which is interesting. I was a teacher before.
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Case Files 17: Rady Children’s Part 1
I think, um, people who had a career before kind of come into medicine a little bit different. I think we've had a little more life or living. And the fact that she was a nurse before, I think puts a different perspective on what she sees. I'm sure. And then she decided to go back. She got her MD in Virginia, did her pediatric residency.
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Case Files 17: Rady Children’s Part 1
And I want to point out that she is actually fellowship trained in child abuse pediatrics. So we met Sally Smith during the Kowalski case, and she was what we call grandfathered in to the specialty because there were not fellowships when she came out of residency. Same as me, although I'm not that old. Pediatric hospital medicine is a relatively new specialty.
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Case Files 17: Rady Children’s Part 1
And so I actually was grandfathered in, which makes me feel extremely old. where there were not as many fellowships offered when I came out of training. And so just because of my years of experience, I was able to sit for the board and I'm board certified in hospital medicine. But Shaylin actually did the training and the actual fellowship in child abuse pediatrics and is also board certified.
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Case Files 17: Rady Children’s Part 1
The time she's called a so-called child abuse expert makes me want to, my head pop off because there is no so-called about it. Like, I mean, and this is not just because I know her. I would say the same about, I said the same about Sally Smith, but like, you cannot, if there's anything you can say about a human, like, She is a child abuse expert. I mean, I don't know what else to say.
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Case Files 17: Rady Children’s Part 1
And if anyone is this specialty, it is Shaylin. She has done her time, she has done her work, she has taken courses and classes and continued her continuing medical education to stay up to date in the field. That's just my sidebar because her name is going to keep coming up.
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Case Files 17: Rady Children’s Part 1
So our first disclaimer is actually that Andrea and I both met Dr. Shailen Neenau, who is one of the defendants in this case. She works for the University of California, San Diego at Rady's Children's Hospital and through their child protection team and Children's Advocacy Center. And we met her at a conference in San Diego this year and actually presented with her.
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Case Files 17: Rady Children’s Part 1
Child abuse pediatricians are not the ones going out and hanging a shingle, you know, in the grocery store strip mall and saying, look, I'm a child abuse pediatrician. Come see me. People don't want to see the child abuse pediatrician.
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Case Files 17: Rady Children’s Part 1
It's not something lucrative. It's not something you go into for, you know, the honestly like the reward like, oh, yes, I'm sorry. You do go into it for the rewards because you are really so important in these children's lives. But you are not going in for the financial gains. You are not going into it for the reputational gains. Speaking to what has happened to some of them.
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Case Files 17: Rady Children’s Part 1
I don't know, honestly, how we're going to get new fellows in the specialty because I'm really worried that. that with everything that's going on, we just, who would choose this, right? And that, for me, I respect them more for still doing it right now.
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Case Files 17: Rady Children’s Part 1
So we have gotten to know her a bit over this time. But again, none of the information that we're presenting here today came from her. It all came from the court documents. And from articles that we've read that have been in the news and peripheral information we were able to find on the Internet.
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Case Files 17: Rady Children’s Part 1
So basically, all of this is stuff that is public record that you guys could look into as well if you're interested. And the one big thing just to point out, anyone who went down the big rabbit hole of the Kowalski court case.
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Case Files 17: Rady Children’s Part 1
We were able to get all of the court records in the state of Florida, and that actually included all of the medical records that were released to the courts for Maya Kowalski. And so we had a little bit more of both sides of the story. In this case, we're relying solely on the documents that are available to the public through the courts.
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Case Files 17: Rady Children’s Part 1
And so we have the claims and then we have the motions to dismiss the claims. And that's really the information we're going on. So there are going to be gaps in the story that we really can't fill in until or if this ends up going to some kind of trial. So that makes this a little bit different.
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Case Files 17: Rady Children’s Part 1
And just so everyone remembers, you know, hospitals, doctors cannot provide any of the medical information or speak to any of the medical portions of the story other than what is in these court documents. And that's very minimal. So they cannot come out and say, but the patient had this or the patient had this. they have to rely on what their lawyers put out, I guess, through the courts.
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Case Files 17: Rady Children’s Part 1
the who what when and where of this story um so yeah so bex uh tell us tell us what this story is about who are we talking about so this all started um to be honest we kind of the further back we can go in the story it allows us to know a little bit more of why we got where we got i think so
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Case Files 17: Rady Children’s Part 1
To take you literally all the way back to 2003 is when Madison, who is the girl at the center of this story, so similar to Maya Kowalski, Justina Poletti are these names that you'll hear kind of coming up. So her name is Madison. She was born in 2003.
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Interestingly, a piece of this story is that the mother, Dana Gaske, and the father, William Meyer, went through in vitro fertilization, it sounds like, at least according to the court documents, three times prior to conceiving Madison. She was born premature. They mentioned somewhere, I think...
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a little bit over three pounds in weight and was the only child of Dana and William, both of whom worked for Kaiser Permanente. Dana was actually a nurse with Kaiser, and then it seems moved into more of an executive role. And then William also worked on the executive side of Kaiser, which is how they met.
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And the court documents do go into their whole story, but we'll kind of jump ahead to when Madison becomes a preteen And she sounds like an active kid doing well in school. And then she started having issues with her knee and then with her shoulder. And I think the shoulder is the kind of the piece of this, but she dislocated her shoulder while at an intensive surf camp.
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And that kind of started her sounds like her medical journey where she really started seeing multiple specialists about her shoulder. First ended up at Rady's Children's in San Diego and kind of that jumpstarted everything. So, I mean, Andrea and I have been through a lot of these cases, but I'm curious, Andrea, what your thoughts are on the pre-Madison story? Yeah.
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Right. She is diagnosed with something called hypermobile Ehlers-Danlos syndrome. And within a few months of kind of all these this diagnosis, she is already on like a modified school schedule just because of her pain issues, it seems at that time. And that also always sticks out to me. And then quickly from this diagnosis. diagnosis of the shoulder dislocation.
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She has her first surgery, which is a surgery on her shoulder. I just want to kind of give a few more details about how her story with Ehlers-Danlos started and with this shoulder issue. So after the first surgery, you know, she thought everything was fixed. And then very quickly, the pain and all of the symptoms started up again. They
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Note many times that she has multiple dislocations of the same shoulder and that there is significant pain. And I think that is that piece that will feel familiar to people who have followed some of these other stories. But pain to the point she was doing, you know, biofeedback, the TENS, which is kind of those little shock therapy to the area.
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She was seeing a pain psychologist, which I think is a wonderful piece, taking medications. And so the injuries were in 2016. And now we're already kind of jumping to 2018, where she has now completed months of like an outpatient pain program, actually at Rady's. Her pain was still severe. At that point, she was on what's called a 504B plan at school.
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Case Files 17: Rady Children’s Part 1
So she had even more kind of restrictions or special modifications made to her school schedule.
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The two surgeries were at Rady's with an orthopedist there. Some of the genetic diagnoses, like the diagnosis of Ehlers-Danlos came outside of Rady's, but it was someone they were referred to. And it sounds like actually Kaiser was the hub at first, because when you work for Kaiser, your insurance is Kaiser. And so most of your, like her primary care physician was from Kaiser.
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When I did my training in California, there was a Kaiser down the road. They did kind of the basics of of pediatrics. They had some of the pediatric specialties, but if things kind of became a little bit more complicated or more extensive, then they would refer to us at the local children's hospital, especially if they didn't have a specific kind of surgical option or things like that.
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So it does sound like Kaiser initially referred them to Radiesse to go to this orthopedist who specialized in shoulder procedures. We are actually going through her second shoulder surgery. They created a cage around her shoulder joint with ligaments from other people or something and somehow recreated this cage around her shoulder and just to try to keep it in place.
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So it sounded like this was a little bit more extensive, but it was still with this surgeon At Rady's during an admission for severe pain after this surgery. So now two surgeries and still with severe pain, unrelenting pain. She is admitted to Rady's and she is diagnosed with complex regional pain syndrome, which
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Case Files 17: Rady Children’s Part 1
Anyone who went with us in the Kowalski case, that was the diagnosis that really played center stage. I would say in Madison's story, the Ehlers-Danlos becomes more of the story, but this was an interesting little sidebar where she was on the inpatient unit requiring pretty strong pain medications. And then they recommended, actually at Rady's, that she go to an inpatient pain program.
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So complex regional pain syndrome, actually in this case, does seem like there may be parts of it that fit. So typically complex means it's difficult. It's difficult to treat. There's a lot of kind of comorbidities that come along with it, but it is a regional pain syndrome. So she injured her shoulder.
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The pain of CRPS would be expected to be kind of in that shoulder that she injured and then distal to it. So through the arm area. where the injury occurred. Often with CRPS, you get other symptoms than pain. So neurologic changes, vascular changes, all of these other things in the extremity that is involved.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
What is rare in CRPS is kind of more what we saw in the Kowalski case, which is kind of this whole body pain, all starts at the same time, very unrelenting. It does seem like at least at the beginning of this story that her pain was mostly in the shoulder and in that general vicinity, although... The information is limited.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
So it does sound like this may have been, you know, something along the lines that maybe was an appropriate diagnosis depending on how she presented. But the recommendation, which it should have been, was to go into an inpatient pain program where she can get treatment from all sides.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
So whether that's medication and therapy and physical therapy and psychotherapy and all of these things together in one place is the ideal treatment. But it is still rare to have to be admitted actually into the inpatient unit of a hospital. from pain or pain associated with something like CRPS, typically they come in for other things.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
So that always stands out to me that this is probably already a little bit outside of the norm or outside of the ordinary, you know, for Radies in this situation.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
Right. And it does sound like, again, a little bit different than the story we heard before is we're now two years into her symptoms and they did an outpatient pain program. There was a pain psychotherapist involved at somewhere. They were using medication, biofeedback. It does sound like they were trying these other things that are often recommended.
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
Yet, despite all of it and despite two programs,
Nobody Should Believe Me
Case Files 17: Rady Children’s Part 1
pretty invasive surgeries it sounds like she was still getting admitted for this severe unrelenting pain and somewhere along the way it does start to be you know pain associated like whole body pain or pain in other locations but this still at this point I would say the shoulder and the multiple dislocations of the shoulder is really a big part of it and that is something we see with Ehlers-Danlos that they that their joints can dislocate easier than you know anyone else's would.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
A clinical diagnosis is a diagnosis that relies on the story and the symptoms that are being described more than anything I can do a specific test for or a physician can do a specific test for. So often there is no lab diagnosis, MRI diagnosis. It is ruling out other things sometimes and then being left with the story and the symptoms fitting the condition.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
The problem is in medicine, there are a lot of diagnoses that we don't have that one perfect test for. And I think I was just talking to my friend this week about how in pediatrics, I think it's even a little bit different because we're not relying on what the patient is telling us. In some cases, we're relying on what the parent is telling us.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
And pediatricians in general are trustworthy people who is taught and is trained to listen to the parent or listen to the story and try to come up with a diagnosis.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
The question is if they're eating and they're doing okay is the difference because there are kids who are not supposed to be taking oral or whatever and they'll get in trouble, right? But if you're having a kid who's eating, I'm just hypothetically, you have a kid who's eating pizza and doing fine or eating all this stuff and doing fine, you have to beg the question of why you have a G-tube.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
Most parents don't want a G-tube. And in fact, I've been involved with lots of ex-preemies where they needed a G-tube for growth and development and the parents so wanted them to eat from a bottle. you know, and they were begging, can we do anything but the G-tube? I want my kid to be normal and well. So that's, that's my experience. And so, no, it doesn't make, it doesn't make any sense.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
And I mean, there's going to be conditions where you're, like I said, you're going to be doing some oral, some G-tube, but there's usually, it's transitional usually, unless like I said, this, someone had a horrible esophageal cancer and they had to do some reconstruction. And it's like, you can take some from up or you had cancer in your neck and
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
You can take some from up, but you'll choke a little bit, but we have to make sure you get enough by G tube, but that's not the case. No, no. If you're eating pizza and pepperoni and all this stuff, it's probably not.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
In medicine, we rely on the honesty, integrity of the parents trying to help their child. And unfortunately, in child abuse and medical child abuse, the motivations, I'm not a psychiatrist, but it's not what we're, we don't have a shared mission of getting this child better.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
So therefore, this, we have to be kind of more sleuth and ask, look for what I call the big disconnects in what we see and what we hear, you know, with these patients. Yeah.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
Jill Glick at 65, my medical record, the University of Chicago, has a lot of mistakes in it. I don't have diabetes. I don't have COPD. I can't get my record fixed because my primary is not at the University of Chicago. He can't go in and get rid of it because somehow that got listed by a mistake and there's no quality improvement.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
When I was a resident, the residents always look at me and roll their eyes. I said, when I was a resident, you got the medical record and you opened up and the first page was the problems list and you took your pen and you crossed out the ones that no longer existed and you made a new progress. You said, these are the current medical and these are your chronic diseases. That
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
Communication's been lost. So Munchausen by proxy cases, MCA cases, we help that process by not having universal medical record. Everybody should have a baseline universal medical record. And the people who make a lot of money off of Epic, I mean, Judy, whatever her name is, God bless her. She was a smart lady in 1970s to come up with electronic record. And I was like, this is so cool.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
So that adds to it. So part of one of the things I would always love is that there be a national requirement of all electronic records have to talk to each other. And not just talk to each other. Show everything. Like right now, if I go into another hospital, I only get like little snippets.
Nobody Should Believe Me
S05 Ep04: When the Cameras are On
Having the youngest daughter with her always sometimes in a wheelchair walking around, sometimes with leg braces on walking around.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Right, the complaint of Madison Meyer. So this is what we had focused on prior to this was the complaints and the court process that was kind of going on between the parents, William Meyer and Dana Gaske, against the defendants, including Rady Children's Hospital and then the County of San Diego and all of the other defendants that kind of came along with that.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Now we started jumping into the story of Madison Meyer, who rejoined, kind of came back in, or we started to hear about again in 2023. And then now we're at the third amended complaint by Madison Meyer since the two, Court cases have been merged, so now it's the parents and Madison are all involved in one kind of court proceeding.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And this is the third amended complaint that actually just came out this year in 2025 and just very recently within the last couple weeks. And so I just looked last night, and there has been a response by the defendants to basically – you know, dismiss the whole claim, the whole thing, but the judge has not responded. The court has not responded. So that's where it stands as of recording today.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And now what I wanted to do is kind of go through each of the claims that are standing right in front of the court right now, hoping that maybe we can talk a little bit about them and kind of see how we're feeling or thinking. And then that way, when the response comes or things change,
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
happen, then we can kind of keep going forward with the case and following along kind of in real time from there.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So now they're just going claim by claim and using all like kind of the legal terminology and really stating out why each of these claims should hold in their mind. And then I guess it goes to the defendants to come back and say if there's kind of legal precedent in cases that would justify dismissing any of these. And then the judge kind of decides. But at this point, this is where we stand.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So I'm just going to go complaint to complaint and then kind of let I have some questions for you specific to each one, just because, again, from our experiences and then my experiences, you know, as a physician, I think we kind of have a unique approach. ability to just kind of talk them through, I think, before we know where everything goes from here.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So the first complaint is a violation of federal civil rights. So again, like we talked about, we are in federal court for this case. So a lot of the claims are going to tie back to federal statutes or even amendments to the Constitution or things like this one goes into the American Disabilities Act.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So again, it's all going to kind of tie back to those kind of federal statutes when they make the claims. So the first one is a violation of federal civil rights, and this is on the unwarranted search and surveillance and the invasion of privacy. So the kind of the basis or the gist, if you read all of the parts of this portion of the complaint, are speaking more to the video surveillance.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So like we talked about last time, it was. Those, I believe at this point they were saying 38 days of video surveillance that occurred in the hospital room of Madison, 24 hours a day, seven days a week, and involved the surveillance of Madison and her parents at any point that they were within the hospital room.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And the claim states that these efforts or the efforts to do the video surveillance were basically undertaken in an investigatory capacity. So they are saying that it was the express purpose and intent of uncovering evidence of child abuse, if such evidence even ever existed. And then they even say in an effort to uncover or manufacture evidence of child abuse.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So we talked a little bit about this last time, but what are your thoughts on that kind of the word, the parentheses or manufacturer kind of stuck out to me a bit?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
I mean, it's it's interesting because I feel like they are sticking very much. Right. And I think we when we read these claims, I've now read so many like I feel like they stick to the script like they they know the terminology. They say things that kind of fit like it is a complaint or it is a breach of this federal statute because of this, this and this.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But that little parentheses or manufacturer that just felt a little bit. felt to me a little bit more emotionally charged or kind of like they were throwing that in as more of a, so maybe you don't think the surveillance is bad, but what if they were manufacturing it, dot, dot, dot. And then it kind of goes on to the next, to the next thing.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And so I think, I mean, to me, it sounds like it's intended to kind of get, kind of grab your attention or make you think, oh, wait, was this intentional or something? But that's my own experience.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And I think the expectation of privacy in the hospital room, I think, again, right now, it seems like it's very hospital dependent based on what the hospital's individual policies are, whether hospitals have private rooms or have double rooms, or how many patients are in a room, because right then and there, you've lost some of the privacy aspect.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
For instance, in an emergency room where there may be curtains separating beds, what is the privacy versus... in a case where, you know, it is a private room with its own entrance. And so I think the way hospitals are changing more to having private rooms, which as a mother, as a patient, I think is wonderful.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But does that change, I guess, that overall assumption of privacy that maybe a family or a I guess time will tell or we'll see how this case or other cases go. And I think I just wanted to briefly touch on the different amendments because I think I took government in. high school, at AP government. And so I was like, I'm just going to brush up a little bit.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But I think the three amendments, just for those that have been following along with us, that really come into play in most of these cases are the first, fourth, and 14th. The first speaks to, and it comes into this claim, this idea of the right to intimate association or the right to familial association, meaning, I guess, this idea that
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
It protects intimate association or your family's association with each other from kind of intrusion by the government. And so this question of if a family is having private conversations within a hospital room and they are assuming, I guess, that they are not being surveilled or watched.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
You know, is it OK to be kind of being through this video surveillance, also listening in potentially on private family conversations? The Fourth Amendment is the one that is search and seizure. But they bring this in about kind of protecting a family's home.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So in the sense of if CPS shows up at your door or Child Protective Services shows up at your door, do you have to let them in or in a hospital situation like happened here? They basically called the dad, it sounds like from the court documents anyway, into a room to tell him that his, you know, at that point that the custody had been changed to the to the county of San Diego.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And he did not get to go back in that room from that moment. So this is where the Fourth Amendment plays in, I think, is the seizure aspect, but also the coming into your place that is assumed to be yours or your private space. And then the 14th is probably the one that gets, I think, interpreted in a lot of court cases. So there's a lot of case history that you can go back to.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
This is that due process doctrine. So the idea that you should be protected, your decision should be protected, and basically nothing should be able to come to you without due process. So meaning that you deserve due process before any of your rights are taken away. And so this is the parents' rights Really, I think their hub is this is the 14th Amendment.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And so all of that is used in this first claim regarding the video surveillance as it's an intrusion into a family association. It's an intrusion into, you know, a family's privacy. And then the idea that should that freedom be taken away without any due process. So like basically without the family being aware.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So the next claim is another violation of federal civil rights. And this one talks to the deception in the presentation of evidence and false reporting. So we did touch on this a little bit last time. But this concept of, you know, the wording in the lawsuit says that these defendants basically knowingly falsified child abuse reports, that there was knowingly false evidence and
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
and that this decision to remove the child was based on a juvenile court order, which the defendant fraudulently obtained, caused to be fraudulently obtained, or knew was fraudulently obtained. So again, the words false and fraudulent kind of continue to come up.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And then they even say it to the point of that these defendants acted, agreed, and or conspired to employ these tactics and then to continue to employ them basically to extend the I think the time that she was detained. And so I think I've said this probably 100 times on the podcast, this concept of conspiring in medicine.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
When anyone who lives in the world of medicine knows that it is difficult to get three doctors to agree on a diagnosis, sometimes let alone get a group of doctors that would all be willing to conspire, quote unquote, against a family, I guess, as as some of these cases have claimed, that seems very far-fetched.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And that's because I work in this field and I cannot imagine walking around being like, hey guys, we should really, you know, do this and having everyone buy into it. It's just not how kind of things work. We all have our own set of, you know, principles. We all have our different specialty. We all have things we're coming in with previous experience.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And to me, the word knowingly, and I'm going to ask you kind of what you think after, but this idea of intentionality, right? That it was intentional, right? you knew you were lying and you lied, or you knew you were falsifying and you falsified. So to me, that is, I am looking at a lab result that says a child's hemoglobin is low, meaning his blood count is low or he has anemia.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And I knowingly look at my report and I'm like, well, patient's blood count was normal for age. Something that is so drastically, it is right in front of you and you are writing it a different way. To me, that is knowingly intentionally falsifying. The thing is, a lot of medicine is still subjective, meaning you can have three x-rays, 100 labs, and you're looking at everything.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And it's kind of how you, based on experience, based on knowledge, based on your specialty, how all that ties together into a diagnosis is not so objective all the time. And so I think, again, the way things are worded or the way someone interprets Information. That's why you have another side of the story. Right. It doesn't mean they're right or wrong.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
It means that in their medical opinion, this is like how to interpret this data. And so I think it's that intentionality that I know they say because it makes it more a stronger case, I think. But what what are your thoughts?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And I think we put stuff into the medical record. We know that is forever discoverable, forever there. It is not hearsay. It is, you wrote the words. So again, I think we, I would hope most physicians are doing that with a I am not going to write something that I did not see with my own eyes.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
It is something I know I heard and that usually someone also heard, like meaning a resident was with me and can also document that they heard it or a, you know, nurse was in the room. And when you say in quotes, you mean like mom says.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And again, I would only quote the part that they said. That is something that goes back to my training, but also I could see where that could be human error. So I think having another, you know, having someone else there and being able to say the same thing or also being able to document in a note what they heard, I think is useful. Because it is going to turn he said, she said at that point.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
claim three for the unwarranted nonconsensual medical procedures and examinations. So we talked about this last time with that swallow study that we went into a little bit of detail about. And I think it also speaks to the covert video surveillance in the sense of if it was used for diagnosis of Munchausen by proxy, then it is a diagnostic procedure.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So then they should have been notified of it like any other diagnostic procedure. This seems like a little bit of a catch 22 to me because it's, if you're using it for the word diagnose, okay, then it is a diagnostic measure. So I see how it fits under, does it need consent or not?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
I guess under that, what we were talking about last time, like would this hospital consider it a procedure that requires a consent or not? And then, but if you, See it as they were coming in with this covert surveillance to manufacture, I think was the word, evidence of abuse. Then was it for diagnosed? Right. I think it's kind of it's used a little bit in both ways.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And I think a swallow study, too, if the parents did refuse that, would that be something you would then go to a court order for, to be honest? Because, I mean, I'm thinking for me, myself as a physician, feeding through a G-tube is not...
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
I'm sorry, sometimes I have to tell a family, look, if that's the one thing they need to be safe and be healthy, big picture, it's a little procedure, you know, like you get a little tube. I can kind of say it that way in the sense of if they can still live their life and do everything else, then isn't that great?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But at the same time, you're saying, but if they can eat, why are we doing it this way, right? I mean, like if they don't have a physiologic reason they can't eat, is it harmful to then not allow them to?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And so number four. So this is where we start getting into the question of Madison having the diagnosis of hypermobile Ehlers-Danlos, along with the other things we've spoken of. This one is now a violation of federal civil rights that they failed to provide adequate supervision, safety, security and health care to her.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And the idea that she was under the custody of the government at this time or under the custody of the County of San Diego. So now we're talking about the time from that shelter or detain order forward, which we don't have a lot of information about in the documentation.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But the idea that if the government has custody of a child, they owe them reasonable safety, minimally adequate care, and then also appropriate medical and mental health care, which I think should go without saying, but also it is stated. And I think...
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
We have talked about before when a child is in a hospital, I think that there've been times where they become less of an urgent priority to get them into placement elsewhere, like into a foster care situation, because a hospital is seen as a safe and healthy place for a child.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And so their argument is, I think that the defendants were aware of her true medical condition, which implying they list off, but hypermobile Ehlers-Danlos is at the top. And that they failed to investigate the actual cause, failed or refused to provide treatment. And then they do get into this use of unapproved and unauthorized hypnotic techniques to inject false memories.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So this plays into the whole sexual assault claims.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Correct. And I think this, yeah, this wouldn't have been available or information that was in the parents' complaints just because we didn't know this piece.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
But I think it always makes me think, and this makes me think of the Kowalski case that Andrea and I covered a couple years ago, this idea that I looked up for myself, and as we said, we will probably speak, hopefully speak with an Ehlers-Danlos specialist, but kind of what the standard of treatment is. And it
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
it starts on patient education, lifestyle changes, teaching awareness of their own body, self-management techniques, physical therapy. It lists as the cornerstone of Ehlers-Danlos care. And then pain management, obviously starting with non-opioid pain medicines and so on. And then you start getting into kind of managing the coexisting conditions that come into Ehlers-Danlos. So
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Those foundational things, to me, in most hospitalizations, those very basics are available, are being offered to a child. So again, because we don't have the medical records, I cannot speak to exactly what her treatment plan looked like. But to me, this feels a lot like where they were saying that Maya Kowalski was being treated as a Munchausen by proxy victim as opposed to a patient with CRPS.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Yep. One of the, we'll talk quickly about the Americans with Disability Act a little bit later where we talk, there are a few specifics mentioned, but I think this one as a physician really stuck out to me as it I kind of feel like if we are doing the standard of care, like does every child look forward to PT and OT every day? No, like there are times they may have pain after it.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So we have to talk about like, how can we make it work for them, make it work. But I still think that as long as you are following the standard of care, I guess at that point it becomes,
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
what if the parent thinks the care should be different and I put myself kind of in this in this position and I've thought about times I've been in it like a parent says they want a lumbar puncture to know for sure that something doesn't exist but in my medical opinion it does not exist based on my exam and that is a procedure I do not feel is warranted and I therefore won't do and
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Can a parent make me do a procedure I don't want to do? You know what I mean? And where is that line of what if one specialist says, oh, do the lumbar puncture? OK, but what if what if I still don't know that in my experience that is standard of care?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
I think these questions are going to come up more and more because there was a time when a parent wouldn't even know to come in and ask for a lumbar puncture. Frankly, you know, so now they know how do we navigate that? And that's what this I think what this claim really brought up for me as a physician was thinking about these things.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
I think what we strive for, but it's getting harder and harder. I'm not going to lie. As a physician. Physicians do have to draw boundaries, you know.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So claim five and six both speak to this idea, kind of like what we were already talking about. But the first one is about in the creation of the case plan for Madison, that they should have been taking into account all elements of her medical condition.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
and that she should have been aware of this case plan and kind of how these discussions went down as far as the case plan, meaning where we go from here, it sounds like. And then going into the Americans with Disability Act and the Vocational Rehabilitation Act, the idea that Madison had a disability and was she in any way kind of discriminated against based on that disability.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And so I think all of these counts get to the heart of if standard of care or if what is needed for this specific child with Ehlers-Danlos is seen differently by the parents and by the physicians taking care of her, how do you reach that joint decision-making?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And if the hospital or doctor is potentially going down the path of what they see the standard of care to be, or the hospital sees the standard of care to be, then how do you even play out one of, I think, one of these lawsuits in the sense of If we started from different points, can we ever kind of see it the same? And then the idea of this being a disability.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So I did look this up just so I could kind of speak a little bit to it. But Ehlers Danlos in and of itself is not in this blue book that the Social Security Administration puts out. for like standalone diagnoses that basically put you in the ability to be able to have like disability services. And so it is seen as a disability, but it is not in that book. It has to be Ehlers-Danlos plus.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So Ehlers-Danlos plus some like substantial functional impairment, inability to maintain walking or standing for long periods, chronic severe instability or pain, things that are actually interfering with your ability to, to work, your ability to, I think it says to perform, quote, substantial gainful activity.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So basically, does this diagnosis have enough of these other features to say that it would do that? And I know that's not really what these claims are saying, but the idea is they are claiming she does have a disability. So by that definition, she would meet those criteria. And then did the hospital, did the physicians consider
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
potentially withhold or discriminate against her in any way based on that disability. This is where one of the specifics comes up. The idea that they denied transfer to a facility that specializes in Ehlers-Danlos. I don't know what the specifics of that were. the use of an appropriate wheelchair, her use of her phone and her tablet were things that were mentioned.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
And again, as a physician, I was thinking through this. If physical therapy evaluations are saying a child has the ability to walk and therefore we are working on them with that, We tend to opt for the least invasive and using maybe the other one as a backup or something like if it is needed, this can be a bit of a gray area.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
If you send someone home with a walker or a wheelchair, it is very easy for that to become what they need and what they use. So often we put kind of timelines on things like, We will send you home with this, but you follow up in this long. And then we'll kind of keep reassessing whether this need continues. The hard part is you can buy these things on Amazon now or anywhere.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
So even if we don't order a wheelchair, they can still get a wheelchair. So again, this is a slippery slope that as a physician, I can read my own way based on my own experience. But this question of the appropriate wheelchair is, Is was it the physicians thought one thing was appropriate and the family thought another? Is that grounds for, you know, a lawsuit?
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Or is that discrimination based on the disability? I think these counts all just kind of keep bringing up these things. And I did look up in Ehlers-Danlos. at least from the data we have, it is a small percentage of people with Ehlers-Danlos and usually on an as-needed basis that a wheelchair is needed. So you're going to spend the day at Disney.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Maybe that may be a long day and you may need the wheelchair. So it's that as-needed basis and then still a very small percentage. So I don't know what your thoughts are.
Nobody Should Believe Me
Case Files 19: Rady Children's Part 3
Yes, at least from the point of view of these complaints, it was while she was underrated children's that they're claiming she was, you know, discriminated against.
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Case Files 19: Rady Children's Part 3
You know, it's kind of the reading between the lines. But I think also I've thought about the whole discrepancy in health care where, you know, a family can take up a GoFundMe to get the fancier, more motorized wheelchair. But I have children on.
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Case Files 19: Rady Children's Part 3
You know, the CMS plan, which is like Children's Medical Services for complex children, children who live in, you know, maybe nursing facilities and things like that, who can't even get the very basic wheelchair, who need it. And so I do start to think bigger picture with some of this stuff that it is sometimes, like I said, ordering it on Amazon or taking up a fund for something.
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Case Files 19: Rady Children's Part 3
It doesn't really matter what. the doctors say. And this is a scary piece of the world to me as well, because I've told you time and time again, my goal with any child is, is getting to be a kid and getting to live life to the fullest. And like, if you want to play baseball, let's find out a way you can play baseball. Like if that's your dream, you know what I mean? Like what could we do?
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Or really, is there no way that it's safe because of your condition? And I think, um, That's that idea of like where Make-A-Wish came from, right? This idea of doing that thing that maybe you never would have gotten that chance to do. Like we want them to feel like kids and be kids. And I think sometimes when the two concepts go very awry, that is a tough decision as a physician.
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Case Files 19: Rady Children's Part 3
Like if I am writing an order for equipment It is something that based on the evaluation we've done, we have determined is medically necessary.
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Case Files 19: Rady Children's Part 3
Writing it because a family wants it or I don't know, that starts to cross into, you know, unethical territory for me, at least assuming I am looking at the whole picture and I'm listening to all sides and I'm seeing what I'm supposed to see as a physician.
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Case Files 19: Rady Children's Part 3
But it is a slippery slope and I think we've seen it in these cases and that's why, you know, these things kind of jumped out at me, I think specifically.
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Case Files 19: Rady Children's Part 3
And it goes into the education system. It goes into every aspect of this. Like there are kids, I've talked to families about getting like a 504 plan for a child with true disability and how many calls a family has to make and how many meetings and how many things.
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Case Files 19: Rady Children's Part 3
And yet some of these children that I have met, I'm saying over my whole career, that are developmentally normal, who could excel in a normal classroom, who these parents do fight to get them these services. But there are only so many services to go around. These things are finite. And it is not just they may have a wheelchair.
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Case Files 19: Rady Children's Part 3
They may have the wheelchair embroidered with the child's name, with all of the newest things, with these things that money does not come out of the equation. There is some piece of that. And the number of times I have fought for a patient who needs to get a G-tube, but whether it makes sense for that family socially, economically, and yet... Other people can come in and demand one and get one.
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It's really the system is it is entering scary levels. And I think, again, we will see how this case specifically plays out. But this does bring into question, I think, a lot of what we do in medicine in terms of
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Case Files 19: Rady Children's Part 3
So trying to get a child home and trying to get a child to function and trying to get a child to be as childlike or as like be as much of a child as they can, if we are working against each other in that, we're going to hit impasses, I think, on all of these things. Yeah. And the next couple of claims, it's the Monell related claims or claim seven and eight.
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That is the exact same claims, this idea of the medical procedures, the deception of evidence, but taken to the level of policy. And are there policies that basically promote these things or are there not policies to prevent these things?
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Case Files 19: Rady Children's Part 3
Right. And then the ninth claim is the UNRWA Civil Rights Act. This is, again, speaking to if you are in a business in California, they shouldn't be able to discriminate against you. So the idea of the hospital as a business and therefore the same claims just under a different act.
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Case Files 19: Rady Children's Part 3
And then the last claim that Madison brings in this third complaint, the 10th claim that she brings is denial of access to medical and mental health records.
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Case Files 19: Rady Children's Part 3
And this is a very short claim and it doesn't give a lot of detail, but basically the statement is that she herself made multiple requests for a complete copy of her records and that there has been refusal on the side of Rady's and the medical defendants in this case. to not comply with these requests.
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Again, I think at this point, this one is going to be probably he said, she said, or they can go back to any email communications and kind of see what holds water. But this to me, I mean, again, I think curious to see where it goes, because if this was done all legally and she was requesting the records, you know, where does that line cross? And I think depends on the state.
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It depends on the county. It depends on the institution, all of those specific policies.
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So there's the county and their defendants, Rady and their defendants. And so from what I could see, again, it was I just looked last night. They have just filed a general dismissal of all claims. And so that's the last document in the court doc right now. I don't know if they're going to come back specifically with each individual claim as they did yesterday.
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With some of the parents complaints or they're kind of trying to kind of close this on a bigger picture point. And then that's where it stands. So I think.
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At least now on this claim itself. And so I think we will know now, I think, how it goes forward as far as the delineation, which this gets into some of the legalese of which plaintiffs are claiming each. Like, you know what I mean? Is it still going to be parents have claims and Madison has claims? Is all of that going to be combined?
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And then which defendants will be potentially taken off completely, which can happen? Will they combine defendants or and then which of these counts will actually even happen? stand at the end. And so this is, I think, a very, very important part of this process is where we stand today with, I don't know what the timeframe that the judge has to come back with their response.
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But it sounds like that's going to be then what goes forward. And that will be the point at which they determine if this is going to head forward into trial or settlement or kind of where it goes from there.
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Case Files 18: Rady Children’s Part 2
The idea of covert video surveillance, if you do capture something, it may mean you're able to save or help the child if you have this piece of evidence. So you're not making something happen. You're doing it as another piece of your, I think, investigation. And what's most important is every state has their own laws as to how covert video surveillance can be used.
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Every probably county DCF or Child Protective Services branch has their own kind of methods for using that. And then each hospital has their own set of consents that come into play in these cases. So it really without knowing very specifically this hospital, this county, this state, this HHSA or their child protective services,
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that's going to be where all the litigation comes into play i think is kind of how that all does play out but as of now this is the parents do not know that the video is in the room um until much later at which point you know they realized they had been watched for 24 hours a day for seven days a week and so that does come in a lot into the court documents when it comes to
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Case Files 18: Rady Children’s Part 2
concern for invasion of privacy, violation of constitutional rights to privacy, search and seizure, all of these other things. The covert video surveillance comes up time and again.
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So I think more to know about the specifics of this case, but you'll just see that this is something that has come up in previous cases and probably will continue to. So we will see how this part plays out. When she does return to Rady Children's, there is another report made to HHSA or called into the abuse hotline. At that time, we do not have access to those reports.
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We know that a report was made. And there is documentation of Dr. Nienau, again, being a part of this because she is the child abuse pediatrician. So she is the one who would be helping with the medical reporting of symptoms that are occurring that are concerning, you know, for medical child abuse or munchausen by proxy or neglect or anything else that is coming up in this case.
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By this point, it is stated in the court documents that Dr. Nino or somewhere in these reports that there was a potential risk of death if Madison remains in the care of her parents. We don't have all of those details, but I don't think that's said lightly in my experience or in my opinion. And Andrea, we've seen it in other cases, but there is a path of no return in some of these cases that
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there may be warning signs and it may be a review of the record and it may be all of the information you have in front of you but at some point there is a concern for death is there not yes i mean we've seen a lot of cases that were escalating in that direction and unfortunately i'm researching a number of cases right now where the parent followed through on that
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And the record review that Dr. Nienau or any child abuse pediatrician would do is, I just want to clarify that their specialty is child abuse pediatrics. So Dr. Nienau actually did the fellowship in child abuse pediatrics, is board certified in child abuse pediatrics.
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I mean, there's other child abuse pediatricians that have a different backstory, but that is hers and has maintained, you know, continuing medical education in the field, all of that. That being said, the record review is the kind of heart of these cases, at least from that side. There are all the medical records there are.
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The doctors, the parents, you know, feel have information that would be important. There's neighbors, there's friends, right? I mean, like all these cases have a lot of people, but this is one piece of the puzzle is the report from the child abuse pediatrician. So just to be clear that a child abuse pediatrician's role is in diagnosing or facilitating
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finding evidence that there is no concern for abuse so their report is going to be a review of the records and what they're finding in those records that is concerning enough to potentially show signs of child abuse that report is part of the entire you know case and information that is put in front of the judge and then it's the judge making the determination based on that information whether you shelter or detain the child from the parents
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makes sense right they're more trained and that's i think that's where maybe there's a little bit of dissension in in how people feel about them but again i think when you put it in that context of they are specialists in this field it doesn't mean they're going to find it and like you said it actually data shows that maybe they find it less i think that's an important just an important piece to kind of set this up before we go forward but um as with a lot of the cases we've we've followed
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it is going to come into question whether this report, whether the initial call to HHSA was falsified or this idea of a false accusation or false elements of these reports. And that also, it's this word false that I think gets to me personally is, is it false or is it what they saw at that time or their, again, reasonable suspicion of whatever it is that they're calling in or reporting?
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which is what we're taught to do, is that you call in when there's a reasonable suspicion. So saying these accusations or these reports are false, I think that word is just is interesting, not to say there couldn't be something that is just blatantly wrong in a report. Of course, there is. But at the same time, that word false accusation or false reporting to me could mean a variety of things.
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Case Files 18: Rady Children’s Part 2
So the report is made very early, but it goes forward to March 7th of 2019. So she was in New York in January. So now we're in March. And this is when the petition or is filed with the court for detention or for meaning like that Madison will be separated from her parents. And so at this point, the decision is made in the court to separate Madison from her parents.
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And the next day there will be the hearing to kind of discuss this when the parents can arrive in court and be a part of the hearing. It is told in the court documents that the father was the one that was present at the time and that he was brought into a meeting with the team and with security is what is said in the document. And it is explained to him that the court has made this decision.
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He is asked to leave the hospital. He needs to surrender his parental badge. It sounds like Dana came up to pick him up, had to surrender her parental badge. And from that moment of that meeting,
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it does not sound like they saw madison again at least you know that day and along with that is the whole report that what was done by the state workers or those who work in the hhsa system and then dr ninow's report and any other collateral information from both sides is brought to the judge.
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And based on what is placed before him, I mean, again, we don't know what that all entailed, but what went in front of him, the decision was made to separate Madison from her parents and to put her in the custody of the County of San Diego.
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Correct, with all of the information provided to them. And I think this is a part of these stories that as a parent, as a human, you know, it sounds a certain way when you hear it, but I don't know.
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And I think children's hospitals, we, I mean, this is not an irregular occurrence, but it has happened. And I think that's why we have all the teams that we do. You know, our job is with the child. That's the patient at our hospital.
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And so, you know, offering all the kinds of support, being present, you know, doing, explaining to the child in child languages, kind of what, you know, what's happening as we're able to. And then also HHSA is somehow communicating with the child when they're in the hospital as well. And
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like you said i don't there's no perfect way to do this i don't think there is but we also know that the time of you know separation or when this is playing out is also a high risk time for children i'm not saying you know in this case in particular but in any case you know tempers emotions fear right are all at their highest so we also have to understand that that's a time where we do have to protect the child because there is still a risk um
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Okay, so the next day, so now we're on March 8th, is the hearing before the judge where the parents are present. And what we know about it from the court documents is that the parents are going to be allowed one visit per week for one hour, and it's going to be a supervised visit.
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One of the things they do say in the document is that they were told they're not to talk about her medical condition, her symptoms, how she's feeling about things. And you and I both know that this is part of kind of the OPSEC guidelines for what should be done in these cases if it gets to the separation point. So do you maybe want to explain that a little bit?
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i think at this point the concern and the reasonable suspicion and what was found by the judge was that there were concerns specifically of this type of abuse so again whether you whether the parents or whoever believes that or not to be true at this point that is what the court had before them and so following this pathway is what is recommended but remember that if it is in fact found that there was abuse happening
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each of these times that that is kind of replaying itself can be very traumatic to that child, or even, you know, set them back if there was, say there was starting to be recovery scene that could lead to another setback.
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During this time, I just want to point this out because, again, once we get into the court process, this is going to come up again because it is one of the claims that is filed as to unwarranted medical procedures that were allegedly performed on Madison while she was at Rady's and while this shelter order or this detention order was in place.
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And this we are relying solely on what was said in the court documents, which is that it seems there were specifics of what the court said the hospital could do and stuff that needed to be told to the parents before it was done. And then things that maybe specifically would need consent because the parents that's important to point out.
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parents are still the medical decision makers in these cases so even though they may not be allowed to be present they are still the ones who would say sign consent forms and if not then it would go to it would have to actually go to a court order so i think a lot of things comes up come up in terms of what constitutes kind of
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a normal medical procedure versus what is something that constitutes needing that extra guidance or extra consent from a parent. And this kind of actually made me think a little bit, to be honest, because there are times that a parent isn't directly at bedside. And if you're kind of following along with what the plan was, a lab test could be drawn while the mom isn't there.
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You know, an X-ray could be ordered and done without the parent there. And it's kind of what is that limit? A lot of things may warrant or may kind of as a physician, you feel like you should be notifying someone versus the act of consent. And I think that is an important point. And again, as we've said a couple of times, it's very state specific.
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It may be in the hospital bylaws as to what procedures require consent. But I think there's some gray areas and that's one of the ones that comes up in this case is this swallow study. And just for those who are following along, I wanna explain to you what it is and maybe we'll hear from you guys what kind of what you think. But the idea is she was describing or Madison was not eating by mouth.
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not very clear exactly what symptoms she was describing but the test that was ordered is what's called a swallow study and a swallow study is you go down to the radiology suite there's usually a speech therapist or an occupational therapist and you drink liquids eat foods that are tagged with a certain dye d-y-e dye so that um you can watch it go down and the idea is you want to make sure the swallow mechanism is intact that they're able to pass it from their mouth to their esophagus and then that it passes down through to the stomach
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And there are pieces of this. Again, it's not just a routine abdominal x-ray, but there is no anesthesia involved, no sedation involved, side effect risk, no pain. I mean, again, if she's having pain when swallowing, sure, but then the study would end. You know, it's not necessarily you wouldn't push through significant symptoms, I don't think, at least in my experience.
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But the idea is she was swallowing contrast and that there were pictures being taken. So I'd be interested, I think, to hear what people think or maybe since you're not in this field, what you think about that. But the point is, it depends really what the hospital, I think what their policy is and then what the court orders said and how those two things play into each other.
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um it sounds like there was another a number of other procedures yeah yeah yeah and i mean again this kind of reading this did make me think a little bit more about about the things we do and kind of what standard of care what falls under that you know general medical consent that the parents sign at the beginning
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And a lot of times in pediatrics, to be honest, parents are present or a family member is there just because of the nature of a child being in the hospital, but there are times they can't be. And so just really thinking that out, I think, especially when I'm talking to residents in the future, kind of about notifying and keeping parents in the loop.
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And I think there are parents that can't be at the bedside for other reasons, you know, work, other children, life, things that they can't necessarily be there and that we're sure we're kind of giving them the same, you know, involvement in the care as if they were within reason too.
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um okay so yeah so take us back take us back to the timeline okay so um this is the window of time where we really lose eyes on madison if you want to say it that way or that there's not a lot in the court documents probably because this is the parents that we're talking about now and they're filing with the courts and they weren't at the bedside right so i think there is some um some information we don't have during this time but just so we know she is
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In Radies, after this shelter order goes into place in March of 2019 until February of 2020, when kind of the story picks back up. And again, there's a lot of reference back to times in there, but we don't know a lot in this time period until February 5th, 2020, when Madison is returned to the custody of her parents. There's another hearing.
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It's in front of a judge called Judge Imhoff in California, in the county of San Diego. And he is now determining that Madison can be returned to the custody of the parents. But he...
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There's there's some terminology and and just so everyone understands it's the terminology that's in the court document, but then the court document occasionally puts things in quotes so we are relying a little bit on what they're saying somebody said so a little bit of he said she said.
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But there was a term that was used at this time that I just it really kind of stuck out to me and i'm curious to hear what you think but.
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he uses the term scarlet letter of munchausen by proxy or basically that this family had been branded with their own scarlet letter of munchausen by proxy and there's times i think like we just said that legal terms opinions adjectives adverbs all these things just get kind of interesting in medicine in law where you want it to be like it's this because of this and that's just not always how it works out
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But this one, I don't know. It hit me a little bit.
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and i think it is interesting how how some seem like you said some seem to have a little bit more to say and you are right in the dependency court this isn't a jury this isn't it's not that same you know kind of a feeling in the courtroom where he really was kind of laying down his final thoughts on this um and then also where what is the state of the case so he says you know or at least the court documents tell us that he um you know spoke out and said um i think about
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the implementation of the covert video surveillance as being an invasion of privacy he does use some of this terminology or these words at least according to the documents and if there is say a police investigation or other things are going on you know these words could be very you know inflammatory or very kind of pushing in in one direction yeah it's i mean these things are really very much ongoing a lot of the time you know and certainly many cases that we've seen
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those of you who were with us on the first episode will remember. So Madison is the patient that we're talking about this time, Madison Meyer. And where we left off was she had been suffering mainly from shoulder dislocations, then admitted to the hospital in pain, began to have kind of different and changing symptoms throughout that course.
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So this is almost a total of a year. So it's less a month. So 11 months, March 7th. I mean, she has been in Rady since January of 2019, but in the custody of the County of San Diego from March 2019. Now we're in February 2020. Oh, I'm thinking what February 2020 was like. See, there's more to come. Now that I think about it. It's a little wild. Yes. But I think so. That's where we are.
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And this is, again, where we're filling in the blanks here and there. But she is still a patient at Rady's. February 5th, 2020, she's returned to custody of parents. So she does remain at Rady Children's. And we'll talk about it, I think, more next time about kind of what we do know about that time frame.
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But this is where we kind of leave off after this is, yes, she was returned to her parents' custody, but she is still a patient at Rady Children's for whatever reason. We don't completely know. And that now the parents are back in the room, back in the...
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yep and just so people understand i think the dependency court process and now the process that we're kind of talking about going forward where then there is a lawsuit by the parents against all of these defendants that's two different courts and that's two different pieces and often the dependency court process a lot of those documents are sealed for other reasons and so there the court now going forward needs to determine whether those documents come into play or not there has to be
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you know, orders and motions to get all of that to happen. So we're relying on the court. When I say the court documents, I'm referring to the court process when the family brings lawsuit of the lawsuit against of the lawsuit.
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And then where we left off was she was about to be taken to New York and to see a specialist or a neurosurgeon who specializes in Ehlers-Danlos Syndrome, which if you remember, she was diagnosed with hypermobile Ehlers-Danlos Syndrome. And she had now been at Kaiser San Diego, Kaiser LA, and back to Kaiser San Diego.
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Yep. And so I think next time we'll we'll pick up and talk a little bit. There's there's some interesting factors that come into play with the lawsuit that the parents file and kind of how they're the counts they're bringing against the defendants. And it's a little bit different than other cases we have covered on the podcast.
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And so we'll we'll get a little bit more into all of that and the court process and where we stand now next time.
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And at this point, she's going to be transferred to a hospital in New York where this neurosurgeon, Dr. Paolo Bolognese, practices and where he sees patients.
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And I agree. And I think what happened during other cases we've covered is that patients who truly suffer from these conditions and have symptoms
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some of the you know long-term consequences and complications of these are actually getting a little bit lost in the shuffle because there are all these places and all these doctors you know that are diagnosing these things kind of in different ways and maybe using different criteria and in a way it's it's kind of what happened with covid with adhd diagnoses right where things are getting diagnosed now even on the internet by other people and the people who are truly suffering from these things at times are now facing drug shortages
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inability to get care from providers because of all of this. So I think that's more, I think what Andrea was trying to say is that these conditions exist and they can be debilitating and there's concerns with it. It's just, it's more that how do we kind of find a place where everybody's getting the care they need, but the appropriate care, you know, in the appropriate places. So.
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okay so madison goes to new york um to see this specialist dr boling they say so what is his he's a specialist in ellers danlos like what does he specialize in so he is a neurosurgeon by training and it sounds like over time he's kind of gotten into this niche of ehlers-danlos syndrome and his specific what he is specifically looking at is the connection between ehlers-danlos and what's called a chiari malformation which is
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where part of your brain the cerebellum actually hangs a little bit lower into your spinal canal and at some point based on measurements it can start to have symptoms or things associated with it and then there's the tethered cord syndrome that he questions or thinks about in this case which is where your spinal cord is actually attached to the tissues surrounding
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it in the canal and it can cause symptoms basically from your waist down. And then the other one is something called cranial cervical instability, where basically your skull and your cervical spine, there's kind of instability and that can have its own set of symptoms. So it seems like those three diagnoses that he works most specifically on and then their links to Ehlers-Danlos syndrome.
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And he works with a neurologist, Dr. Kula, who I believe since has retired, according to the website. But at that time when Madison went, it was Dr. Balagnesi and Dr. Kula. And it's not extremely clear in the court documents what testing was done or how much was done when she was there. But they do give us a list of diagnoses that came out of that visit.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
So to start with, they do say they agree with the Ehlers-Danlos diagnosis. The other one that we had already spoken about was the diagnosis of POTS or postural orthostatic tachycardia syndrome. And at least from the documents, it seems like a tilt table test was done in New York that did, according to them, confirm the POTS diagnosis.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
And the one thing that was mentioned, which again is what Dr. Bolognese seems to specialize in, is that there were concerns she may have what's called a tethered cord. And that really seems to be the focus of his research is this connection between Ehlers-Danlos and these different other conditions.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
Correct. And at this point, Kaiser Permanente San Diego has been in communication with Rady Children's. And the decision was made that based on Madison's complexity, that when she returned to San Diego, she would be admitted to Rady Children's as opposed to back to Kaiser Permanente.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
As I was saying on the first episode, that that did occur even when I practiced in Southern California, where if there are specialists or if there are things that a child needs that are not available at Kaiser Permanente, they will reach out to whatever the local children's hospital is and potentially transfer patients.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
So at this point, Madison is transferred back from New York to Rady Children's. And we again meet Dr. Shaylin Niinau, who is a child abuse pediatrician associated with Rady Children's. So we're now in January and Madison is back in San Diego, but now at Rady Children's. And we're going to go into a little bit of what happens now during this stay at Rady.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
This is where the question of covert video surveillance comes into play. And I speculate or kind of assume that this is going to be a big part of the court process going forward because it has shown up multiple times in the complaints filed by the parents as to this timeframe during which Madison and her family were under this covert video surveillance within the room.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
So when they arrived back to Rady Children's, they were placed in a room that has the capability for video surveillance.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
because there was the report made prior that had been closed for, it sounds like the investigator, it was closed after an evaluation for not having enough evidence at that time to proceed.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
So now that she's at Rady and they have the ability to do video surveillance in the rooms, a discussion was had, again, that depending on which side we're hearing kind of different stories, but whatever it's worth, video surveillance began in the patient's room at that time when she was placed at Rady's and carried on for, Over 30 days.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
There's times where it says 36 and times where it says 38, but it was 24 hours a day, seven days a week for at least 30 days or over 30 days. Andrea and I have talked about this a little bit about using video surveillance in these cases. And maybe you can speak a little bit to your experience with video surveillance being used.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
And I think it's important to say, too, that doing video surveillance is not to falsify evidence of medical child abuse or munchausen by proxy. So just placing the camera in and of itself is not forcing evidence to occur, right? The idea is you have an eye in the room, and you can see behaviors and patterns and things that may stand out. It doesn't mean you're going to find any.
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
It means it's a tool, like you said, to use, because it's often
Nobody Should Believe Me
Case Files 18: Rady Children’s Part 2
varying versions of the same story right there's the medical record there's social media there's what the parents are reporting there's what the child is reporting and you may have two doctors who got two different stories as well so part of it is i think in the world we live in people want to see evidence people want to see clear concise evidence that is going to say this is what is happening and i have no doubt it's 100 and that just doesn't exist in this you know in this world but