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What happens when Florida child abuse pediatricians get it wrong?

Court records show flaws in doctor abuse conclusions
Posted: 6:19 PM, Nov 25, 2019
Updated: 2019-11-26 16:54:40-05
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 Dr. Suzanne Haney, Chair of the Council of Child Abuse and Neglect for the American Academy of Pediatrics
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Florida families around the state are speaking out about being wrongly accused of child abuse by experts hired by the state to identify abuse.

“We’re thinking we’re taking him to the right hospitals, right doctors to get him the best of care and we sort of got ambushed we felt like,” said Jeremy Graham, a West Coast Florida firefighter and paramedic who was arrested and charged with aggravated child abuse four years ago.

“I knew something was going on”

He and his wife had spent years trying to have a baby. After two rounds of IVF, Tristan arrived four years ago. But four months into their adventure as a family, the trio was torn apart when a child abuse pediatrician determined a seizure Tristan had was the result of a brain bleed caused by “physical abuse, specifically abusive head trauma...such as violent shaking injury,” according to court records provided to us by the parents.

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The Grahams denied the accusations. Weeks prior to Tristan’s seizure, they said, they had taken Tristan to a sleuth of specialists because, “I knew something was going on,” said Vivianna.

First, Tristan stopped breathing while Jeremey was feeding him. They brought him to the ER. Doctors found no obstruction and Tristan was released. Then came bouts of vomiting and, on October of 2015, their 4-month-old baby had a seizure.

“Call 911, Tristan is having a seizure,” Vivianna recalls her husband telling her. “I could him see him holding Tristan and Tristan is seizing."

Tristan was rushed to the E-R by ambulance. Doctors determined Tristan had a brain bleed and a child abuse pediatrician knew why, “physical abuse, specifically abusive head trauma, such as violent shaking syndrome,” according to court records.

“Inflicted? What are you talking about?” Vivianna recalled.

A new breed of doctor

Child abuse pediatricians are specially trained to spot child abuse. There are 22 in Florida who work as experts across the state with child welfare investigators. It's an industry where records are kept private to protect children. While these expert opinions can save thousands of lives each year, court records reveal they can also tear families apart when their conclusions implicate parents who seem to have done everything right.

“He was seen by so many different doctors before we took him again to the hospital a second time so to us, we were like what is going on,” Vivianna said.

Tristan was removed from the parent’s home to live with relatives while the Graham fought the state’s findings and Jeremey’s criminal charges.

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When the child abuse pediatrician gets it wrong

The Grahams are among a small but vocal group of parents now speaking out about a child abuse system, they said, that doesn’t always get it right.

The Florida Investigative Team

“It’s like losing everything,” said Vadim Kushner, of Sarasota County, recalling how the state removed his newborn son and year-old daughter last year after a state pediatrician determined seizures his 33-day-old son was having was the “result of shaken baby or blunt force trauma.”

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“We said we didn’t do anything, she said 'yes you did,'” Kushnir. The state filed a case to terminate the Kushnirs’ parental rights following the determination of abuse. But The Kushnirs fought back and spent $30,000 on attorneys and experts who argued the baby’s condition resulted from a complicated birth, not abuse.

A Sarasota County Judge agreed. In the final order denying the Florida Department of Children & Family's motion to terminate the Kushnir’s parental rights, the Judge also criticized the state's doctors for not knowing the month-old baby had a complicated birth which left him not breathing because the umbilical cord was wrapped tightly around his neck. One doctor even admitted during court he, “never reviewed all his [baby’s] medical records.”

“The doctors have to be more responsible and investigate more instead of just signing off,” said Kushnir. “Take it more seriously, this is destroying families."

For weeks, we've been seeking answers from the FL Department of Health (FDOH) which overseas Child Protection Teams, including child abuse pediatricians. We asked for interviews but our requests were denied by FDOH Communications Director, Alberto Moscoso. We submitted records requests, but most of those records have not been provided to us.

Last week, we sent FDOH and Moscoso a list of questions including the department's response to frustrated families who believe they were wrongfully accused. We also asked for the department's reaction to court orders criticizing some child abuse pediatricians for their lack of thorough investigations into some cases of potential abuse. On Tuesday, we finally heard from Moscoso who told us in an email these doctors, "operate in accordance with medical standards of practice; however remain open to receiving input from others who are involved in protecting the health and safety of Florida's children," he said.

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Child Abuse Pediatrician: ‘We are not the lone ranger’

“We do everything we can to make the appropriate diagnosis,” said Dr. Suzanne Haney, Chair of the Council of Child Abuse and Neglect for the American Academy of Pediatrics. She explains how child abuse pediatricians are extensively trained requiring an additional three-year fellowship and (3) additional years of subspecialty training with exposure to everything from x-rays to testifying in court. A 2009 University of Missouri study found certified child abuse pediatricians are actually less likely than other doctors to diagnose abuse.

 Dr. Suzanne Haney, Chair of the Council of Child Abuse and Neglect for the American Academy of Pediatrics
Dr. Suzanne Haney, Chair of the Council of Child Abuse and Neglect for the American Academy of Pediatrics

“We understand all of the possible mimics and misdiagnoses that can happen,” said Haney who also said abuse should be diagnosed by a team, not just the child abuse pediatrician who should also know the child’s full medical history and interview the parents directly.

But Jordan Abramowitz, a South Florida attorney, said that doesn’t always happen.

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“The procedure of how they commence these cases is flawed,” said Abramowitz. Last year, he started representing a young South Florida family torn apart when the state pediatrician concluded abuse caused (22) fractures and bruises on their 7-week-old baby girl.

Nydia Ortiz is the baby’s grandmother. “I kept thinking this is a mistake, this is going to be corrected. It’s not right,” she told us through tears.

According to Abramowitz and court records, the child abuse pediatrician did not review the baby’s medical records before he concluded the baby’s condition was the result of abuse. Abramowitz said had that happened, the doctor would have learned the baby’s parents spent weeks in and out of doctors offices over “concerns” about “bruise marks” on the baby according to medical records provided to us by the family. One doctor even suspected the baby suffered from a rare genetic disorder which causes bruise-like symptoms. Turns out, the baby and her parents did.

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“In criminal trials you’re innocent until proven guilty but in child abuse cases, I felt like we were guilty and now it was upon us to prove it, do the research and diagnose the baby,” said Ortiz.

Dad: ‘I’ll never forgive and forget’

Approximately 8-months after the state removed Tristan Graham from his parents, it dropped its case over “insufficient evidence.”

“I’ll never forgive and forget,” said Jeremy Graham whose criminal case was also dropped.

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Every year, Vivianna sends the state pediatrician who concluded her son’s seizure was the result of child abuse- a family holiday card. Last year, the doctor wrote back.

“I try very hard to be thorough and get it right but perhaps I need to be more careful to consider grey areas,” the pediatrician allegedly wrote back.

Meanwhile, in May a Miami Judge ruled in favor of Nydia Ortiz’s family. According to the judge’s final order, “there was no child abuse.” In the order the judge also criticized the state’s doctors for “not interviewing the parents to assess their histories, an important diagnostic tool necessary to be done by a physician (not just a nurse) when genetic disorders are probably or even possible,” the judge added.

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The young family was reunited immediately.

It only 7 -months Ortiz's entire life savings.

“It cost $130,000 in total,” she said. “It was unnecessary, it didn’t have to get to this point,” she said. Ortiz believes child abuse pediatricians need to be required to interview families directly and not rely on nurses or other team members. She also believes these experts need to do more thorough investigations and be required, in some cases, to seek an independent 2nd opinion before a child is removed from their parents.

“How many cases are out there where the parents don’t have the money, didn’t have the ability to get the right experts and the parents lose their children,” asked Abramowitz.

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