Friday, July 29, 2016

Medical child abuse revisited 3

When the Department of Children and Families sought emergency custody last year of a 7-year-old girl whom doctors suspected had been poisoned by her parents, it didn't have to start a new file on the couple.

The department had been aware of Christopher and Julie Conley for at least six years, going back to 2009, when the girl was a toddler suffering from what a prosecutor has called unexplained medical issues.

The department's counsel was able to convince a juvenile court judge at that time that there was reasonable proof that the Conleys had harmed their daughter through medical child abuse, also known as Munchausen by proxy.

The child was removed from their care and according to court filings by Assistant Northwestern District Attorney Linda Pisano, "every single medical condition went away" during that time.

Still, the child was returned to her parents in 2011. Pisano said her medical issues came back sometime later, after DCF ceased to monitor the girl and closed the case.

The indictments grand juries returned against the parents charge them with abusing the girl going back to July 27, 2013.

On April 15, 2015, according to prosecutors, either one or both of her parents poured a caustic substance into her cecostomy tube, a medical tube used to flush her intestines. She became critically ill and lost two-thirds of her bowel and part of her bladder. Christopher Conley confessed to the crime but later recanted.

So why was the girl returned to her parents after DCF had determined she was more likely than not medically abused?

The decision was made by a juvenile court judge who heard arguments from both sides, including from DCF officials who opposed letting the girl go home…

An expert in Munchausen by proxy said that a judge's decision to return a child to their parents who medically abused them flies in the face of what research shows: people who medically abuse their children once will do it again.

"The risk of reabuse in confirmed Munchausen by proxy cases is very high," said Marc Feldman, a clinical professor of psychiatry at the University of Alabama who has studied Munchausen by proxy cases for 25 years…

The girl, now 8, has been living with a foster family since being discharged from the hospital.

In the case of Christopher and Julie Conley of Northampton, there is a fairly strong piece of evidence of medical abuse by at least one of the parents in that their daughter was seriously injured with a caustic substance April 15, 2015. 

But her parents for years before that maintained that she has mitochondrial disease, the same disease with which Pelletier was diagnosed. Court records have not clarified whether the Conley's daughter was officially diagnosed with it.

Like Pelletier's case, doctors at Boston Children's Hospital first raised the question of medical abuse, but court documents do not indicate that they filed a report with DCF. The Conleys moved their daughter to Tufts Medical Center, where doctors suspected abuse and filed a report.

Christopher Conley confessed to pouring Liquid-Plumr into his daughter's intestinal tube, although he later recanted. His wife has maintained her innocence, but she was also charged with similar crimes more than five months later.

A Department of Children and Families official said in court that Christopher Conley's time sheets at work have made investigators wonder if he could have been home when he was alleged to have poisoned his daughter, which points to his wife.

But another thing mentioned in court documents about Julie Conley's role in the suspected medical abuse is her level of involvement in her daughter's medical care. She was described as the primary care giver for her daughter, very knowledgeable and interested in her daughter's care, present at all her appointments and the one who makes medical decisions for the child.

The prosecutor in the case said medical staff indicated that both parents "either did not mention previous medical treatment and/or testing done and misrepresented, minimized or exaggerated medical testing or results."

But Feldman said that he was "wary of condemning the mother" based on behavior in a hospital.

Sometimes mothers accused of Munchausen by proxy are pushy or argumentative, Feldman said, which can strain doctors' relationships with them. He said that while a person who disagrees with doctors and insists the child has a different or undiagnosed condition may be more likely to be medically abusing the child, "it's not proof."

And while doctors have said a caustic substance is the only explanation of the Conley girl's injuries last year, there is at least some possibility that the girl had medical problems she was born with. Christopher Conley told police he was attempting to kill his daughter because she was suffering — it's still criminal, but it's not an intention typically seen in Munchausen by proxy cases.

In court Allen has said that the girl's parents believe she has mitochondrial disease, severe hypoglycemia, seizures, and other issues.

A charitable foundation that provides free family photos for children with serious illnesses posted an online album of photos of the Conleys Sept. 25, 2014. It named mitochondrial disease and other illnesses and also said that the girl was born with a duplication of her 22nd chromosome.


  1. A Cleburne woman whose 13-year-old son’s “terminal illness” prompted donations, media coverage and a visit from a wrestling superstar, was arrested Friday on accusations that she lied about her son’s medical condition.

    Danita Tutt, 40, is accused of causing serious bodily injury to her son, Colby, by lying about his medical history to the boy’s doctors, prompting the boy to undergo unnecessary surgeries and be placed on unneeded pain medications.

    Those surgeries, police say, included placement of a central line that later led to a potentially life-threatening blood infection. She also withheld food and water from the boy, investigators said.

    Tutt was arrested Friday afternoon by fugitive officers at her home in Johnson County, said Sgt. Wade Walls, supervisor of the crimes against children unit. Bail on the warrant is set at $25,000.

    Child Protective Services took custody of Colby and his younger brother May 6 after a report was made to the state agency that the Tutts had removed Colby from the Ronald McDonald House of Fort Worth, where he had been receiving palliative care since April 21.

    The report claimed that Tutt had been refusing to feed and provide water to Colby and that she had already made funeral arrangements and purchased a casket for the boy.

    “Mrs. Tutt is an attention-seeking type person and enjoys the attention she gets for having two medically fragile children,” the allegations included, according to CPS documents obtained by the Star-Telegram. “There are concerns that she may end Colby’s life. There are concerns for the safety of his sibling.”

    Medical staff told CPS and police that they feared Colby would die prematurely under the care of his mother, who allegedly asked more than once if there was something that could be given to her son “to make him go to sleep” and not “wake up.”...

    When removed from his mother’s care in May, an arrest warrant affidavit states, Colby weighed 51 pounds, had a feeding tube, a central line and a colostomy bag, and was on several pain medications.

    Now, he eats only by mouth, has gained approximately 10 pounds and has had his central line and colostomy bag removed, states the affidavit, written by Crimes Against Children Detective B.W. Kesler.

    Colby has also been weaned off all pain medications, the affidavit states...

    Christopher Cooke, Tutt’s attorney, said Colby has suffered from a variety of medical problems since his premature birth...

    “This lady has literally devoted her life to taking care of this little boy and his medical problems,” Cooke said. “… In our opinion, there’s no way the allegations against Mrs. Tutt are true. There were too many people looking over her shoulder — physicians, family, friends. I literally have 25 affidavits sitting on my desk attesting what an outstanding individual she is.”

    Read more here:

  2. Marc Feldman, a clinical professor of psychiatry at the University of Alabama, has studied Munchausen by proxy cases for 25 years…
    And out of all of the cases he has researched or been involved in, Feldman said the allegations of the use of a caustic, poisonous substance on a 7-year-old Northampton girl are "more dramatic than I've ever heard of before."

    Adults who intentionally harm children usually use more subtle means that produce results that are not so easily identified as medical abuse, he said.

    But the allegations against Christopher and Julie Conley are that on April 15, 2015 one or both of them poured a caustic substance, possibly Liquid-Plumr, into an implanted tube in their daughter's abdomen that was used to flush her intestines.

    The girl was hospitalized for 9 months and underwent numerous surgeries, including a seven-hour emergency surgery to remove two-thirds of her intestines that had "essentially disintegrated," according to court records…

    In addition to the dramatic method allegedly used to sicken the girl, other unusual features of the case include the alleged involvement of both parents, the alleged involvement of the girl's father, a confession or false confession, and the presence of pretty clear evidence of medical abuse…

    "I consider Munchausen by proxy or medical child abuse to be a form of maltreatment like any other, just like sexual abuse and physical abuse," he said. "It lets abusive parents off the hook if they claim it's a mental illness."…(continued)

  3. (continued)Among the things that are still unclear is whether the prosecutor is leaning toward one parent as being responsible for the April 15 poisoning — which Christopher Conley confessed to but then recanted — or whether she intends to make a case to a jury that they worked together to harm their daughter on that occasion or others before it…

    Police wrote in court records that on May 20, Conley confessed in an interview that in March 2009 he dipped his daughter's central line in feces and reattached it, hoping it would kill her.

    He also said that after his daughter had a fever April 15, 2015, she begged not to go back to the hospital. He then administered the Liquid-Plumr and when his daughter was in pain immediately after, gave her an overdose of painkillers, he told police.

    He again told police he hoped it would end her suffering from an unspecified illness, police wrote.

    Statements made in court later revealed that her parents believed the girl had mitochondrial disease and other conditions and allergies. Signs of mitochondrial disease and medical child abuse have been confused in the past because it has such a wide variety of symptoms and is difficult to diagnose with certainty…
    Feldman said it is extremely unusual for both parents to be accused of medical abuse.

    "It's rare to have both parents kind of working in a coordinated way to sicken a child," he said. "When I search through my case files, I really have not seen parents working together in this way."…

    Feldman said that when medical abuse is suspected, the mother is more often the culpable one and the father is "largely or totally unaware."

    If Christopher Conley is found to be solely or partly responsible for harming his daughter, Feldman said, that's another "atypical feature" of the case compared to those previously studied in the field.

    A review in 2003 of 451 cases of Munchausen by proxy cases found that mothers were the perpetrators approximately 75 percent of the time, Feldman said. In the remaining cases in which other adults were believed to be responsible, fathers accounted for only about 5 percent.

    None of those cases involved suspicions of both parents being involved, Feldman said…

    Feldman said it is also very rare for a "confession of any kind" in Munchausen by proxy cases.

    Most will deny the crime, he said, "sometimes even when confronted with incontrovertible evidence, like a video of the abuse."

  4. The separation test

    Feldman said that one of the best ways to confirm or rule out Munchausen by proxy is often called the separation test. "You separate the parent from the child and see if the child improves," he said.

    According to statements Pisano made in court documents, when the girl was removed from the Conleys' home in 2009, "every single medical condition went away."

    Before that, she had been diagnosed with a "failure to thrive," her mother had reported seizures, allergies and other conditions, and the child also had several unexplained central line infections, Pisano wrote. While documents do not specify when the girl was removed in 2009, that is the same year, according to the confession of Christopher Conley, when he dipped her central line in feces.

    At some point after she went back to her parents in 2011, "enormous medical issues started arising."

    The results of the so-called separation test are less clear in the present case because the girl's internal injuries are so serious and, according to the prosecutor, will continue to affect her in the long term. Pisano and Allen have made conflicting statements about the girl's health since DCF took custody of her.

    At a June hearing about whether to lower Julie Conley's bail, Allen said that since the girl was hospitalized in 2015, doctors have reported medical episodes and diagnoses that support Julie Conley's statements that her daughter has real medical issues.

    She has also been hospitalized twice since she was initially released from the hospital in February. Pisano later said one of those incidents was because the girl's colostomy bag "exploded."

    Pisano said that while the girl's condition "was and is very grave" because of the serious internal injuries, many of her symptoms are disappearing as time goes on.

    She said medical staff report the girl has been "transformed from a lethargic, almost non-responsive, bed-ridden, extremely sick child to a vibrant little girl (who) is active, playful and engaging."

    Feldman said that while there are some common signs of medical child abuse, there isn't a standard list that one can tick off symptoms or behaviors to come to a determination of guilt. Even the separation test isn't a sure bet.

    "Usually they rely on strong circumstantial evidence," he said of the cases.

  5. If investigators and the Northwestern district attorney's office has more than circumstantial evidence against Julie Conley, it has not been made public.

    At a June court hearing, Allen said that her client was indicted after doctors testified before a grand jury about their beliefs that Julie Conley had fabricated or exaggerated her daughter's medical conditions for years.

    "Our theory is she fooled the best doctors in the world," Pisano said of Julie Conley at that time.

    But at least one investigator has questioned whether Christopher Conley could have been home poisoning his daughter when he said he was.

    Some court documents have made mention of getting records of the "employee door log, time sheets and badge logs" from L-3 KEO, the Northampton company where he worked until his incarceration. It was also stated in records that the prosecution is seeking Verizon phone records to try to establish where Christopher Conley was when his daughter was sickened.

    In an April hearing in Northampton District Court, the girl's adoption social worker, Jennifer Rhodes, said that a court-appointed investigator who compiled a report in June 2015 on the suspected child abuse had "questioned whether it would have been possible" for Christopher Conley to have been the one who poisoned his daughter.

    Judge W. Michael Goggins ruled that there was sufficient evidence for a year-long order against Christopher Conley, but said that DCF did not meet its burden of proof to show that the girl, who now lives with a foster family, is in danger from her mother.

    Pisano also wrote in court documents that Julie Conley was by her daughter's side "almost 100% of the time" while she was being treated at various hospitals, while Christopher Conley was less involved. The mother was often the only one reporting seeing symptoms and requesting testing and procedures, she wrote.

    Both parents "either did not mention previous medical treatment and/or testing done and misrepresented, minimized or exaggerated medical testing or results," Pisano wrote.

  6. A Northampton man found guilty of trying to murder his sick 7-year-old daughter in 2015 by injecting her with drain cleaner and overdosing her on painkillers was sentenced to 16 to 18 years in prison on Monday.

    Christopher Conley, 37, was sentenced in Hampshire Superior Court after a jury found him guilty on Friday on three counts: attempted murder, assault and battery on a child by means of a dangerous weapon (opiates), and assault and battery on a child causing substantial bodily injury. The sentencing came after an almost three-week trial that heard testimony from medical professionals, members of law enforcement and Conley himself.

    The jury had found Conley guilty of injecting Liquid-Plumr through a medical device in the girl’s intestines on April 15, 2015, and then overdosing her on painkillers. Doctors had to remove over 6 feet of her intestines and a third of her bladder in successive surgeries. She was discharged from the hospital in February 2016.

    The girl’s adoptive mother, whom the district attorney’s office declined to name, read a victim impact statement before the sentencing. She said that the girl, now 12, sees a therapist weekly to cope with the physical and emotional damage her family caused her.

    “She continues to deal with the unknown: the unknown of why this was done with her, the unknown of what she will have to face in the future, the unknown of whether her reproductive organs have been damaged and whether she will ever be able to have children of her own,” she said.

    The adoptive mother went on to say that the significant internal damage the girl suffered has led to problems with her bowels and anxiety that her organs will fail. The girl has to constantly monitor every bite of food she eats to make sure it doesn’t irritate her digestive tract and has suffered bullying and embarrassment for the way her body now functions, she said.

    “She now lives with multiple physical and emotional scars,” the adoptive mother said. “She will live with these scars for the rest of her life.”...

    In sentencing Conley, Judge Richard Carey said that Conley’s actions justified a sentence harsher than the state’s sentencing guidelines call for.

    “The intentional and horrific acts of the defendant on April 15, 2015, require a significant and upward departure from the sentencing guidelines so as to arrive at a true and just verdict and sentence in this case,” Carey said...

    Conley’s ex-wife, Julie Conley, has pleaded not guilty to assault and battery charges related to her daughter and her trial begins March 9, according to the Northwestern district attorney’s office.