By Dani Donshik '24
What happens when the people we are supposed to trust the most turn their backs on us? Have we put too much faith into a system that has failed us countless times? Numerous victims of medical child abuse charges have shared their stories of the mistreatment they have endured at the hands of medical professionals and Child Protective Services. At what point can families feel comfortable asking for help without being questioned as if they are criminals? This article focuses on the journey of the Kowalski family as they navigated through the tides of the medical and legal system to regain custody of their daughter.
In the summer of 2015, 10-year-old Maya Kowalski was admitted to the emergency room for severe abdominal pain. She had suffered from an acute asthma attack, which led her to experience burning sensations in her lower extremities. Days later, she was taken into state custody and prohibited from seeing her family. Over just a few weeks, Maya had lost the ability to walk and never had a waking moment without any pain; her parents did not know where to turn but were recommended to see anesthesiologist Anthony Kirkpatrick, the head of a Complex Regional Pain Syndrome (CRPS) clinic in Tampa, Florida. Complex Regional Pain Syndrome is a "neuropathic pain disorder characterized by ongoing pain disproportionate to the degree of tissue injury and persists beyond the usual expected time for tissue healing." (1) CRPS is a complicated condition to diagnose, as it is mainly one of exclusion and based on clinical criteria. After seeing Dr. Kirkpatrick, Maya was officially diagnosed with CRPS and had been recommended to try intravenous ketamine to mitigate her symptoms. While ketamine is commonly known as a party drug, it is used in emergency room settings as an "FDA-approved anesthetic." (2) The Kowalskis decided to give Maya these infusions as a last resort to offer her some symptom relief. After many infusion sessions, Maya's pain started to improve, and it seemed like the ketamine could be a viable option to help manage her CRPS.
Following one of her infusion appointments, Maya started to experience abdominal pain, which led her parents to bring her to Johns Hopkins All Children's Hospital in St.Petersburg, Florida. It was here that doctors and nurses began to suspect something was awry when Maya's mother, Beata, began to ask for ketamine for her daughter to help dull Maya's pain. Physicians became suspicious after Beata requested such high doses of ketamine and thus submitted a report to the Florida Department of Children and Families (DCF) diagnosing Beata with Munchausen syndrome by proxy. At this time, Maya’s parents told the hospital they wanted their daughter discharged. They were told that if they did so, they would be leaving the hospital “against medical advice” (AMA), and if they tried to take Maya out of the hospital, they would be taken into police custody. (3) As stated by the Journal of Law, Medicine, and Ethics, “It is established in law that patients are entitled to consent or refuse medical treatment. They can therefore leave hospitals ‘against medical advice’ (AMA).” (4) According to this information, this was entirely untrue when the doctors told the Kowalskis that they could not take Maya home. Therefore, the legal rights of the Kowalskis were violated, as any individual has the right to relinquish themselves from the care of the hospital at any given time or refuse treatment. In this situation, as Maya was a minor, it was up to her parents to refuse medical treatment, and since this was the course of action they planned to pursue, it was justified for them to turn down medical treatment.
Doctors grew more apprehensive of Maya and her family throughout their stay at All Children’s and became increasingly convinced that Maya was a victim of Munchausen syndrome by proxy, so they videotaped her actions to see if she was capable of any physical movement. After this video trial, medical professionals adjusted her diagnosis to a factitious disorder and claimed she was concocting all her symptoms.
Maya was subsequently removed from the custody of her parents and confined to All Children's, resulting in many restrictions being imposed upon her. She had limited visitation with her father and almost no contact with her mother, who had previously been accused of making her daughter sick. Maya's family hired lawyers to fight their removal of custody. However, the presiding judge, Judge Haworth, denied Maya’s requests to see her family multiple times as he deemed it unsafe for her to have prolonged contact with them. As the court proceedings were occurring, the Kowalskis’ worst nightmare happened: Beata Kowalski, 43, committed suicide in the family's garage. The family had no choice but to continue to fight for guardianship over Maya – so they kept up with the trial. Finally, Judge Haworth ruled that Maya’s father was allowed to take her to be medically evaluated by a professor at Brown University, Pradeep Chopra, who is a CRPS specialist. Chopra deemed that Kowalski’s symptomatology and positive reaction to the ketamine were in alignment with a CRPS diagnosis and that the other diagnoses of factitious disorder and Munchausen syndrome by proxy were “incorrect.” (5) After retrieving this information, Judge Haworth ordered Maya back into the custody of her father.
A year after Maya’s release from the hospital, The Kowalskis sued Johns Hopkins All Children's Hospital for the damage that had been inflicted upon their family. $211 million in “compensatory damages“ and $50 million in “punitive damages for false imprisonment, battery, medical negligence, and other charges” were awarded to the Kowalskis. (6)
Let's rewind to the beginning of Maya’s story to pinpoint the issues that led the state to remove her from the custody of her parents and place accusations on them. According to The Florida Statues, Title XLVI – Crimes, Chapter 827 (Abuse of Children), Section 03 (Abuse, aggravated abuse, and neglect of a child; penalties), child abuse is defined as the “intentional infliction of physical or mental injury upon a child; an intentional act that could reasonably be expected to result in physical or mental injury to a child; or active encouragement of any person to commit an act that results or could reasonably be expected to result in physical or mental injury to a child…” (7) All Children’s was under the belief that the Kowalskis, specifically Beata, were trying to harm their daughter, ultimately leading to her being taken under state custody. This raises multiple issues; for example, proper investigations into Beata’s background were not carried out to ensure that the diagnosis of Munchausen by proxy was correct. Additionally, Maya denied on numerous occasions that her parents were abusing her. While child testimony is not always reliable, it is equally essential to consider the accounts of the individual whose life is at stake.
If the medical and legal system has anything to learn from the case of Maya Kowalski, it is to always listen to the patient first, as they are the ultimate advocates of their medical care. The only people who can truly stop the brewing epidemic of unwarranted medical abuse charges are the physicians who bring them to light in the first place. It is imperative that families feel safe enough to bring their children to hospitals to get the medical care they deserve instead of hiding in the shadows for fear that they will be persecuted for asking for help. (8)
Endnotes
Dey, S., Guthmiller, K. B., & Varacallo, M. , Complex Regional Pain Syndrome, Pᴜʙᴍᴇᴅ. https://pubmed.ncbi.nlm.nih.gov/28613470/#:~:text=Complex%20Regional%20Pain%20Syndrome%20(CRPS,expected%20time%20for%20tissue%20healing. (Last visited Apr. 15, 2024).
Dyan Neary, The True Story Behind ‘Take Care of Maya’, Tʜᴇ Cᴜᴛ (Nov. 09, 2023, 5:12 PM). https://www.thecut.com/article/child-abuse-munchausen-syndrome-by-proxy.html.
Ibid.
Audrey Laur, Discharge against Medical Advice, Pᴜʙᴍᴇᴅ. https://pubmed.ncbi.nlm.nih.gov/30136563/#:~:text=It%20is%20established%20in%20law,medical%20outcomes%20and%20malpractice%20litigation. (Last visited Apr. 15, 2024).
Dyan Neary, The True Story Behind ‘Take Care of Maya’, Tʜᴇ Cᴜᴛ (Nov. 09, 2023, 5:12 PM) https://www.thecut.com/article/child-abuse-munchausen-syndrome-by-proxy.html.
Christine Hauser, ‘Take Care of Maya’ Family Awarded $261 Million in Court, Tʜᴇ Nᴇᴡ Yᴏʀᴋ Tɪᴍᴇꜱ (Nov. 10, 2023, 7:42 PM). https://www.nytimes.com/2023/11/10/us/take-care-of-maya-trial-damages-kowalski.html.
Chapter 827 Section 03 - 2023 Florida Statutes, Tʜᴇ Fʟᴏʀɪᴅᴀ Sᴇɴᴀᴛᴇ. https://m.flsenate.gov/Statutes/827.03 (Last visited Apr. 16, 2024).
Maxine Eichner, ARTICLE: When the Helping Hand Hurts: How Medical Child Abuse Charges Are Undermining Parents' Decision-Making Rights over Children's Medical Care, 35 J. Am. Acad. Matrimonial Law. 123, (2022). https://advance.lexis.com/api/document?collection=analytical-materials&id=urn:contentItem:66N5-TDK1-FG12-639D-00000-00&context=1516831.
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