LVHN, child abuse workers should take controller’s report seriously, with humility

Diagnostic error is common in medicine; the Journal of the American Medical Association estimates that between 10-20% of diagnoses are missed, delayed, or incorrect. It therefore should be no surprise when doctors err. And yet—stunningly—no acknowledgement of the ubiquity of misdiagnosis is present in the responses to the Lehigh County Controller’s Report, “The Cost of Misdiagnosis.”

This is not new to us. In our roles as leaders of a criminal legal reform nonprofit, we are familiar with resistance to progress. Here, the responses from the hospital and county workers are the same we hear when other types of forensic error and misconduct are discovered.

First, are the procedural complaints, which are common deflections when error is revealed. Lehigh Valley Health Network and county workers complain that the Controller—a county official responsible for ensuring taxpayer money is stewarded responsibly—shouldn’t be investigating their use of taxpayer money, that he didn’t follow the procedures they would prefer. But these complaints are not substantive responses to the community’s concerns about error and misconduct, nor do they solve the problem articulated by both the report and the crowd of distraught parents at the recent County Board meeting.

As the report makes clear, troubling circularity is rampant in the investigation of medically based allegations of child abuse. The child protection workers rely on the medical opinions of the child abuse teams and the child protection determinations are then used to validate the medical opinions. While the medical providers claim they do not make removal decisions, the truth is that children are often removed based only on their opinion that abuse occurred.

Then, the Department sets up a false conflict between parents and children. Where parents are upset because children are wrongfully removed, there is not a “parent side” and a “children side,” there is only the family on one side and a wrong diagnosis on the other. Children can be harmed and traumatized from removal alone, and it appears from the report and commentary by accused parents that some children in these cases may have been mistreated in foster care. It is wrong to assume that removing children from their families and putting them into foster care is always a safe option. Even placement in high-quality, loving foster care can be traumatic to children and families. And, as the Report points out, when removal is unnecessary, it is a waste of significant taxpayer funds.

Instead of expressing concern, LVHN described the stories of these families as “emotionally driven and unsubstantiated criticism.” This type of dismissive behavior is common when errors are uncovered. LVHN complains that the Controller did not follow the hospital’s preferred procedures. But it seems the Controller had little other choice; from the report it appears that the Child Abuse Center at LVHN does not listen to outside opinions, including medical opinions from more qualified Cleveland Clinic and Children’s Hospital Of Philadelphia specialists.

This, too, we have seen before.

This has been a theme throughout efforts to reform forensic sciences and medicine. It is routine for families facing wrongful allegations to be ignored and belittled. Some child abuse professionals have even suggested that those who stand up for the wrongfully accused should be professionally attacked and deprived of their livelihood. This report suggests a troubling pattern that is common in faulty forensic science. Specifically, when a child abuse pediatrician (or any expert) does not receive feedback from patients, families, or colleagues appropriately, the system can neither learn nor correct itself.

The proper response to allegations the Controller’s Report contains is humility. All professionals need to be open to hearing about their errors, because error is inevitable when dealing with human beings. Those without the ability to listen to feedback objectively and humbly do not belong in this “complicated and emotional” profession.

We have no doubt that the families involved in these incidents are emotional. What happened to them was traumatic and unjust. But to weaponize that emotion to try to claim that the fault lies with the parents is offensive and wrong. We encourage the County to adopt the modest recommendations in the Controller’s Report for the welfare of their constituents.

Kate Judson, Executive Director, Center for Integrity in Forensic Sciences

Keith Findley, President, Center for Integrity in Forensic Sciences, Professor, University of Wisconsin Law School