Medical child abuse is slipping through the cracks of Texas’ justice system, experts say

Medical child abuse cases upend society’s expectation of the caring parent. In these cases, parents who appear to be utterly devoted to their child’s healthcare are accused of the unthinkable.

Laurie Williamson, a Houston mom convicted in 2008, faked a plethora of illnesses in her three children, including a mitochondrial disease that she said would kill them before adulthood, authorities said. Danita Tutt was found guilty of attempted murder in 2018 after Tarrant County investigators said she lied about her 13-year-old son’s health and withheld food from him for so long that he almost died. Kaylene Bowen, convicted in Dallas in 2019, exaggerated and lied about her son’s health for seven years, during which he had 13 major surgeries, according to court documents.

In each of these cases, Child Protective Services received reports about potential medical abuse, but either CPS or family courts did not immediately remove the child from the mother’s care or returned the child before the mom’s conviction.

Dr. Carole Jenny, child abuse fellowship director at Seattle Children’s Hospital, has seen firsthand children who medical staff believe are victims of abuse be returned to their caretaker in family court.

“If you have a weak family courts system, that allows the child to go home when they’re being abused,” said Jenny, who is a member of the medical child abuse committee for the American Professional Society on the Abuse of Children.

Experts on medical child abuse, like Jenny, say a lack of training and protocols in the justice system can leave children in medically abusive households. In Tarrant County, Texas and the rest of the country, medical and criminal justice experts say more education for Child Protective Services and family courts staff would help prevent children from remaining with abusive parents while protecting innocent parents from false accusations.

Tarrant County Sheriff’s Office Detective Mike Weber, who primarily investigates medical child abuse cases, has advocated for an official course on medical child abuse in Tarrant County for several years.

“What we know about these offenders is that they have a compulsion to commit this abuse that overrides any fear of consequences,” Weber said. “When the people in positions of power in the systems in place to stop the abuse fail in their responsibilities to the victims of this abuse, this often emboldens the criminal offenders in this abuse to continue and sometimes escalate their behavior.”

‘The wheels came off’

Doug Welch said his son’s case — which ended with the charges dismissed and custody returned to the mother — is an example of how family court systems do not understand allegations of medical child abuse.

For years, Doug Welch thought his wife was simply an overprotective mother. Her constant anxiety about their son’s health seemed understandable, especially after his son fell from a balcony and had a brain injury at 5 years old in 2008, he said.

Doug and Mary Welch’s son was constantly in and out of the hospital. By the time he was 11, the boy had undergone repeated brain surgeries, had a feeding tube inserted, and had reportedly suffered from migraines, asthma, epilepsy, normal pressure hydrocephalus (excessive fluid on the brain) and muscular tightness that required the use of leg braces.

Doug Welch had been a strong advocate for his son’s health, helping his wife run a Facebook page and fundraisers about the boy’s treatments. Those treatments included the use of a private jet to fly the family to Minnesota when Mary Welch said her son was in critical condition and needed to have a shunt surgically inserted in his brain. Doctors at Cook Children’s Medical Center in Fort Worth had referred the boy for surgery, she told her husband, but could not do the surgery themselves. Doctors interviewed in Texas as part of the later investigation into Mary Welch said they made no such referrals.

Doug Welch’s world changed when, in 2013, Child Protective Services and a Tarrant County Sheriff’s Office detective met with him and told him his wife was being investigated on suspicion of medical child abuse.

“(The detective) explained to me what was going on, and all of a sudden it began to click,” Doug Welch said. “That this was child abuse instead of trying to help your child.”

According to an arrest warrant affidavit issued in May 2014, Mary Welch was accused of lying about and exaggerating her son’s health conditions since at least 2008. A Cook Children’s Medical Center doctor who treated her son said in the affidavit that the boy was the victim of medical child abuse.

In 2014, Tarrant County prosecutors indicted Mary Welch on charges of criminal attempt of injury to a child with serious bodily injury and endangering a child. In April 2014, Doug Welch obtained primary custody of his kids and he said his son was healthier than ever. The boy, who previously used leg braces and was on various medications, had started rollerblading and playing club baseball.

But as the case continued in family court, according to Doug Welch, the judge saw a custody fight between parents, not an abusive situation. The judge gave Mary Welch’s grandparents temporary custody of the Welches’ kids as a compromise, Doug Welch said. And eventually, Mary Welch regained custody.

“And this is where … the wheels came off,” Doug Welch said. “Everything was going right and then in family court, it fell apart.”

Mary Welch did not answer a call from the Star-Telegram, but her attorney, Michael Heiskell, answered questions on her behalf in regard to the medical child abuse accusations. Heiskell said the accusations against Mary Welch are false, and her son is thriving because “the shunts worked.”

Heiskell said he did not handle the custody case so he could not speak to the details of it, but said it was “based upon a lot of misrepresentations and falsehoods.”

Mary Welch was elected to Grandview’s City Council in May 2022. During the election, she posted on Facebook in March 2022 about the accusations made against her.

“Fact..” her post said, “I had false allegations made against me in Tarrant County (sic) by a cruel ex husband and corrupt officer. It took everything I had to fight for my innocence and my children to be safe.”

The criminal case against Mary Welch was subject to jurisdictional complications and never went to trial. In November 2015, the Tarrant County District Attorney’s Office dismissed the charges in Texas and deferred charging decisions to authorities in Ramsey County, Minnesota, because the surgeries took place there. But Ramsey County had already informed the Tarrant County District Attorney’s Office in May 2015 that it was deferring any charging decisions “until such time as the pending case against her in Texas is resolved,” according to KARE 11 News In Minnesota. Charges were never filed in Minnesota, and no charges are pending.

CPS investigations

Medical child abuse cases can be “hard or impossible to see,” said Daniel Lester, the Tarrant County investigations director for the Department of Family and Protective Services, which oversees Child Protective Services. In his 15-year tenure as investigations director, he estimated he has overseen or been directly part of eight to 10 confirmed cases in Tarrant County.

The Department of Family and Protective Services does not have any training on medical child abuse specifically. “Medical child abuse” is not even listed as an option for case workers investigating possible cases, and most CPS professionals have no training to identify or investigate this type of abuse.

However, CPS in Tarrant County has become uniquely situated to recognize and investigate medical child abuse thanks to Weber, Lester said.

Weber specializes in medical child abuse cases and, according to multiple experts, is one of the most experienced law enforcement professionals in the country in investigating this form of abuse. Lester said he and his staff contact Weber quickly if they come across a possible case.

The agency receives several reports a year of suspected cases, he said, many of which are determined not to be medical child abuse. Lester noted that many cases may not be reported, however, because “it looks on the surface like (parents) are doing what they’re supposed to do.”

Medical child abuse investigations are typically time consuming, and are uniquely challenging for investigators. Even with Tarrant County’s resources, this investigative process can take months, especially for CPS workers who already have large caseloads.

Department staff may have to go through thousands of pages of medical records in a suspected abuse case. Records can span across numerous medical facilities and even across states. The CARE Team at Cook Children’s Medical Center, which provides medical evaluations for various kinds of abuse, assists the local office of the Texas Department of Family and Protective Services with evaluating records, Lester said.

Roadblocks in family court

Medical child abuse cases face further obstacles in family courts.

If CPS suspects medical child abuse, the agency can remove the child from the suspected abuser’s home. The agency has 10 days after the removal to present evidence at a show cause hearing.

According to the American Professional Society on the Abuse of Children, if a child is believed to be a medical abuse victim, the best way to protect the child is to separate them from the suspected abuser.

The society’s guidelines note this step is “fraught with clinical, legal, and ethical concerns,” but say it “is often the only way to objectively evaluate the well being of the child.” If a child is only sick around the suspected parent, that could be an indication of abuse.

Judge Patricia Baca Bennett is a family law judge who oversees the 360th District Court in Tarrant County. Baca Bennett said medical child abuse cases are rare, and she has only seen one or two in her six years as a Tarrant County judge. Baca Bennett said she could not speak to medical child abuse cases specifically, but said generally the state has “a very high burden” of proof when trying to override a parent’s medical decision.

In a CPS case, attorneys from the District Attorney’s Office represent the agency. It is up to those attorneys to provide clear and convincing evidence that a child is the victim of medical abuse.

Cook Children’s staff, either those who witnessed the alleged abuse or members of the CARE team who investigated it, often testify, Lester said. But the high standard of proof required before family courts means even a well-documented case might not result in removal of the child. The agency has to prove the child has a risk of substantial harm or death, Lester said, while also making sure the judge knows what medical child abuse is.

Child Protective Services’ goal is to keep a family together whenever possible, Lester said. That’s why medical child abuse cases take so long to investigate, he said, “to make sure the child is safe and that we’re not removing a child who doesn’t need to be removed.”

CPS has to prove a child was physically abused for a judge to order the child’s removal, Lester said. But when medical care is the tool of abuse, cases become more complicated to prove. If a judge does not know what Munchausen syndrome by proxy or medical child abuse is, CPS also has to educate a judge while also laying out its case.

“You are going to have a parent show up and say this parent is doing everything possible for the child and here is CPS taking the child away,” Lester said. “And we have to argue all of these things they are doing are hurting the child because they are not needed.”

Doug Welch believes when he went before a family court judge in 2015, the judge did not understand medical child abuse and “simply doesn’t want to hear about this new problem.”

His son is still on his health insurance, and he still receives notifications about medical treatments. On Jan. 20, he received a notice that his son, who is now 19, had had another cranial surgery. According to insurance documents shared with the Star-Telegram, the Welches’ son had a shunt inserted. Doug Welch said it’s possible his son needed the surgery, but he has his doubts, and he wants his son to see a doctor without his mother attending.

Doug Welch said he has not been able to see his son for several years. While he is legally permitted to see his kids, his son has not wanted to see him. The last time Doug Welch saw him, his son stood 10 feet from the car and said he could not talk to him, Doug Welch said.

“And I have some responsibility for the next child who comes along,” he said. “I have lived through this and seen how awful it was. I want my voice to be heard that this is a reality that could happen to any family.”

More education needed?

Andrea Dunlop, a member of the American Professional Society on the Abuse of Children’s medical child abuse committee, said “the general lack of knowledge about medical child abuse” creates “various institutional barriers at every level.”

“The reality is, if you are informed about this issue, the behavior of an abusive parent does not look anything like the behavior of a parent of a legitimately sick child,” said Dunlop, who also hosts a podcast about medical child abuse.

According to Baca Bennett, whether a judge has education on medical child abuse is not the point, because in any case, it is up to attorneys to lay out a clear case before the judge.

“We can have all the education in the world, they still have to plead the case and prove the case,” Baca Bennett said.

Baca Bennett said more education is needed for attorneys, not judges, on how to recognize and make a case for medical child abuse.

A staff member within the Tarrant County Family Courts system, who asked not to be identified by the Star-Telegram, said judges, attorneys and CPS need more education about medical child abuse. The staff member said medical child abuse cases seem rare, but they are also overlooked. Potential cases are not flagged by attorneys or judges, the staff member said, because there is no procedure in place to catch medical child abuse in a family court setting.

The staff member had education on medical child abuse only because they happened to see a presentation that Weber gave on the topic. At the presentation, the staff member immediately thought about a case they had overseen years prior, where a mother was suspected of medical child abuse.

“I remember thinking, ‘I have to get these kids away from this woman,’ but I was too late to do anything,” the staff member said.

Every fiscal year, district judges are required to complete 16 hours of courses approved by the state. Currently, there are no approved courses about medical child abuse in the state of Texas.

On March 30, the Tarrant County Family Court Bar plans to host a course specifically about medical child abuse; the first of its kind in the state. Weber will lead the training, which is open to judges and attorneys who are members of the Tarrant County Family Court.

‘A lot of hesitation’

Tarrant County is not the only place where family courts and CPS struggle with medical child abuse cases .

Gilbert Sawtelle, a prosecutor at the Harris County District Attorney’s Office, focusesexclusively on child abuse cases involving death or serious bodily injury. Family courts in Harris County have a difficult time handling medical child abuse cases, he said. The complex cases have become more time consuming due to high turnover in CPS staff and a general backlog due to COVID-19. Sometimes, he said, it seems that cases are also slowed down because “family courts rely on what our decision is going to be on criminal court before they seek to end parental rights or not.”

“When you’re talking about taking a kid away from a parent and the whole accusation is that the parent is causing the illness that the parent is seeking treatment from, if you’re wrong, that’s horrible,” he said. “And so I think there’s a lot of hesitation not only from the family court side but also the criminal side.”

Too much hesitation, however, can come with a cost.

In 2013, CPS investigated Susan Reynolds, a Haltom City mom, for potential medical child abuse after a Cook Children’s Medical Center nurse practitioner reported Reynolds may have Munchausen syndrome by proxy. In a nine-month period, Reynolds took her infant to urgent care or the emergency room 28 times. She said her child had a variety of symptoms and illnesses, but medical tests came back negative or inconclusive, and hospital staff never saw the symptoms that Reynolds reported, according to court records. Reynolds’ infant daughter was removed from her care in 2013, but was returned to her within a year.

In 2019, a staff member at Cook Children’s reported Reynolds again to CPS, but there was not enough medical evidence to confirm abuse.

In 2021, Reynolds was reported again by a school nurse. This time, Weber investigated the case through the Tarrant County Sheriff’s Office, which led to her arrest.

The arrest warrant affidavit for Reynolds details allegations dating back to 2013. According to the affidavit, Reynolds falsified her 5-year-old son’s medical history, had him on 23 medicines and forced him to use a wheelchair. According to the affidavit, the boy did not need those medical treatments.

Teachers, relatives and doctors said Reynolds’ children appeared healthy and had no medical problems when they were not around their mother, according to the affidavit.

Reynolds was charged with endangering a child, bodily injury to a child and exploitation of a child in November 2021. She has not gone to trial yet and her next court hearing is scheduled for March 30.

Reynolds’ attorney did not respond to requests to comment, and the Star-Telegram was unable to reach Reynolds.

©2023 Fort Worth Star-Telegram. Visit star-telegram.com. Distributed by Tribune Content Agency, LLC.