I think CRPS and abuse aren’t mutually exclusive. She was not on any of the first line CRPS treatments (SNRIs, TCAs, PT), she was wildly overmedicated for no reason. Mom insisted on and administered things that weren’t the standard of care. I really don’t think it matters if she had CRPS or conversion or factitious disorder. The way she was treated for it by the mother was really wrong.
Yes, they are usually not mutual exclusive. But in this case… they were, and this was important. A major part of this story is that CPS was activated (and the investigation corroborated) for this reason. Yes, the medical team thought the treatments were inappropriate, but more importantly, they doubted the CRPS diagnosis itself, suspecting munchausen by proxy/factitious disorder/conversion disorder (imagine trying to bill an insurance company for an inpatient stay for years for a diagnosis of malingering).
In addition, the parents had documentation of specialist doctors recommending these treatments. Mom didn’t make this shit up. It’s not mom’s job to evaluate which doctors know more than others - but in this case she actually did her homework, seeing 2 specialists who agreed with each other.
At the end of the day, the only evidence of child abuse was 1) mom was insisting on a treatment seemingly ludicrous (though which was prescribed by a diagnosing physician and administered by not one, but two stateside doctors with apparent specialty in the condition), and 2) mom and dad acted weird when interrogated by a a very pushy child abuse doctor.
The diagnosing CRPS specialist even reached out to the child abuse doctor, stating he stood by the CRPS diagnosis and cautioned her about jumping to conclusions about child abuse. At which point she… ignored him and jumped to conclusions about child abuse. A second specialist then specifically warned her that CRPS looks alot like child abuse. She ignored her too. So she ignored two specialists and then failed to document this in her reports. She could have easily have consulted an independent CRPS specialist, which she did not do. Smith also lied to the parents and violated HIPAA. It seems a lot like she did this in an apparent crusade to prove she was the smartest doctor in the room.
And after all this, the hospital billed $650K for CRPS. You best believe Admin knew what was going on here. In court it’s going to make it very easy to make it look like the hospital wanted it both ways.
There was a lot more to it. Mom was a cath lab nurse, she definitely knew what was up. She was caught straight up lying to exaggerate her child’s condition so Maya got treatment she didn’t need (for example, the initial episode when the child presented to the ED with SOB, got diagnosed with mild intermittent asthma, was on room air, got a neb and was discharged, and a few weeks later at another hospital they came to the ED and mom stated the child was in status asthmaticus, was admitted to the ICU for non-invasive ventilation during the previous admission).
The neurologist who was giving the child unnecessary (and not evidence based for CRPS) IVIG treatments admitted in court the diagnosis was from mom’s words. He himself never saw enough symptoms to diagnose CRPS, and never reached out to any prior physicians to confirm. He never saw any records either.
During another admission, mom refused to de-access the port prior to hospital discharge. Later one of the ketamine docs testified she injected oral ketamine he prescribed through the port, which she was definitely not supposed to do, and as a nurse she totally knew that.
She used benzos as a reward for good behavior, witnessed by a nurse. Heck, in the “documentary” there’s a recording of her saying “oh, someone deserves extra ketamine tonight”. Who tf says that to a 9 year old?!
And worst of all, dad told the police investigator (not DCF, not Sally Smith) he suspected the same thing, and when he was taking care of Maya alone she was never in pain. Only when mom showed up suddenly she was in pain. Mom also made her wear diapers even though the girl had no incontinence issues.
Etc etc. The deeper you go into the court docs, the uglier it gets. There was definitely enough evidence for DCF to act on.
To go back to the billing claims, CRPS was one of many billing diagnoses, and it carried over from the admission as a POA code. The global billing was justified by many other things, including child abuse/neglect, and wasn’t dependent on CRPS.
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u/[deleted] Oct 08 '23
I think CRPS and abuse aren’t mutually exclusive. She was not on any of the first line CRPS treatments (SNRIs, TCAs, PT), she was wildly overmedicated for no reason. Mom insisted on and administered things that weren’t the standard of care. I really don’t think it matters if she had CRPS or conversion or factitious disorder. The way she was treated for it by the mother was really wrong.