In re McCabe

• Citation: 580 S.E.2d 69,157 NC App. 673
• Decision Date: 20 May 2003
• Docket Number: No. COA02-1030.,COA02-1030.
• Court: Court of Appeal of North Carolina (US)
• Parties: In the Matter of Arielle McCABE.

580 S.E.2d 69

157 NC App. 673

In the Matter of Arielle McCABE.

No. COA02-1030.

Court of Appeals of North Carolina.

May 20, 2003.

Lanier & Fountain, by Timothy R. Oswalt, Jacksonville, for respondent appellant.

James W. Joyner, Jacksonville, for petitioner appellee.

TIMMONS-GOODSON, Judge.

Karrie McCabe ("respondent") appeals from an order of the trial court adjudicating her minor daughter ("juvenile") abused and neglected. For the reasons stated herein, we affirm the order of adjudication.

The facts pertinent to the instant appeal are as follows: Respondent is the natural mother of juvenile, who was born 24 May 1999. On 18 January 2001, Thomas McCabe ("McCabe"), respondent's former husband and the natural father of juvenile, served respondent with a civil domestic petition of custody for juvenile.

On 9 February 2001, the Onslow County Department of Social Services ("DSS") filed a petition alleging juvenile to be abused and neglected, on the grounds that juvenile was admitted to a hospital on 29 January 2001 for a history of intermittent episodes of cyanosis, or "blue spells." Respondent told admitting hospital physicians that juvenile's hands and feet, as well as the area around her mouth, had turned blue numerous times within the previous days, and that respondent brought juvenile to the hospital after she lost consciousness during the latest incident. Respondent asserted that juvenile was particularly likely to exhibit such symptoms when cold, and that she was lethargic and unresponsive during such episodes. According to respondent, juvenile had exhibited these symptoms since her "neonatal period." Treating physicians later diagnosed juvenile's condition as being possibly induced by respondent. DSS therefore requested that custody of juvenile be placed with McCabe, and that any visitation between respondent and juvenile be supervised. The trial court issued an order for nonsecure custody placing physical custody of juvenile with McCabe.

The adjudication hearing was held before the trial court on 29 March 2001, at which time the following evidence was presented: Dr. Elaine Kabeanfuller ("Dr.Kabeanfuller"), a pediatrician specializing in the treatment of abused children, testified to a form of child abuse known as Munchausen syndrome by proxy. Dr. Kabeanfuller explained that Munchausen syndrome by proxy

was first described in 1977 by a Dr. Roy Meadow.... [H]e was the first one to put case reports out in the literature [and] since then there have been hundreds of case reports and many reviews and actual books written on the subject. It is a case where we often see children where they have ... either a parent or caretaker [who] will either simulate or induce an illness in the child, present them for medical care multiple times, [and] often

... deny any knowledge of ... the symptoms or the signs, what their etiology is and then when that child is removed from that caretaker or parent's care, these signs and symptoms abate and no longer occur.

Dr. Kabeanfuller testified that she became involved in the present case in February of 2001 after the hospital physicians who were treating juvenile requested her consultation on the case. After observing juvenile, interviewing respondent and treating health care professionals, reviewing juvenile's medical history as well as records from juvenile's daycare providers, and consulting other medical experts, Dr. Kabeanfuller opined that juvenile possibly suffered from Munchausen syndrome by proxy. Dr. Kabeanfuller specifically based her opinion on the fact that juvenile's cyanotic episodes, witnessed by her daycare providers and reported by respondent as occurring "every day" before juvenile's hospitalization, occurred only after juvenile had been in the exclusive care of respondent. Numerous medical procedures revealed no organic abnormalities in the child, and juvenile never exhibited any symptoms during her eleven days in the hospital. When she later learned during her testimony that juvenile had shown no sign of the symptoms reported by respondent since being removed from respondent's care, Dr. Kabeanfuller altered her diagnosis from "possible" Munchausen syndrome by proxy to "probable."

Dr. Kabeanfuller further stated that juvenile also potentially suffered from "Vulnerable Child Syndrome," which she explained as

a syndrome we sometimes see in pediatrics where a child who is otherwise well and healthy is presented multiple times for medical care by a parent or caretaker who is convinced that the child is ill or has some serious symptoms and requires a lot of reassurance by the physicians or medical personnel but in fact there is no organic disease process going on in the child.

Dr. Kabeanfuller noted that

[t]here's a continuum of an illness going from Vulnerable Child all the way to Munchausen syndrome where you have Vulnerable Child where the child actually is well and the parent is just overly concerned, and then the next, it can evolve into a Munchausen syndrome by proxy, um, type situation because you can have a child whose parents or caretaker believes that they're ill when they truly are not or may, may evolve into a parent who creates symptoms or fabricates a history in order to present that child to various physicians and receive various medical procedures. The risk of morbidity or mortality associated with Munchausen syndrome by proxy, according to Dr. Kabeanfuller, is fifteen to thirty percent. This form of abuse may also lead to survivors being "very fearful, and they often have some psychological illnesses of their own, later on." Dr. Kabeanfuller added that, during her hospitalization, juvenile underwent extensive, painful, and invasive medical procedures to determine the source of the symptoms described by respondent.

Dr. Dale Newton ("Dr.Newton"), a pediatrician and expert in child abuse, testified on behalf of DSS. Dr. Newton treated juvenile during her hospitalization and concurred with Dr. Kabeanfuller's diagnosis of Munchausen syndrome by proxy as probable. Dr. Newton testified that he became juvenile's primary treating physician when respondent dismissed juvenile's original physician, Dr. Stephen Boyce Coker ("Dr.Coker"), after Dr. Coker diagnosed juvenile as suffering from Munchausen syndrome by proxy. During her hospitalization, juvenile underwent numerous medical procedures to screen out any possible organic abnormality. In Dr. Newton's opinion, juvenile's cyanotic episodes were potentially induced by either smothering or administration of a toxin. Dr. Newton agreed with Dr. Kabeanfuller that returning juvenile to the care of respondent would put juvenile at risk of harm.

Dr. Coker, a pediatric neurologist, gave further testimony. Dr. Coker stated that he examined juvenile on 25 January 2001 when respondent brought her to the hospital. Based on respondent's reports of frequent cyanotic episodes, Dr. Coker originally believed juvenile to be suffering from a form of epilepsy, but changed his diagnosis to Munchausen syndrome by proxy after medical procedures revealed no abnormalities and juvenile exhibited no symptoms after five days in the hospital. After Dr. Coker advised respondent of his diagnosis, she requested his removal as juvenile's treating physician.

Stephanie Leger ("Leger"), a registered pediatric nurse, testified that while juvenile was under her care at the hospital, respondent attempted to induce a cyanotic episode in juvenile by giving the child popsicles. Respondent asked Leger "what did [she] think would happen when [respondent] put [the popsicles] in [juvenile's] hand?" Respondent then placed two wrapped popsicles in juvenile's grasp and asked Leger if she observed juvenile's "feet ... turning colors, her hands turning violet colors." Despite respondent's insistence that juvenile was "turning blue," Leger did not observe any blue or violet discoloration.

Respondent presented testimony by Dr. David Hannon ("Dr.Hannon"), a pediatric cardiologist. Dr. Hannon consulted with juvenile's physicians during her hospitalization and diagnosed juvenile as suffering from what he labeled as "benign paroxysmal acrocyanosis." Dr. Hannon explained

[t]hat's simply a linking of three terms, benign would indicate that I believe that children who do this do not have a serious medical illness. Paroxysmal is just a medical word meaning that it occurs very suddenly and acrocyanosis means that [you're] blue but distally blue in the hands and feet. So this is not an established medical diagnosis although I have written a small piece for an educational thing to the American Academy of Pediatrics on it mainly because I think that it probably, well I know that something like this does occur, whether my understanding of physiology is correct or not, I can't say.

Dr. Hannon testified that he had witnessed two other patients in the...