Munchausen Syndrome by Proxy occurs when a person--95 percent of the time, it's the mother--injures a child, again to get attention. Sometimes the mother kills the child. The condition was first noted in 1977 by a British pediatrician named Roy Meadow, who discovered that a mother was tampering with urine samples to make it appear as though her child had a urinary-tract disorder.

Meadow writes that some of the loneliest times in his life were in the early days of his work with Munchausen Syndrome by Proxy, because the medical community thumbed its nose at his theory.

It's taken nearly two decades of careful documentation--many times by surreptitious videotape--and the rare confession to convince caregivers that Munchausen Syndrome by Proxy even exists.

In some cases, the abuse is blatant. Even then, it can be difficult to diagnose without a videotape showing tampering or abuse, or a confession, because the typical Munchausen Syndrome by Proxy perpetrator appears to be the model mother: doting, willing to follow doctors' orders and always quick to point out symptoms in her child. Often, she encourages doctors to perform invasive and painful tests on her child.

According to Dr. Herbert Schreier--chief of psychiatry at California's Oakland Children's Hospital and co-author of a 1993 book about Munchausen Syndrome by Proxy titled Hurting for Love--more than 200 cases of Munchausen Syndrome by Proxy have been documented nationwide. That's a vast underestimate, he says, because many cases go unreported and even more go undetected.

"It's far from rare, and in many locales, it's pretty darn common," says Schreier, who is considered the nation's leading expert on this disorder. One of Schreier's colleagues recently attended a medical conference and learned that with surreptitious cameras, one hospital found 35 cases of Munchausen Syndrome by Proxy in just one year.

At that rate, Munchausen Syndrome by Proxy is either an epidemic or the flavor of the month--the next false-memory syndrome, perhaps? It's difficult to tell, because cases are cloaked in secrecy, ostensibly to protect the children. Maricopa Medical Center officials report having seen four cases in the past 20 years.

The Arizona Department of Economic Security would not release the number of Munchausen Syndrome by Proxy diagnoses it receives through Child Protective Services. What is believed to be the first Munchausen Syndrome by Proxy case to be tried in Maricopa County Juvenile Court was dismissed last year, after the judge declared that there was insufficient evidence to convict the mother, according to the December 1994 issue of Maricopa Lawyer. Juvenile Court records are also secret.

Even with "conclusive evidence," the Munchausen Syndrome by Proxy diagnosis isn't foolproof.

Schreier describes the true case of a 26-year-old mother sent to jail for life, charged with the murder of her three-month-old son. Lab tests found ethylene glycol, an ingredient in antifreeze, in the baby's blood, after the mother had been alone with him. It wasn't until her second baby--she gave birth in prison--was diagnosed with the same condition that doctors discovered both babies suffered from a rare genetic disorder. She was freed.

Such mishaps are rare, says Schreier. "Usually, by the time the diagnosis is made, the evidence is overwhelming rather than the other way around."

Chandler attorney Tom Ryan vehemently disagrees. He's litigating his third Munchausen Syndrome by Proxy case; all were misdiagnosed, according to Ryan. He's represented clients in Arizona, Nevada and Illinois, and has received calls from Oklahoma and Minnesota.

Yes, Ryan admits, there are cases of out-and-out child abuse. But he wants hard evidence. Munchausen Syndrome by Proxy should be used only to explain motivation, he says.

"It is modern-day medical McCarthyism," Ryan says. "If a woman comes in and is very assertive about her child's condition, automatically she is now a suspect of Munchausen Syndrome by Proxy."

The Rimsza name is familiar. Skip Rimsza, Mary's brother, is Phoenix's new mayor.

In the medical community, the name has been prominent for 20 years. Mary Rimsza is one of the state's leading experts on Munchausen Syndrome by Proxy. She's a professor at the University of Arizona Medical Center and a recent past president of the Arizona chapter of the American Academy of Pediatrics; she's widely quoted in the local press on all matters relating to the care and rights of children.

Jan Brooks has a quote of her own. "Dr. Rimsza was just out to get me, I believe," Brooks says.

Rimsza declined to be interviewed for this story, but responded generally to written questions submitted by New Times. She said she's consulted in the diagnosis of about 20 cases of Munchausen Syndrome by Proxy in her career (often providing second opinions) and has never made a misdiagnosis. She did not specify whether that includes Jan Brooks.

As for Brooks' allegation, Rimsza responds, "I was not 'out to get' Miss Brooks. In fact, despite Ashley's problems, it was my plan to discharge her from Maricopa Medical Center to the care of her mother. These plans were abruptly changed on the day of the discharge by CPS when they received new information [referrals] regarding Miss Brooks from community sources."

True, it is impossible to know if Ashley would have been taken into custody solely on the basis of a diagnosis of Munchausen Syndrome by Proxy. Two days prior to Rimsza's diagnosis, Child Protective Services received a call from Brooks' former roommate, who alleged that Brooks had molested her 3-year-old son. The charge was quickly cleared. According to a Mesa police report, the boy later told police he had been lying.

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