CRIMES AGAINST NURTURE

CLAIMING A RARE DISORDER MADE JAN BROOKS AN UNFIT MOTHER, THE STATE TOOK HER DAUGHTER AWAY. THE DIAGNOSIS WOULDN'T STAND.

After the CPS worker left--her fears allayed for the time being--Hopkins assessed the situation. She asked a lot of questions, and had Brooks show her how she fed Ashley.

Hopkins never suspected that Brooks was lying about Ashley. Hopkins took control, calling Gahagan and requesting that the tube feeding be increased (it was) and asking Brooks if she'd allow Ashley to spend the day at Hopkins' home (she did).

At first, Ashley played with her food and refused to eat, just as she had with her mom. But by the end of the day, Hopkins had her eating. She showed Brooks how to feed Ashley, scooping food back into her mouth if she spit it out, showing her who's boss. For the next few weeks, Hopkins and Brooks spoke by phone. By February, they'd made an agreement with Gahagan to try to wean Ashley from the tube. By March, they'd done it. Ashley managed to stay off tube feedings for March and April, but her eating wasn't always good. She did manage to gain weight.

Then Ashley got sick. Brooks says she caught a bug, her ear infections came back and she got bronchitis. Her weight began to dip. Ashley was admitted to Maricopa Medical Center on May 5. From the beginning, Brooks sensed the bad vibes. "I said to Barbara, 'Something fishy's going on,'" Brooks recalls. For the first time, Hopkins thought Brooks was being hypersensitive. Call it mother's intuition, but Brooks' suspicions were founded.

According to the medical charts, Brooks had earned a reputation for questioning the staff's decisions. It is not an uncommon development among parents who must spend prolonged periods in hospitals. As May wore on, both sides became more frustrated.

By the middle of the month, CPS had moved in. The agency wanted to take custody of Ashley. At that point, the term "Munchausen Syndrome by Proxy" hadn't shown up in the charts. But Gahagan had noted that Ashley had gained weight, and wrote, "I am concerned that mother may try to sabotage Ashley's marvelous progress."

On May 18, CPS officials notified Brooks that they were taking Ashley into temporary custody. Within a day, a meeting had been held and a plan was in place whereby--with an apartment, help from Hopkins and other stipulations--Ashley could go home.

Brooks sensed that Gahagan didn't trust her, but things got worse when Gahagan left the country and was replaced by Mary Rimsza. Hopkins tried to reassure Brooks, telling her of Rimsza's excellent reputation and trying unsuccessfully to arrange meetings.

Brooks says, "The one time I went to her, she turned her back on me, and I said, 'Excuse me, but I'm Ashley Brooks' mom,' and she was just really high and mighty and didn't want to talk to me, and I said, 'I would like a three-way conference call with Barbara.' . . . And she said, 'Well, I'm busy now.'" On June 9, as Brooks prepared for Ashley's homecoming, Rimsza lowered the boom, writing: Ashley . . . has demonstrated excellent weight gain. Her weight today is 9.21 kg. Since admission she has gained approximately .8 kg. None of this has been by tube feeding. Mother's behavior towards me, other staff and Ashley continues to be "strained." She seems to have a strong need to keep Ashley ill. It is my medical opinion that Ashley is a victim of Munchausen syndrome and non-organic failure to thrive. Ashley's dramatic improvement in weight and behavior indicates to me that she has been living in a neglectful environment. Since mom is not open to the concept that Ashley is a normal child, I fear that she will try to convince other physicians that Ashley is ill once she has her out of our care. This is typical of Munchausen. . . .

Rimsza, who had been following Ashley's case for less than two weeks, recommended foster placement while Brooks received a psychiatric evaluation. She added, "I am willing to testify to the above statements in court," and signed the chart.

In 36 years of nursing, Barbara Hopkins had never seen a diagnosis made in such a way. She says, "I know that Maricopa Medical Center didn't say, 'Oooh, here comes this mother that we're going to do in.' . . . [But] I don't think that [Rimsza] did all she needed to do to make that kind of serious diagnosis."

Dan Cloud, a former pediatric surgeon and the former president of Phoenix Children's Hospital, is a member of the board of directors of the Arizona Consortium for Children With Chronic Illness. He recalls that he questioned the group's defense of Jan Brooks because of Rimsza's fine reputation. "I thought we should certainly be careful about questioning her diagnosis," he says.

But Cloud became concerned about the process once Brooks' court-ordered psychological workup called for reunification.

"I just had no idea there was so little recourse left for parents when this sort of thing happens, irrespective of the accuracy of the diagnosis in the first place," Cloud says.

Ashley was placed at the East Valley Child Crisis Center. Brooks received a psychological workup through CPS from Dr. James Thal, who did not support Rimsza's finding. Thal wrote that Brooks' account of Ashley's feeding disorder seemed "plausible." He described Brooks as "defensive and seemingly bitter," probably chronically depressed and possibly suffering from a personality disorder.

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