CRIMES AGAINST NURTURE
Jan Brooks was bustling about her new Mesa apartment, preparing for her daughter Ashley to come home from the hospital. It was June 9, 1993, and in a few days, Ashley would be 18 months old.
Happy days like this one had been rare for Brooks, who had moved from the Bronx with Ashley the year before. Since they'd arrived, Ashley had been in and out of hospitals and doctors' offices; the toddler refused to eat, and her weight dipped precariously. To make matters worse, Ashley had had croup and frequent ear infections. Surgery was required to repair a hernia.
But now, after a month at Maricopa Medical Center, the county's public hospital, the little girl had recovered from her latest ear infection, gained some weight and was ready to be released. With the help of social-service volunteers, Brooks--who'd fallen into a succession of doomed roommate situations--had found and furnished an apartment. A church had stocked it with essentials, and hospital staff had found a pharmacy within walking distance; someone had even arranged a taxi ride home.
Ashley's discharge would also end the animosity that Brooks had encountered at the hospital. Ever since Ashley had been admitted this time, the staff had treated Brooks like a leper. In hushed tones, one of the friendlier nurses told Brooks to get herself a lawyer. Brooks didn't know what that meant, but she did know that Dr. Mary Rimsza, Ashley's latest doctor and the head of pediatrics at the hospital, wouldn't speak to her at all.
More ominous, Child Protective Services had been suggesting that Brooks relinquish custody of her daughter to the state. Social workers said Brooks' living situation was inadequate, and they were worried because Ashley's weight kept fluctuating.
But Brooks was confident that all of that was behind her. She and the CPS workers had devised a plan by which she could keep Ashley; it involved getting the apartment and continuing supervision with CPS.
Finally, the call came from Maricopa Medical Center: Come and get your daughter!
Brooks rushed to the supermarket to pick up food for Ashley. But when she returned to her apartment, her euphoria was shattered.
"There was a CPS notice on the door saying, 'Don't go pick up your daughter. CPS has her in custody,'" Brooks recalls. "They didn't even put it in an envelope," she says as she pulls the wrinkled Temporary Custody Notice from her files.
Unbeknownst to Brooks, for weeks, staff at the county hospital had been making veiled references in Ashley's medical records to their suspicion that Brooks was somehow preventing her daughter from getting proper nutrition.
On June 9, 1993, just 13 days after taking responsibility for Ashley's care, Dr. Rimsza transformed the veiled references into her official diagnosis: Ashley Brooks was a victim of Munchausen Syndrome by Proxy, a rare and bizarre condition in which a parent injures a child to get attention from medical professionals.
It would take four months for Jan Brooks to get Ashley back.
Laura Knaperak and Barbara Hopkins are not doctors, but neither believed that Jan Brooks was trying to harm her daughter. And as it turned out, they were correct.
Providence smiled on Brooks when Knaperak, who at the time was executive assistant for the Arizona Consortium for Children With Chronic Illness, and Hopkins, a pediatric nurse and ACCCI president, became aware of Brooks' case. The two women stood by Brooks, and, in doing so, may have saved Ashley from becoming a ward of the state.
Brooks looks like the girl next door, but she isn't. She was born and raised in England. When her troubles with Ashley peaked, she was barely 30, alone and poor in a strange city, in a strange country. Nobody could explain why her baby was so sick, so the doctors decided it was her fault.
Hopkins sighs at the recollection of Brooks' plight. "This woman had nobody," she says. "She didn't have a single soul, except for us. I really believe that she would not have her child back if it were not for us."
Knaperak, who is now a Republican state representative from Tempe, recalls Brooks' travails with the doctors and the state with equal incredulity.
"People will think in the back of their minds, 'There's got to be more to this. There's no way this could happen.' I hear that all the time. Well, there isn't more to it. I was there. I saw it," says Knaperak.
Hopkins and Knaperak helped Brooks unravel the red tape that had ensnared and snatched away her child. They counseled her through the depression that accompanied the ordeal.
Brooks says, "I didn't even know what Munchausen by Proxy was, and I had to read about it, and I thought, 'Boy, if I'm this person, I'm really screwed up.' I mean, they have you believing you're this person."
Munchausen Syndrome by Proxy has been the topic of a made-for-TV movie, a segment of 20/20, an episode of L.A. Law and at least one true-crime paperback. And still, most people haven't heard of it.
It's a weird psychological condition with an exotic name and tragic implications. Munchausen Syndrome, which was first officially diagnosed in the 1950s, is a condition in which people injure themselves to get attention from medical personnel. The condition is named for Baron Karl Friedrich Hieronymus von Munchausen, an 18th-century hunter and soldier renowned for his outlandish travel tales.
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.
Medical records show that, contrary to what she says now, Rimsza had, in fact, recommended that Ashley be removed from her mother's care, based on the Munchausen Syndrome by Proxy diagnosis. And Rimsza wasn't recanting. In its June 11, 1993, report to the court, DES requested that, on Rimsza's recommendation, Ashley be held in custody for 30 to 90 days, pending a second opinion and psychological workup of Brooks. (New Times obtained files on the case from Brooks.)
Laura Knaperak says the ordeal was "heartbreaking." And as for Brooks, whom Knaperak trusts with her own kids, she adds, "She's not your perfect person. She's not Betty Crocker, homemaker. But she was clean. . . . She cared about her daughter. She had good parenting skills, I thought."
So do other people accused of Munchausen Syndrome by Proxy. And just because Ashley is doing well now doesn't mean her mother doesn't--or didn't at one point--suffer from the condition.
Schreier, the expert from Oakland, warns, "The overwhelming preponderance is still to believe the mother. I am sure that as it becomes more known, we will see cases like this where we are never going to know."
They call Arizona the "do-over" state, and like so many single moms, Jan Brooks moved here for a fresh start. She was born and raised in the small English town of Hull, and her parents divorced when she was 2. She lived with her mother and younger sister, seldom seeing her dad, a carpenter.
Life was lower-middle-class, supplemented by the government. She always dreamed of becoming a social worker, even though she didn't do well in school and the kids teased her, mostly because of her eyes--one's hazel, the other brown.
At 18, Brooks left for America. She settled in the Bronx, and found work as a nanny. She met Walter Brooks--four years her senior, training to be a police officer--through a friend. They married and had two children, Katie and Daniel (now 8 and 6, respectively).
Walter became a cop. Brooks cared for the kids and worked off and on as a nanny, then at a restaurant. The marriage soured, and with divorce looming, Brooks began to date a man she met at the restaurant.
The divorce was final in 1990. Brooks had her boyfriend's baby in 1991, but says she never planned to stay with him. For a while, she lived alone with her three children, but the New York winters were rough.
So she took six-month-old Ashley on a vacation to Arizona to visit a friend, and two months later, they returned for good. Katie and Daniel stayed behind with Walter, but Brooks always planned to get custody. (Walter now has full custody; Brooks has visiting rights. Reached by phone in New York, Walter expresses bitterness toward Brooks for leaving, and says Katie and Daniel have behavior problems as a result. However, he says neither of the older children experienced strange or prolonged illnesses under Brooks' care.)
From the beginning, Ashley was a difficult baby. By the time she was a month old, she had a cold. "She cried all the time. She was just real colicky," Brooks recalls. Ashley had persistent ear infections, which exacerbated her eating problem.
From their first days in Mesa, it was back and forth to the doctor for the ear infections, the croup and what the medical profession calls "failure to thrive." Ashley wasn't gaining enough weight.
When it came time for Ashley to eat solids, she refused. She chewed her food and spit it out, played with it or just ignored it. Brooks panicked; at this rate, Ashley would starve to death. Finally, the doctors suggested Brooks place the baby at the county hospital, because Brooks had no money.
From September through November 1992, Ashley was a patient at Maricopa Medical Center. She gained weight because she was fed through a tube placed through her nose and down into her stomach. She also had a hernia operation.
Brooks brought Ashley home, with instructions to return regularly for appointments at Maricopa Medical Center's child-development clinic. She was told to cut back on the amount of nourishment Ashley received through tube feedings, with the hope that Ashley would develop an appetite for solids.
The tube frightened Brooks, but she learned how to feed Ashley through it. Ashley still wouldn't eat solids, however, and lost weight. Dr. Sheila Gahagan, the pediatrician in charge of the growth clinic, was concerned. She advised Brooks to place Ashley in voluntary foster care. (Although Brooks signed a release granting Gahagan permission to speak about Ashley's care, Gahagan refused.)
Brooks balked. She didn't want to lose her baby. She was desperate. She started calling local social-service agencies, thinking, "They [doctors] didn't help me. Who's going to help me? How do I feed this kid?"
Enter Barbara Hopkins, a pediatric nurse with a knack for getting babies to eat and a knack for getting her way with CPS.
When a CPS social worker paid Jan and Ashley Brooks a visit in January 1993, Hopkins and Laura Knaperak sat in to lend Brooks some support.
Hopkins and Knaperak had never met Brooks, but both instantly liked her. And Brooks liked them.
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.
Brooks' difficulty in getting Ashley to eat, Thal wrote, is likely "the result of an emotionally distressed and nearly overwhelmed young mother attempting to care for a vulnerable and seemingly high-risk newborn without much support. It is not unlikely that this very distressed young mother was unable in her emotional condition to provide the comfort and security vital to the care of an infant with feeding problems."
He wrote that Ashley and Brooks appeared to be well-bonded, and recommended reunification when Ashley was medically stable, along with counseling and parenting-skills training. Thal added, "Those working with Ms. Brooks need to keep in mind that she is extremely sensitive to virtually . . . all criticisms. A far more beneficial impact with this woman will be seen if she is approached in a supportive fashion and those with important resources and knowledge are seen as allies in her efforts to care for her young daughter."
Along with a psychological workup for Brooks, the court ordered a second opinion for Ashley, which was provided by Mesa pediatrician Albert Schwartz.
Schwartz, who declined to speak to New Times, advised the return of the child, according to court documents dated September 17, 1993.
Ashley and Brooks were reunited on September 27, monitored closely by CPS for six months, and then taken out of CPS' control. They've been on their own for about a year.
Hopkins, who worked closely with Brooks during the struggle to get Ashley out of custody--including securing review of the case by a legislative joint oversight committee--says she "never, ever, ever" doubted Brooks. She leans across her dining-room table and smiles. "I mean, the fact remains they're wrong, aren't they, because look what we have today."
Jan Brooks and Ashley, now 3, live in a government-subsidized apartment in Mesa. Brooks is in school full-time; she still wants to be a social worker. Ashley goes to day care, and she's still underweight. Not dangerously so, Brooks says. She takes her to Schwartz--now Ashley's regular pediatrician--often, more often than may be necessary, Brooks admits. She blames her British upbringing. "I do go to the doctor's a lot, but I'm also from England, and have been told that you don't medicate over the counter, you go to the doctor to get it diagnosed and then do what the doctor says. I've just always done that."
Brooks treats her rambunctious daughter with humor and good-natured discipline. Brooks threatens to send her to the corner if she doesn't stop misbehaving, but Ashley seldom pushes it that far. She races around the living room, stops to cuddle with mom, then she's climbing on chairs and opening cabinets to show off her Barney tapes. Then she disappears into the kitchen.
Brooks laughs as her daughter emerges, cramming a miniature 3 Musketeers bar into her tiny mouth. "I guess you can use the calories," she sighs, pushing Ashley's hair back from her face. Fifteen minutes later, it's a bagel, then some 7-Up.
Ashley's the "spitting image" of her father, Brooks says. They're not in touch. She doesn't even have a photograph of him. He's Pakistani, she says; that's where Ashley gets her deep-brown eyes and dark complexion.
The four-month separation took its toll. Kathryn Flores first met Brooks at a volleyball game shortly after Jan and Ashley were reunited. She says Ashley wouldn't leave Brooks' side; finally, after about six months, Brooks told Flores her story.
Flores recalls, "She had this article about [Munchausen Syndrome by Proxy], and so I read it, and I just started laughing because I thought it was hilarious because it was so off, so far from the truth of her case, that I thought that it didn't make any sense how they came up with that conclusion."
Flores worked at the day-care center where Ashley stayed for a while; now she baby-sits when Brooks has classes at odd hours.
Sometimes Ashley asks for second helpings at mealtimes, Flores says. "There's other times where I can't get her to eat anything on the plate, not one bite of anything. She's really a picky eater."
Mother and daughter never part easily, Flores says. "Even [now] when she leaves her, [Ashley'll] say, 'Are you coming back, Mommy?' She's worried that Mommy's not coming back.
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