(Interestingly, the two therapists who first noticed the shudders — and who had been treating Sarah for more than six months, at that point — were never consulted when the MSBP diagnosis was made. Not by the doctors at Phoenix Children's Hospital, and not by CPS.)
Twelve days later, Dunlavy lost her daughter.
She never suspected a thing, but Carol Dunlavy and Sarah were under constant surveillance at Phoenix Children's Hospital.
The hospital would not comment on her case, nor would it answer questions about Munchausen Syndrome by Proxy. Debra Stevens, a spokeswoman for the hospital, did say the hospital has a zero tolerance policy when it comes to child abuse.
In Dunlavy's situation, it's difficult to determine from the records exactly what she was doing wrong.
The accusations made against her by CPS claim she wanted to expose her daughter to unnecessary medical procedures, like the feeding tube.
But Dunlavy made it clear she didn't want the surgery for her daughter from the moment it was brought up, a fact documented in reports from both GI surgeons she visited and the admitting physician at PCH who wrote, "Mom says she would rather not see her child get a PEG tube."
Yet on October 26, forensic pediatrician Jennifer Geyer wrote a report recommending the child's removal and accusing Dunlavy of pushing for the tube.
"I am concerned that [the child] may have progressed to surgery if there had been no intervention," she wrote, despite a report written only one month earlier from a GI doctor at the same hospital stating otherwise.
The doctors at PCH also accused Dunlavy of lying about seizures in her child. While Sarah was admitted to find out what caused the shudders observed by her therapists, the admitting documents show Dunlavy never said the word seizure. She still just calls them "shudders."
The hospital found no evidence of epileptic activity, though it did record two shuddering episodes, which have never been explained.
Because Sarah was hooked up to an EEG, to monitor her brain activity and detect seizures, the room was under video surveillance — though notes show this was used more to watch Dunlavy than to monitor the child.
During the hospital stay, controversy constantly swirled around Sarah's eating habits. She was put on a strict feeding plan — too strict, in Dunlavy's opinion. She worried her daughter wouldn't eat anything, and notes do show behavior typical of Sarah's fussy eating habits. Sometimes she would eat a few bites, but she was just as likely to throw her pancakes or use her fruit slices as building blocks. She did this whether or not her mother was in the room.
Dunlavy decided she didn't want to follow the strict plan and made it known that if her daughter asked for something to eat, she was going to give it to her, even if it wasn't on the menu.
"My view was, why don't you feed her what she normally eats? And then you can see what her normal intake is," she says. "When she didn't eat, I wanted to be allowed to give her other things like ice cream to fatten her up."
She was caught on camera doing so. A nurse's note from October 20, 2007, says, "RN got call from video monitor today said mom is feeding patient bagel and milk via sippy cup."
A note from the attending pediatrician that same day indicates there was no medical reason why Sarah's diet couldn't be expanded.
Another note accuses Dunlavy of throwing a diaper away. Under the feeding plan, Dunlavy was supposed to weigh and save all diapers. She acknowledges she put it in the trash but says she wasn't trying to hide it from doctors; she'd just forgotten. By this point, there was so much controversy over the plan, in general, that the diaper incident was regarded with great suspicion.
Boston-based psychologist Eric Mart, a national expert on Munchausen Syndrome by Proxy, says this is common in cases where MSBP is alleged.
"One thing you see frequently is that these allegations often come up after there's an altercation between the parent and doctor," he says. "Next thing you know, it's Munchausen."
On October 22, the doctors decided they had enough evidence to remove the child from her mother's care. Up until this day, her father had not been very active in Sarah's life. He'd come by the house to see her on occasion, but medical records show he admitted in an interview with a PCH speech therapist his lack of involvement.
Records also show he became very concerned about Sarah after the allegations CPS made against her mother.
The thing is, nothing about the child's feeding behavior changed after Dunlavy was out of the picture.