U.S. has no laws criminalizing medical child abuse. Texas experts aim to change that

Kristi Carroll started to lie about her son’s health when he was just a few months old.

The Tarrant County mom took her son, born in 2016, to the hospital frequently and told doctors he could not keep food down. Carroll lied about and faked her son’s sickness from 2017 to 2018, according to an arrest warrant affidavit. Doctors, under the impression the child was seriously ill, inserted a gastric feeding tube. Carroll told doctors the boy was vomiting with the feeding tube, prompting the hospital to insert a central line to administer nutrition through the baby’s veins.

Medical staff started to notice strange behavior by Carroll, according to the arrest warrant. She posted on Facebook that at one point, her son stopped breathing and had to be revived — but medical staff said that never happened. She got excited when staff told her that her child might need an intestinal transplant. In January 2018, Carroll told staff at Cook Children’s Medical Center her son had thrown up. Video surveillance revealed Carroll had spilled liquid on the child’s bed to create fake vomit.

Hospital staff reported Carroll for potential medical child abuse, and the Texas Department of Family and Protective Services started to investigate in 2018. The child was removed from Carroll’s care within a month, and his central line was removed in February 2018.

The disorder in which a caretaker lies about or causes a child’s illness to obtain unnecessary medical care goes by several names: Munchausen syndrome by proxy, factitious disorder imposed upon another, fabricated or induced illness by carers. The act itself is referred to as medical child abuse.

One county catches more perpetrators of medical child abuse than any other, according to leading experts in the field. Tarrant County, according to experts, is an anomaly. In Tarrant County, multiple systems are able to recognize, report and investigate suspected cases of medical child abuse in a unique way.

But even here, suspected cases are difficult to prosecute. Evidence may show a child is being medically abused, but no laws exist to criminalize medical child abuse specifically. It is not illegal to lie to a doctor about your child’s health, even if those lies result in unnecessary surgery. Authorities have to prosecute a perpetrator for injury caused by a surgery or medical treatment, which experts say creates a convoluted case juries and judges may not understand.

“I think Tarrant County … is doing the best job in the United States of exploring the possibility of Munchausen syndrome by proxy,” said Dr. Marc Feldman, who has been a leading expert in medical child abuse for decades. “But the jury is still out, literally, on how the court system is handling these cases.”

Advocates want to change that with a groundbreaking Texas state law that would legally address medical child abuse with a specific criminal charge for the first time.

Carroll’s case is just one example of how the court system is wholly unprepared to protect children from medical child abuse or to prosecute perpetrators, experts say. While the Department of Family and Protective Services found evidence Carroll was harming her son, a family court judge granted her custody of the child. And despite warnings from Cook Children’s as early as January 2018, a criminal investigation did not start until 2019. Carroll was eventually arrested, but with a makeshift charge that allowed her to take a plea deal and retain custody of her son.

In April 2018, the Department of Family and Protective Services investigated Carroll and determined she had Munchausen syndrome by proxy, had lied about her son’s medical conditions and, according to the department’s psychological evaluation, saw “little that needs to be changed on her part.”

But in March 2019, a Tarrant County judge returned Carroll’s 2-year-old son to her. Because family court records are not public, it is unclear why the judge decided to return the child to Carroll.

The criminal investigation started in October 2019, eventually leading to her arrest. According to the arrest warrant, Carroll continued to abuse her son through unnecessary medical care after she regained custody of him. Carroll was charged with three counts of injury to a child in March 2021, which had a maximum penalty of two to 10 years in prison.

Carroll took a plea deal and admitted she faked her son’s illnesses. She pleaded guilty to one felony count of injury to a child and received a light sentence: five years of probation, 160 hours of community service and a court fee of $355. Carroll is prohibited from “harmful or injurious contact” with her son, but she still has custody of him. The court also ordered the child’s father to be present at any medical appointments.

Carroll’s attorney did not respond to requests for comment, and the Star-Telegram was not able to contact Carroll.

‘Tarrant County leads the field’

Since 2009, 11 women in Tarrant County have been accused of medical child abuse and convicted. Three other women have been charged but not yet gone to trial.

There are no national statistics on medical child abuse because most cases, Feldman said, fly under the radar. Feldman, a clinical professor of psychiatry and adjunct professor of psychology at the University of Alabama, has written or co-authored five books on the disorder. Only a small number of cases are detected because “it is a diagnosis surrounded by deceit,” he said.

Tarrant County and Harris County have about the same number of medical child abuse investigations per year, despite Harris County being more than twice the size of Tarrant.

The District Attorney’s Office in Harris County — the largest county in Texas with about 4.7 million people — investigates about one to two such cases per year, Assistant District Attorney Gilbert Sawtelle said. Sawtelle, who has been a prosecutor for 10 years, focuses exclusively on child abuse cases involving death or serious bodily injury.

The unusually high case load in Tarrant County is reflective of the fact that the county has one of the most effective systems in the United States for identifying, investigating and prosecuting medical child abuse cases, according to leading experts.

“I think Tarrant County leads the field,” said Carole Jenny, child abuse fellowship director at Seattle Children’s Hospital. “… They are much more cognizant than at other places.”

In Seattle, for example, the Children’s Hospital has a team to identify possible medical child abuse, but does not have the necessary criminal justice support to investigate those cases. Jenny estimated the hospital’s team confirms about 12 cases a year. However, only one case confirmed at the hospital has been prosecuted, she said, because law enforcement does not have the training to deal with such cases.

“You have to have strong medical system, a strong legal system, a strong child protective system,” Jenny said.

According to a 2006 literature review published in the research journal Psychiatry (Edgmont), there are “no reliable statistics” on the number of people in the U.S. with Munchausen syndrome by proxy. The review does note that between 9 and 10 percent of known cases end in the child’s death.

Medical child abuse is often only revealed when a child dies, as was the case with Olivia Gant, whose mother pretended the girl was terminally ill for years until she died at 7 years old, according to the Denver Post. Olivia died in hospice care after being fed only ice pops and juice for 19 days, and her mother was sentenced to 16 years in prison after pleading guilty to a felony child abuse charge, the Post reported.

The abuse can happen in two different ways, according to Jenny, who co-authored the 2008 book “Medical Child Abuse: Beyond Munchausen Syndrome by Proxy.”

“Sometimes parents exaggerate or make up illnesses — they say the child is having these seizures and the child goes on seizure meds — but no one ever sees the seizure,” Jenny said. “And other times they induce illness, they poison the child. They don’t feed them and say the child can’t eat.”

There are cases in which parents are falsely accused of medical child abuse or munchuasen syndrome by proxy. Gender-affirming care specifically has been called medical child abuse by some groups. But experts are clear that gender-affirming care is not medical child abuse.

Jenny said such accusations against parents of transgender minors are “way out of the ballpark.” If a young person wants to transition and the parent supports them, that is not medical child abuse. She also emphasized that gender-affirming care teams in hospitals work closely with the patient, and would not go along with a parent who did not have the patient’s best interest in mind.

Investigating medical child abuse

Medical child abuse primarily occurs in a medical setting, so medical staff are in a unique position to identify it.

Cases in Tarrant County primarily come from Cook Children’s Medical Center. Dr. Jamye Coffman is the medical director of the Child Advocacy Resources and Evaluation (CARE) team at Cook Children’s, which examines cases of potential child abuse based on referrals from Child Protective Services, law enforcement agencies or a medical provider. The team also flags potential cases and reports them to CPS. If warranted, the Tarrant County Sheriff’s Office will carry out an investigation.

“Cook Children’s works closely with these entities for all abuse cases, including sexual and physical abuse. Medical child abuse is no different, though in these cases, the medical providers are the weapon,” Cook Children’s Medical Center said in a statement.

When treating children, doctors rely on parents to give correct medical histories. Catching discrepancies can be difficult, especially if the caretaker has gone to multiple facilities or is falsifying symptoms in their child.

“You have to remember that ninety-nine point nine percent of our parents are good parents giving us accurate information,” Coffman said in a 2019 press release about the CARE team. “But if all an abuser has to do is say their child is vomiting and they’re secretly withholding food from them, how are we supposed to know that? We are depending on parents to tell the truth.”

The evidence is usually found within a victim’s thousands of pages of medical records. Records can include red flags such as discrepancies in medical history, notes about unusual behavior from caretakers — like Carroll’s excitement over a possible transplant — and caretaker-reported symptoms that medical staff do not witness themselves. The CARE team goes through those thousands of pages to determine if they may be dealing with a possible abuser or simply an overanxious parent.

On the law enforcement side, Mike Weber is perhaps the most experienced criminal investigator of medical child abuse cases in the country. He started investigating such cases while working for the Tarrant County District Attorney’s Crimes Against Children Unit from 2009 to 2018. With the district attorney’s office and now the sheriff’s office, Weber said he has investigated 35 medical child abuse complaints.

In 2011, Weber investigated a case of a 3-year-old who was a victim before she was adopted by a Fort Worth couple. Her biological mother, Brittany Phillips, lied about her daughter’s medical history and symptoms, withheld food from the girl and put feces into her IV line or feeding tube to make her sicker, according to court records in the case. Doctors said the feces in the IV line or feeding tube caused Phillips’ daughter to contract a potentially deadly blood infection. Phillips was convicted in November 2015 of serious injury to a child and sentenced to five years in prison.

The child’s adoptive father was horrified by this form of abuse, which he had never heard of. That father was Bill Waybourn, who became Tarrant County sheriff in 2017. Waybourn hired Weber to focus specifically on medical child abuse.

“If not for Mike and Coffman,” Feldman said, “I think Tarrant County would be in the same position as much as the rest of the U.S.”

‘Flaw in our system’

Even in Tarrant County, the prosecution of medical child abuse cases is difficult.

There is no law in the country that specifically criminalizes medical child abuse. Laws criminalize injury to a child or medical neglect, but lying to a doctor to obtain unnecessary medical treatments for one’s child is not specifically illegal.

“We’re currently shoehorning this abuse into existing laws,” Weber said.

When Weber investigates a case, he typically needs to prove the child was physically injured in order for the abuser to be charged. Since there is no “medical child abuse” charge, a person accused of such abuse may face charges of serious bodily injury or endangering a child. Investigators may have their hands tied in a case until a child has a “serious” enough injury.

Daniel Lester, investigations supervisor for the Department of Family and Protective Services’ Tarrant County office, said the lack of a medical child abuse law is a “flaw in our system.”

“You have to wait until the child gets hurt to actually do anything,” Lester said.

George Hunnicutt, a Marine previously stationed in Fort Worth, said if it were not for Weber, his wife might not have been held accountable for poisoning his son.

From February 2010 to 2011, Elisabeth Hunnicutt told doctors her youngest son had various medical problems. She said the baby was extremely unresponsive and slept almost all day. As a result, doctors drilled a hole in his skull and placed a monitor on his brain. She created a support group page about the 1-year-old’s diseases, which she said included cerebral atrophy, hydrocephalus and cerebral palsy. However, the monitor in the boy’s brain had already ruled out those diseases, according to court documents.

In June 2011, George Hunnicutt caught his wife slipping drugs into their 1-year-old son’s yogurt. He confronted her, locked himself and his youngest son in a closet and called 911. Hunnicutt said the Fort Worth Police Department had “absolutely zero interest” in the case. The police department’s Crimes Against Children Unit did not respond to requests for comment on this case.

“I can tell you this,” George Hunnicutt said. “If it were not for Mike Weber, this case never would have been prosecuted.”

When she was investigated, Elisabeth Hunnicutt admitted she had given their 1-year-old son Clonidine — which was prescribed to her older son for ADHD — five times in two weeks, according to her arrest warrant affidavit. Investigators believe that she slipped him the drug to make him appear unresponsive, leading to the unnecessary surgery to place a monitor in his skull.

For causing her son to have unnecessary brain surgery, the maximum charge Elisabeth Hunnicutt could face was causing bodily injury, which has a potential sentence of two to 10 years. Serious bodily injury carries a potential sentence of five to 99 years, but can only be applied in cases where someone had a significant risk of death or was significantly scarred.

“The drill that went through (my son’s) skull was not considered to be a life-threatening incapacitation,” George Hunnicutt said. “It’s so much more difficult to prosecute these offenses because there’s no clear and specific language that addresses it.”

Elisabeth Hunnicutt pleaded guilty to causing bodily injury to her son. She was sentenced in 2013 to 10 years of deferred probation.

George Hunnicutt was furious.

“Up until that point in my life, I thought if you screwed up, you went to jail,” he said. “That’s the way I was raised. And then she didn’t, and that threw my understanding of our justice system into utter chaos.”

In 2015, Elisabeth Hunnicutt voluntarily terminated her parental rights to her two sons, who now live with George Hunnicutt. The boy who had the surgery is now 12 years old and is a “typical teenager.”

“He has not had a single medical problem since then,” George Hunnicutt, who now lives in Alabama, said. “And if that’s not proof that this exists, then I don’t know what is.”

Proposed law and false accusations

In 2021, Weber approached David Cook — the former mayor of Mansfield and member of the Texas House of Representatives from the 96th District — about sponsoring House Bill 1773.

The bill would make it a crime to intentionally misrepresent or lie to a medical professional about a person’s medical history or symptoms for the purpose of obtaining unnecessary medical treatment for a child, elderly person or person with a disability. In short, it would criminalize medical child abuse. The proposed law would be named “Alyssa’s Law,” after Waybourn’s adopted daughter. Cook agreed to sponsor it.

“Anytime where we as society see a child — most often a helpless child — being abused, we want to take steps to stop that abuse,” Cook said. “This is a good bill to make that happen.”

Before introducing the bill, Cook said, he and other sponsors met with the Tarrant County Criminal District Attorney’s Office, law enforcement and think tanks to determine how best to help investigate possible medical child abuse cases.

“What it says is, if someone goes in and intentionally and knowingly lies to a medical provider … to do harm to their child, then that should be a crime, a clear crime,” Waybourn said. “And I think that’s common sense.”

But HB 1773 faced resistance in a committee hearing. Parents from various groups, including Protect TX Fragile Kids and Texans For Vaccine Freedom, said at the March 2021 hearing that they were concerned the law would lead to false accusations of medical child abuse.

Adrienne Trigg, a parent with Protect TX Fragile Kids, testified at the hearing that she was falsely accused of medical child abuse because her son had complex medical issues that were difficult to diagnosis.

“This law is unfortunately subjecting a large number of medically fragile population to more scrutiny,” she said at the committee hearing.

The bill did not pass.

Cook is sponsoring the bill again this legislative session. The bill, now called HB 3381, was referred to the Criminal Jurisprudence Committee on Wednesday, and is set to be heard during the legislative session.

Cook said advocates for the bill have talked with the groups who were concerned about false accusations and been able to compromise.

Jackie Schlegel spoke out against HB 1773 in 2021 on behalf of Texans For Vaccine Freedom. Schlegel told the Star-Telegram via email that she has had conversations with various stakeholders about HB 3381 and has “been encouraged by the willingness of those involved to go to such extraordinary lengths to ensure we protect the children and the loving families and parents that care for them.”

When asked about her current concerns about the bill, Schlegel told the Star-Telegram it “is not a priority for (Texans For Vaccine Freedom) as we are focused on medical freedom and pushing back against employee mandates.”

According to experts, including Feldman, Jenny and Weber, the bill would make false accusations — which they said are already rare — more unlikely.

The best way to avoid false accusations of medical child abuse, Feldman said, is education. A large number of cases are likely overlooked across the country because of a lack of education and knowledge, according to the American Professional Society on the Abuse of Children.

When abuse appears in the guise of treatment, medical staff must first be able to identify it. In the medical field across the country, Feldman said, medical child abuse cases are “viewed as marginal and not worthy of discussion.”

“Doctors who are in training for so many years don’t hear about Munchausen by proxy very often,” he said. “You can’t diagnose what you’ve never heard of.”

Sawtelle said as a prosecutor, he also thinks HB 3381 would help raise awareness about medical child abuse in the criminal justice realm, which would improve training and policies.

The bill would also bring in law enforcement earlier in a suspected case, which would help authorities rule out as well as confirm abuse more quickly.

Weber used the example of one case he investigated in which law enforcement determined medical child abuse was not happening. Cook Children’s notified Weber early about its concerns and Weber sat down with the mother and daughter separately. Through his interviews, he found evidence that showed the daughter had faked her own symptoms. Her doctors were able to get the daughter a psychological evaluation and the help she needed.

“Criminal investigations are not just to find the guilty,” Weber said. “They’re also to rule out the innocent.”

Raising awareness

Victims of medical child abuse hope laws like HB 3381, if it passes, would also allow survivors to get the justice and help they need.

Jordyn Hope, 27, believes they were medically abused for most of their life, but did not realize it until they were 22 and sitting in a psychology class. As their professor talked about Munchausen syndrome by proxy, Hope said, they were flooded with memories. They took out their phone and started to take notes and “started to put together this was my life, this happened to me.”

From infancy, Hope was in and out of the hospital in Minnesota. According to medical records provided to the Star-Telegram, Hope’s mother told doctors her child had a fever as high as 107 for multiple days, but staff would measure the toddler’s temperature at 99 or 102. Hope’s mom said Hope had a blood disorder, but doctors ruled out that condition, according to medical records. In one instance, medical staff gave the child a saline placebo instead of the IV antibiotics requested by the mother, the records say.

In 1997, Hope’s mother was investigated by the Midwest Children’s Resource Center. According to Hope’s medical documents, which they shared with the Star-Telegram, investigators believed Hope’s mom might have Munchausen by proxy and a doctor wrote that “there was evidence that (Hope’s) symptoms had probably at very least been greatly exaggerated in the past.” According to Hope, the case was dropped because there was not enough physical evidence. Their mother was never criminally charged.

Hope’s mother has publicly denied that she abused Hope or that she has Munchausen syndrome by proxy.

In Hope’s case, in order to get help from those in authority, “it would have been better if my mom was breaking my bones,” Hope said.

When Hope was in high school, CPS removed them from their mother’s care because of their mother’s alcoholism, Hope said.

As an adult, Hope talked with their pediatrician, who said she believed Hope was being medically abused, but felt powerless since the investigation had been closed.

“That’s when I realized how impossible it was to get help when you’re going through this type of abuse,” Hope said.

As a 27-year-old living in St. Louis, Hope said they still struggle with childhood trauma. They are an activist for raising awareness about medical child abuse, and help facilitate a support group for victims. In October, they spoke directly after Weber at a Conference on Child Abuse and Neglect in Michigan.

“It’s the most lethal form of child abuse. A lot of children die,” Hope said. “And yet it is the hardest to criminalize or get the child out.”

If you or someone you know might be a victim of medical child abuse, contact the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). All calls are anonymous and confidential.