nl_e17

False Allegations of Child Abuse
False Allegations of Child Abuse
When I was an associate medical examiner for Jackson County, I got a lot of enjoyment from
assisting with the prosecution of real criminals, and putting bad people where they belong.
When child abuse has really occurred, it is a dreadful thing, and the perpetrators deserve to be
punished as examples to others.
The system is imperfect, and occasionally an innocent person is accused on bad medical
evidence. Once the initial error is made, it is very hard to stop the process.
In late March, 1996, I went to court in another state to help a working-class family which had
contacted me through this home page. A 2 1/2 year old girl had obvious nonspecific
vulvovaginitis, with a mix of flora on gram stain which included some gram-negative diplococci,
mostly extracellular. The child was just getting over chickenpox, which might have triggered the
vulvovaginitis. The pediatrician, a self-styled expert on child sexual abuse, found an "apparent
healed laceration" at the 2-3 o'clock position in the hymen, no further description. Cultures and
DNA probes were negative for gonorrhea. Cultures of all family members, including the
grandfather, a former chief flight mechanic on a Navy ship, were negative for gonorrhea. The
child denied any sexual stuff during the medical exams. The child struggled and cried a lot
during the child abuse exams and cultures. A smear of the "purulent" exudate showed no white
cells, only a lot of epithelial cells. Afterwards, she talked about "monster(s)" and "doctor
monsters", and said, "The monster(s) put a bone in my mouth and the hair choked me" (the
cotton-tipped swabs, dummies) and said "the monster had a mask" (duh).
On the strength of this evidence, the Department of Human Services told the court, "The
perpetrator has been identified" as the grandfather, the evidence being that he owned a
Hallowe'en mask. They told him that if he admitted his crime and got counselling, the child
would be restored to the mother. The entire family refused. I was the sole medical witness for
the defense, which I took for free.
I poked around the medical library, confirmed and improved on what I already knew, and was
able to testify that (1) 3% of girls had a little nick in the hymen at the 2-3 o'clock position, just
naturally, and around 20-30% of three-year-old girls have such innocent nicks ("apparent
healed lacerations", I thought), which are no more indicative of trauma than is a double-chin; (2)
relying on a gram stain in this situation was totally unacceptable as a means of diagnosing
gonorrhea, and the bugs were probably Neisseria sicca or one of it kin, common commensals,
which tend to be extracellular while gonorrhea bacteria are usually mostly intracellular; (3) the
CDC guidelines specifically direct physicians NOT to rely on a gram stain in this situation; (4) if
this were gonorrhea, there would have been white cells in the exudate, and the abundance of
epithelial cells suggested "resolving chickenpox" to me; (5) the negative culture and DNA
http://www.pathguy.com/abuse.htm (1 of 17) [6/5/2005 8:41:13 PM]