Monday, March 3, 2014

The Case of Justina Pelletier Calls for Nuance and Moderation

I've given a fair bit of thought as to whether or not to write this post. I may end up inadvertently offending people who have very firm opinions on the matter. The subject is rather controversial, evoking very strong emotions on both sides of the issue, which has gained national attention. The main problem is that what is known stems predominantly from media reports, with verified facts being unavailable. This is the case of Justina Pelletier, a 15-year-old girl who has been the center of a custody battle for over a year between her parents and the state of Massachusetts. The majority of coverage has taken the side of the parents. Most of the people speaking out do so on behalf of the parents, often quite vehemently decrying the Department of Children and Families (DCF) and Boston Children's Hospital (BCH), which started the ordeal. Articles siding with DCF are almost non-existent, but like their counterparts, take a very firm position based on media reports. Rarer still are measured, nuanced analyses of the story.

The dearth of more neutral approaches, and the vehemence with which people have spoken out about this, prompted me to write. I am not going to make any firm conclusions. I will not take a side. There isn't enough verified, primary source information available for me to do so. Instead, I will summarize the details that have been reported and talk a little about the possible scenarios: that the parents are right and that DCF and BCH are right. It is a complex topic about which I'd like to start a conversation, so feel free to post your thoughts in the comments below, but keep it civil.

The majority of information I found about this case comes from a two-part story in the Boston Globe (click here for part 1 and here for part 2) and an ABC News story (here). These articles offered the greatest detail, but they rely largely on anonymous sources when it comes to the details of the dispute. I recommend reading the links at the end of this post for more information and to see examples of some of the reactions I mention. The parties involved in the legal struggles are under a gag order and are not allowed to discuss the case with the media, though Justina's parents have violated that order, appearing, for example, on Fox News. In addition to the gag order, the medical teams involved in Justina's care are also barred from discussing individual patients by HIPAA regulations, which guarantee patient privacy.

The Details, As Reported

Justina Pelletier is 15 years old. For several years, she had been sick off and on. Starting in 2010, she began suffering severe stomach cramps and blockage. After exploratory surgery, doctors at Connecticut Children's Hospital discovered cartilage wrapped around her colon. They removed the cartilage and Justina's appendix, but her condition did not improve. In 2011, her doctors referred her to a gastroenterologist at Tufts, Dr. Alejandro Flores. In 2012, surgeons performed a cecostomy, a relatively new procedure. Dr. Flores referred her to Dr. Mark Korson, a respected specialist in mito disorders. Dr. Korson reportedly made the diagnosis of a mitochondrial disorder by classifying each of her symptoms. He apparently did not order a muscle biopsy, which is a standard means of diagnosing mito disorders, and it is unclear whether or not he ordered blood or CSF tests. Justina's older sister was also diagnosed with a mito disorder after having a muscle biopsy.

In early 2013, Justina suffered a bout of influenza and gastrointestinal symptoms. Dr. Korson recommended her family take her to see Dr. Flores, who had transferred to BCH. Having stopped eating, her parents brought her by ambulance to BCH on February 10. She was seen in the emergency room by neurologist Dr. Jurriaan Peters. After getting Justina's history, he questioned the mito diagnosis, noting that she had not had a muscle biopsy and that her metabolic workup was not unusual. He called in a psychologist, Dr. Simona Bujoreanu. Dr. Bujoreanu reportedly noted that Justina's symptoms got worse when her mother was around. This led to the suspicion of a somatoform disorder, in which distress manifests as physical symptoms not adequately explained by a medical diagnosis.

Justina's parents rejected the psychiatric diagnosis and treatment plan, insisting instead on continuing her medical treatment, which included "Tegretol for neurological problems, Metoprolol for a rapid heart rate, and Midodrine for boosting blood pressure" (Boston Globe). According to the Globe article, it is not the first time they opted against psychiatric treatment for Justina, having rejected mental health services in 2011 as part of Justina's treatment.

This is where DCF became involved, as the BCH doctors suspected medical child abuse, a term that has recently been proposed instead of Munchausen Syndrome by Proxy. Justina was moved to BCH's psychiatric wing, her parents' visitation rights eventually being limited. In the summer of 2014, DCF discussed moving Justina to Webster House in New Britain, CT, but Webster House backed out when Justina's father, Lou, threatened to sue them if they took Justina. Although they eventually visited and softened their stance, Webster House declined to take Justina, stating, "We have determined, unfortunately, that we are unable to take on the risk of becoming involved in a protracted legal battle that could be very costly." In January of this year, she was moved to a foster care program at Wayside Youth and Family Support. In February, DCF discussed transferring her to Shared Living Collaborative, but they allegedly declined to accept Justina because of the nature of the case and media attention it has drawn. This past Friday, February 28, it was reported that DCF is endorsing a plan to return Justina's medical care to Tufts.

Throughout all of this, Justina's parents have stated that her condition has deteriorated. In contrast, BCH says that she has shown improvement, but, due to HIPAA, no details are available.

Articles about this commonly use terms like "kidnapped", "hostage", "horror" and "nightmare". Many frame the issue in terms of parental rights. Some go for the full-on conspiracy-mongering. The majority tend to support the parents, viewing BCH, DCF and the courts as overstepping their bounds and doing far more harm than good for Justina. They tend to assume that Justina's condition as described by her parents is unequivocally correct. Conservative and Christian groups have rallied around the parents, protesting outside the courthouse and holding a vigil outside Wayside Youth and Family Support. State legislators have even started working on a resolution calling for the immediate return of Justina to her parents. Few, if any, articles side with DCF, taking the BCH diagnosis without question. Some mainstream media, like the Boston Globe, have taken a more middle-of-the-road stance, as has at least one state legislator.

The core dispute involves her diagnosis. The Tufts doctors believe that she has a mitochondrial disorder and have prescribed a number of medications and vitamins. The Boston Children's Hospital doctors believe that her symptoms are psychologically based and that the treatment regime for the mito disorder is overtreatment and puts Justina at increased risk of harm. Other than some of the drugs that were prescribed by Dr. Korson, we do not know what all her treatment at BCH involves or whether her family has sought out other treatment options (e.g., alternative medicine). The basis of the "medical child abuse" allegation, therefore, is that Justina is being overmedicated.

So, are her parents and the doctors at Tufts right? Or are the BCH doctors correct? Those not directly involved in the case cannot make that conclusion without knowing all of the information available to her doctors at both locations. We don't have access to the information leading up to the diagnoses, nor do we know the details around whether or not the treatments have been objectively beneficial. What makes this case somewhat unusual is that both Tufts and BCH are large, respected institutions. It's not a case of legitimate doctors against an obvious quack. Rather, we have two competing, relatively new and controversial diagnoses. What is at stake?

If the Parents Are Correct

If Justina's parents are correct and Justina does have a mitochondrial disorder, then erroneously taking her away from her parents can cause completely unnecessary stress and emotional trauma for both Justina and her family. In addition to the psychological burden of separation and dealing with the court system, there are the burdens of time (going to court, driving long distances to visit, etc.) and money (lawyer fees, medical costs for the altered treatment, if not covered by Medicaid, travel expenses and so on) that would otherwise never have occurred. Medically, discontinuation of her treatment plan could, potentially, result in a more rapid progression of her mitochondrial disorder, assuming that the drugs prescribed by her doctors at Tufts have actually been effective in stabilizing her condition.

If she is placed in a foster home, it is possible that the new family will be very loving and attentive to her needs, but there is also the risk that her new caregivers may have been inadequately vetted and may be abusive. That risk is especially concerning in the case of a child with reportedly complex medical needs.

If the parents are correct, and Justina's separation from her family continues, then emotional harm is being done to both her and her family with no benefit.

If Boston Children's Hospital Is Correct

On the other hand, what if the parents are wrong? What if Justina does not have a mitochondrial disorder, but instead has, as BCH contends, a somatoform disorder? What would be the impact of immediately returning her to her parents?

By all accounts, her parents appear to be absolutely convinced that her mitochondrial disorder diagnosis is correct and will correspondingly pursue treatment for that. They had reportedly already been averse to mental health services before they even approached BCH. If Justina were returned to them, it is almost certain that she would resume the cocktail of drugs and vitamins that had been prescribed to her. This could put Justina at increased risk of serious harm from unnecessary drugs for no added benefit: Tegretol (carbamazepine) may increase the risk of developing a serious or life-threatening blood disease, as well as carry other side effects that negatively affect her quality of life; Metoprolol can increase the risk of adverse cardiovascular complications and potentially worsen allergic reactions, if she has any allergies; and Midodrine can dangerously elevate blood pressure, as well as cause side effects that decrease quality of life.

In addition to the risks associated with over-medication, if Justina's symptoms do stem from a psychological cause, she likely would not receive the mental health care that she needs to treat her underlying anxiety. This would mean she would continue to experience physical symptoms, such as pain, nausea, weakness or dizziness potentially leading to more unnecessary and ineffective medical treatment with no resolution of her symptoms.

If BCH is correct, and she is immediately returned to her parents, the she is at risk of physical harm that could be serious and life-threatening.

Hopefully, I've made clear just how complex this case is and how difficult it is for bystanders and laypeople to make any sort of objective, informed conclusion about it. Emotions run very high and often lead people to make hasty judgments not supported by facts. The most common approach I've seen is support for the parents' rights to decide their child's medical care. More extreme versions of this almost seem to view the parents' rights above all else, despite the fact that children are not property; their rights to make medical decisions for their children are not absolute. Certainly, no child should be taken from their home and away from their parents without some damn good reason to do so. Alleging abuse should not be done lightly. Yet few of the sources I've read consider the other side of the coin. There is potential for very serious harm to Justina, if the allegations are correct. Child abuse and custody cases are complicated to begin with, but they are made even more so when medical care enters into the equation. The issue calls for moderate, nuanced discussion, not knee-jerk condemnations of either the parents or BCH/DCF based on insufficient data.

ETA: Forgot to include the list of additional reading. Here it is:
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Additional Reading and References Used

34 comments:

  1. Why did this happen? Hannah Poling, whose parents won a multi-million dollar settlement for vaccine injury a few years ago, also has mitochondrial disorder. Autism is iatrogenic. I’m betting mitochondrial disorder is, as well.

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  2. Robin, mitochondrial disorder appears to be a genetic disorder. This has nothing to do with vaccines or autism.

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  3. No, it does have a lot to do with anti-vax parents. A lot of parents of 'mito' kids tend to be cut from the same cloth as Age of Autism parents: 'martyr' narcissistic parents who treat their children like infants, hover over them like hawks, subject them to unorthodox treatments and never let them escape. At least Jessica, unlike her sisters, will get her chance.

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    1. Unlike your perjorative opinion of families challenged with autism, "mito" kids get DNA tests which easily prove the diagnosis.

      Justina has several people in her family with "mito" diagnoses - including her sister. Justina's medical information has not been released due to massively strict HIPPA law compliance from all sides in this mess. Since Justina's close blood relatives have mitochondrial genetic disorders (proven with undeniable tests) it is highly likely she has the same.

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    2. According to reports available at the time, it does not appear that Justina had any DNA tests. Instead, as noted in my post, Dr. Korson is reported to have diagnosed her according to her symptoms.

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  4. My bad, Justina. I'm terrible at names.

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  5. I think if the far right wing is supporting these parents, then it’s easy to make a judgement. No fence-sitting here. The parents seem anti-mental health and won’t accept the diagnosis. Justina, at 15, is old enough to decide where she wants to be and who she wants to help her make medical decisions.

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    1. @Janet Campe

      I don't think it's as simple as looking to see who is supporting the parents. Whether or not the parents are in the right in this case, they may still attract hangers-on, especially since this is a ripe subject for being framed as "individual freedom" vs. "overreaching government" or other authority figure.

      As for Justina, legally, she is still a minor and is not legally qualified to make medical decisions for herself, though her wishes might be taken into account.

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    2. Political viewpoints (esp assumed ones) have nothing to do with this.

      Justina's PHYSICAL illness has been proven with DNA studies, repeatedly, by experts (Tufts genetic & biochemical chief, and his mitochondrial disorder colleagues around the globe).

      By law, Justina is not "old enough" to make her own decisions.

      Are you insane by chance?

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    3. Are you certain that DNA tests have proven that she has a mitochondrial disorder? Please provide links to that evidence; I have yet to see any such proof.

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  6. You have perfectly good doctors at Tufts saying she has this disorder. By removing her from her family, BCH is accusing Tufts of being unethical, and therefore someone should be investigating both hospitals. SOMEONE is being unethical here, and blaming the parents for following the orders of a doctor is insane.

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    1. Exactly! Children should not be removed from their parents because doctors are (effectively) having a pissing contest. It doesn't actually matter which bunch of doctors was right, they never should have taken her from her family.

      Also, this somatoform disorder sounds like a bunch of hokum in line with "hysteria". Guaranteed most people diagnosed with it are women and girls who have symptoms that drs can't diagnose. How many hundreds of thousands of women have been told over the years that their symptoms are all in their heads, only to finally be diagnosed, often after decades, with things like fibro, B12 deficiency, hypothyroid, etc. Now they've just invented a "disease" to go along with that line of bs.

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  7. Let me take an alternate angle. What if her parents are wrong, and what does that say about Jessica (her sister). Assuming that she's doesn't have mito, and does have a somatoform disorder, what was the benefit of taking her away from her parents for over a year. We can assume that Jessica was "abused" in the same way that she is being abused, and Jessica seems to have turned out reasonably well The whole family might be "mentally ill", but even so they still function in their own way. Even if DCF is correct, they've disrupted the normal functioning of this family, probably causing more harm that good. Bottom line, what is the end game for Justina? What exactly constitutes successful treatment?

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    1. If her parents are wrong about Justina, that says nothing about Jessica. It is entirely possible that Jessica may have a mito disorder and Justina not. Or both do, or both do not. We can assume nothing. We don't have the facts, and speculation of that nature is pointless. If the parents are wrong, and Justina returns to them, even if as a family they function "in their own way", there is still, as I wrote above, the problem of the drugs for mito disorder. If the parents are wrong and keep giving her these drugs, then she is at risk of serious side effects without any benefit at all. That aspect seems to get ignored in these discussions. It isn't solely about how the family interacts.

      From the latest news (see this post), the ultimate goal is to get Justina back to Connecticut and, hopefully, back home with her family. CT seems unwilling to get involved, though, which will certainly delay things. But the court definitely seems to want Justina to get the care that she needs, which, in their opinion, based on the evidence they've seen, includes mental health care. That's an aspect that the parents appear to be opposed to, and, as noted by the Boston Globe, is something that has come up even before BCH ever entered the picture.

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    2. Physical genetic tests have confirmed the mitochondrial disorder in Justina and her family memberS who have it (incl her sister, an aunt, 2 cousins, etc.).

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    3. Again, as I wrote in my article, Dr. Korson is reported to have diagnosed Justina based on her symptoms, rather than through muscle biopsy or other lab tests. If lab tests have since been done, please provide links to those reports.

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  8. What about the DCF worker telling the judge she had no idea where the mito diagnosis came from? She perjured herself as Dr Korson said he spoke to them and gave history which DCF choose to ignore. Also the judges ruling doesn't speak to Justina but to the Pelletiers being angry and verbally abusive to BCH staff and DCF staff. If your child were locked in a psych ward...would you not be angry?

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    1. @beignet

      Do you have a source for that DCF testimony? I was unable to find any court transcripts to verify this.

      To play devil's advocate for a moment, the Pelletiers' behavior has been erratic (e.g., threatening to sue foster programs before even visiting them, agreeing with a plan, then backing out, then agreeing again, etc.), they have violated court orders, rejected mental health treatment for their daughter even before they ever came to BCH, threatened the social worker to the point they requested to be removed from the case, etc. These kinds of actions portray them as unwilling to work with the system to get their daughter home sooner. In particular, if the concern is that Justina will not get the care that the court, based on the evidence presented, believes she needs (e.g., mental health care) and that she will be given drugs that pose a risk to her for no objective benefit, then the ruling is right to focus on her parents' behavior.

      That said, yes, I would also be angry. However, I am in no position (nor are the majority of people commenting on the case) to favor one side or the other. I do not have the necessary facts to do so. I cannot state with any firm conviction that the parents are in the right, nor can I state that the state is in the right. Neither can anyone who is not directly involved in the proceedings or care of Justina.

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    2. Be careful on what heresay you take as "factual".

      HIGHLY common for psych depts to create fabricated '(false) evidence' to justify their egomaniacal goals.

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    3. While it is certainly possible (and has happened in the past), there hasn't been any solid evidence from either side that either diagnosis was fabricated. As I wrote above, both diagnoses (mito disorder and somatoform disorder) are, as I understand it, difficult to diagnose.

      Also, I would recommend using caution in your comments. You attack others for using pejorative language toward the parents, yet you use pejorative language to attack psych departments. If you are going to make claims such as that, be prepared to back them up with good evidence.

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  9. Heil Hitler And all of you Americans think you live in a free country? Think again!
    It's about time someone has done something about this Gestapo bullshet! How does this Dr. Eli Newberger, have such enormous and unchecked power? This Juvenile Court Judge Joseph Johnson’s should be investigated as well. This poor girl and her family's rights have been totally destroyed for the last year. How this could ever happen in America is a travesty. I hope they sue Massachusetts, this Pravda doctor and the Peoples Republic
    Boston Children's Hospital for 100 million dollars.
    Let them all lose their jobs and their reputations for this unbelievable disdain for justice. This is the most ridiculous news story ever in America.

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    1. @call me roy

      Thank you for stopping by and ranting in my comments. While you're in that frame of mind, I suggest you look up "Godwin's Law". If you are absolutely certain that the parents are correct and that DCF and BCH are wrong, I have to assume that you have read documents that are not available to most members of the public like myself (e.g., medical records, court documents, etc.) and that you have reached your opinion based on a careful weighing of the actual facts in the case. If so, I'd be happy for you to share that information with myself and the other readers to also evaluate.

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  10. It is a shame that "journalism" in the US has devolved into taking sides on an issue rather than focusing on facts only. It's a shame the parents don't appear to have open minds about mental health issues - it's either too much of a stigma for them, or they believe there is no such thing as a mental disorder. One thing for sure, however: If the parents ever had much trust in the medical establishment when this started, they certainly have less trust now.

    True, children are not "property" of parents; but they are also not "property" of the state. Believing one medical diagnosis from a reputable medical establishment while not believing another, and being "angry and difficult" with the medical establishment in Boston hardly constitutes child abuse. The parents and Tufts may, indeed, be wrong; but it is obvious to me there is no malevolent intent of the parents or the Tufts doctors. Therefore, even if the decision to return Justina to her parents results in a miserable life or an early death for her, the "correct" people ultimately will have been given the rights over Justina's well-being until she reaches age 18. The fact is, the case is dealing with differing medical *opinions*, not undisputed facts. Since it is opinions, the non-malevolent parents' rights should ALWAYS trump the opinion of the state. If not, the implication is any Government authority can trump any citizen's authority over himself or a dependent family member if that Government authority can find a "subject matter expert" opinion that fits his own personal agenda; or, in this case, the "subject matter expert" with the differing opinion can find a Government authority to pull a power play to fit *his* agenda. This is what has the "right wingers" all hot and bothered about this case. Seizing control from parents over a human being's life because of a debatable opinion of an "elite medical professional" is simply wrong, especially when other "elite medical professional" opinions disagree.

    That stated, I'm also open minded enough to realize we may be missing facts that could support the side of the state of MA. I wonder whether the Tufts doctor who referred Justina to the gastroenterologist in Boston she never saw had some kind of hidden agenda, and may have even warned the folks in Boston about a "medically abusive" situation that got out of his control; and this was his means to make the "right thing" happen. In other words, some Tufts doctors could have been pandering to the parents with the mito disorder diagnoses for some misguided reason. This raises a big question around the lack of a muscle biopsy. If there was pandering "to difficult parents in order to pacify them" going on at Tufts, that would certainly put another interesting angle into this story. It's speculative on my part, but could involve some of the facts hidden by the gag order.

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  11. Thank you for writing this. I haven't read too many articles on this particular case that aren't one sided. I think there's a huge part of the story we're missing here (like you pointed out, probably due to HIPAA)

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  12. Thank You, Now Just in a is at home, we can now treat her like a celebrity.

    I volunteer at MA DCF, while I can't comment on the case, I'm familiar with the process.

    My thoughts from March .

    http://cappadociainlowell.blogspot.com/2014/02/petitions-by-means-of-social-media.html

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    1. Thanks for sharing your post. Some good insights that a lot of the public should have kept in mind.

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    2. To follow up, the local media all covered her coming home. The father went on a rant how she was abused/tortured, that brought up Deval Patrick (Massachusetts' Governor) potential run for President in 2016. Earlier this year they harassed him (approached him) in the state house with video recording the incident. The two state legislators (who I usually like) had tried yo pushed for the a resolution in the state house and planned rallies and prayer vigils. Totally politically orchestrated.

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  13. It has been hard, I'm Catholic and social conservative with a liberal bent for social programs. It is a small and loud crowd, who have more issues with the liberal state, then the facts. Lou Pelletier cares more about going after the state, then the service plan for his daughter. It wasn't until March 2014, they started to work with DCF (which they did) despite the statements they are telling the media.

    “I'm going to make sure the world comes down on this state,” -Lou Pelletier

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  14. I have not search out to set if it is true but this article states the psychologist who changed Justina's diagnosis to Somatoform Disorder had a research grant specifically for Somatoform Disorder. That is a huge conflict of interest if it is true.
    http://www.lc.org/index.cfm?PID=14100&PRID=1453

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    1. Joy,

      That is not necessarily a conflict of interest, particularly if that is the physician's area of expertise. Would you say that a surgeon who specializes in brain tumors has a conflict of interest treating a patient for a brain tumor if they are also doing research on brain tumors under an NIH grant? If they doctor were getting grants from a company providing grants for research on one of their products, which the doctor also prescribes over other approved products, that would be a COI. Having been on an Institutional Review Board, I would not classify an NIH grant as a COI.

      Also, that link also says, "Any Massachusetts ward of the state is subject to research being performed upon them without their consent." That is simply not true. There are very specific regulations governing research involving human subjects, with additional protections above and beyond the standard rules when special/vulnerable populations are involved, such as children. In addition to IRB approval for research in general, for children, the IRB may require that the assent of the child also be obtained before they can be enrolled in a study. For wards of the state, if participation in the research is approved, a child advocate must also be assigned to ensure the best interests of the child. This advocate must be completely independent and unassociated with the research, the investigators or the guardian organization.

      I should also point out that the link you provided was a press release written by Liberty Counsel, which took on Justina's case on behalf of Lou and Linda Pelletier. If you want to talk about conflicts of interest, that is a pretty big one. Also, I would expect a law firm would be a bit more cautious about making inflammatory and incorrect statements regarding the law governing human subjects research. Their article is a perfect example of what I discuss in my post above. They are free to speculate and opine about the case, but it is a) one-sided and biased and b) there is no opportunity for the doctors and other caregivers involved in the case to speak, due to HIPAA privacy regulations. The reader has no way to fact-check the pertinent details of the article.

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  15. Justina's progress should tell the story, if she did not need the medicine and her parents were a bad influence shouldn't she be thriving instead of regressing?

    Unless you thinking part of her mental disorder is that she prefers a wheelchair over ice skating?

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    1. Two months ago her parents told the media she was 'dying' in DCF custody and her condition deteriorating. Children's/DCF couldn't defend themselves from the statement due to privacy.

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    2. Here are a couple things to keep in mind, though.

      1) According to reports back when she was first brought to BCH, she had suffered a bout of influenza, followed closely by difficulty walking. It's unclear if the illness directly caused damage to her legs or nervous system or if it was just coincident.

      2) The only word we have on Justina's condition and progress is her parents, who, from day 1, have been fighting and villifying anyone that did not agree with them. They were motivated to get their daughter home. They may have been telling the truth; they may have exaggerated things to make it seem like conditions were worse than they were; they may have made things up. Meanwhile, as Renee notes, the clinicians treating Justina are barred from commenting due to various state and Federal regulations. We don't have a complete picture. All we have is a very biased view of things. We cannot reliably say that she whether she was deteriorating or improving, nor can we state with certainty the role played by her illness or by her treatment at BCH and then at the other facilities.

      3) You are assuming that if someone suffers from a somatoform disorder that they have any conscious choice in their symptoms. Even though the cause is psychiatric in origin (i.e., there's nothing physically wrong that's causing the symptoms), that does not mean that the individual is making things up, faking it or can in any way control what is going on. That's the difficulty dealing with a somatoform disorder: the symptoms are real, but there is no physical intervention you can do to alleviate them.

      4) It should be noted that while she has been returned home, according to various news reports, her treatment plan, and the agreement that allowed her to return home with her parents, stipulates psychiatric treatment for somatoform disorder.

      I think it is great that Justina is back home, since that is much more likely to be a more comfortable environment for her than other facilities, and I hope that her parents stick to the agreement and support her through her mental health treatment. That's something that, per various news articles, they have been opposed to in the past, even before she got to BCH.

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  16. I don't question Justina's miserable experience, but DCF goal was always reunification and as the judge stated the parents sabotage the process and blamed DCF. I know from my own experience, that we rarely speak negatively of the parents. Our goal is to help parents be parents.

    We don't know the details, but all we have us the parents "woe is me' story, having teens being told by their parents NOT to cooperate is common. When I'm in the DCF lobby, I overhear cellphone conversations of parents speaking with foul language about the social worker.

    Remember the Pelletier's were so verbally abusive, a social worker had to be reassigned. Their daughter was to go home June 2013, but Lou was going to sue the Connecticut medical facility. So they backed out...

    Again we always work with a family's positives, not negatives.

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