This article was published in partnership with the Houston Chronicle.
HOUSTON — Texas lawmakers are calling for stronger safeguards in the state’s child welfare system after an NBC News and Houston Chronicle investigation found children had been taken from their parents based on disputed medical opinions from doctors trained to spot child abuse.
The reporting showed that child welfare workers removed some children from homes after receiving reports from state-funded child abuse pediatricians that were later called into question, leading to traumatic family separations and months-long legal fights.
Rep. James Frank, chairman of the Texas House of Representatives committee that oversees the state’s Department of Family and Protective Services, said the investigation exposed serious problems.
“I’m very concerned with the premature, unnecessary removal of children, and I think it happens a lot more than people in Texas understand,” said Frank, a Republican from northern Texas.
Frank said he plans to call for a series of legislative hearings in the coming months to explore potential improvements. Some legislators have suggested creating a way for courts, child welfare workers or accused families to request a second medical opinion before the state removes a child from a home.
Texas provides $5 million in grants each year — including $2.5 million from the agency that oversees Child Protective Services — to support the work of child abuse pediatricians, a small but growing subspecialty of doctors who examine children who come into hospitals with suspicious injuries. The Texas grants deputize some of the doctors to review cases on behalf of child welfare investigators, who then rely on their reports when deciding whether to remove children from parents.
Frank acknowledged that these state-supported physicians have a difficult job and that they play a critical role in protecting abused children, likely saving lives. But he said he’s heard from numerous parents in recent years whose children were removed by Child Protective Services based primarily on a report from a child abuse pediatrician and despite contradictory opinions from other doctors.
In those cases, Frank said he thinks child welfare workers are sometimes too deferential to agency-funded abuse doctors and fail to complete a thorough investigation before taking children.
“In most cases, the doctors aren’t saying ‘This is child abuse,’” Frank said. “They’re saying that they are concerned that it’s child abuse. And so I don’t know there are enough checks and balances to make sure that we have confirmed that it really is child abuse.”
Rep. Harold Dutton Jr., a Houston Democrat and lawyer who has represented a mother who says she was wrongly accused by a child abuse pediatrician, said he has begun discussions with Frank to figure out potential improvements.
“We haven’t come up with anything yet, but we’re working towards it,” he said. “One of the things that needs to happen is we need to better define when CPS should remove children. We’ve got to do a better job of that.”
In a statement, Patrick Crimmins, a spokesman for the Department of Family and Protective Services, said the agency relies on the expertise of child abuse pediatricians when its caseworkers and other medical specialists are unable to determine if a serious injury is a result of abuse.
“We believe this process has worked well to detect abuse in complex cases and has protected children,” Crimmins said. “But any process — particularly one with the lives of children and their families at stake — can be improved, and we want to work with legislators and stakeholders to do just that.”
In interviews, leading child abuse pediatricians said they are careful to rule out underlying medical conditions and accidental causes before issuing their opinions. The doctors acknowledged that a mistaken child abuse diagnosis can result in a child being taken from caring parents. But overlooking warning signs, they said, could lead to a child being left in a dangerous home, with potentially fatal consequences.
To state Rep. Gene Wu, the issues raised by the NBC News and Chronicle reporting were familiar. Wu, a Houston Democrat and lawyer, sometimes handles cases involving Child Protective Services and allegations of abuse.
“I have personally dealt with a couple of cases … where you had day-to-day physicians who said, ‘This is a typical type of bone break that is common in children of this age because they’re learning to walk,’” Wu said. “Then the case gets looked at by the child abuse expert and they say it might be child abuse, and then everyone sort of freaks out.”
In those instances, Wu said, “CPS is sort of caught in this damned-if-you-do, damned-if-you-don’t situation.”
Child abuse pediatricians are trained not only to identify abuse, but to identify medical conditions that can mimic abuse. The doctors say they rule out or fail to confirm abuse more times than not.
But Wu said when medical specialists are focused on finding and preventing child abuse, it’s natural that some run-of-the-mill injuries may appear more sinister.
“If you’re a hammer, then everything is a nail,” Wu said.
In many cases, the only doctor consulted by Child Protective Services and called to testify in court is the child abuse expert who initially flagged the concerns, in part because many families do not have the money to hire seasoned lawyers or outside medical experts.
To address that, Frank and other lawmakers have suggested requiring Child Protective Services to seek additional medical opinions in some instances before removing children. Another fix, Wu said, might be to create a mechanism for courts across the state to bring in independent experts to evaluate medically complex cases and offer a second opinion.
“We could create a pot of money that courts could dip into,” he said. “One party could make a motion to the judge to request an independent expert, and the state could have a list of medical experts to take a look at it.”
There are no “easy solutions,” he cautioned.
“I’ve described the CPS system as a very finely balanced seesaw,” Wu said, “and if you tip it too much you’re going to take kids away from good parents, and if you tip it the other way, you’re going to have dead kids. … Whatever we do, we need to make sure that this policy solution doesn’t tip the balance.”