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Is Munchausen by Proxy a clue for Munchausen's Syndrome?

FACTITIOUS DISORDERS ARE CHARACTERIZED BY PHYSICAL OR PSYCHOLOGICAL SYMPTOMS THAT ARE INTENTIONALLY PRODUCED OR FEIGNED IN ORDER FOR SOME TO "ASSUME THE SICK ROLE." Munchausen's Syndrome is the most severe form of factitious disorder. Munchausen "By Proxy" is a term applied when an adult, usually the mother of a patient, presents a false history to a physician regarding a child who is not suffering from any of the "fabricated" symptoms. The history given by the mother causes a physician to perform the appropriate diagnostic tests. Much to the disappointment of the parent, diagnostic tests come back negative. The parents involved routinely go from physician to physician. Consequently, no physician has the opportunity to make the diagnosis of Munchausen By Proxy. More Munchausen By Proxy would be diagnosed if more primary care physicians, who routinely make referrals to specialists, were involved. However, this would be to the dismay of the classic Munchausen By Proxy parents, who would be highly likely to reject the diagnosis.

ANNETTE NASH, MOTHER OF WILLIAM HEINES, A MINOR, SUED SEVERAL PHYSICIANS AND STATEN ISLAND UNIVERSITY HOSPITAL FOR MEDICAL MALPRACTICE. The suit was for injuries allegedly sustained by William in connection with orthopedic surgery performed by Dr. Barbara Minkowitz at the hospital on January 6, 1999. Nash alleged that the defendants were negligent in performing a tibial osteotomy to correct in-toeing of the right leg. Nash's rationale was that the surgery was unnecessary. The defendants moved for an order to compel Annette Nash to consent to a HIPAA authorization for her psychiatric, psychological, and social worker records on the grounds that the behavior and psychiatric profile of Annette Nash played a major role in the creation of her son's medical history and complaints through a pattern of exaggerating, feigning and/or inducing many of his medical signs and symptoms, seeking unneeded and/or unwarranted medical evaluation and treatment for him and interfering with appropriate medical evaluation and treatment. Dr. Jane Epstein, a Board-Certified Psychiatrist, the Associate Director of Neuropsychiatry at the Weill Medical College of Cornell University, after reviewing all of the records available to her, concluded that she believed that a thorough examination of Annette Nash's role was necessary. She concluded that an interview of Ms. Nash and a review of her psychiatric records was vital.

THE SUPREME COURT OF NEW YORK HELD THAT THE DEFENDANTS HAD PROBABLE CAUSE TO SHOW THAT MS. NASH HAD MUNCHAUSEN BY PROXY, WHICH AFFECTED THE COURSE OF HER SON'S TREATMENT. The court held, inter alia, that the defendants' motion to compel HIPAA authorizations for Ms. Nash's psychiatric, psychological, and social worker records should be granted for an in-camera inspection to ascertain whether they were relevant to the case, and if so, that they be disclosed to the defendants.

ARE PARENTS INVOLVED IN MUNCHAUSEN BY PROXY CANDIDATES TO BE MUNCHAUSEN'S SYNDROME PATIENTS AFTER THEIR CHILDREN HAVE ALL GROWN UP? After the all too convenient child is grown and out of his/her mother's scope of influence, is such a parent likely to persist in behavior which is characteristic of Munchausen's Syndrome, albeit without proxy? Physicians should be keenly aware that many Munchausen By Proxy personalities are likely to persist in their aberrant behavior. In 1995, the American Psychological Association Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), included a definition for factitious disorder by proxy, which is now the accepted psychiatric category for Munchausen's Syndrome By Proxy (MSBP). The definition includes the following: 1. The intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care. 2. The motivation for the perpetrator's behavior is to assume the sick role by proxy. 3. The external incentives for the behavior, such as economic gain, avoiding legal responsibility or improving physical well-being are absent. Often, physicians encounter cases in which Munchausen's is not by proxy, but involves patients who seek attention by feigning their own symptoms in a desperate attempt to attract the attention of family and friends. These patients often go undiagnosed because they fail to give true and accurate medical histories, which might lead physicians to more readily recognize Munchausen's Syndrome. Some of the telltale signs are that, in spite of the symptoms complained of by such patients, all diagnostic testing for the cause of the symptoms complained of is negative. Further, many such patients "doctor shop" and refuse to accept the fact that they do not have an illness when tests results come back normal. Some literally argue and fight with their physicians when told that they are not ill! At least not physically ill! Heines v. Minkowitz, (N.Y. Sup. 12/13/2006)--NY

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's Who in America and Who's Who in the World.
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Author:Tammelleo, A. David
Publication:Medical Law's Regan Report
Date:Jan 1, 2007
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