Lehigh County controller criticizes child welfare system in new report

Lehigh County’s fiscal watchdog is calling for a series of child welfare reforms, citing a report that found an “abnormally high number” of medical abuse cases in the region that he says creates a fiscal burden on local taxpayers and, if misdiagnosed, needlessly tears families apart.

County Controller Mark Pinsley was backed at a news conference and later joined at the Lehigh County commissioners’ meeting Wednesday by more than two dozen Lehigh Valley families who said unsubstantiated claims of medical abuse made by doctors led to their children being placed in foster care and taken off their medication, and caused trauma for their families.

The report was highly critical of doctors for what it alleges are rushed medical decisions that did not take into account children’s complicated medical history. It does not name doctors nor health systems, but Lehigh Valley Health Network’s John Van Brakle Child Advocacy Center is the only child protection unit in the region. Families at Wednesday’s news conference pointed to LVHN and the center’s head, Dr. Debra Esernio-Jenssen.

Pinsley’s report, “The Cost of Misdiagnosis,” created over the course of roughly two to three months, says the Northeast region of Pennsylvania diagnosed 40% of the state’s Munchausen syndrome by proxy cases in 2017-21, despite having 11% of the under-18 population. The 40% figure is equivalent to 10 cases.

Munchausen syndrome by proxy refers to a caretaker of a child either making up fake symptoms or causing real symptoms to make it look like the child is sick.

This indicates “potential systemic misdiagnosis,” according to the report, adding that people accused of child abuse have “little recourse” to defend themselves and can lose employment opportunities, even if an independent appeals board later overturns the finding 90% of the time.

The report states the controller’s office cannot determine the cost of misdiagnosis in a single case, drawing on national averages and public information instead.

However, Pinsley is calling for systemic reforms due to the financial burden misdiagnoses can cause Lehigh County taxpayers, including for casework, foster care, parental programs and defending lawsuits.

The report references that it costs $25,000-$30,000 annually to support a foster child.

“It is crucial to address these concerns to ensure the efficient allocation of resources,” he said.

These potential reforms included:

“As the watchdog of Lehigh County finances, I urge the county to take these recommendations seriously,” Pinsley said.

Pinsley is referring the issue to the Pennsylvania auditor general’s office, which has more power to investigate.

The report was immediately met with criticism, with a child welfare advocate, Lehigh County Children & Youth and Lehigh Valley Health Network all saying it oversimplifies a complicated issue.

Cathleen Palm, founder of the child advocacy group Center for Children’s Justice in Berks County, said the report raises legitimate issues, such as how to best investigate cases and how people get put on the state’s child abuse registry. But she called it a “gotcha” report, and criticized Pinsley for not including more of the perspectives of children and child advocates.

“It just feels like he didn’t do enough due diligence — or enough service to the fact that it was so complicated and so worthwhile — for him to bring something more intentional than what I think he got to,” she said.

Lehigh County Assistant Solicitor Catharine Roseberry provided an unsigned statement on behalf of the County Department of Human Services, stating, “At first glance we are concerned that this appears to be rather one-sided in its presentation of facts and conclusions regarding the County of Lehigh’s Office of Children and Youth Services. … While we are constrained by both State and Federal law from fully discussing the situations of the specific Lehigh County cases identified by Mr. Pinsley, we have reviewed the facts and are comfortable with the County’s handling of these matters, and the protection of the children involved.”

Mark Pinsley, Lehigh County controller, speaks about his investigation that has uncovered evidence of an abnormally high number of medical child abuse diagnoses in the Northeast region of Pennsylvania that impact Lehigh County costs Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. Some families say they have been affected by misdiagnoses in Lehigh County, experienced loss of their children to CYS, lengthy court battles, job loss, financial ruin, falsely labelled abusers, incarceration, and ongoing trauma. (April Gamiz/The Morning Call)

Kim Steltz of Emmaus speaks out about her family's experience Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. (April Gamiz/The Morning Call)

Families and others gather to speak Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. Some families say they have been affected by misdiagnoses in Lehigh County, experienced loss of their children to CYS, lengthy court battles, job loss, financial ruin, falsely labelled abusers, incarceration, and ongoing trauma. (April Gamiz/The Morning Call)

Sisters Willow and Hazel, mother Stacy Feeney and father Mike Kwiatkowski of Hellertown share their story of what they have gone through Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. (April Gamiz/The Morning Call)

Beth Maloney, attorney, speaks Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. Some families say they have been affected by misdiagnoses in Lehigh County, experienced loss of their children to CYS, lengthy court battles, job loss, financial ruin, falsely labelled abusers, incarceration, and ongoing trauma. (April Gamiz/The Morning Call)

Carin Radonga speaks out Wednesday, Aug. 23, 2023, at Lehigh County Government Center in Allentown. Some families say they have been affected by misdiagnoses in Lehigh County, experienced loss of their children to CYS, lengthy court battles, job loss, financial ruin, falsely labelled abusers, incarceration, and ongoing trauma. (April Gamiz/The Morning Call)

The report was highly critical of doctors for what it alleges are rushed medical decisions that did not take into account children’s complicated medical history.

In a statement, LVHN said it disagreed “wholeheartedly” with the report’s conclusions and defended Esernio-Jenssen. The health system said the doctor doesn’t initiate child abuse cases. Rather, she evaluates, collaborates with the child’s medical team and usually does “not find evidence of child abuse, which is consistent with national averages.”

The statement added that LVHN clinicians don’t unilaterally determine whether child protective services intervention is appropriate in cases of alleged child abuse. That power goes to those in the judicial system or child protective services after considering evidence and witnesses.

“Due to the sensitive nature of their work, physicians specializing in child protective medicine are often the unfortunate target of emotionally driven and unsubstantiated criticism,” the statement read. “The Lehigh County Controller has no jurisdiction over the CAC, nor the clinical credentials to conduct a review of a clinician or the services rendered by a clinician.

“Our community relies on us to heal, comfort, and care for them, especially in their most critical time of need. That remains our focus.”

Pinsley’s report says the catalyst for the audit was a June video from an attorney about an alleged child abuse case in Allentown. He reached out to the Parents’ Medical Rights Group, a Lehigh Valley organization that has been critical of the child welfare system.

The group shared the story of a family whose two children were removed from their care after a hospital visit in which a doctor believed one child, who had complicated medical issues, was actually a Munchausen syndrome by proxy victim. Eventually, both children were removed from the home. A year later, Children & Youth dropped the case, according to the report.

After Pinsley hosted a news conference Wednesday in front of the Lehigh County Government Center explaining his findings, roughly 30 residents went to the Board of Commissioners meeting and described how child abuse misdiagnoses have affected them, urging commissioners to take action.

“Not one person involved in the process was interested in the truth,” said Kim Steltz, who said her son was removed from her care after Esernio-Jenssen diagnosed medical child abuse, despite never speaking with her.

Stacy Feeney said her daughters, Willow and Hazel, were “kidnapped” after the doctor declared their medical issues were false and the result of medical child abuse. Like with Steltz, Feeney said she was never questioned by the doctor about her children’s medical conditions.

“I had always promised to protect my children, and they were in a terrifying situation that I could not protect them from,” Feeney said, adding that CYS kept her children in a building that looked like a prison.

Eventually, the state dismissed the case after Esernio-Jenssen’s reports were found “not credible,” Feeney said.

Criminal defense attorney Alexander Ward told commissioners about what happened after he slipped on the stairs in his home and accidentally dropped his infant daughter, including having to speak with the police.

A caseworker, Ward said, asked him and his wife several “offensive” questions, such as if he had started drinking again due to his recovering from alcoholism and if they wanted their daughter. Esernio-Jenssen implied to Ward’s wife that he abused their daughter, he said.

“My faith in the system is shaken by this,” Ward said.

Lehigh County commissioners listened quietly to the parents’ comments but took no action on the report or its recommendations.

Commissioner Geoff Brace said the misdiagnosis allegations in the report should have gone to the Department of Human Services before Pinsley published it.

“I think the allegations are worthy of that kind of consideration,” Brace said.