In re Jessica Z.

Jessica M. was a baby who began having unexplained bouts of severe diarrhea over the course of four months that led to major surgery and nearly caused her death. The New York Commissioner of Social Services (the commissioner) (plaintiff) alleged that Jessica’s mother, Lori Z. (defendant), had intentionally caused Jessica’s condition and placed her at risk of death by giving Jessica laxatives from March to July 1986. The commissioner offered evidence that Lori had Munchausen syndrome by proxy (MSP), a psychological ailment that causes a parent to make a child sick or to fabricate a sickness. The factors for MSP, which were all present in Jessica’s case, included: (1) a child’s sickness with confounding symptoms, eluding diagnosis and impervious to medical treatment; (2) repeated hospitalizations and invasive procedures, such as surgery; (3) the child’s significant improvement when the parent has no access to the child; (4) the parent’s training in medicine or similar fields; (5) the parent’s extraordinary attention to the child while hospitalized; (6) the parent’s extraordinary support for medical personnel; and (7) a symbiotic relationship between the parent and the child. When a doctor finally suspected that Lori was making Jessica sick, the doctor tested Jessica’s stool in July 1986 and found phenophthalien, a chemical used to make laxatives. This laboratory report, in July 1986, was the only factual evidence that someone had given Jessica laxatives. Evidence regarding March to June 1986 remained circumstantial. At a child-abuse hearing that lasted for 14 days, expert witnesses testified both in favor of and against the notion that Lori had MSP and had caused Jessica’s condition. Considering the MSP factors, the New York Family Court found that Lori had given Jessica laxatives, causing her severe illness not only in July 1986 but from March to June 1986 as well. No other satisfactory alternative was provided to fit the facts of the case.