Thursday, May 14, 2009

The long, long learning curve of Dr. Perri Klass

It was 20 years ago that I first encountered the writing of Perri Klass, M.D. At the time, she was doing her residency at Boston Children's Hospital and I was researching my book, Wounded Innocents: The Real Victims of the War Against Child Abuse (Prometheus Books: 1990, 1995).

In an essay for The New York Times Magazine, Dr. Klass wrote about how tough it was on her when her husband brought her own three-year-old into the E.R. with a cigarette burn. The child ran into the cigarette while running in a restaurant. She described how tough it was on her to be interrogated, but concluded that it was not only justified but commendable, and everyone should be glad to put up with the same treatment.

"Bear with us," Klass wrote at the time.

For decades, pediatricians missed child abuse; the children marched past, bruised or burned, and their parents' stories were accepted. Now we live in fear that someone will get by, that we will believe a story that shouldn't be believed. Be patient with us as we ask you these questions, and understand that we are bound, ethically, morally, and now legally, to suspect everyone. It may seem harsh and unfair that you are not immediately and obviously cleared, but it would be much worse if we gave in to our instincts and promptly cleared all parents who seemed ''like us.'' It would be more than unfair; it would be dangerous. We all know too much now; our innocence is gone. We are trying, if you will pardon a corny turn of phrase, to protect the innocent.

It's not that Dr. Klass was unaware of racial and class bias in child welfare – it's just that she saw it solely in terms of doctors not being tough enough on most rich white people; whereas they were exactly tough enough on her.

Easy for her to say.

She, her husband and, most important, their son, were allowed to go home that night, and that was the end of it.

As it happens, at about the same time, in the same hospital, another mother, Geraldine Churchwell, said there was no need for her child to be institutionalized at a residential treatment center. She was not accused of abusing or neglecting her daughter, and there certainly was nothing so flagrantly suspicious as a cigarette burn. No, Churchwell's child simply had asthma. The child's allergist said Churchwell took superb care of her daughter. And she had a comprehensive alternative treatment plan of her own. But she also was poor and Black. So Dr. Klass' hospital strong-armed her: Institutionalize the child or we'll call Child Protective Services.

Of course I compared the two cases, and the two outcomes, in my book.

In the years since, I don't know what happened to Geraldine Churchwell. Perri Klass, however, would go on to write several books, fiction and non-fiction, and innumerable essays for the Times. The latest essay from Dr. Klass turned up Tuesday. Once again, child abuse was the theme. This time Dr. Klass was celebrating how much more doctors supposedly know about how to detect it, and the fact that "child abuse pediatrics" is about to become an official medical specialty – complete with board certification.

But most important, we learn in this new essay that the story she told 20 years ago has a sequel. Klass writes:

[T]he incident [with the cigarette burn] made enough of an impression on my colleagues that a year or so later, when the same child came back with a broken femur at age 4, an attending doctor said to me, with the harsh humor of the emergency room: "I don't know, Perri. First cigarette burns, now a major fracture— doesn't look so good for you." (I knew enough to be theoretically glad that abuse was on his mind; on the other hand, 20 years later, I haven't forgotten or forgiven the remark.)

Pooooooooor Perri. She had to endure an unkind remark. Try, Dr. Klass, please, just try to imagine where your son would be now had you been poor and Black, and your son had turned up in the E.R. with a cigarette burn one year and a major fracture the next. Almost certainly the child would have been detained at the hospital and thrown into foster care for a year or more. And if you had the wrong attitude, Dr. Klass, if you'd gotten too angry, and protested your innocence too much, odds are you'd have no child at all today, your parental rights having been terminated.

But if the past 20 years have made the good doctor more reflective, it doesn't show. Does she regret the atmosphere of paranoia she helped to spread? Does she regret all the harm done to innocent children whose lives were destroyed by needless foster care in the name of "protecting the innocent"? Does she regret the maltreatment inflicted on children taken from safe homes only to be abused in foster care? Nope. On the contrary, her conclusion now is almost identical to the one 20 years ago. She writes:

[I]t's an emotionally difficult diagnosis for a pediatrician to contemplate, especially when it concerns a family you feel you know well. And all too often, it is a diagnosis we fail to consider in families that don't match our mental profiles of abusers.

And no wonder she feels that way. After all, the children of Perri Klass, M.D., including the one with the cigarette burn and the broken femur by age four, never had to endure even one minute of foster care.