Oregon stay-at-home mom faces trial in rare medical child abuse case
Records and interviews challenge many of the accusations, Medill Justice Project investigation finds
By Olivia Exstrum, Rachel Fobar, Morgan Kinney, Jeanne Kuang, Orko Manna, Megan McDowell, Jasper Scherer, Fallon Schlossman, Caroline Spiezio and Evelyn Wang
The Medill Justice Project
Updated: Dec. 23, 2015
GRANTS PASS, Ore.–Joshua Parker is not breathing.
Alarms blare from the monitors attached to the 5-year-old boy, warning of dangerously low oxygen levels and a plummeting heart rate. It is about 2 a.m., and he is in bed circled by his brothers and sisters, who watch helplessly while their mom jostles him awake to buy another breath.
“Is this the day that he’s going to die?” his dad Charley thinks, standing over Joshua. “I’m not prepared for this.”
Charley starts praying aloud: Please, God, don’t take Joshua yet, give him more time, help him breathe. Joshua, struggling for breath, talks about seeing angels in heaven. Hours pass, nothing changes. Joshua’s mother, resigned to the inevitable, just asks that he go in peace and without pain.
Joshua did not die that night in August of 2011. Nor is he dying. In September of 2013, his mother, Katherine G. Parker, was accused of medical child abuse—a controversial diagnosis that alleges she subjected him to unnecessary treatment, including several surgeries. Authorities also accused Parker, 45, of harming her two adopted daughters. Police arrested Parker at her home at the end of a quiet cul-de-sac in Grants Pass, a remote river town in southern Oregon, on April 1, 2014, in the middle of a family dinner.
No one in Parker’s family has accused her of wrongdoing. Prosecutors in Josephine County, where Parker lived, considered but declined to bring charges against her, according to Brett Claar, one of her attorneys. (The District Attorney’s office would not confirm whether it contemplated any charges.) Instead, more than 200 miles away, the District Attorney’s office in Multnomah County, which includes Portland, Oregon, where Joshua received much of his medical treatment, has pursued the case.
Parker faces 43 criminal charges, including assault, and her attorneys say she confronts what amounts to a life sentence: up to more than 30 years in prison in what they believe is the first criminal medical child abuse case in Oregon history. Prosecutors in Portland declined to discuss the case, but in a recent court filing, they accused the defense of improperly providing The Medill Justice Project with confidential records and demanding that MJP not retain the documents. Parker’s trial is set for Feb. 29.
At the center of the case is a stay-at-home mother of eight who home-schooled her children. Parker considers herself an evangelical Christian and said she had never received so much as a parking ticket. Two of her children underwent brain and spine surgeries about a decade ago and have recovered. Four of her other children have never undergone significant medical procedures, Parker said, including one daughter who has a neurological condition like her brother Joshua but didn’t exhibit symptoms. Born with a more severe neurological defect, Joshua received regular medical intervention for more than seven years from multiple doctors who approved his procedures before his mother was accused of manipulating surgeons and other medical specialists into unnecessary treatment. Parker was also accused of under medicating then 5-year-old Bethany but since her adopted daughter was removed from the home in 2013, her medical condition has remained serious, according to records. Meanwhile, as Parker has lived apart from her family for about a year and a half, including six months in jail and now under court supervision, Joshua continues to exhibit symptoms, including vomiting, headaches and difficulty breathing, according to his family.
In an 11-week investigation, The Medill Justice Project interviewed dozens of sources in Oregon and elsewhere and reviewed thousands of pages of records, including emails, blogs and letters as well as court, medical, police, bank, adoption and other documents. The Medill Justice Project probe found numerous questions about the case against Parker:
- The pediatrician who made the accusations against Parker said in a letter to authorities that Parker said Joshua was dying when, “This has not been reproduced in the medical record.” The pediatrician also said in court testimony that Parker said her daughter Bethany was dying, but “none of the doctors ever reported that she was terminal.” Emails and medical records, however, show doctors discussing Joshua and Bethany as terminal or in grave condition.
- The pediatrician who made the accusations against Parker said hospital staff did not observe his symptoms as reported by Parker, including pain, difficulty breathing and a low heart rate. But interviews and medical records show family, friends, doctors, nurses and other medical staff witnessing several of these symptoms.
- Parker is accused of administering high doses of narcotics to Joshua, but his prescriptions were approved and supervised by several doctors and administered by not just Parker but other family members. Records show Parker sought and received permission for even over-the-counter allergy medicine. Doctors discussed with each other and with Parker that they were giving Joshua heavy doses of painkillers to keep him comfortable, believing he was about to die.
- Parker was accused of under medicating Bethany, but Parker said she administered the proper doses, although she sometimes gave Bethany the same medication prescribed to Joshua. Parker also said she was hundreds of miles from home with Joshua at a Portland hospital, which records corroborate, when others administered Bethany’s arthritis medication. Legal experts also note parents, under the Constitution, have discretion, within reason, to decide what medicine to administer to children.
- In an interview with Joshua’s neurosurgeon, a police detective said, “ … we’re not questioning the surgeries.” But Joshua’s surgeries comprise many of the criminal mistreatment and assault charges.
- Parker is charged with identity theft for using Joshua’s and Bethany’s medical conditions to solicit funds online. Parker said funds were raised—about $12,000—but about $10,000 was used for what she said it was intended—for instance, to help her husband take time off from work to spend time with Joshua when they thought he was dying. The rest—$2,315—wasn’t used once she learned of the accusations, she said. Parker was accused of creating an online fundraiser page with a post claiming Joshua was dead. She said the post was published by accident, and The Medill Justice Project confirmed no money was raised as a result.
- Parker is charged with abandoning then 3-year-old Hannah, but the Parkers said this is a gross exaggeration, saying they first placed their adopted child with an Alabama family, who later went through the process to adopt her.
As Parker’s case unfolds in Oregon, medical child abuse is itself under scrutiny in the United States and abroad.
There is little debate that caregivers sometimes fake or cause a child’s illness so the child receives unnecessary medical treatment. But virtually every other aspect of medical child abuse is debated in the medical and legal communities, interviews with experts show; there is little agreement on what to call the diagnosis, what kind of diagnosis it is, whom to diagnose, how to diagnose it and what it looks like.
“The diagnostic accuracy of medical child abuse is a joke,” said Dr. Michael Freeman, a forensic epidemiologist at Oregon Health & Science University in Portland who examines the causes of medical conditions as an expert in cases and through his consulting firm. Part of the problem, Freeman said, is that no one knows how widespread medical child abuse is because such a study has never been done; what makes such a study difficult, he notes, is that medical child abuse is hard to distinguish from complicated illnesses. Questions have been raised in courts in the United Kingdom and Australia, which have been increasingly skeptical of charges of medical child abuse, in some cases rejecting expert testimony on the diagnosis.
“It doesn’t come up to scratch,” said Helen Hayward-Brown, an Australian medical sociologist and anthropologist who has consulted on hundreds of cases involving medical child abuse accusations in the United States, the U.K. and Australia. “This diagnosis is just based on opinion and that is all.”
In many ways, the debate about medical child abuse overlaps with another disputed diagnosis: shaken-baby syndrome. Both deal with questions about the science employed to determine abuse occurred; both target caregivers on largely circumstantial evidence; and both involve some of the same pediatricians and other doctors.
Parker’s case also touches on broader questions: Where do parental rights end? When should doctors go beyond their medical expertise to make a criminal accusation? Can parents be held criminally accountable when their doctors have provided the challenged medical care and prescribed the allegedly unnecessary medication? How has the Internet unleashed medical information, turning deeply personal stories public and making armchair doctors out of anxious caregivers, complicating the doctor-patient relationship?
Parker asks her own set of questions.
“A year and a half into this and I still cannot wrap my brain around the fact that they’re charging me with everything they’re charging me with,” said Parker, who has pleaded not guilty to all of the charges. “ … and I am a very logical person, and so I think, well, but the evidence shows that I didn’t do all this. So how—where are you getting this?”
Things came to a head in Parker’s case on Aug. 28, 2013, when she drove about four hours from their small city to Randall Children’s Hospital at Legacy Emanuel in the big city of Portland. Joshua, then 7, was being considered for a second stint in hospice, an end-of-life care service. A pain specialist recommended he first be seen by other specialists who could simplify his complex concoction of medications.
When Joshua was admitted, records show he was on three different forms of fentanyl, a powerful painkiller; methadone, an opiate that reduces withdrawal symptoms; Seroquel, an anti-psychotic drug; Ativan, an anti-anxiety medication; and an anti-seizure drip, among others.
Dr. Andrea Hoogerland, a pediatrician, met Joshua in the pediatric intensive care unit. After reading his chart and observing him, Hoogerland was struck by how this child did not seem seriously ill.
“[T]here was nothing about him that looked like he was dying,” Hoogerland later told police.
The doctor said she had never seen a patient given such high doses of medication and added, “ … he looked like an autistic child who’d been drugged.”
Hoogerland informed Parker that Joshua would be immediately weaned off the painkillers. Parker, recoiling, said in an interview for this story that she felt the doctors new to the case didn’t know Joshua well enough to make such a drastic change. Hoogerland’s assessment also flew in the face of everything Parker said doctors had been telling her about her son—that he needed the medication—since she came to believe he was dying.
“My feeling was, you’re coming in and you’re making all these decisions that are contrary to what everybody has been telling me for the past two years,” Parker said in an interview for this story.
Adam, Parker’s then 20-year-old son, witnessed the confrontation between Parker and Hoogerland, acknowledging they “clashed, had a bit of an argument” in the hall over Joshua’s painkillers.
An attorney representing Legacy Health Center, which encompasses Randall Children’s Hospital, said no hospital personnel would be available to discuss the case, though some, including Hoogerland, did speak with The Medill Justice Project.
Hoogerland said in the day and a half she attended to Joshua she noticed what she viewed as some of Parker’s questionable behavior. For instance, when Hoogerland told Parker that Joshua didn’t appear to be dying, Hoogerland said Parker didn’t seem happy, instead focusing on Joshua’s continuing pain. “Usually, when you tell a family good news like that, there’s a lot more positive emotions expressed,” Hoogerland said in an interview for this story. Joshua also seemed to take his cues from Parker, exhibiting more signs of pain and illness when his mother was around, Hoogerland said. And the doctor found it odd that Parker was raising funds online by writing about Joshua’s illness.
Less than two weeks later, in September 2013, Dr. Cathleen Lang, a pediatrician asked to consult on the case, accused Parker of medical child abuse, detailing her allegations in a four-page letter to the Oregon Department of Human Services. Lang, a child abuse specialist, said Joshua and Bethany were in grave danger and should be removed from their home. Lang’s letter was dated Sept. 9, 2010, but Joshua was admitted in August 2013, and records show Lang’s letter, which referenced events in 2011, 2012 and 2013, was faxed to authorities in September of 2013.
Lang said, “The pain regimen that [Joshua] was on upon admission was extremely robust and had surpassed that of most adults with chronic pain issues.” She added, “These high doses of medications are dangerous and potentially fatal if not given correctly.”
Lang did not respond to requests seeking comment for this story.
Prosecutors followed up by accusing Parker of administering high doses of narcotics to Joshua, charging her with recklessly endangering another person, on or about Aug. 28, 2013, when he was admitted to the hospital, according to a spreadsheet of the prosecutors’ charges.
Records show more than a dozen doctors, ranging from gastroenterologists to pain specialists, prescribed Joshua more than 30 kinds of drugs, including painkillers and mood drugs.
Pharmacy records show Joshua’s physicians approved at least 23 painkiller dose increases from 2011 to 2013 as his condition appeared to worsen. In some cases, the doses were decreased or combined with other painkillers.
Medical records also show doctors were aware Joshua was being heavily medicated with potent painkillers, but because they believed he was dying, they were less concerned about the drug’s side effects.
“Everyone wants the same thing, comfort for a dying child and peace for the household,” Dr. Barbara Sibley, Joshua’s primary care physician, wrote in an email to Parker on Aug. 27, 2013.
“My priority is that Joshua not suffer,” Parker wrote in an email to Sibley that day, just before her son was admitted to Randall Children’s Hospital to prepare for hospice. “No matter what is happening, I do not lose sight of that goal.”
Email records show at least 35 instances when Parker emailed Sibley requesting renewed or increased prescriptions; Parker also cleared doses of an over-the-counter allergy medication with Sibley in May of 2012.
Sibley did not respond to a request for an interview for this story.
“Theoretically, it is [up] to the clinician to determine what is being prescribed and to what dose and then to get information about how effective those are and then changing medications as necessary,” said Ryan F. Holmes, assistant director of health care ethics at the Markkula Center for Applied Ethics at Santa Clara University in California.
In her letter to authorities, Lang accused Parker of telling Joshua to push a button to administer a painkiller even if he wasn’t in pain and when he didn’t, hospital staff noted Parker would press it for him.
Parker said this was in line with instructions from a home health nurse that only an adult should press the button when Joshua wasn’t in the hospital. He had been on the pain pump for months at this point, Parker said, and he was conditioned to ask for her assistance even though he was allowed to control the pump in the hospital.
Authorities have also accused Parker with the opposite of over medicating: under medicating her other sick child, Bethany, now 8.
In one of the three counts of first-degree criminal mistreatment for medical neglect, Parker is accused of withholding from her daughter Zantac, a drug that limits stomach acid buildup. Zantac tablets are available over the counter, but Bethany’s physician, Sibley, prescribed it for Bethany in syrup form. The medication limited heartburn and stomach ulcers resulting from the steroids Bethany took for her systemic juvenile idiopathic arthritis, a disease that creates inflammation throughout the body and causes joint pain.
In an interview for this article, Parker said Joshua also received Zantac prescriptions, which she said he wasn’t needing, so she gave Joshua’s Zantac to Bethany instead of refilling Bethany’s prescription.
Medical records show Joshua received at least two Zantac refills, in March and May 2013, during the time when Bethany’s prescription wasn’t filled. A medical report signed by Sibley on Feb. 6, 2013, indicated Joshua was prescribed the same Zantac that Bethany was prescribed.
“Technically speaking, if those children had the exact same prescription and one prescription had run out, that’s not harmful,” said Dr. Alan H. Wang, a gastroenterologist at the Illinois-based DuPage Medical Group.
Maxine Eichner, a law professor at the University of North Carolina at Chapel Hill, said she had given her medication to her own child, who had been prescribed the same medication and suffered from a mitochondrial disease, a rare, difficult-to-diagnose disorder. “Does that violate prescription drug medications?” asked Eichner, a family law expert who has challenged medical child abuse as a diagnosis. “… Is that child abuse? No, it certainly cannot be.”
Bethany was also prescribed prednisolone, a steroid that reduces inflammation. Parker was charged with failing to give steroids to Bethany on or about Oct. 1, 2013, according to the prosecutors’ spreadsheet of charges.
“I hadn’t seen Bethany for the five weeks prior to that, so I’m unsure how I could have been withholding anything from her at that time,” said Parker, who noted other family members were administering Bethany’s prescription while she was in Portland for an extended hospital stint for Joshua just before the state placed Bethany and him in foster care.
Steroids produce rapid elevation in blood sugar levels, and records show Bethany maintained such high levels on May 18, 2013, well above the normal range, which was consistent with her high levels in February 2011 and January 2012. Another report from June 26, 2013, said her results suggest Bethany had regularly elevated blood glucose levels, which could indicate the presence of the steroid.
“There was never an instance when my sister, to my knowledge, went without medication,” said Adam, Bethany’s 23-year-old brother. “I saw on a day-to-day basis when she got her steroids, and we all tried to stay on top of that.”
Parker’s third mistreatment charge for medical neglect, on or about Oct. 1, 2013, is for allegedly failing to care for Bethany’s gastrostomy feeding tube—called a G-tube—inserted in her stomach. Adam said Bethany’s G-tube would sometimes leak a green pus-like substance, which an email and other medical records show Parker brought to doctors’ attention.
Records of Bethany’s medical visit in October 2013 indicate mild erythema, or reddening on the surface of the skin, around her G-tube opening. “Redness around the G-tube site is very common, and it can mean a whole slew of things with a very wide range of possibilities,” said Wang, the gastroenterologist. “There’s always going to be some sort of gastric content, whether it’s food or stomach acid, leaking through that tube.”
The responsibility for handling and maintaining the G-tube, Wang said, “falls on multiple people, both the primary caregiver and the home health care nurses, but also doctors who should be routinely seeing the patient.”
Bethany did not develop any palpable abscesses, a pocket of pus-filled tissue, and x-rays determined her G-tube was, according to a medical report, “in proper position.”
Many of the charges against Parker relies on the idea that the scalpel was her weapon, carried out on her behalf by an unwitting brain surgeon.
According to Lang’s extensive medical child abuse evaluation report, Joshua underwent about 30 medical procedures during his treatment for spina bifida and Chiari malformation. Spina bifida—an uncontested diagnosis Joshua received in infancy—is a birth defect that prevents the bones in the spine from fully forming. Chiari malformation is characterized by the brain extending below the skull and into the spinal cord, restricting the flow of fluid that cushions the brain, which can lead to intense headaches, imbalance, difficulty swallowing and abnormalities in movement and sensation.
In the prosecution’s spreadsheet of charges, about 12 of Joshua’s surgeries were considered acts of criminal mistreatment and assault. These surgeries include the insertion of a feeding tube that allows nutrition and medication to go directly into the stomach; the placement of a port in the chest that facilitates the long-term delivery of medication into a vein; and a ventriculostomy, a neurological procedure that creates a hole in the skull to drain fluid to relieve cranial pressure. The charges also include six Chiari decompressions, during which part of the skull and vertebrae are surgically removed to ease pressure, and three untetherings of the lipomyelomeningocele, a surgical freeing of the spinal cord from a lump of fat at the lower back, which enables the spinal cord to grow normally as the child grows.
During the course of his treatment, Joshua underwent two other untetherings, in 2008 and 2010, for which Parker doesn’t face charges.
The doctor in 10 of the surgeries in question was Dr. Monica Wehby, a pediatric neurosurgeon at Randall Children’s Hospital and a former Republican U.S. Senate candidate.
In an April 2014 interview with a Portland police detective, Wehby produced MRI images of Joshua’s head and spine that showed the presence of a Chiari malformation and noted his condition “got better after every operation.”
Afterward, the police detective, said, “And that’s what we want you to understand, is we’re not questioning the surgeries. We’re trying to figure out how we went from the child is—has significant medical issues and needs surgery to the child is dying and we’re not going to survive.”
The Portland police officer did not respond to several requests for an interview. Wehby also declined to comment.
In a September 2013 PowerPoint presentation to police and medical staff, Lang said, “Most children with Chiari 1 [malformation] and his form of SB [spina bifida] do well” and that Joshua’s treatment followed a “[v]ery unusual course” with “multiple surgeries.”
In the same police interview, Wehby explained how Joshua’s tissue surrounding his spinal cord repeatedly scarred internally following each surgery.
“[T]his kid it’s just, like, ‘Holy crap,’” Wehby said to police about her reaction to his repeated scarring, which constricted the flow of fluid, causing Joshua pain and other discomfort. As a result, Wehby repeatedly operated on Joshua to clear out the scar tissue. “And the interval [between surgeries] kept getting smaller,” she said. “Well, we’d scan him and, by God, he’s scarred back up again.”
In Lang’s accusation letter, she wrote it was “evident that Joshua was not acutely terminal or dying” and that Parker had “reported that she has been told that Joshua could die and [at] any point in time from his brainstem. This has not been reproduced in the medical record.”
Medical documents, police records and emails show how doctors repeatedly referred to what was accepted as Joshua’s looming death. On Aug. 18, 2011, when Joshua visited Sibley, the Parker family physician, for pain and vomiting, the doctor wrote he was “clearly becoming endstage.”
Four days later, Sibley wrote a letter to “Whom It Concerns” that Joshua, then 5 years old, was “terminally ill due to brain stem dysfunction as a complication of a chromosome 2 duplication abnormality & Chiari Malformation.”
In an interview for this article, Dr. George Anadiotis, a geneticist at Randall Children’s Hospital, said he told Parker that Joshua had a rare genetic abnormality and it was unclear what impact it would have on her son’s health. Parker said Anadiotis left her with the impression Joshua was dying.
In a medical note Anadiotis wrote in 2011 about Parker’s visit, he said, “The fact that he is not showing improvement is obviously problematic and concerning, but it is difficult to say where he will end up.”
In an interview for this story, Anadiotis said he never told Parker that Joshua was terminal. He said his diagnosis was not definitive and he wasn’t sure of the significance of the abnormality. “I would even question whether a diagnosis was given,” Anadiotis said.
Shortly after the appointment with Anadiotis in 2011, Sibley emailed Parker, saying, “He is lucky to be surrounded by so much family support. This is a terrible position for a family to be with no good answers or solutions. I don’t think there is any fix any of us can do at this point except to give him comfort and lessen any suffering. Right now you can count your blessings for any good day that little Joshua has and try desperately to not focus on the future. As they say, the only thing we really can effect is the present moment, can’t change the past, can’t predict the future. Give them all a bug [sic] hug, and an especially big one for Joshua. Hang in there Kate, you are being wonderful parents for him, Barb.”
Wehby, who performed most of Joshua’s contested surgeries, said in a police interview in April 2014 that she told Parker that Joshua “didn’t need more surgeries because there was nothing to operate on.” Parker said she took Wehby’s prognosis to mean Joshua’s condition was hopeless.
In 2011, Joshua was provided hospice care in Grants Pass, records show. A hospice note that August stated the Parker “family is at bereavement risk level II,” partially due to “Joshua’s pending death.” Joshua’s family, wanting to care for him themselves, later took him out of hospice. In 2012, Sibley threw a birthday party for Joshua in her office, records show. A summary of Sibley’s police interview in January 2014 said the pediatrician “believed Joshua and Bethany were dying because Ms. Parker told her they were. She said Ms. Parker explained after seeing the geneticist, she learned his genes were abnormal causing him to be terminal.”
Sibley and a pain specialist recommended Joshua for hospice again in August 2013, records show.
Sibley’s office also supported the Make-A-Wish Foundation, which grants special trips and other gifts to children with life-threatening conditions, providing Joshua with a gift. The foundation declined to comment.
Parker also said she was under the impression that Bethany was terminal because of her systemic juvenile idiopathic arthritis, which medical experts say can be deadly. In an interview with police, pediatric rheumatologist Dr. Daniel Kingsbury, who treated Bethany’s condition at Randall Children’s Hospital, said Bethany is prone to a complication of the disease that “has high levels of morbidity and mortality.” Bethany had undergone two heart surgeries in Ukraine and one after adoption in the United States.
In September 2013, Joshua was taken into state custody. Bethany followed suit that October. In Circuit Court testimony in March 2014, Lang said “none of the doctors ever reported that she was terminal.”
Police asked Kingsbury whether he cried when talking to Parker about her ill children. Kingsbury denied he cried but said, “I think I became a little tearful.” He also denied saying Bethany was terminal but acknowledged that he “said to the point that she’s got very aggressive disease and that we do not have a lot of options that are available to us and that it doesn’t look – you know, I may [have] said, ‘It doesn’t look good.’”
Living a life largely removed from her sylvan community, Parker sought friendship online. A prolific blogger, she shared intimate details with hundreds of followers about her children’s medical plight but also about her own struggles with her marriage and her frustration with doctors. Authorities say she went further: An online post announcing Joshua’s death was published in May of 2013, according to records.
The announcement was posted on the fundraising site FundRazr. Asked to confirm a screenshot of the post, which read in part, “Joshua Parker bravely fought brain stem deterioration caused by a chromosome abnormality for 7 years. He just went to heaven … ,” FundRazr said, “There has only ever been one campaign created in our system using the same title as the one in your screenshot.” The title was “Kate Parker’s story update on Help Joshua Parker’s Family.” The website confirmed the post has been deleted.
Parker said Kate Estes, a friend she met online, suggested Parker draft a post announcing Joshua’s death when it seemed imminent. Parker said she agreed because she was afraid she would be too overwhelmed with grief to post after his death.
“I’d written just, you know, a little, tiny bit and then I was like, ‘I can’t do this. I can’t do this. I can’t write like he’s dead,’” Parker said.
Instead, she said she allowed Estes to finish the post for her, and Estes planned to make it public after Joshua died. “Then I completely forgot about it,” Parker said.
In a police interview in February 2014, Estes said she worked with Parker on the wording of the post but denied posting it.
“I can’t say if this was a click of a button gone wrong or if it was a deliberate act on [Parker’s] part,” Estes said. “But my actions in that were simply to have something at the ready if he were to pass away.”
Estes declined to comment for this story. Parker said she received a call in September 2013 from an acquaintance she met online, Jessica Hilliard, a mother who had lost her daughter to a rare disease. Parker said Hilliard alerted her to the post about Joshua being dead. In an interview for this story, Hilliard said she does not remember calling Parker or seeing the FundRazr post, but she does not deny it happened. She remembers finding a WordPress blog, which details the charges against Parker, though Hilliard cannot remember when she found it.
“I’m sure I would’ve reached out to her after reading the blog … because I consider that a form of cyber bullying,” Hilliard said. “ … I also don’t believe it’s particularly ethical for other parents to write things about somebody that they don’t know.”
Parker said Estes never activated the fundraising campaign, so no money was raised. FundRazr confirmed in an email that “the campaign in question did not raise any money.” Parker said she called Estes to tell her the death announcement had been posted but she cannot remember if Estes gave her the login information so Parker could remove the post or if Estes took down the post herself.
Prosecutors have accused Parker of profiting from other online posts, charging her with four counts each of felony computer crime and identity theft, seeking to make money from donations by knowingly lying online about the gravity of her children’s illnesses.
For one set of the computer-related charges, in July 2011, the family received about $10,000 so Parker’s husband, Charley, could take off work when they thought Joshua was dying. The Parkers said they used the money to replace Charley’s lost wages from managing a diner, Shari’s Restaurant, while he spent time with Joshua. That month, in the second set of computer-related charges, Parker posted about a party celebrating Joshua turning five and a half—they feared he wouldn’t live to see his sixth birthday—and in an Aug. 3, 2011, post, thanked her followers for sending presents. Parker said she also created an Amazon wish list for gifts for Joshua.
The third set of computer-related charges involved an online fundraiser in January 2013 to pay for Bethany’s funeral expenses. Parker said Estes accidentally published this fundraising page but according to the website, “the campaign is currently showing $0.00 raised,” which means no funds were raised or contributions were refunded.
As part of the fourth set of computer-related charges, an online fundraiser in August 2013 raised money so Charley could take time off work following Joshua’s death. Parker said the $2,315 that was raised hasn’t been touched in the wake of the police investigation. She also said she wanted to return the donations, but Claar, one of her attorneys, advised her not to do so until the criminal case was over. In an interview for this story, Claar said he doesn’t remember advising Parker about what to do with the money, but if he did, he would have told Parker to not spend it.
In late 2009, the Parkers said they prayed about the idea of adopting special-needs children at a time when Joshua appeared to be on the mend after surgery that placed a shunt at the base of his spine.
“The Bible says take care of widows and orphans,” Parker said. “ … It was kind of in the back of our heads that, you know what? If we figure out what’s going on with Joshua and if he gets fixed that maybe something that, you know, if God opens the door for us to do that, then maybe one day we’ll do that.”
Months later, in the fall of 2010, Parker and her husband flew to Ukraine to adopt two children with Down syndrome—Hannah, then 14 months old, and Bethany, then nearly 3 years old—giving them nine children in their household.
Only later, they said, did they learn that Bethany had a serious form of juvenile idiopathic arthritis.
As Joshua’s condition worsened, along with Bethany’s, Parker and her husband said they felt overwhelmed. According to the Parkers, Hannah never emotionally attached to the family so, after much prayer, they sought temporary care for her.
In early 2012, Parker said she began planning Hannah’s transfer to another family, whom they met through an online support group for adoptive parents. That summer, Parker said she and Hannah flew to Nashville, Tennessee, where they met a friend of Parker’s who took Hannah to their home in Athens, Alabama. Parker said she gave her friend Hannah’s birth certificate, medical records, Social Security card and records proving she had legally entered the United States. Parker said she and her husband also signed a declaration of temporary guardianship, granting the Alabama family custody of Hannah for up to a year. In spring 2013, Parker said she and her husband signed a termination of parental rights form.
In November 2013, an Oregon Department of Human Services case agent confirmed Hannah was going through the adoption process, records show.
Nonetheless, Parker is charged with abandoning Hannah when she was nearly 3 years old. In an interview for this story, Charles Mickley, the Portland prosecutor on this case, would only address a hypothetical in which a family gives a child to a family friend. In that case, he said, “If it’s a safe and caring environment, it’s not abandonment of the child.”
Medical child abuse
The International Classification of Diseases, also known as the ICD, is the standard guide used by doctors around the world to categorize illnesses. Published by the World Health Organization, the United Nations’ public health agency, the medical guide is used in 194 nations and the latest version contains more than 14,400 diagnostic codes for various injuries, illnesses and symptoms.
Medical child abuse, or Munchausen syndrome by proxy, is not mentioned under any name in the medical guide. Nor do those terms appear in the ICD-10-CM, the version of the medical guide used in the United States.
It’s unclear why medical child abuse or Munchausen syndrome by proxy is not in the medical guide, according to a spokesperson for the National Center of Health Statistics, the Centers for Disease Control and Prevention division in charge of the U.S. medical guide. Physical, sexual, psychological and unspecified child abuse are all listed in the U.S. medical guide.
Dr. Jeffrey Linzer Sr., a member of the World Health Organization group that provides advice on revisions to the guide, said a diagnosis typically becomes widely accepted within a medical society before it becomes a part of the guide. Usually, Linzer said, a medical society proposes a revision to the guide, and it will then be reviewed and put through a vetting process that includes a public hearing and a period of public comment. Linzer, a professor of pediatrics and emergency medicine at Emory University in Atlanta, said medical conditions may not be recognized in the guide if, for instance, no one has proposed a diagnosis, the diagnosis lacks scientific support showing it is a new condition or the diagnosis is only recognized in a certain country.
No health professionals have proposed Munchausen syndrome by proxy or medical child abuse be added to the ICD-10-CM, according to the National Center of Health Statistics spokesperson.
The foundation of medical child abuse originated in the United Kingdom and rests on a controversial pediatrician, Sir Roy Meadow, who wrote the landmark 1977 paper on the diagnosis, using the term “Munchausen syndrome by proxy” to describe two cases of mothers who intentionally sickened their children.
Meadow became a leading expert witness, testifying in many cases accusing parents of abusing their children. In the 1990s, Meadow said in several articles he believed Munchausen syndrome by proxy was over diagnosed, saying, “at times I have regretted coining it.” Then when some high-profile murder cases that used Meadow’s testimony were overturned, his credibility was called into question. In one of the cases, he had testified using inaccurate statistics that suggested accidental infant deaths were more implausible than they are, according to a panel formed by the British General Medical Council, which oversees medical practitioners for the country. In 2005, the council found Meadow guilty of misconduct and struck him off the list of licensed doctors who are registered to practice medicine in the U.K. He appealed and the decision was overturned a year later, with a judge ruling Meadow had “acted in good faith” and had “made one mistake, which was to misunderstand and misinterpret the statistics.”
In 2008, the American Academy of Pediatrics, which now calls it “caregiver-fabricated illness in a child,” published the book, Medical Child Abuse: Beyond Munchausen Syndrome by Proxy, by Drs. Carole Jenny and Thomas A. Roesler. They argued for Munchausen syndrome by proxy to be replaced by the label “medical child abuse,” a diagnosis a child—not a caregiver—receives.
Taking a different stance, the Diagnostic and Statistical Manual of Mental Disorders or the DSM-5, the standard manual used by U.S. doctors to diagnose behavioral and psychiatric disorders, calls medical child abuse “factitious disorder imposed on another” and diagnoses the caregiver.
“The biggest problem with medical child abuse is there’s no diagnostic standard for it,” said Freeman, the forensic epidemiologist.
Freeman said there have been no studies that show the accuracy or reliability of the criteria used to diagnose medical child abuse.
“There’s no short list of tests or signs that you look for because there are so many ways a factitious illness can manifest,” said Dr. John Stirling, a pediatrician at the Center for Child Protection at the Santa Clara Valley Medical Center in San Jose, California. Although most pediatricians go through the basics of looking through the child’s medical records for inconsistencies with the caregiver’s claims and evaluating the child, experts say other steps vary from doctor to doctor and case to case.
Some doctors who suspect medical child abuse do not interview the parents, while others will. Some will film the parent without their knowledge to catch them in a suspected act. Some may do additional tests specific to the illness that is suspected of being fabricated or induced, such as a blood test for salt in the child’s system.
Characteristics of medical child abuse vary according to different guides. For instance, in a document from the Michigan governor’s task force on child abuse and neglect in 2013, one possible “warning sign” of medical child abuse is said to be when “a highly attentive parent/caretaker is unusually reluctant to leave his/her child’s side.” An American Academy of Pediatrics’ report on medical child abuse published the same year does not list this sign, but includes “sensitivity to multiple environmental substances or medicines.”
Medical child abuse has been diagnosed when there is a reasonable alternative explanation, such as other medical conditions, said Loren Pankratz, a psychologist who teaches at Oregon Health & Science University and has frequently served as an expert witness for the defense. “Once that idea [of the diagnosis] comes into your head, you begin to see things through that lens,” he said.
Courts, meanwhile, are debating whether the research behind medical child abuse is robust enough to admit expert testimony on the diagnosis, and some U.S. courts have rejected such testimony as have courts in the U.K. and Australia. The judge in a landmark Australian state Supreme Court case ruled expert testimony diagnosing the mother with Munchausen syndrome by proxy, as well as general evidence about the condition, is inadmissible since the syndrome describes behavior and is not an “illness or condition” that has “an organised or recognised reliable body of knowledge or experience.” The judge ruled that the determination of whether a caregiver has intentionally harmed a child should be left to jurors and not determined by expert witnesses. A case tried in England’s High Court of Justice, one of the senior courts of England and Wales, adopted this judgment.
Parker’s complex case is complicated by comments she said were taken out of context.
In her PowerPoint presentation to police and medical staff, Lang described Parker as “constantly online blogging,” and she said Parker posted on “multiple sites asking for money.” Lang lists social network, money and need for attention as “secondary gains” that could motivate Parker to falsify her children’s illnesses. Other doctors were put off by how Parker used the Internet to research her children’s illnesses, records show.
July 20, 2007: “[M]om spending inordinate amount of time on web researching medical literature,” stated a note written by a doctor in a spina bifida clinic, according to Lang’s child abuse evaluation records. “Mother sends multiple extensive long emails to dr. Sibley weekly.”
Aug. 10, 2007: “Mom had already researched this quite a bit on the internet,” stated a medical note from a gastrointestinal clinic.
One of Parker’s attorneys hired a psychologist to evaluate her, and after a battery of tests, he found, “the preponderance of psychological evidence argues against the likelihood of Ms. Parker having behaved in the way that she is alleged.”
But doctors have painted a grim picture of Parker’s parenting style. Hoogerland, the pediatrician at Randall Children’s Hospital, said Parker described Bethany as a “potted plant” who doesn’t do much.
“When you talk to her … there was zero sense, in fact, of any actual caring,” Hoogerland said in a police interview. “ … I think [Parker is] one of the scariest people I’ve ever met.”
Parker said her remark about Bethany was meant to be a light-hearted reference to the child’s relative inactivity.
In a police interview, Wehby, the neurosurgeon, said Parker told her she wanted Joshua’s spinal cord cut in half.
Parker said that in May 2008, Wehby removed only half the scar tissue from Joshua’s spinal cord. According to Parker, Wehby said she might need “to cut a nerve root” to finish removing all the scar tissue, which would leave Joshua’s leg partially paralyzed.
“I said, ‘That’s a huge risk and I know that, but if she does the surgery, will it get him out of pain?’” Parker said she asked Wehby’s physician assistant over the phone. “And she said yes.”
Parker said she understood the risks but felt the potential benefits outweighed them. Parker also said the physician assistant asked her to have some from Joshua’s medical team write letters describing the symptoms they had seen as a way to reinforce the need for the surgery. Parker said she asked Sibley and Joshua’s physical therapist, Sue Nicklin, to send letters to Wehby.
“I would certainly agree with what the surgical plan is if there is hope that it could cause relief of his pain and progression of some of his symptoms,” Sibley wrote in an Oct. 22, 2008, letter.
Wehby’s office received a Nov. 6, 2008, letter signed by Nicklin that described Joshua’s pain and stated, “Despite the significant risk of paralysis with this surgery, I feel that his global, long term outcome will be better with surgery, even if paralysis occurs.”
In a police interview, Nicklin denied writing this letter. She said the letterhead and signature are not hers, and the address is incorrect. Parker, asked about the letter in an interview for this story, said it never passed through her hands. Nicklin did not respond to requests for an interview.
Parker doesn’t deny she was and is a fierce advocate for medical treatment for her children but her lawyers said she shouldn’t be punished for that.
“Even if you assume that a mom is insistent that a kid needs a certain treatment, … that is not evidence of a mom intentionally abusing a child,” said Tiffany Harris, one of Parker’s attorneys. “ … Does that, the fact that Joshua was on all those meds or had surgery … prove that Kate intended to abuse him? … It proves lots of different things, but does it prove abuse? And certainly does it prove it beyond a reasonable doubt?”
Parker’s lead attorney, Lisa Ludwig, said there is “no basis” for thinking her client intentionally harmed her children.
“It is actually pretty uncommon for a client to completely deny guilt as Kate does,” Ludwig said in an email. “And it is even more rare for that to happen along with a real lack of actual evidence, as is the case here. And on top of that, the science is not there in terms of [Munchausen syndrome by proxy] – it was a hysteria, and an anti-female one at that, perpetrated by prosecutors and ignorant fake social scientists. … My feeling that Kate is innocent is not based on my gut or my affection for her. It is based on 20 years of criminal defense and my distrust of the case as a whole.”
Family photos, Bible quotes and letters of support fill a scrapbook board that hangs on one of the walls of Parker’s tidy bedroom in a fellow churchgoer’s home in a suburb of Portland. She has lived within the county, away from her family, as a condition of her release on bail since October 2014.
One of the messages on the wall is from Parker’s eldest daughter Megan, 24. “I love you, you are as much a part of me as my own heart,” she wrote. “I will always fight for you, with you and I will never stop waiting for you. Not ever.”
Parker said the wall is “for those days when I think I can’t do this anymore.”
To pass the time, Parker said she likes to cross-stitch. She just finished a cross-stitch wall hanging of a spiritual poem, Footprints, about faith with 85,750 stitches for Charley’s 50th birthday: “During your times of trial and suffering when you saw only one set of footprints,” she stitched. “That was when I carried you.”
For many of her waking hours, Parker works the graveyard shift at a nearby supermarket, “hauling freight” and stocking the grocery shelves.
She wears an ankle bracelet with a GPS device 24 hours a day so authorities can monitor her movements.
The last time she’s seen all of her children? “Today is day 598,” Parker said recently.
A multicolored construction paper chain hangs from Parker’s wall. It’s not decorative; it’s informative, each link counting down a day until her trial.
A similar multicolored construction paper chain resides in the Parker family home just a few minutes north of a bend in the river and a world away in Grants Pass. Each day, one of her children tears off a link, throwing it in the wood stove in the family room and watching it burn.
To pass the time, Emily, 16, surfs the Internet, Joshua, 9, plays the video game Minecraft and David, 14, bakes brownies in the kitchen.
Charley said he quit his manager position at Shari’s Restaurant last year and became a waiter at the nearby Black Bear Diner. Charley said he works half as many hours at his new job so he can spend more time at home with his children.
“Is it hard being a single father? Yes, it’s extremely difficult,” said Charley, who has limited contact with his wife under court supervision. “ … but as I, as I told Kate the other day, … I am not a single father. I am just a father whose wife is absent at the moment.”
Charley said Joshua no longer takes prescribed medication. However, he has had dozens of episodes this year involving headaches, vomiting and difficulty breathing—all of which Charley documents on a list kept on their refrigerator white board.
On April 29, Charley wrote, “Joshua threw up right before bed.” On May 27: “Complained of stomach pain and said he was having trouble breathing.” On Oct. 10: “J. had headache at bedtime.”
Eight-year-old Bethany, the only Parker child still living in foster care, is continuing to struggle medically, according to records. Throughout 2014, she was hospitalized for respiratory distress and a high fever, records show, which also describe how she “has been struggling with her oxygen levels” and doctors inserted a tube to improve her lung functions.
“I would not be able to take care of her the way that she needs to be taken care of, and I hate saying that, I really do,” Charley said.
Megan, who helps look after her siblings and works in the nearby Wal-Mart Vision Center, thinks back to her mother’s arrest.
“It was an absolute utter shock,” Megan said. “Do you know how awful it is to lose your best friend and your mother in one fell swoop?”
Adam, 23, who also lives at the Parker home with his wife and daughter, remembers going with his mother to doctors’ visits for Joshua, his “little man.”
Emily reminisces about spending time with her mother alone—time that she misses.
Sarah, 14, said she and her mother bonded over her passion for anime.
David said he doesn’t “remember her very much.”
Isaac, 12, remembers her scent the most.
And Joshua said his memory of his mother is just a blur. He can only recall sleeping with her, snuggled together in his bed: “All I remember is she sleeped [sic] with me.”
This investigation was conducted by 10 undergraduate students at Northwestern University as part of an investigative journalism course taught by Prof. Alec Klein, director of The Medill Justice Project, which supported the class work. Amanda Westrich, director of operations at MJP, and Allisha Azlan, MJP associate, also contributed to this report.