Munchausen's role in case of mom guilty of killing son

WHITE PLAINS, N.Y. — They're usually recommended by pediatricians, for very premature babies and children with serious illnesses or disabilities — when they can't properly absorb nutrients or have difficulty swallowing.

To this day it's not clear how Lacey Spears, 27, convinced an Alabama surgeon to insert a gastric feeding tube into her son's stomach before he was a year old, after doctors at another hospital refused, saying it wasn't needed.

What is now clear is this: Spears used the plastic tube as a murder weapon.

"The motive is bizarre, the motive is scary, but it exists," prosecutor Patricia Murphy said in closing arguments at Spears' murder trial. "She apparently craved the attention of her family, her friends, her co-workers and most particularly the medical profession."

Without calling it by name, Murphy was describing Munchausen syndrome by proxy — a form of child abuse where a parent, usually a mother, sickens a child on purpose for sympathy or attention. The syndrome was never formally introduced during the trial, but cast a shadow over the case from the beginning.

Convicted Monday of second-degree murder in the death of 5-year-old Garnett, Spears poisoned her son with salt. The case's "smoking gun" turned out to be a feeding bag Spears asked a friend to take from her Chestnut Ridge, N.Y., apartment when Garnett was declared brain dead from sodium poisoning on Jan. 22, 2014. He died the next day. Garnett's doctors testified that they could find no medical explanation for the sodium spikes that killed him. Residue in the feeding bag contained the equivalent of 69 McDonald's salt packets, prosecutors said.

In and out of hospitals since he was born, Garnett's short, tragic life was marked by frequent moves and more frequent illnesses — vaguely explained problems treated by doctors who usually made decisions based on Spears' version of her son's medical history, without the benefit of his actual medical records.

According to Garnett's New York state child fatality report, medical authorities in Spears' native Alabama, where her son was born, were concerned for her "emotional stability" and "presumed she suffered from Postpartum Depression and Munchausen Syndrome by Proxy."

As Garnett turned 5, authorities have suggested that Spears may have worried that he would tell others that she did things to make him sick. If a parent with Munchausen syndrome by proxy is questioned by a suspicious nurse or doctor, experts say, the risk of medical abuse for the child increases.

"That's the most dangerous time for the child," said Louisa Lasher, a Georgia child welfare expert who wrote a book on the subject and has served as an expert witness at many Munchausen trials. "Once someone starts asking questions, the mother is in the position where she wants to prove what she is saying is true. She wants to show that the child is having the problems she is describing."

If their versions of a child's medical history and symptoms are challenged, as was the case with Spears, a parent with this disorder may switch doctors or hospitals, move, or step up the abuse.

In hindsight, experts say, Spears displayed classic signs of Munchausen — lying compulsively, exaggerating Garnett's illnesses on social media, giving vague explanations of his symptoms, inaccurate depictions of his medical history and moving frequently. The feeding tube Garnett had most of his life, and the parade of doctors and hospitals his mother brought him to, also point to the syndrome.

"They only use their child as an object, a tool to satisfy their own needs," Lasher said.

Much of the saga began as it ended — with questions about the feeding tube.

"That's an avenue for medical chaos," said Marc Feldman, an Alabama psychiatrist who has written extensively about Munchausen syndrome. "A feeding tube is a real red flag."

The tube was inserted in 2009 at Birmingham Children's Hospital in Alabama after doctors at Decatur General Hospital refused to do so. Dr. Albert Chong conducted the 15-minute procedure — one of 800 to 1,000 he estimated he did that year.

"I don't remember him or the mom at all," Chong said, adding that he never sought Garnett's medical records.

A series of doctors in Alabama, Florida and New York questioned the need for the tube, including Dr. Ivan Darenkov, a pediatric gastroenterologist who in 2013 treated Garnett. Darenkov said the medical history Spears provided was scant. He pressed her about the tube and for Garnett's medical records, which she never provided.

"I couldn't get the information," he said. "I never got the records about his first surgery, when the G-tube was put in. ... I did my own investigation, and found no medical reason for his eating problems."

Had he known the history, Darenkov said, "my approach to this patient would have been radically different."

Feldman said he was not surprised that Spears was not forthcoming with the records. "It's another red flag if the mother offers lots of different explanations for the absence of permission to access records," he said. "You have to wonder if she's concealing something."

Spears' inconsistent stories and frequent hospital trips were enough to raise suspicions among medical professionals in Alabama, where a nurse called the state child protection agency but a case was never opened. Spears then moved to Florida, where in 2011, state investigators described Garnett as an "intermediate risk" for neglect.

While Garnett suffered, Spears cultivated a loyal, supportive group of social media followers by faithfully chronicling her son's many maladies. In photo-filled Facebook, Twitter and blog posts, Spears portrayed herself as a doting supermom who kept her chin up through an astonishing 23 trips to the hospital by Garnett's first birthday. She garnered more sympathy posting about "Blake," her "soul mate" and Garnett's supposed father, who she described as a police officer who was killed in a car crash. Notably, there were no photos of him.

Friends said they'd never seen Blake. Garnett's real father, garage-door installer Chris Hill, lives in Alabama.

Feldman, the psychiatrist, described Spears' social media activity as "Munchausen by Internet." He said doctors who suspect the syndrome commonly check their patients' Facebook or Twitter accounts, looking for exaggerated or misrepresented descriptions of a child's illness.

"All that's involved is clicking into a support group, and they find they can get a tremendous amount of sympathy and nurturing," Feldman said. "It's a conduit to an enormous audience."

Spears continued her social media activity throughout Garnett's life. His "soul is already with the angels," she wrote when her son was declared brain dead.

And on his final day, a final post: "Garnett the great journeyed onward today at 10:20 a.m.," wrote the mother who killed him.

"It has always been about Lacey," Murphy told the jury in her closing argument. "This case has never been about Garnett. It's all about Lacey. Mother of the year."

The prosecution will seek the maximum prison term — 25 years to life — when Spears in sentenced on April 8.

Contributing: Lee Higgins, Peter D. Kramer, Jane Lerner and Hoa Nguyen, The (Westchester County, N.Y.) Journal News. Written by Richard Liebson, The (Westchester County, N.Y.) Journal News.

About Munchausen

Munchausen syndrome is a type of factitious disorder in a person with a deep need for attention that is a serious psychiatric illness. People with the syndrome generally suffer from borderline personality disorder, a psychiatric condition marked by problems regulating emotions and thoughts, impulsive and reckless behavior and unstable relationships.

Munchausen syndrome: A person exaggerates or fakes illnesses or gets ill or injured on purpose.

Munchausen by proxy: A caregiver exaggerates or fakes illnesses or deliberately sickens or injures an individual he or she is caring for.

The disorder has been recognized since the 1950s.

Signs of Munchausen by proxy include:

• A child who often is hospitalized with unusual and unexplained symptoms that seem to go away when the caregiver is not present.

• Symptoms that don't match the child's test results.

• Symptoms that worsen at home but improve while the child is under medical care.

• Drugs or chemicals in the child's blood or urine.

• Siblings who died under strange circumstances.

• A caregiver who is overattentive to the child and overly willing to comply with health care workers.

• A caregiver who is a nurse or who works in the health care field.

Source: Marc D. Feldman, psychiatrist

— Jane Lerner, The (Westchester County, N.Y.) Journal News