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VanWinkle v. Nichols

United States District Court, S.D. Indiana, Indianapolis Division

September 22, 2017

Stacey VanWinkle and Derek VanWinkle, on behalf of MV and AV, their minor children, and Paul Gresk, Trustee for the Bankruptcy Estate of Derek VanWinkle and Stacey VanWinkle, Plaintiff,
Seanna Nichols, Monique Miller, Peggy Surbey, and Maribryan McGeney, Defendants.



         Stacey and Derek VanWinkle have two daughters, MV who was born in 1999 and AV who was born in 2001. In November of 2012 and June of 2013, the Indiana Department of Child Services (“DCS”) received calls to its hotline in which the callers alleged that Stacey VanWinkle was mistreating MV and AV. After an investigation which included two care conferences with several medical providers, DCS employees, and others, MV and AV were removed from the VanWinkle home. Two days after their removal, the Marion Superior Court found that the removal of MV and AV was necessary to protect them. Twenty-three days later, MV and AV were returned to their parents pursuant to a Marion Superior Court Order. Nearly two years later, this lawsuit followed in which Plaintiffs allege that various constitutional rights were violated. Presently pending before the Court, and ripe for decision, is a Motion for Summary Judgment filed by Defendants Seanna Nichols, Monique Miller, Peggy Surbey, and Maribryan McGeney, who are all DCS employees (the “State Defendants”). [Filing No. 120.]


         Standard of Review

         A motion for summary judgment asks the Court to find that a trial is unnecessary because there is no genuine dispute as to any material fact and, instead, the movant is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(a). As the current version of Rule 56 makes clear, whether a party asserts that a fact is undisputed or genuinely disputed, the party must support the asserted fact by citing to particular parts of the record, including depositions, documents, or affidavits. Fed.R.Civ.P. 56(c)(1)(A). A party can also support a fact by showing that the materials cited do not establish the absence or presence of a genuine dispute or that the adverse party cannot produce admissible evidence to support the fact. Fed.R.Civ.P. 56(c)(1)(B). Affidavits or declarations must be made on personal knowledge, set out facts that would be admissible in evidence, and show that the affiant is competent to testify on matters stated. Fed.R.Civ.P. 56(c)(4). Failure to properly support a fact in opposition to a movant's factual assertion can result in the movant's fact being considered undisputed, and potentially in the grant of summary judgment. Fed.R.Civ.P. 56(e).

         In deciding a motion for summary judgment, the Court need only consider disputed facts that are material to the decision. A disputed fact is material if it might affect the outcome of the suit under the governing law. Hampton v. Ford Motor Co., 561 F.3d 709, 713 (7th Cir. 2009). In other words, while there may be facts that are in dispute, summary judgment is appropriate if those facts are not outcome determinative. Harper v. Vigilant Ins. Co., 433 F.3d 521, 525 (7th Cir. 2005). Fact disputes that are irrelevant to the legal question will not be considered. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

         On summary judgment, a party must show the Court what evidence it has that would convince a trier of fact to accept its version of the events. Johnson v. Cambridge Indus., 325 F.3d 892, 901 (7th Cir. 2003). The moving party is entitled to summary judgment if no reasonable fact-finder could return a verdict for the non-moving party. Nelson v. Miller, 570 F.3d 868, 875 (7th Cir. 2009). The Court views the record in the light most favorable to the non-moving party and draws all reasonable inferences in that party's favor. Darst v. Interstate Brands Corp., 512 F.3d 903, 907 (7th Cir. 2008). It cannot weigh evidence or make credibility determinations on summary judgment because those tasks are left to the fact-finder. O'Leary v. Accretive Health, Inc., 657 F.3d 625, 630 (7th Cir. 2011). The Court need only consider the cited materials, Fed.R.Civ.P. 56(c)(3), and the Seventh Circuit Court of Appeals has “repeatedly assured the district courts that they are not required to scour every inch of the record for evidence that is potentially relevant to the summary judgment motion before them, ” Johnson, 325 F.3d at 898. Any doubt as to the existence of a genuine issue for trial is resolved against the moving party. Ponsetti v. GE Pension Plan, 614 F.3d 684, 691 (7th Cir. 2010).

         The following factual background is set forth pursuant to the standards detailed above. The facts stated are not necessarily objectively true, but as the summary judgment standard requires, the undisputed facts and the disputed evidence are presented in the light most favorable to “the party against whom the motion under consideration is made.” Premcor USA, Inc. v. American Home Assurance Co., 400 F.3d 523, 526-27 (7th Cir. 2005).


         Statement of Facts[1]

         A. AV's Health

         AV's long medical history began when she was an infant. For example, AV had several gastrointestinal issues beginning in infancy, including difficulty keeping formula and baby food down, followed by nausea and vomiting as she got older. [Filing No. 138-6 at 4-5.] AV's gastrointestinal issues were confirmed by several medical tests, and witnessed by her parents, her sister, her in-home tutor, her in-home nurse, school officials, and her grandparents. [See Filing No. 138-7 at 4-5; Filing No. 138-8 at 6-7; Filing No. 138-9; Filing No. 138-10 at 5-7; Filing No. 137-12; Filing No. 137-13; Filing No. 137-15 through Filing No. 137-17.]

         In December of 2007, Dr. Brian Hainline, a biochemical geneticist and pediatrician at Riley Hospital, diagnosed AV with a mitochondrial-like disorder described as a neuromuscular disease or myopathy of unknown etiology. [Filing No. 138-11 at 27-29.] AV's disorder is complex and difficult to explain to patients and even to other physicians. [Filing No. 138-11 at 12-15.] Dr. Hainline felt the term “mitochondrial disorder” accurately described AV's condition, and encouraged the VanWinkles to use that term when describing her diagnosis to other physicians or to the school. [Filing No. 138-11 at 62-65.]

         Also in 2007, Dr. Joel Boaz performed surgery on AV for an Arnold Chiari Malformation, a condition where “the cerebellum…, which should stop at the base of the skull, extends further than it is intended to and goes down into the spinal canal.” [Filing No. 143-2 at 7; Filing No. 143-2 at 12.] The surgery also involved a tethered cord release, spinal taps, and placement of a spinal shunt to relieve spinal and intracranial pressure. [Filing No. 143-2 at 6-9.] ¶ 2010, AV complained of headaches which Dr. Boaz attributed to increased spinal and intracranial pressure. [Filing No. 143-2 at 25-26.]

         B. Initial Concerns Regarding AV's Care

         In 2012, some of AV's doctors became concerned that her symptoms were being over-reported or that the reported symptoms were not consistent with what was being observed by her doctors during appointments. [Filing No. 121-6 at 5.] Dr. Shannon Coffey Thompson was a physician at Peyton Manning Children's Hospital at the time, and on November 27, 2012, at her direction, a hotline call was made to DCS and a Preliminary Report of Child Abuse or Neglect was filed regarding AV. [Filing No. 121-5 at 4-6; Filing No. 138-1.] The Preliminary Report of Child Abuse or Neglect indicated:

Is Child In Imminent Danger of Serious Bodily Harm? No Allegation Narrative:
This incident occurred in Marion County.
RS [(Reporting Source)] reports that [AV] and sibling reside with their mother, Stacey Vanwinkle (sic), and father, Derek Vanwinkle….
RS reports that [AV] has been suffering from multiple medical issues and conditions, since birth. RS reports that Mr. and Mrs. Vanwinkle have sought medical attention for the issues and conditions, but Mr. and Mrs. Vanwinkle do not always follow up with the appropriate medical treatments or follow the doctor's medical recommendations. RS reports that this medical neglect causes new medical issues and problems for [AV]. RS reports that this is an ongoing problem that the doctors and the hospital have been dealing with for years. RS reports that the doctors are having a hard time helping [AV] when Mr. and Mrs. Vanwinkle do not follow up with the treatments and recommendations as needed.
RS reports that Mr. and Mrs. Vanwinkle will also request extreme procedures from the doctors. RS reports that…Mr. and Mrs. Vanwinkle have requested a G tube for feeding, due to [AV's] current weight problems. RS reports that Mr. and Mrs. Vanwinkle have also requested the doctor's [sic] to perform a Tracheotomy on [AV] due to the respiratory issues that [AV] is currently suffering from. RS reports that both of these procedures are invasive and are medically unnecessary at this point.
RS reports that [AV's] doctors at Riley's and St. Vincent both have great concerns for the wellbeing and the safety of…[AV]. RS reports that there is going to be a medical case conference at St. Vincent's Hospital on 11/29/2012, at 1200. RS reports that the doctors and nurses are requesting that the DCS caseworker attend the meeting before making any contact with the family.
RS reports that [AV] is not currently in the hospital.
RS reports they are unaware of information regarding the parent's violent tendencies, mental health, criminal history, or DCS history….

[Filing No. 138-1 at 1.]

         C. The November 29, 2012 Care Conference

         As the Preliminary Report of Child Abuse or Neglect reflects, a Care Conference to discuss AV's case was planned for November 29, 2012. [Filing No. 121-5 at 6; Filing No. 138-1 at 1.] The Care Conference was attended by Dr. Susan Maisel, DCS representatives, and representatives from the Child Protection Team at Peyton Manning Children's Hospital (“CPT”), and the goal was to “come up with [the] best plan of action to appropriately evaluate this extremely complicated case.” [Filing No. 121-5 at 6.] At the conference, Dr. Maisel, who had been treating AV since she was a toddler, expressed concern that the VanWinkles were over-reporting AV's symptoms. [Filing No. 121-6 at 11.] Specifically, Dr. Maisel was concerned that AV's significant weight gain in under a year was not consistent with the symptoms the VanWinkles had been reporting such as excessive vomiting, loss of appetite, and recorded food intake. [Filing No. 121-6 at 11; Filing No. 121-6 at 23.] Dr. Maisel also noted that AV was quiet during appointments and took all verbal cues from her mother, and that Stacey VanWinkle was adamant that AV remain on a feeding tube when Dr. Maisel raised the possibility of getting rid of it. [Filing No. 121-6 at 24-25.] No action was taken by DCS based on the November 29, 2012 care conference. After the care conference, DCS employee Corey Miller asked DCS employee Austin Hollabaugh in an email whether he knew why the report from the November hotline call was withdrawn. [Filing No. 138-2 at 57.] Mr. Hollabaugh replied “It's probably the one that I took Zmich out on with me…I withdrew it after we met them because they didn't have a case.” [Filing No. 138-2 at 57.]

         Dr. Maisel's concerns continued after the November care conference. [Filing No. 121-6 at 26.] Dr. Thompson also had concerns, but her concerns related mainly to the VanWinkles' reporting of AV's issues with breathing and obstructive airway symptoms, and reports from two other doctors that the VanWinkles were pushing for AV to get a tracheostomy when it was not indicated. [Filing No. 121-5 at 15.]

         D. Dr. Demetris Takes Over AV's Care

         In May of 2013, Dr. Cortney Demetris took over the medical investigation of AV's case. [Filing No. 121-3 at 5.] As part of that investigation, Dr. Demetris:

reviewed medical records from the St. Vincent or Peyton Manning Children's Hospital pulmonology office, the GI office, the ENT office. [She] reviewed medical records from Riley Hospital metabolic pulmonology, some inpatient records from Riley, urology records from Riley. Neurology records were requested; however, [she] did not receive those. [She] received records from multiple subspecialists at Cincinnati Children's Hospital, including some swallow study information, pulmonology, ENT, the genetics…. [S]ome records…from an outside hospital, maybe Community Hospital, maybe some records maybe from ortho or x-ray type of records. [She] reviewed records from an orthopedic surgeon's office….

[Filing No. 121-3 at 6.] Dr. Demetris diagnosed AV as a victim of medical child abuse.[2] [Filing No. 121-3 at 4.]

         E. AV is Admitted to the Hospital

         In June of 2013, AV was admitted to the hospital so that doctors could observe her symptoms. [Filing No. 37 at 9.] The symptoms that led to AV being admitted to the hospital included excessive vomiting, ongoing weight gain, ongoing reporting of mitochondrial myopathy without a definitive diagnosis (or a diagnosis of mild mitochondrial myopathy), and that she was in a wheelchair and was not walking. [Filing No. 121-6 at 54-55.] Additionally, AV was taking approximately 25-30 medications, and using other, additional medical interventions. [Filing No. 121-3 at 8.] AV's hospital stay was videotaped unbeknownst to the VanWinkles, and there were symptoms the VanWinkles had reported that were not observed on video. [Filing No. 121-3 at 16.] For example, there were no reports of AV vomiting during her stay. [Filing No. 121-3 at 17.] AV was discharged from the hospital on June 12, 2013 to her parents. [Filing No. 138-12 at 13.]

         F. The June 12, 2013 Hotline Call

         On June 12, 2013, another hotline call was made to DCS, this time at the request of Dr. Demetris. [Filing No. 138-3.] A Preliminary Report of Child Abuse or Neglect dated June 12, 2013 states:

Is Child In Imminent Danger of Serious Bodily Harm? No Allegation Narrative:
RS states that Stacey and Derek VanWinkle reside….with their children [AV and MV]. Derek is a stay at home parent and Stacey is a registered nurse.
RS reports that the family does have DCS history. RS states that [AV] has a long list of medical problems and medications.
RS states that [AV] has a very long medical history and it has been questioned over time by several different doctors whether [AV] needs all of the medical treatment and medications that Stacey thinks that she needs. RS states that [AV] is not as sick as Stacey presents her to be. RS states that Stacey takes [AV] to doctors and when the doctors will not do what Stacey thinks that they should do Stacey takes [AV] to another doctor until Stacey finds a doctor that will provide the medical treatment and/or procedure that Stacey wants for [AV].
RS states that [AV] has a feeding tube and Stacey reports that [AV] has been vomiting liters when she is at home. Stacey also reports that [AV] cannot walk across the room without being out of breath and having difficulty breathing. RS states that [AV] has gained about fifty pounds in the past year. RS states that Stacey used the feeding tube to give [AV] her medications which is not necessary.
RS states that [AV] has had several tests regarding her feeding and tolerance issues and all of the test results have been normal. RS states that there is a concern that [AV] is getting too many calories and Stacey reports that if [AV] gains much more weight that she is going to have to have a tracheotomy. RS states that this would be completely unnecessary.
RS state[s] that it is reported that [AV] has motorized wheelchair at home and Stacey will not allow [AV] to go to school. RS states that [AV] has not had any difficulty getting around while at the hospital.
RS states that Dr. Courtney (sic) Demetris, Child Protection Team at Peyton Manning Children's Hospital requested that this information be reported. RS states that there is a concern for medical child abuse. RS states that Stacey has also scheduled a procedure for [MV] and [MV's] doctor has already contacted Dr. Demetris with concerns that the procedure is not something that is medically necessary.

[Filing No. 138-3 at 1-2.]

         G. The June 17, 2013 Care Conference

         On June 17, 2013, the following individuals attended a second Care Conference related to AV: Seanna Nichols, Sheila Day, Dr. Cortney Demetris, Dr. Susan Maisel, Dr. Bryan Hainline, Dr. Ronda Hamaker, Dr. Roberta Hibbard, Monique Miller, Corey Miller, Maribryan McGeney, Kate Peterson, Patrick Rhodes, Indianapolis Metropolitan Police Department (“IMPD”) Detective Justin Hickman, Detective Shawn Looper, Richard Rink, Occupational Therapist Kristen Harris, Physical Therapist Erica Klene, Dr. Rachael Meadows, and Dr. Raminder Sufi. [Filing No. 138-4 at 12.] The following are notes from the June 17, 2013 Care Conference[3]:

On 6/17/2013, a case conference was held at Peyton Manning Children's Hospital, including numerous physicians, medical providers, and other pertinent individuals involved in care for both [MV and AV]. Many physicians were interviewed via teleconference, while others presented at the meeting in person. [IMPD] Child Abuse Unit was present by two detectives, as well as multiple representatives from [DCS]. Both Peyton Manning Child Protection Team and Riley Hospital Child Protection Team, including a Board Certified Child Abuse Pediatrician, were present for the duration [of] the meeting.
On 6/17/2013, Dr. Rhonda Haymaker (sic), Otolaryngologist with Peyton Manning Children's Hospital and medical provider for both [MV and AV], reported that most recently, her clinic has compared notes with pulmonology, gastroenterology, and all departments received different accounts of symptoms and different familial histories, both crucial to appropriate diagnostic practices. Dr. Haymaker (sic) stated that after holding a small conference of physicians, it has been documented that Ms. Vanwinkle is splitting care for her children between offices, often giving false information regarding other physicians and their recommendations. Dr. Haymaker (sic) stated that after reviewing [AV's] chart, there are concern[s] that long-term appropriate care has been sought for the child, and now, her sibling. [Omitted as disputed]. Dr. Haymaker (sic) stated that [MV's] respiratory issues, while mild, were of great concern to Ms. Vanwinkle; Dr. Haymaker (sic) reported that many of [MV's] symptoms, reported by mother, did not make sense with the child's clinical presentation. Dr. Haymaker (sic) stated that while the child has a larger basal tonsil, less invasive options were proposed to Ms. Vanwinkle. [Omitted as disputed]. Dr. Haymaker (sic) reported that Ms. Vanwinkle stated that she could be going to Cincinnati to have the child evaluated, despite the office's findings. [Omitted as disputed]. Dr. Haymaker (sic) stated that [AV] received her lingual tonsillectomy at Cincinnati Children's Hospital in October 2012, and now, Ms. Vanwinkle is seeking the same procedure for [MV]. Dr. Haymaker (sic) reported that mother has reported all of the child's symptoms in the office. Dr. Haymaker (sic) stated that Ms. Vanwinkle has also attributed both children to mitochondrial disorder, and continues to report she is seeking treatment for the children for this disorder in Cincinnati. Dr. Haymaker (sic) stated that despite being fourteen years old, she was concerned that when [MV] presented for minor testing, such as scoping, she cried uncontrollably and was inconsolable in the office. Dr. Haymaker (sic) stated that in a younger child, this may be less concerning, but it was unsettling to observe in an older child. Dr. Haymaker (sic) stated that [MV] is scheduled for evaluation on her birthday, and when this was discussed with mother, she became defens[ive] and irate, stating “don't you think I know when my child's birthday is?” Dr. Haymaker (sic) stated that Ms. Vanwinkle has previously made requests for a tracheostomy, to which she was denied, both at Riley Hospital and Peyton Manning.
On 6/17/2013, Kristen Harris, Occupational Therapist, was present in person at the meeting. Ms. Harris reported that when she came to evaluate [AV] during her inpatient stay last week, [AV] was awake in the playroom with her sister, playing a board game, and Ms. Vanwinkle was not present. Ms. Harris stated that her main assessment, functions include fine motor and self-help/hygiene skills. Ms. Harris stated that she spoke with [AV] concerning these skills, and the child reported being able to dress, bath[e], and complete toileting independently. Ms. Harris stated that when describing her showering habits, [AV] stated she stands, without loss of balance, and is able to complete her showers independently. Ms. Harris reported that she spent approximately forty-five minutes with [AV] for assessment, and denied the child complaining of pain or fatigue at any time during the assessment. Ms. Harris reported that the child reported that she has broken her arm six times, despite previous records that there was only one fracture. Ms. Harris reported that [AV] completed functional skills, such as fasteners, with no difficulty, and was able to maneuver standing on a tipping plank while throwing a ball at a target, and maintaining balance while distracted. Ms. Harris stated that [AV] was able to complete this activity for approximately three minutes with no support and no loss of balance. Ms. Harris reported that she was not present when Ms. Vanwinkle discovered [AV] had been assessed, but was informed that Ms. Vanwinkle denied much of the report and [AV's] capabilities, wanting the report amended by the hospital. Ms. Harris reported that after her evaluation, the recommendation she would make is acute inpatient during the child's hospital stay, and outpatient follow up for the child's handwriting, which was illegible. Ms. Harris denied any concerns for self-care fine motor skills at this time based upon her assessment with the child.
On 6/17/2013, Erica Klene, Physical Therapist, was present in person at the meeting. Ms. Klene stated that she attempted to complete an evaluation with the child twice while in the hospital last week during her scheduled inpatient stay, and both times, mother immediately told her that [AV] has autism and would not speak with her. Ms. Klene reported concerns that mother would not allow [AV] to be evaluated without first making an excuse for her lack of participation. Ms. Klene stated that both parents were present for her ultimate evaluation with the child, where [AV] walked for approximately 300 feet with no support and no loss of balance. Ms. Klene reported that Ms. Vanwinkle stated the child uses a wheelchair, and stated the child must have had a “good day, ” and intimated the child's physical ability is far less than she demonstrated that day, even after observing the child stand on each leg, alternatively, with no swaying and no balance issues. Ms. Klene stated the child was slightly out of breath following the therapy evaluation, but would attribute this, based on her observation, to the child's deconditioned status. Ms. Klene stated that Ms. Vanwinkle reported history to her including previous leg braces for the child. Ms. Klene stated that when she attempted to gather more information as to why the child no longer wore braces, Ms. Vanwinkle stated the child outgrew them. Ms. Klene reported that she asked mother if/when she pursued to have the child fitted again for braces, to which Ms. Vanwinkle denied further evaluation. Ms. Klene denied [AV] expressing symptoms of pain or fatigue during the evaluation. Ms. Klene reported that she attempted to gather more information from Ms. Vanwinkle about the alleged falls and other concerning mobility issues that the parents reported for [AV], but Ms. Vanwinkle was unable to provide specifics on occurrences, situations, and other necessary details. Ms. Klene stated that [AV] never answered questions during the evaluation, but rather, looked to her mother when she answered on the child's behalf. Ms. Klene reported that her recommendation following the assessment would include thirty minutes of physical activity five times a week.
On 6/17/2013, Dr. Demetris reported that she has spoken with Dr. Richard Rink, pediatric Urologist with Riley Hospital, and provider for [AV]. Dr. Rink was currently out of the country, and only available by phone. Dr. Rink reported that there are no objective test results that show the child has bladder dysfunction, despite receiving weekly bladder baths in NaCl and [catheterization] four times a day by a caregiver. Dr. Rink stated that it was agreed among providers that with [catheterization] four times a day, this would greatly increase the risk for urinary tract infections, from which the child suffers on a regular basis. Dr. Demetris informed Dr. Rink that while on video feed, [AV] was observed only to have 20 mL post-residual urine, which is far less than reported by mother.
On 6/17/2013, Dr. Raminder Sufi, Pulmonologist with Peyton Manning Children's Hospital and medical provider for [AV], was present in person for the meeting. Dr. Sufi stated [AV] was his patient until March 2012; at this time, Dr. Sufi completed a “six minute walk test, ” which is often referenced as a diagnostic tool to distinguish whether or not an individual is disabled. Dr. Sufi stated when he administered this test to [AV], she walked 1600 feet, and approximately twelve minutes of walking with no support and no loss of balance. Dr. Sufi stated that this performance directly opposed all reported symptoms by [AV's] parents, who stated the child could only walk from the bed to the couch, and back, resulting in shortness of breath and pulmonary strain. Dr. Sufi stated that on a scale of exertion, [AV] scaled a seven out of 10 (7/10), showing she is deconditioned, not unable to complete the task. Dr. Sufi stated that a respiratory therapist was present for the duration of the testing to observe and monitor the child's condition; following the test, a detailed exercise plan was created, day to day, for the child. Dr. Sufi stated the family reported they completed the plan, but it is unknown who monitored the completion. Dr. Sufi stated that [AV's] respiratory issues, at this time, are directly related to her obesity; he reported that after a Pulmonary Function Test (PFT), there was no evidence [of] any restrictive lung disease, cough levels were normal, and inspiration ability was normal; Dr. Sufi stated that if the child were suffering from organic respiratory issues, one of these factors would appear abnormal on testing. Dr. Sufi stated that after testing, the BiPAP machine was not considered necessary; when discussing this with the family, Dr. Sufi was informed by the family that they believed the machine was, in fact, necessary, and would continue to use it, despite the physician's recommendation. Dr. Sufi stated that following the test, he scheduled a sleep study for [AV] to establish a baseline for the child. Dr. Sufi stated that when Ms. Vanwinkle brought [AV] to the study, and it was requested to complete the sleep study without BiPAP support, Ms. Vanwinkle refused, took the child, and failed to complete the study. Dr. Sufi stated that following his dismissal of the need for the BiPAP machine, and the failed sleep study, [AV] has not returned to his office.
On 6/17/2013, Dr. Roberta Hibbard, Board Certified Child Abuse Pediatrician, and physician with Riley Hospital for Children Child Protection Team, was present in person at the meeting. Dr. Hibbard informed FCM that the only way to distinguish [AV's] valid medical needs from the history of exaggerated symptoms and falsified illnesses, would be to isolate the child medically from the influence of her parents, and have the child evaluated by objective physicians, dismissing all previously disclosed history; by reviewing only objective and evident medical date, [AV's] current levels of functioning could be appropriately assessed and only necessary medical interventions continued. Dr. Hibbard reported concerns for both children in the home, as multiple physicians reported similar behaviors by the parents of the children regarding [MV] as well.
On 6/17/2013, Dr. Rachael Meadows, primary care physician associated with Community Health Network, and ongoing primary care for both [MV and AV], was made available to the meeting via teleconference. Dr. Meadows stated that she has provided medical care for both [MV and AV]. Dr. Meadows stated that she believes the parents of these children are seeking medically inappropriate care, especially for [AV]. Dr. Meadows reported that when [AV] first came to her office in August 2011, she was prescribed seventeen medications. Dr. Meadows stated that she has seen [AV] multiple times, and all appointments were for concerns and symptoms reported, but not present in the clinic, other than general coughs. Dr. Meadows stated that despite numerous complaints, she has not observed presentation of symptoms reported by Ms. Vanwinkle on behalf of [AV]. Dr. Meadows stated that the most common complaint for the child was chronic and debilitating fatigue. Dr. Meadows reported that the child suffers from constant Urinary Tract Infections (UTIs), which may be exacerbated by the constant [catheterization] the child receives. Dr. Meadows stated that [AV], to her knowledge, has not attended school since Fall of 2012, pursuant to bullying. Dr. Meadows stated that mother has also reported the child cannot attend school due to immune issues, and varies on the excuses given for the child being home-bound. Dr. Meadows reported that [AV] transferred to her office, per mother, because Ms. Vanwinkle “did not agree” with the care for [AV] provided by her previous primary care physician. Dr. Meadows reported she had limited medical history, but not a full medical history, nor full medical records for the child, and much of the child's history was given by mother, verbally, in the clinic. Dr. Meadows stated that she has observed very mild hypotonia, or lack of muscle strength, in [AV] but he feels this can be attributed to the child's deconditioned status, and it does not present significantly. Dr. Meadows stated that Ms. Vanwinkle, when reporting for [AV], will demean the child and discredit anything the child may seem, attributing the child's “confusion” to her autism. Dr. Meadows stated [AV] was diagnosed with autism at age three years of age, but does not have medical documentation to support this. Dr. Meadows reported that if she were to only evaluate [AV] based on objective data and observable symptoms, her only diagnoses at this time would be obesity, and undefined developmental delay. Dr. Meadows reported that she is beginning to see the pattern of exaggerated reporting being with [AV's] older sister, [MV], at this time. It was noted that Ms. Vanwinkle was offered an educational assessment for [AV] most recently, but Ms. Vanwinkle adamantly refused.
On 6/17/2013, Dr. Susan Maizel (sic), Gastroenterologist with St. Vincent Health Network and medical provider for [AV], presented in person at the case conference. Dr. Maizel reported that she has been associated with [AV's] medical care since infancy, when [AV] was diagnosed with eosinophilic esophagitis, which is inflammation of the esophagus and upper digestive tract. Dr. Maizel reported that the esophagitis began to resolve spontaneously around the year 2005. Dr. Maizel reported that there has been no diagnostic evidence since that time of esophagitis. Dr. Maizel reported that [AV] has been found to possess a duplicate ureter, but this would not cause any of the symptoms mother is reporting regarding [AV's] gastroenterology issues. Dr. Maizel reported that no familial history of alleged gastroenterology issues have been made available to her, and all familial history of esophagitis and reflux have been disclosed by mother. Dr. Maizel reported that Ms. Vanwinkle has told her on multiple occasions that [AV] has mitochondrial disorder. Dr. Maizel reported that much testing has been continually conducted on [AV], including stomach emptying studies, and other films, which have revealed no ongoing concerns for the symptoms reported during appointments. Dr. Maizel reported that [AV] has a gastrostomy tube, previously a [gastro-jejunal] tube which diverted past her stomach directly to her small intestine. Dr. Maizel reported that based on reported symptoms by Ms. Vanwinkle, the gastrostomy tube was initiated with [AV], as symptoms reported including feeding issues, vomiting, and nausea. Dr. Maizel denied [AV] disclosing any symptoms, and that largely, history and symptoms are presented by mother. Dr. Maizel reported that [AV] has gained a significant amount of weight in under a year, and is now clinically obese, which contradicts the symptoms reported by both parents, such as excessive vomiting, extreme nausea, loss of appetite, and reported food intake. Dr. Maizel stated that when the parents attend appointments together, they contradict symptoms and histories. Dr. Maizel stated that [AV], in her opinion as a professional, and a medical provider for the child, has been infantilized by her parents, and as a result, is not enrolled in school. Dr. Maizel reported that several times, mother has made excuses for lack of educational involvement, stating on occasions that another provider, specifically Dr. Hainline, reported that [AV] has a compromised immune system, and cannot attend school, which other times, blaming fatigue and the child's alleged mitochondrial disorder. Dr. Maizel stated that when discussing with mother the possibility of removing the gastrostomy tube, and the child only uses it for medication injections at this time, not for supplementary feeding, which is the primary need for such intervention, Ms. Vanwinkle is adamant the tube remain, as the child has difficulty “taking so much medication by mouth every day.” Dr. Maizel reported concerns that [AV] is quiet in appointments, and takes all verbal cues from her mother before speaking. Dr. Maizel agreed that many of the child's symptoms are over reported and intentionally done so, in order to maintain current medical interventions, while seeking more invasive care.
On 6/17/2013, Dr. Bryan Hainline, Metabolic Specialist with Riley Hospital for Children and medical provider for [AV], was made available to the meeting via teleconference. Dr. Hainline reported that he has been working with the VanWinkle family since “almost the beginning” of [AV's] medical care. [Omitted as disputed]. Dr. Hainline reported that there are no specific clinical tests for fatigue, but the child has not appeared severely fatigued during appointments. [Omitted as disputed]. Dr. Hainline reported that the family has been informed multiple times that [AV] does not have mitochondrial disorder, which would only present severely until three to four years of age. Dr. Hainline reported that many times, symptoms of mitochondrial disorder resolve as the child grows; Dr. Hainline reported that despite repeatedly informing the family that [AV] does not have mitochondrial disorder, the parents are continually reporting to other physicians that not only does [AV] have this disorder, diagnosed by Dr. Hainline, but that the condition prevents the child from interacting with others. [Omitted as disputed]. Dr. Hainline reported that he has actually made a clinical recommendation for the opposite, encouraging [AV']s parents to involve her in a least restrictive environment, including a school setting, and only limit activities based on physical limitations. [Omitted as disputed]. Dr. Hainline reported that there is no objective testing and/or testing information for the child, and the history ...

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