Ginnie Graham: Child-abuse pediatricians lend safe hands for healing

Dr. Sarah Passmore was on call one night in 2007 when a baby and a toddler died from being abused. It haunts her.

“I’ll never forget the details of those cases. Never,” she says. “Those were extreme in the type of abuse. And I think of our social system. They were 2 years old and 8 months old, and I wonder why we can’t prevent this from happening. What red flags were missed?”

She has examined all manner of child abuse.

Children in diapers with black eyes. Infants limp from their soft brains being shaken against their skulls. Potty-training kids thrown against a wall. Burns. Broken bones. Perforated organs.

Then there’s the child pornography. Equally nightmarish.

Babies raped. Toddlers fondled. Pre-teens molested for years, suffering in silence.

“You can’t wash your eyeballs enough to get rid of it,” Passmore said.

But Passmore is there with safe and gentle hands. To explain medically what has happened and what will happen next.

Dr. Michael Baxter is there, too. Soon, Dr. Lauren Conway will be there.

“Those who work in child maltreatment see the absolute worse in humanity,” Baxter said. “From babies who sustain head injuries to school-aged children being beaten to exploitation of children with child pornography and sexual abuse or children who are neglected in every way.

“We see it every day, and we know it happens everywhere. This side of humanity is crushing for not only us in child maltreatment, but our society as a whole. But what happens for those of us involved is that we also see the absolute best of humanity simultaneously.”

These are Tulsa’s healers for child abuse. These are the certified child-abuse pediatricians.

It has to be one of the toughest — yet crucial — jobs anywhere. It’s an emotionally jarring profession. But someone — some people — must do this work to save, protect and seek justice for children who have been battered and exploited.

‘Look at the medical side’: For years, I’ve heard about the child-abuse pediatricians and have seen their names often on court records. I’ve wondered what attracts a person to that specialty.

“People think we come here and cry all day. That’s not necessarily the case,” Baxter said. “It’s enjoyable to help children and their families. It’s not depressing like people think. I am happy doing this job.”

They speak of it being a calling — immediately knowing this was meant to be. They speak of enduring “secondhand trauma” to help a child.

This is a job about diagnosis and treatment. The specialty, which was officially created in 2010, weeds out the false allegations and fake cover stories. It provides a medical opinion steeped in research, experience and neutrality.

Dr. Michael Baxter works in his office at the Child Abuse Network April 19, 2016. MIKE SIMONS/Tulsa World

Of the children the Tulsa child-abuse pediatricians examine, about 50 percent of injuries do not result in a definitive medical conclusion, for reasons such as fading wounds. About 25 percent are confirmed abuse, and 25 percent are found to be caused by other reasons.

The physicians are part of a multidisciplinary team located at the Justice Center, 2828 S. Sheridan Road, which is administered by the Child Abuse Network. The team is made up of prosecutors, police, social workers, a nurse and forensic examiners. The center, which was designed to handle about 50 cases a month, has been averaging 50 cases a week recently.

The doctors are busy. The number of children and youths confirmed as victims of child maltreatment has increased by about 110 percent since 2010 — from 7,248 children to 15,252, according to the state Department of Human Services.

“Our role is not to do investigations or decide what evidence there is. We look at the medical side,” Passmore said. “The other team members bring more to the table.”

It’s sad some Oklahomans cannot seem to stop abusing and neglecting children. But it’s tied to other factors — mental health, substance abuse, teenage pregnancy, lack of education, economic stress and generational poverty. It’s not an issue that exists in a vacuum.

Programs to help families and people dealing with these issues are being restricted or eliminated after state funding is cut as part of the $1.3 billion budget shortfall.

“We don’t value prevention or early childhood experiences,” Passmore said. “We have wonderful programs in early childhood covering as many people as we can. But as a society, there are a lot of people needing help.”

Dr. Sarah Passmore(left) and Assistant District Attorney Sarah McAmis meet about cases at the Child Abuse Network April 19, 2016. MIKE SIMONS/Tulsa World

Recruiting difficulty: The child abuse sub-specialty grew out of a national movement among pediatricians with Tulsa’s Dr. Bob Block in the lead. He served as the state’s child-abuse examiner from 1989 to 2011 and was the first to receive the certification when it was established. He is retired.

Most exams are conducted at the Justice Center, and about 10 percent are seen at Saint Francis Hospital. On average, the doctors spend about one day a week in court providing testimony.

The sub-specialty training in the legal system sets this certification apart from others. Receiving subpoenas is routine among child-abuse pediatricians, so understanding the language and tactics used in courtrooms and depositions is crucial.

The Tulsa child-abuse pediatricians earned their medical degrees from Oklahoma State University College of Osteopathic Medicine and then completed pediatric residencies at the University of Oklahoma-Tulsa School of Community Medicine. They received their child-abuse certification under the mentorships of Dr. Block and Dr. Deborah Lowen, who is now at Vanderbilt University.

Even though the whole D.O. (osteopath) versus M.D. (allopath) gap was bridged more than four decades ago, attorneys have tried using it to question their expertise. Also, Passmore has a non-science undergraduate degree. The physicians expect it, though.

“I’ve been on the stand and attacked personally, but we are a little more accustomed to going to court,” Passmore said. “I’m proud of my diverse education, but I explain I went through the same medical training as any pediatrician and obtained the child-abuse certification. I’ve learned if they don’t have a defense, they start a personal attack.”

The court aspect of their job is another reason why the certified sub-specialty came into being — it’s a validation of expertise. It’s credibility for those who doubt them.

Case Manager Sue Barrows, LPN, works at the Child Abuse Network April 19, 2016. MIKE SIMONS/Tulsa World

Only four certified child-abuse pediatricians are practicing in the state — two in Tulsa and two in Oklahoma City. Conway is the first fellow in a training program offered by OU-Tulsa School of Community Medicine and funded by Saint Francis Hospital. Nationally, there are 352 certified child-abuse physicians as of November.

Unfortunately, Oklahoma needs even more child-abuse pediatricians. It’s a reason why OU-Tulsa School of Community Medicine and Saint Francis Hospital agreed to establish a fellowship to train more in the sub-specialty.

“It’s a very difficult profession to recruit into, and that is being addressed nationally,” Baxter said.

‘Gives me hope’: I’ve heard other things about the child-abuse pediatricians. They joke around, a lot.

Baxter once taped 200 rubber cockroaches to a co-worker’s computer and rigged a net of balloons to drop when a another co-worker pulled out her chair. Each holiday, their families gather for a Harry Potter film marathon followed by Quidditch games. Their office is accessorized with references to the literary wizard, Doctor Who and medical textbooks. The good, name-brand chocolate candy is hidden in the second desk drawer.

“I play practical jokes to relieve the stress,” Baxter said. “I find balance in exercise, playing sports and spending quality time with my family.”

Being able to lean on others working in the field of child abuse plays a big role. They value each other.

“I see protecting caregivers holding their child and, despite the emotion of what is happening, focusing on helping the child in any way,” Baxter said. “Sometimes, this is as simple as a reassuring smile or bending down and kissing his or her forehead. I see child protection workers strive to bring help to families in need. I see them stay with a child who had no one else there, including being the only non-medical person there when the child is pronounced dead.

Case Manager Sue Barrows, LPN, receives a file from Dr. Nichael Baxter at the Child Abuse Network April 19, 2016. MIKE SIMONS/Tulsa World

“I see detectives work cases to bring the best evidence to light by going to crime scenes more traumatic than one can imagine and documenting what happened. I’ve seen forensic interviewers recount horrific stories of children to others so proper decisions can be made, and then go right back into the interview room to let another child tell her story. I see prosecutors pore over evidence in case after case to make sure they understand it so that justice can be done for the child and family.

“I see my nurse holding a child with such compassion that the child is calm despite being with a total stranger. I see my colleagues across the nation advocate for the rights of children.

“Seeing the absolute best of humanity daily despite overwhelming sadness gives me hope and the ability to come back day after day.”

Child abuse and neglect

• One in 14 children in Tulsa County will be involved in a child abuse or neglect investigation.
• 15,252: Confirmed child victims of abuse or neglect in Oklahoma last year.
• 1,995: Child victims in Tulsa County last year.
• 15: Child abuse murder cases pending in Tulsa County.
• 10: Number of investigations the Oklahoma Department of Human Services has launched into child deaths in Tulsa County since Jan. 1.
• 2,500: Number of children seen at the Child Abuse Network on average each year.
• 1,404: Tulsa County children in foster care last year.
• 38: Percent of Tulsa County children placed in foster care outside the county as of March 1.
• 35: Percent of Tulsa County children living with all their siblings as of March 1.
• 48: Percent of Tulsa County foster children with a kinship placement as of March 17.

Oklahoma child abuse confirmations

For the past five years, Oklahoma child abuse allegations and confirmations have gone up.

Foster care placements have hovered at about 10,500 to 11,000 children since 2013.

Source: Oklahoma Department of Human Services