In Re Colin R.

493 A.2d 1083, 63 Md. App. 684, 1985 Md. App. LEXIS 437
CourtCourt of Special Appeals of Maryland
DecidedJune 13, 1985
Docket1471, September Term, 1984
StatusPublished
Cited by14 cases

This text of 493 A.2d 1083 (In Re Colin R.) is published on Counsel Stack Legal Research, covering Court of Special Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Colin R., 493 A.2d 1083, 63 Md. App. 684, 1985 Md. App. LEXIS 437 (Md. Ct. App. 1985).

Opinion

KARWACKI, Judge.

Thomas R. and Donna R. appeal from orders of the Circuit Court for Charles County placing their son, Colin R., under the protective supervision of the Charles County Department of Social Services. These orders were entered in disposition of the court’s earlier adjudication that Colin R. was a child in need of assistance, (hereafter “C.I.N.A.”), as defined in Md.Code (1974, 1984 Repl.Vol.), § 3-801(e) of the Cts. & Jud.Proc. Art. They present the following questions in urging reversal of the lower court’s determinations:

I. Did the court err in admitting certain evidence?
II. Was the lower court clearly erroneous in adjudicating Colin R. a C.I.N.A.?
III. Was the court appointed physician who testified at the disposition hearing improperly permitted to do so since he had not reduced his findings to a written report?
IV. Should the trial judge have recused himself on the appellants’ motion?

The tragic scenario which gives rise to this appeal opens during 1982 when Colin R. was three years old. At that time he began to suffer episodes of vomiting, dehydration, high urinary output, and markedly low potassium levels. These episodes were cyclical in nature and required his repeated admission to the Southern Maryland Hospital Center where a preliminary diagnosis of his malady as Bartter’s *689 Syndrome was made. That disease is characterized by chronic vomiting and dehydration, according to the expert testimony before the court, and is treated medicinally with Indocin with potassium supplements. When Colin failed to respond to this treatment he was referred to the Children’s Hospital National Medical Center, (hereafter “Children’s Hospital”), in Washington, D.C., in July of 1983. There he came under the care of Jose Salcedo, M.D. and Edward Ruley, M.D., specialists in pediatric nephrology.

Because Colin was not responding to treatment as a Bartter’s Syndrome child, his treating physicians decided to perform a kidney biopsy to aid them in confirming or rejecting the diagnosis of Bartter’s Syndrome. That biopsy disclosed abnormal calcium deposits which were inconsistent with impaired functioning of the kidneys to be expected of a Bartter’s victim. The physicians then suspected abdominal epilepsy as the cause of Colin’s episodic illness and performed an electroencephalogram in September of 1983. When that procedure revealed a slight abnormality in the occipital area of Colin’s brain, Dr. Salcedo prescribed an anticonvulsive drug, Dilantin. This medication failed to control Colin’s cyclical vomiting and dehydration.

On January 30, 1984, Colin was admitted to Children’s Hospital during another episode of vomiting and dehydration. Because he had not responded to the accepted medical treatment for Bartter’s Syndrome or abdominal epilepsy, his physicians decided to determine whether the previously discovered abnormal calcium deposits disclosed by the kidney biopsy could have been the result of some unprescribed drug being introduced into his system. Accordingly, urine samples were collected from Colin every twelve hours on January 30th and 31st and forwarded to a laboratory for analysis. This analysis disclosed the presence of diuretics in Colin’s system. After receiving this report, the treating physicians, in order to double check the accuracy of the report, on February 7th and 10th again took urine samples from Colin and certain Children’s Hospital staff volunteers *690 for a further analysis. These second tests confirmed the presence of diuretics in Colin’s urine specimens.

Colin’s physicians explained to the court that the diuretics found in Colin’s system, Furosemide (sold under the brand name of Lasix) and Hydrochlorothiazide, act to block sodium in the kidneys causing high urinary output. This in turn causes dehydration, low potassium levels and vomiting. Colin’s physicians further testified that diuretics, once administered, have a very short life within the body so that a dose of diuretic administered on any given day would not be evident in a urine sample taken the next day. To further confirm their diagnosis that diuretics were being injected into Colin’s body, the treating physicians denied the appellants unsupervised access to Colin, and on February 10th discontinued all medication of Colin. Notably, Colin’s urine sample of February 11th was free of any evidence of diuretics. Moreover, the symptoms from which he suffered since age three did not and have not reappeared since that date.

Because Colin had been in the custody of the appellants since birth and since the appellant, Donna R., was constantly at his bedside during earlier hospital admissions and during his admission to Children’s Hospital on January 30, 1984, Dr. Salcedo confronted Donna R. with the results of the testing. Donna R., a licensed practical nurse employed at the Southern Maryland Hospital Center, disclaimed any knowledge of how the diuretics had been introduced into Colin’s body.

Based upon these findings, Colin’s physicians agreed upon an ultimate diagnosis of the illness he had suffered— Munchausen Syndrome by Proxy. This diagnosis describes an aberration where parents, for one warped reason or another, induce an illness in their child so that it appears to the medical community that the child is actually suffering from a disease.

Having made this diagnosis, the staff at Children’s Hospital notified the Charles County Department of Social Servic *691 es 1 of their conclusions and advised the Department that Colin would not be released to the appellants upon his discharge from the hospital. The Department then filed a petition with the court alleging that Colin was a C.I.N.A., and an investigator from the Charles County Sheriffs Department obtained a search warrant for the appellants’ home. On February 16th, in executing that warrant, members of the Sheriff’s Department seized hypodermic syringes and two vials of Lasix from the bedroom dresser drawer of Donna R.

After an emergency shelter care hearing on February 16, the court placed Colin in the temporary care and custody of the Department. An adjudicatory hearing on the C.I.N.A. petition held on March 19th and 20th resulted in the court’s finding that Colin was a C.I.N.A. After disposition hearings on April 18th and 24th, the court permitted Colin to be returned to the custody of the appellants under the protective supervision of the Department. On August 7th a further disposition hearing was convened after which the court, on September 10, 1984, modified the terms of the protective supervision of Colin by the Department.

I. Admissibility of Evidence

A. The urinalysis results

After both Dr. Salcedo and Dr. Ruley had testified below to the hospital treatment of Colin during his January 30, 1984 admission to Children’s Hospital, the appellee Department offered into evidence two memoranda contained within the properly authenticated hospital record of Children’s Hospital. Dr. Ruley testified that such memoranda were made in the ordinary course of treating his patient, Colin R.

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Bluebook (online)
493 A.2d 1083, 63 Md. App. 684, 1985 Md. App. LEXIS 437, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-colin-r-mdctspecapp-1985.