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This article was written by Martin Gottesfeld on day 76 of a prison hunger strike. He defended 15-year-old patient Justina Pelletier when many feared she would die from malpractice by Boston Children’s Hospital doctors. More information about him is available on FreeMartyG.com, the FreeMartyG Facebook page and on Twitter @FreeMartyG.
A teenage girl ends up in a psych ward at a leading children’s hospital, but her psychiatrists come to believe her problems are not mental. They become convinced she is “being influenced by, speaking with, and being hurt by evil spiritual entities.” They consult with the hospital chaplain, give the girl a cross to wear, and one of them brings her to his church.
Does this sound like real life, or a B-movie cross between The Exorcist and One Flew Over The Cuckoo’s Nest? Well, if you answered real life, pat yourself on the back.
According to the Massachusetts Board of Registration in Medicine, a year before the now-infamous Pelletier case, another misdiagnosis was made by mental health doctors at the renowned research hospital, a spiritual one. In the Pelletier case, a physical diagnosis was incorrectly challenged by doctors and parents were falsely reported to state authorities for child abuse and stripped of custody. It ended with their daughter locked in the psych ward and kept from her family, religious practices and the medications she actually needed for the actual disorder that she actually has.
But this earlier case was nearly the polar opposite. A mentally ill teen was apparently misdiagnosed by a group of three hospital psychiatrists who believed she was “possessed.” When told that her mother had pushed her down a flight of stairs and tried to strangle her, they failed to follow the law and report it to social services. But one of the mental-health M.D.s appointed himself her “spiritual mentor.” He took her to his church and let her sleep at his home. Also unlike the highly publicized Pelletier scandal, this earlier incident barely made a media blip, even in the local papers.
According to state documents, available here and here, it started when Boston Children’s attending psychiatrist Dr. Raymond Kam began going to sessions with the girl and a psychiatry fellow who had been having a hard time getting her to open up. She appeared more talkative with Kam around, and the doctor started to believe her condition had spiritual aspects to it. So, Kam began talking about the case with his congregation.
The girl eventually was locked in the psych ward. While she was there Kam met with her alone. After those meetings he believed the spiritual component of her condition was more and more significant. He shared his view with both the senior attending psychiatrist, Dr. Enrico Mezzacappa, and the psychiatry fellow. All three agreed her condition could have spiritual aspects. Mezzacappa complimented Kam for his courage coming forward with the unusual spiritual diagnosis. Mezzacappa expressly noted that not all doctors “would entertain” such a possibility. So, Kam, the psychiatry fellow, who is not named in the state documents, and Mezzacappa kept it to themselves, neither notifying other physicians nor recording their beliefs in hospital logs and records.
Later, While she was still in the psych ward, Dr. Kam gave her a cross in exchange for a different, undisclosed religious symbol she had been wearing, perhaps a Star of David. The day after that, he apparently decided her problems were not in any way psychiatric. He announced he was taking himself off the case. The three doctors subsequently seemed to agree that Dr. Kam would take on the role of the girl’s “spiritual mentor.” He began operating under the notion she was “being influenced by, speaking with, and being hurt by evil spirits,” and that the “conditions were not psychiatric in nature but were caused by evil spirits.” Mezzacappa told Kam to seek a consultation for the girl with Kam’s own church, and also directed and introduced Kam to the hospital chaplain for the same purpose.
Following the girl’s discharge from the psych ward, Kam exchanged text messages “of a personal nature” with her. He also indeed took the girl to his church and met with his own assistant minister as well as the hospital chaplain to develop a “plan to address” her spiritual issues. That sounds at least a bit like an exorcism.
When she told him her father had kicked her out and she had nowhere to sleep, Kam and his wife invited her to spend some nights at their house. And when she reported that her mother had pushed her down a flight a stairs and had tried to asphyxiate her, as mentioned above, he failed to notify authorities, as state law required. Though Mezzacappa was aware of the girl’s situation, he too failed to make the required report to social services.
When all of this eventually came to light, the Massachusetts Board of Registration in Medicine suspended Kam's license and reprimanded Mezzacappa. Both were sanctioned for failing to report the alleged abuse, but also for engaging in conduct that undermines the public’s confidence in medicine. Though Kam was fired before the board’s decision, Mezzacappa continued in his role as a senior attending. B.C.H. said his reprimand “does not affect his ability to practice at Boston Children’s Hospital and he remains a member in good standing in the Department of Psychiatry.” Ironically, the state board required Kam to undergo a psychiatric evaluation himself in order to reinstate his license.
This case is a stark reminder that though Boston Children’s Hospital, on the whole, enjoys a stellar reputation, individual or even small groups of practitioners there still engage in inappropriate and decidedly unscientific behavior. Like the Pelletier scandal, this incident involved the cooperation of multiple hospital physicians and is especially relevant, as here too they were mental health professionals. Many people are dubious that a few such doctors could evade hospital oversight or so largely escape meaningful consequences for such behavior. But perhaps the most surprising aspect common to both otherwise inverted cases is that the majority of the doctors responsible for the two debacles continued to practice at Boston Children’s Hospital. If you ran B.C.H., might you have done more? Perhaps if someone had, Justina Pelletier would not have lost the use of her legs a year later.
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