‘I Love the Kids’ : From an Anonymous Trailer at Childrens Hospital, Astrid Heger Directs a Passionate--and Sometimes Controversial--Fight Against Child Abuse

Yes, the young girl has been raped, probably more than once, Dr. Astrid Heger tells the police officer who has brought the 7-year-old to the Sexual Child Abuse and Neglect program at County-USC Hospital.

“I’m startled by her exam,” says Heger, who has conducted about 5,000 evaluations during her eight years as program director. The child’s genital area was bleeding, her vagina had been penetrated.

Earlier that morning, Heger had examined the child with a colposcope, a camera-equipped, low-power gynecological microscope that graphically documents sexual abuse damage on children’s bodies. Often, colposcope photographs--backed by Heger’s testimony--become critical legal evidence.

But in this case, Heger says prosecution will be difficult: “This child is so damaged . . . she’s never going to make a good witness.”

In a rapid dialogue, Heger and the cop agree arrests are less important than protecting the child from further attacks. The girl’s case will be referred to the county’s Department of Children’s Services. Meantime, the detective will keep tabs on her and see that she is kept away from her suspected molesters, who live outside the child’s home.

The officer leaves.

Next case . . .

So it goes this particular morning in the Kingdom of Dr. Heger, an anonymous trailer tucked behind Childrens Hospital of Los Angeles.

Here Heger and SCAN staff examine about 1,000 children a year. For the past eight years, they have determined whether these children have been abused and often have assisted law enforcement in the prosecution such cases.

It is tough work with an existential twist. Although staff members do some follow-up with children, mostly they see their young patients only once or twice. Usually they never know whether they have been a way station on a road to safety or a pit stop on a highway to hell.

(The county-USC program is one of three such regional public centers in L. A. County; others are at Martin Luther King and Harbor-UCLA hospitals.)

From this base Heger has established an international reputation as a leader in the diagnosis and treatment of sexual and physical child abuse.

Heger is a complex, intense and sometimes controversial professional who friends and colleagues describe as “absolutely irrepressible” and “inspiring.” Indeed, Heger--usually good-humored, often sharp-tongued, always articulate--sometimes seems to be an elemental force like wind or rain, dominating a setting with a powerful personality backed by confidently wielded expertise.

“I’ve never, ever been afraid to say what I think’s right,” Heger says. But, she adds, “I’m much more focused on making change through cooperation than confrontation.”

Heger, 50, sees herself principally as an advocate for children. Occasionally uneasy or reticent discussing herself, the pediatrician becomes forthright and animated when discussing children’s issues:

“I’m a product of the ‘60s and I went through all that ‘make a difference’ stuff. Child abuse has afforded me that luxury of making a difference . . . I love my job . . . I hate my job, I love the kids.”

It was really sad. I mean this is a 9-year-old little girl. I mean, she looks 9 years old. Not only did she get abused by the mother’s boyfriend but she’s been abused by two other family members. It’s kind of like . . . “I’ve had Maria, you try Maria.” --Heger discussing a recent case While Heger seems to take each case personally, she also sees her patients in a more detached way--as a chance to increase her medical knowledge.

“I think she’s one of the leaders in this field and probably one of the most experienced clinically,” says Dr. Richard C. Krugman, dean of the University of Colorado medical school and a highly regarded expert on sexual and physical abuse. The sheer number of children Heger has seen has helped refine the diagnosis of child abuse, Krugman says. He adds that he respects Heger for her intellectual honesty, especially her willingness to admit her mistakes and to learn from them.

“Astrid’s considered to be state-of-the-art (medically),” says Deanne Tilton, executive director of the Inter-Agency Council on Child Abuse and Neglect, an organization of law enforcement, medical and other government offices.

Beyond the medical role, Tilton calls Heger “a very critical catalyst” in keeping public attention in the county focused on child abuse despite widespread skepticism after the McMartin Pre-School trial (in which Heger testified for the prosecution), and national and local backlash caused by widespread false reports of child abuse several years ago.

Tilton also praises Heger, who is married to a cardiologist and has three teen-age sons, for her rapport with children, who frequently tell Heger secrets they won’t tell anyone else: “If you’re a little girl and you see Astrid walk into the room, you’re going to be OK.”

A relative of a 14-year-old incest victim seconds that opinion. After seeing Heger, the woman says that she was impressed by the doctor’s sensitivity in treating the teen-ager, who had been sodomized while visiting family members in another state.

Heger has even been validated by the California Court of Appeal. Ruling on a case in which Heger’s testimony played a key role, the court’s opinion said: “While Dr. Heger does see herself as a child advocate, she means by that an advocate for the child’s well-being, not an individual who takes sides.”

Heger’s public critics apparently are few. Some sources, who do not want to be quoted by name, say she is the target of some professional resentment or jealousy because she seems “too good to be true.” Heger also has been challenged by criminal defendants, including those in the case that prompted the appeals court comment.

What am I going to do with (Maria)? This really severely physically damaged child, has definitely been raped multiple times, still has healing trauma from that, still has severe anal trauma from being sodomized probably a hundred times. This guy was doing this kid every morning after the mom went to work.

By all indicators, minister’s daughter Heger has been a major force for change in the way sexual abuse is diagnosed and treated.

A decade ago, she and another doctor pioneered use of the colposcope to photograph child abuse. It was a boon to prosecutors and child-abuse professionals because doctors previously relied on clinical drawings that could be readily disputed.

And this month, Oxford University Press is publishing “Evaluation of the Sexually Abused Child,” co-authored by Heger and the first definitive hard-bound text on child abuse.

Essentially, Heger campaigns worldwide for “centers of excellence”--programs staffed by medical and sociological child abuse specialists, who work with law enforcement, if necessary.

“I’m trying to advocate for the same basic system of intervention with children all over the world,” Heger says. With a hint of self-deprecation, she adds, “The only place in the world that has done exactly what I want them to do is New Zealand.”

Her statement is, in fact, true, according to Dr. Robin Fancourt of New Plymouth, New Zealand, president of the 300-member Doctors for Sexual Abuse Care.

In three trips totaling two months, Heger helped doctors set up a uniform countrywide system of sexual-assault response units, Fancourt says: “She has really established for us the guidelines and sort of standards we should be looking at in child sexual abuse cases.”

Heger also has worked with Britain’s Royal College of Physicians to establish diagnostic standards in child abuse cases and she has taught in Canada and Australia.

Wherever they may be, state-of-the-art child abuse programs can dramatically cut wrong diagnoses of abuse and give children the short-term and follow-up care they need, she asserts. Furthermore, such centers can assist police and prosecutors with diagnoses that are more likely to stand up in court.

“In my type of cases, (medical evidence) is absolutely crucial. It is the most important factor,” says Ryan Rainey, a senior deputy district attorney who prosecutes criminal child abuse and child homicide cases.

Abuse witnesses are rare, Rainey explains, noting that “the family always seems to cover for each other.”

Tilton adds that centers such as Heger’s not only aid law enforcement, but also protect parents and children who may have been unjustly separated by courts and social service agencies.

In 1990, the latest year for which she has numbers, Tilton says the USC-County Clinic conducted 247 re-examinations of children and found that “at least 100” had not been molested and had been unnecessarily placed in foster care for more than three months. The wrong diagnoses and subsequent foster care cost the county more than $1 million, Tilton says.

“We’re not going to send out the police to remove a child from the home based on a 2-year-old masturbating, which were a huge number of cases that we had reported to us seven or eight years ago,” Heger says. “Or a nurse looked at a kid’s genital area and thought the hymen opening was too big. Well baloney, we know that doesn’t mean anything. We’ve proved that with the research we’ve done here. It means nothing.”

Both Tilton and Heger argue that Los Angeles County should have three more child abuse medical centers--two in the San Fernando Valley and one in the Antelope Valley.

Now, Heger says, she sees children from both areas at County-USC, a time-consuming and inefficient process.

Moreover, the workload continues to increase. Last week the Inter-Agency Council reported that in 1991 sexual and physical abuse in Los Angeles County jumped 11% to 120,358 cases. Murders of children by parents or caretakers shot up 33% to 61.

Then what do I do with (Maria’s) family? So instead of it being an hour visit, it’s a three-hour visit because the two hours at this end are spent with the father defining virginity. “What’s virginity? Is my daughter still a virgin? “ “Yes she is a virgin.” Loss of virginity implies consent. It doesn’t mean somebody raped you. This is a big issue in this part of town. It’s never not asked, never not asked. . . . Every kid that leaves here is a virgin to their parents, from me. . . . It’s a neat piece of power to have . . .

Although she staunchly backs “conservative” diagnosis of sex abuse, Heger, who often testifies in court, clearly wants more sex abuse prosecutions.

On the phone one recent day, her anger boils over when she learns a suspect will not be kept in custody, even though he’s a threat to a patient.

“This guy is going to kill this kid today if (law enforcement) doesn’t intervene . . . ,” she snaps. “I am completely and totally disgusted.”

A few minutes later, Heger says, “Kids are safe to be abused. . . . It’s not like taking a gun out and shooting your next-door neighbor to death. If you do that with your frustrations, you’re going to do big time. If you do that with a kid, you’re not going to. They’re vulnerable, they’re small, they nag, they pick on you, they come and ask you things at the wrong time.”

With some bitterness, Heger remembers what a prosecutor once told her: “When you have victims who are dead, it’s easy to convince a jury that something bad happened. If they’re dead, it’s easy.”

The interesting thing on this 9-year-old . . . It’s just egregious assault on this kid, it’s just disgusting. I called law enforcement because we’re required to report . . . and he says, “Well, you know, we probably won’t be able to prosecute this case because we have no money to bring witnesses from Southern California to Santa Rosa.” So isn’t that an interesting message? It’s like that assault against (Maria) is so insignificant in the overall process of our financial woes that we would not prosecute this guy.

Heger’s experience with the courts--and with controversy--stretches back more than a decade. She was a major prosecution witness in the McMartin case, which dragged on for years and ultimately resulted in no convictions despite two trials for the principal defendant.

Heger testified she found indications of sexual abuse in most of the children involved in the infamous case. Her testimony was disputed, at least in part, by defense witnesses.

Jurors in both trials said they believed the children had been molested, but were unable to agree on who committed the abuse.

Today, Heger won’t discuss specifics of the case but acknowledges that it was a crucible of personal transformation. It taught her, she says, that “if your ego is why you’re involved in this field, you’re there for the wrong reasons.”

More recently, Heger became involved in a furor over San Diego’s child care system, which has been rocked by mishandled cases in which abuse was wrongly diagnosed. Heger disputed one doctor’s clinical finding of abuse, and a letter she wrote regarding that diagnosis was leaked to the press.

But even if the justice system were perfect from her viewpoint, Heger points out that abused children tend to become abusive parents. And that is a cycle she thinks can only be broken by massive intervention.

If she had her way, Heger would provide medical and mental health services in every school, along with sexual abuse prevention programs. Ideally, abused children would be identified and put into therapy, breaking the cycle.

“I see sociopaths in the making here all the time because of the violence in their homes,” she says.

She also advocates parenting programs in junior high schools, and she also would start providing birth control information in junior high schools.

Most of the time, Heger thinks she does pretty well in handling her own reactions to the social wreckage she sees. Once in a while her defenses break down.

“Some days are very hard here,” she says. “Some days you weep when you go home in your car.”

In particular she recalls an interview with a child who was shuttled between his foster and natural parents.

“At 4 years he reunited with his biological mother and they proceed to tie him up and lock him in closets. . . . He’s just the cutest thing. His (foster) mom comes in the room after I’ve been talking to him and he says to (her), ‘But, mom, when they put me in the closet and I called for you, you didn’t come.’ And I go home and relate it to my own kids and it makes me kind of weepy.

“You end up accepting the fact you can’t make it perfect for everybody. That was the hardest thing in the world for me. I’m not kidding you.”