After a 1994 visit to the White House, where 7-year-old Jennifer Bush gave First Lady Hillary Rodham Clinton a lucky silver dollar during a much-ballyhooed media event and expressed her hope that "everyone can have good insurance," the blond youngster seemed a poignant symbol for the administration's battle to reform health care.
In a relatively short life, Jennifer's mother explained, her child had been hospitalized some 200 times and undergone 40 surgeries in which doctors removed her gallbladder, appendix and a portion of her small intestine. After $3 million worth of medical treatment, Kathleen Bush said, the family's finances were wiped out and Jennifer was still plagued by a variety of mysterious illnesses that had left her tethered to a feeding tube implanted in her chest.
Now, less than a month from her 10th birthday, Jennifer is in the custody of welfare workers and her mother has been charged with fraud and aggravated child abuse by deliberately making her daughter sick.
According to police, prosecutors and a host of medical experts, Kathleen Bush, 38, exhibits signs of a mental illness called Munchausen syndrome by proxy, in which sufferers, usually a mother, lie about their child's health or purposely make them ill to gain attention from doctors and the public.
Beginning when Jennifer was 6 months old, prosecutors allege, Kathleen Bush induced illnesses or infections in her child and reported false symptoms that have led to unnecessary surgeries and other invasive treatments. In a 48-page affidavit, Hollywood, Fla., police Det. Curtiss Navarro detailed dozens of incidents in which Bush is accused of "willfully torturing" her daughter.
"This is an extremely classic case," says Herbert A. Schreier, chief of psychiatry at Children's Hospital in Oakland, Calif., and an expert on Munchausen syndrome by proxy.
After reviewing Jennifer's medical history, Schreier concluded that "Mrs. Bush directly caused illness in this child of the most severe and life-threatening nature, by injecting material in and around her surgically implanted feeding tubes and into her bladder."
Bush, also charged with fraud in connection with obtaining more than $50,000 in medical care or charitable donations, has been ordered to stay away from Jennifer, the youngest of her three children. Jennifer has been in a Cincinnati pediatric hospital for a week, undergoing tests to determine if any of the ailments are real.
Free on $25,000 bond, Bush has proclaimed her innocence.
Her husband, Craig, and their two teenage sons have not been implicated in the alleged abuse.
Schreier calls Munchausen syndrome by proxy "a bizarre but not a rare illness" that takes its name from Baron Karl Friedrich Munchausen, an 18th century German soldier known as a teller of tall tales. Munchausen syndrome applies to those who seek attention by feigning or causing their own illness; Munchausen syndrome by proxy describes those who use others, often their children, for the same end.
According to Schreier and other experts, the signs of a possible Munchausen syndrome by proxy case include a child whose maladies baffle doctors and a parent who will "doctor-shop" for a diagnosis, urge invasive treatment and remain calm in the face of the child's illness. The parent usually is medically knowledgeable and comfortable with hospital staff.
Bush, who for years worked as office manager for Jennifer's pediatrician, seems to exhibit all the characteristics, including a hunger for publicity, prosecutors say. While pleading financial hardship due to Jennifer's illnesses, prosecutors say, the Bushes spent freely. Even as a local newspaper recounted the Bushes' disappointment over their inability to buy Jennifer the playhouse she wanted for Christmas in 1994, the couple was spending lavishly on vacations, motorcycles, cars, a swimming pool and remodeling.
Times researcher Anna M. Virtue in Miami contributed to this story.