### The Zoom Call that Brought Clarity and Conflict

It was set to be a standard Zoom meeting, a digital bridge connecting disparate lives intersected by crisis and advocacy. On my side, the Controller's team was prepared—Nanton Johns, my Deputy Controller; Joe Buick, our senior auditor; and Michelle Hobel, the operations manager. We had the familiar setting of our small conference room, equipped with a projector hooked to a PC, a large dry erase board which we would use as our screen, and an array of bookshelves loaded with auditing literature, save for one outlier—a book of dad jokes that offered a much-needed respite from the grueling numbers.

The purpose of the meeting was clear which was to understand the story that the ladies would present and see if it represented an area where the county needed to make changes.

We were to engage with individuals from the alleged victim side: Beth Maloney, a lawyer known for her fierce representation of her clients Kim and Steve Steltz; Kim Steltz herself, a woman ensnared by the system that unjustly removed her children; and Alyx, Kim’s steadfast friend and advocate.

As we logged onto Zoom, the faces of Beth, Kim, and Alyx appeared. {MAYBe WE DESCRIBE THEM} They had clearly done their homework on what my office did, grasping that my primary role wasn't just bureaucratic but fundamentally aimed at preventing financial waste—a critical understanding that would soon link our fiscal responsibilities with their fight for justice.

Beth Maloney was the first to speak, her voice steady, indicating both her experience in representing people that had interactions with Children and Youth and those people were being mistreated and misunderstood.

She outlined the case of Kim Steltz, whose children had been taken by the system under dubious circumstances that suggested a misallocation of resources and perhaps deeper systemic issues.

Kim's then began to tell her story through her eyes. As Kim shared her story, it was not just a recounting of loss and pain but an exposé on the bewildering maze of social services and legal proceedings that had engulfed her family.

{TALK ABOUT HER SON SAYING HE WAS ABUSED}

It was during this difficult revelation that she mentioned that she and her husband had been diagnosed with Munchausen Syndrome by Proxy (MSBP), by a Lehigh Valley Hospital's Child Abuse Pediatrician. The doctor had never even met the parents (that bears repeating. She never met the parents)

A child abuse pediatrician is a medical doctor who specializes in identifying, treating, and preventing child abuse and neglect. There are only about 350 of these types of doctors in the USA. These professionals play a role in the medical evaluation of children who are suspected victims of abuse or neglect.

The first time I had ever heard of MSBP was through a song titled "Cleanin' Out My Closet" by the American rapper Eminem from his album *The Eminem Show*. Eminem's raw lyrics touched on his tumultuous relationship with his mother, who he suggested had issues related to mental health and deceit, aligning somewhat with the characteristics of MSBP. At the time, the internet was still still in its early years. I had to go look up what MSBP was in a dictionary.

I learned that it is psychiatric condition wherein a caregiver, often the mother, pretends that their child is sick. The mom does this to show that she is loving. However in reality she is the one who is in need of positive reinforcment. The mom is just pretending that the child is sick but in fact is that the child is not sick.

{TALK ABOUT HER SON SAYING HE WAS ABUSED - include the information about the nurse and what she thought}

The implications of such a diagnosis are severe and multifaceted. In Kim's case, the diagnosis had triggered an immediate and aggressive response from social services.

[describe her and her husband leaving Orion at the hospital and then coming back and being denied access to their child. In fact they were not even should he was still in the hospital]

Her children were removed from her home under the suspicion that she was harming them by manufacturing symptoms of illnesses they did not have. This kind of diagnosis not only leads to legal and social repercussions but also casts a long-lasting shadow over the accused, affecting their relationships, their standing in the community, and their interaction with healthcare and legal systems. For Kim, 60 days from the time they took her child she would no longer be able to provide mental health services to children. {in PA if you are accused of child abuse, even before you are found guilty, you go onto a child abuse registry. There has been no judge, no jury. Just the word of a caseworker}

The challenge with MSBP lies in its diagnosis and the subjective nature of the evidence often used to substantiate it. Symptoms are deliberately produced or lied about by the caregiver, but these must be distinguished from legitimate medical conditions. Furthermore, the healthcare system's reliance on caregiver reports can make it particularly vulnerable to manipulation by those suffering from MSBP.

[WE NEED to develop the emotional connection with the reader specifically about her children being taken away and that there wasn't a real diagnosis]

As the meeting progressed, the gravity of the situation and the complexities of diagnosing such a disorder became clear. It was evident that MSBP is not just a medical or psychological issue but a profound social and legal conundrum. The condition's secretive and deceptive nature makes it incredibly challenging to manage and treat, often requiring a coordinated approach among medical professionals, psychologists, and social workers to ensure the safety of the child involved and to provide the necessary mental health support to the caregiver diagnosed with the disorder.

Kim's narrative was a stark reminder of the critical need for accurate diagnosis, compassionate treatment, and a fair legal process.

Alyx, supporting her friend, added layers to the story with details on her efforts to be the Kinship care provider to Kim's younger son. Alyx made personal sacrifices to support the Steltz family. Her contribution painted a vivid picture of a diagnosis gone wrong.

As the meeting progressed, the room—the very essence of bureaucratic functionality with its brown bookshelves and whiteboards—seemed to shrink under the weight of the real-life implications of our work. The book of dad jokes, a light-hearted anomaly among serious tomes, reminded us of the need for humanity in our dealings; that behind every figure we scrutinized was a human story, perhaps as compelling or as tragic as Kim’s.

The resolution of the meeting was not in actions. We had to decide if we were in fact going to do an audit and if so what kind of audit. We needed a moment to process the information shared by our three guests. They were smart as their presentation effectively linked their personal experiences to the various expenditures by the County, including caseworker time, legal services, therapy sessions, and more. They understood that the Controller's office was focused on misuse of taxpayer dollars. They showed misuse.

The immediate question was whether this incident was an isolated case—a single family entangled in an unfortunate situation—or indicative of a systemic issue in the county protocols for removing children from homes.

The room was filled with a sense of bewilderment; none of us had previously encountered such a problem. One of the constraints on the Controller's Office in terms of the hours allocated for audits, and the legal requirement to conduct multiple audits, we had a vigorous discussion on how to proceed. Ultimately, it was decided that I would conduct further research on the matter and report back to the team with my findings.