Madison Meyer spent much of her early adolescence suffering from a mysterious illness that caused broken bones, dislocated joints and chronic pain, and led to multiple surgeries.
An initial diagnosis pointed to a connective tissue disorder. But as her health continued to fail, Madison and her parents, Bill Meyer and Dana Gascay, criss-crossed the country in a desperate search for doctors who could explain what was stealing her childhood.
“To say we were concerned is an understatement,” Gascay said. “Obviously, as a parent, you hate standing by and seeing your child suffer.”
By early 2019, Madison’s condition had reached the point where her medical team transferred her to Rady Children's Hospital for round-the-clock care. Meyer and Gascay stayed by their daughter’s side, helping to clean and bathe her and taking turns sleeping on a makeshift bed in the hospital room.
What the family didn't know was they were being watched.
For more than a month, according to a lawsuit filed by the family, the hospital’s child protection team kept Meyer, Gascay and Madison under secret, 24/7 video surveillance in a failed effort to prove the parents were abusing their daughter. In court documents, hospital employees acknowledge using video surveillance to monitor Madison’s hospital room. But the Meyer family alleges they didn’t have a search warrant and never captured any evidence of abuse on tape. The family is suing in federal court, alleging that San Diego County, Rady and individual employees violated their privacy rights.
“This was just beyond a horrific violation,” Gascay said through tears during a recent interview. “You feel violated and dirty, because somebody's there watching everything that you do.”
Rady’s child protection team and San Diego County’s child abuse investigators suspected Madison was the victim of a condition called Munchausen syndrome by proxy, also known as factitious disorder imposed on another. It’s a form of child abuse in which a parent fabricates or causes real injuries to a child, with the aim of getting medical attention. The hospital used the surveillance in an effort to prove their suspicion.
Munchausen by proxy is among the most dangerous forms of child abuse, according to researchers, with an estimated 9% mortality rate for victims. As a result, many physicians and child abuse investigators in recent decades have secretly monitored parents in suspected cases. In fact, Rady’s lead child abuse pediatrician acknowledged in her response to the complaint that the children’s hospital has used hidden cameras in these situations.
However, there is sharp disagreement among medical professionals and legal experts about the practice.
Supporters argue that the substantial risk of a child dying justifies covertly monitoring parents and patients, even in sensitive settings like a hospital room. Opponents argue that the surveillance is a blatant intrusion on privacy and runs the risk of victimizing innocent families.
In the Meyer family’s case, according to their complaint, a San Diego County Superior Court commissioner said the 38 days of surveillance went beyond the pale. When awarding Meyer and Gascay custody of Madison in 2020, the family alleges, Commissioner Michael J. Imhoff called it an “unbelievable” and “insensitive invasion of privacy.”
Rady declined an interview request.
“At Rady Children’s Hospital-San Diego, our top priority is providing the highest level of care to our patients and families,” read an emailed statement provided by Ben Metcalf, the hospital’s corporate communications manager. “The hospital does not comment generally on pending litigation and cannot comment specifically on this case due to patient privacy protections under federal and state law.”
San Diego County also declined an interview request.
In an email, county spokesperson Michael Workman emphasized that “social workers and medical professionals are required by law to report and investigate suspected child abuse” and that “no county employees were involved in the decision to surveil plaintiffs’ daughter’s hospital room.”
However, Dr. Shalon Nienow, Rady’s division director of child abuse pediatrics who recommended the covert surveillance, confirmed in a court filing that she communicated with the main county investigator about Madison’s care throughout the investigation.
Attorneys for Nienow, a defendant in the lawsuit, did not respond to multiple requests for comment.
Madison’s failing health
On a recent afternoon, Meyer and Gascay flipped through a thick folder of photos, letters, drawings and award certificates on their dining room table. It looks like a scrapbook of keepsakes from Madison’s childhood. But it’s not — it’s a collection of exhibits from the parents’ battle to retain custody of their daughter.
Meyer and Gascay had submitted the file to the juvenile dependency court several years ago, in an effort to prove that they provided a loving, caring home for Madison. With so much at stake, they packed the folder with every scrap of evidence they could find.
The photos show an active child who enjoyed soccer, archery, rock climbing and karate, among other sports.
“She wanted to try everything,” Gascay said.
Madison paid an unusually cruel price for this typical childhood exuberance. Between the ages of 9 and 12, she broke her foot, both wrists and a finger, and then underwent surgery for a knee that randomly seized up.
Within a few years, Madison would go from an injury-prone kid with mostly musculoskeletal complications to a bedridden teenager whose failing health perplexed and alarmed a coast-to-coast team of doctors, according to the 120-page complaint Meyer and Gascay first filed in 2021.
Earlier this year, the judge in the case dismissed part of the Meyer family’s complaint but allowed it to proceed on several claims, including on Fourth Amendment grounds, which covers privacy rights.
In August, Madison, who is now 20 years old, filed a very similar lawsuit in San Diego County Superior Court. The family shares the same lawyers, who anticipate the cases might be combined at the federal level. Madison declined to be interviewed for this story but agreed to let her parents speak for the family.
Meyer and Gascay both spent their careers in health care working for Kaiser Permanente. Meyer helped open medical facilities and hospitals around Southern California, and also assisted with the rollout of new technology within the company. Gascay held various leadership roles in program development and in the neonatal intensive care unit.
In 2013, the family moved to Carlsbad from the Los Angeles suburb of Claremont. Gascay said she and Meyer “weren't hysterical parents,” but Madison’s accumulating injuries caused concern. Especially after she dislocated her shoulder in 2016.
“She was at surf camp, had fallen off the surfboard and hit her shoulder in the sand,” Gascay recalled.
The dislocated shoulder never healed properly and continued to pop out of its socket. Madison underwent surgery to stabilize the joint, which initially showed promise, until a physical therapist accidentally dislocated the shoulder again. Her doctors eventually diagnosed her with a genetic connective tissue disorder called hypermobile Ehlers-Danlos syndrome. Common symptoms include overly flexible joints and chronic pain; the condition can also result in a variety of health complications.
At her middle school graduation, Madison delivered a speech while wearing an elaborate sling wrapped around her shoulder and midsection. In her yearbook, she submitted a self-portrait with a message that provided a glimpse of her suffering.
“My shoulder caused problems and led to surgury (sic),” read the yearbook entry. “I am optimistic that this year will be better.”
But Madison’s health problems only got worse.
After a second reconstructive shoulder surgery in the spring of 2018, doctors gave her another diagnosis — complex regional pain syndrome — and urged Meyer and Gascay to enroll their daughter in an in-patient pain management program.
The injuries and hospital stays had forced Madison into a modified school schedule and kept her from the kind of basic activities — playing sports, hanging out at the beach — that most teenagers take for granted.
“She kept saying, ‘Is there something that can be done?’” Gascay recalled. “‘I want to be like other kids. I want to be able to do fun stuff.’”
Meanwhile, the diagnoses kept piling up.
By the fall, Madison had spells of dizziness from dysautonomia, a nervous system disorder. She underwent a battery of tests at Kaiser Permanente’s San Diego Medical Center as doctors struggled to wrap their arms around her sprawling ailments.
Her team transferred Madison to Los Angeles, where her health deteriorated further. Her vision began to fail; she started experiencing non-epileptic seizures. She eventually required a feeding tube and central venous catheter to get essential nutrients and fluids.
Madison returned to Kaiser’s San Diego Medical Center as Meyer and Gascay grew increasingly desperate for answers.
“We weren't sure what to do for her,” Gascay said. In their darkest moments, she added, “We weren't sure if she was going to make it.”
But soon, they’d have a new fight on their hands — trying to keep custody of Madison.
An anonymous allegation
In December 2018, according to court documents, an anonymous caller dialed San Diego County’s child abuse hotline. They claimed Gascay was abusing her ailing daughter by tampering with her IV pump and interfering with medical staff.
To Madison’s parents, it sounded preposterous.
“It was like, what is this? What does this mean?” Meyer said.
But the county is required to investigate any credible allegations of abuse. A child welfare investigator named Kayla Valenzuela interviewed Meyer, Gascay, Madison and members of the medical team. One doctor acknowledged that some nurses disliked Gascay for supposedly "babying" her ailing daughter, the lawsuit alleges, but the doctor emphasized there was no evidence of child abuse.
Amid the investigation, Madison’s medical team in San Diego agreed to transfer her to a New York-based neurosurgeon who specialized in hypermobile Ehlers-Danlos syndrome. In January of 2019, Madison flew to New York via air ambulance. Gascay and Meyer traveled to the east coast, too.
The doctors in New York ran tests that fleshed out Madison’s litany of complications, stemming from her hypermobile Ehlers-Danlos syndrome, according to the Meyer family’s complaint. Upon returning to San Diego in late January, Madison would be transferred to Rady to receive round-the-clock care.
Valenzuela eventually closed the child welfare investigation and “no findings were made,” according to the county’s response to the complaint. Yet, it didn’t end there.
During her investigation, Valenzuela contacted Nienow, the child abuse pediatrician at Rady.
Nienow has a high profile in her field. In addition to her role at Rady, she’s the clinical director of Child Abuse Pediatrics at UC San Diego School of Medicine and helps lead the American Academy of Pediatrics’s Council on Child Abuse and Neglect.
Nienow reviewed Madison’s medical record and grew alarmed. She suspected potential medical child abuse — another name for Munchausen by proxy. So Nienow, according to the complaint, developed a plan.
38 days of covert surveillance
Nienow recommended placing Madison in a Rady hospital room equipped with hidden video surveillance when the ailing teenager returned from New York.
“Dr. Nienow admits (Madison) was monitored in a room with video surveillance as a medical diagnostic tool to determine whether (she) was a victim of medical child abuse,” she stated in her legal response to the complaint.
The Meyer family alleges Nienow then instructed Elizabeth Reese, a member of the child protection team at Rady, to call the county’s child abuse hotline and make another report against Meyer and Gascay. Reese allegedly told the county that Madison, with the involvement of her mother, was purposely dislocating her shoulder, faking seizures and feigning partial blindness. The county again assigned Valenzuela to investigate.
Reese, in her legal response to the complaint, denied involvement in Nienow’s surveillance plan. She states she did not agree to place Madison in a camera-equipped room to “prove Nienow’s hypothesis” and “denies that the use of the video-equipped room was to develop evidence of medical child abuse.”
Nevertheless, the video was rolling from the time Madison entered her hospital room, according to the complaint, and continued recording for the next 38 days. (The family alleges there were actually two hidden cameras watching them.)
The covert surveillance captured Madison during her most vulnerable moments — while Gascay undressed Madison and cleaned her after bowel movements, as well as during sensitive medical procedures, such as the placement of a urinary catheter.
“To have that video go on, and on, and on for 38 days … it's gross, and it's inhuman,” Gascay said. She watched the video recordings during the custody battle and said it left her traumatized.
What the surveillance didn’t capture, according to the Meyer family, was evidence of abuse.
“Not even one snippet of the secretly recorded video supported Nienow’s fraudulent conclusions,” the complaint states.
Meanwhile, the county pursued its investigation after the second hotline referral. Valenzuela again interviewed Meyer and Gascay, according to court documents. The parents claim Nienow never spoke to them.
Valenzuela also interviewed Madison’s doctors. The complaint quotes several of her physicians, who allegedly told Valenzuela that they saw no evidence of abuse or interference by Madison’s parents. The specialist in New York specifically explained how doctors sometimes mistake Ehlers-Danlos syndrome for Munchausen by proxy, according to the complaint.
Throughout her investigation, Valenzuela also maintained consistent communication with Nienow to discuss the suspicion that Madison was a victim of medical abuse at the hands of her parents, according to court documents.
The Meyer family alleges Nienow submitted a report to Valenzuela in February that contained surprising claims of medical child abuse. For example, according to the complaint, Nienow claimed Madison didn’t break her finger, foot and wrists in 2013, and that she was treated for multiple fake fractures at the insistence of her parents.
Nienow, in a response filed in court, acknowledged writing the February report but didn’t address its specific contents.
Nienow followed up with another report, according to the complaint, claiming Meyer and Gascay had to be “immediately removed” in order to prevent their daughter from dying.
Valenzuela used these reports and other evidence to petition a judge to place Madison in protective custody. The judge issued a warrant on March 7, 2019, to remove Madison from the care of her parents and scheduled future hearings for additional review of the medical child abuse allegations.
Meyer had spent that day at his daughter’s bedside, unaware that he would soon lose custody of her for nearly a year. As evening settled, he stepped away from the hospital to get dinner at the nearby Ronald McDonald House. Gascay was at home resting.
Meyer said he received an urgent call from Rady, asking him to return immediately. He left his half-eaten dinner and encountered staff and security members when he arrived at the hospital. They led him to a conference room, where Valenzuela, Reese and others were waiting, according to the complaint. Valenzuela told Meyer he and his wife no longer had custody of their daughter. The hospital revoked their parental access badges.
“I was absolutely stunned,” Meyer said.
Rady’s security led Meyer to the lobby, where he waited for Gascay to pick him up. Some people passed through, but the room remained mostly empty. In the corner, a child sat next to a train set and kept pressing the button to make it roll.
Meyer sat there, watching the train go round and round, wondering if he would ever see his daughter again.
The debate over surveillance
The precise details of what happened over the next 11 months, as Meyer and Gascay litigated the county over Madison’s custody, remain something of a black box.
Child abuse and juvenile custody cases are closely guarded by the judicial system and typically are not available to the public. While the Meyer family’s ongoing civil litigation has shed some light onto the custody proceedings, much of the information introduced into federal court has been sealed by the judge.
During the custody litigation, according to the family, Meyer and Gascay were only allowed to see Madison twice a week during supervised, one-hour visits in the hospital. They weren’t allowed to discuss her medical treatment or the custody proceedings during visits.
In February of 2020, Michael J. Imhoff, the San Diego County Superior Court commissioner, awarded custody of Madison to Meyer and Gascay. But 11 months of separation — after more than a month of alleged covert video surveillance — took its toll.
“It ruined our family — tore us apart,” Gascay said. “We're doing our best to get our family back together. We're all in therapy.”
While many aspects of this case are under seal, no one up to this point appears to dispute that Rady’s child protection team, while in communication with county investigators, made the controversial decision to secretly surveil Madison and her parents for more than a month.
Hospitals and child abuse pediatricians have used covert surveillance to investigate many suspected cases of Munchausen by proxy in recent decades. Studies have found it can be an effective tool for gathering evidence.
But the practice has sparked impassioned debate among medical and legal experts for as long as it’s been implemented.
“On the face of it, it's both unethical and unnecessary,” said Michael Flannery, distinguished professor of law at the University of Arkansas at Little Rock’s William H. Bowen School of Law.
“It ruined our family — tore us apart. We're doing our best to get our family back together. We're all in therapy.”— Dana Gascay, Madison Meyer's mother
When using video surveillance, he argues, medical staff are required to let the child abuse play out in order to gather evidence. Flannery believes a more ethical — and effective — approach is to temporarily separate the parents from a child or require supervised visits. If the child’s condition improves as a result, that’s reliable evidence of potential medical abuse.
Flannery reviewed the Meyer family’s complaint and was troubled by the alleged use of covert video surveillance.
“It struck me as just violative of the family's Fourth Amendment right to privacy,” he said.
He said the highly sensitive material captured by the recording — while Madison was changed, bathed and treated medically — indicates there was a reasonable expectation of privacy in the hospital room.
He also expressed concern about the alleged duration of the surveillance. Covertly monitoring a family for 38 days, especially without a warrant, seemed excessive, he said, and “an indicator that there's not much going on in that hospital room.”
The use of surveillance appears to be much shorter in other documented cases of Munchausen by proxy. One study examined 41 cases that involved covert surveillance. On average, investigators confirmed Munchausen by proxy using less than four days of video surveillance.
Other child abuse experts, however, argue surveillance plays an essential role in diagnosing Munchausen by proxy cases, given the high mortality rate for victims and lasting debilitation suffered by many survivors.
“I'm an advocate for all the tools that we could possibly use that could help us protect children from this,” said Beatrice Yorker, professor emerita of nursing and criminal justice at California State University Los Angeles.
She said hospitals should use covert video surveillance after doctors have ruled out other likely causes of an ailment.
Yorker, who has led trainings and written articles on diagnosing Munchausen by proxy, emphasized the incomprehensible and horrific nature of these cases. She’s reviewed cases, for example, where a mother has smothered her child and claimed they suffered from sleep apnea; in other cases, mothers have induced E. coli sepsis in their children. (Yorker notes, and research affirms, that most cases involve a mother.)
She argues that a patient might have limited privacy rights in a hospital room. However, she believes certain safeguards should be in place, such as hospitals developing clear protocols and establishing review teams to sign off on the use of surveillance.
And when there are signs of abuse, she added, hospitals should seek court approval to continue their surveillance.
“When you have probable cause of a crime, then you need to get a warrant,” she said. At that point, the hospital should also involve child protective services and potentially law enforcement.
Yorker also spoke in defense of Rady in general, and said she has “the utmost respect for them being leaders in the field of child abuse and neglect.”
Experts on either side of the debate acknowledge the dire stakes at play.
Raanan Gillon, a prominent physician and former president of the British Medical Association, wrote that the issue posed a “poignant moral dilemma” for medical professionals. He cautiously argued for the use of covert surveillance in suspected medical child abuse cases, but admitted there are pitfalls.
“There is a risk that innocent parents will as a result from time to time be wronged,” he wrote.
The Meyer family claims they fall on the innocent victim end of the moral equation. Surveilled, stigmatized, torn apart — and now left to put the pieces back together.
The family said they intend to prove as much in court.
“I don't want this to happen to another innocent family,” Gascay said. “This is unconscionable.”
