Transcript of Episode 3: Better Safe Than Sorry

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It's been two years since all those people showed up at the Lehigh County Commissioners' meeting to tell their stories. Now, 27 families are suing Lehigh Valley Health Network, Dr. Jensen, and members of the child protection team she led. The lawsuits make several claims, including medical malpractice, negligence, and malicious prosecution. Again, I wanted to talk to Dr. Jensen and to decision-makers at the hospital where she worked. But in an email, a spokesperson for the hospital wrote that while they had a lot to say about the family's allegations, and they very much wanted to speak with us, they couldn't because of the pending litigation. Instead, they pointed us to a court filing, a lengthy response to the claims in one of the lawsuits. That filing, they said, was a good representation of their position. In that response, the hospital unequivocally defends the reputation and expertise of Dr. Jensen. They call her dedicated passionate, passionate, and eminently qualified, heroic even. The filing argues that child abuse is actually underreported and that the, spurious claims made by the plaintiffs represent a danger to children in the community. Unfortunately, they write, child abuse pediatricians are often attacked by parents seeking retribution.

Parents accused of abuse often have a history of embracing a, The best defense is a strong offense mindset, frequently lodging complaints against those who identify mistreatment in an effort to deflect blame. The hospital was implying that these families hadn't really been harmed. Instead, they'd hurt their own children and were only suing to hide that fact as a smokescreen. In other words, let these parents complain. That's fine. We can take it because we know what we're doing is right. That's pretty much what the Lehigh County executive, Phil Armstrong, said to me, too. He's the county's highest elected official. I'm very, very confident in our youth program and what they've been doing. I really think all along we've been following the correct steps, the correct procedures, and doing what we think is best. Pennsylvania is actually one of a handful of states where child welfare isn't state-run, it's county-run. So Armstrong oversees the system's funding, policy policymaking, case worker training, et cetera. He wasn't Dr. Jensen's boss. She worked for the hospital, but he was as close as I could get. Armstrong couldn't discuss any specific cases, but he did talk generally about the county's approach to child welfare and to complaints from parents.

We want to always make sure if there is going to be an error, it's going to be to help the children stay safe. That was our number one concern. Okay, so what I hear you saying is it's a better safe than sorry approach. Oh, absolutely. I mean, the opposite. If you look and say, what if the child welfare system didn't act and something happened to that child, then, oh, my gosh, that's just one of the worst things. So I think you have to be overprotective for the children. If the parents are going to yell at me later, as long as I insured the child's safety, I would make that my number one priority. I thought a lot about this phrase, Better safe than sorry. Of course, the Phil Armstrong's of the world want to err on the side of caution. I understand that conservatism, especially where children are concerned. When abuse is obvious, better safe than sorry is a defense responsible choice. And intervention, even the most serious kind, taking a child away, might make sense. But what about when abuse is not obvious? What about the cases where doctors and caseworkers are making judgment calls about events obscured by a giant question mark because the only witness is a small child, or the injury isn't necessarily caused by abuse, but you also can't roll it out?

What then? What's the harm of better safe than sorry in cases like that? My answer to that question is the story of Amanda Serenovski. She's one of the people now suing. Amanda's story goes past the ER and Dr. Jensen's office, past the children and youth caseworkers and county prosecutors prosecutorsers, and deep into the question of how she's supposed to even be a mother now that the worst of their ordeal is supposedly over. From serial productions and the New York Times, this is The Preventionist. I'm Diane Neri. And for our final episode, I want to tell you about Amanda, about how her family was taken apart, and then the unvarnished story of how she tried to stitch it back together. I spent more than a year talking to Amanda as she tried to figure out, in real-time, how to repair her family of five young children. From our first meeting, I was floored by how and vulnerable she was and how little she tried to hide it. She was 31 when all this started. It was mid-December of 2019. Amanda had given all five kids their baths, fed them dinner, and put them to bed. The kids were little.

The oldest was eight, the youngest, just seven weeks. She had her hands full, obviously. A note here. We're not naming any of Amanda's children in this story to protect their privacy. So when you hear bleeps in the tape, That's why. Amanda's house is small, a mobile home with three bedrooms. One of the bedrooms was being renovated, so the sleeping arrangements were make do that night. Four children were in the biggest bedroom. The newborn was in the living room with her. Amanda on the couch, the baby beside her in a bassinet. 5: 30 AM, Amanda says she was jolted awake by the sound of a thud. She looked around and immediately saw the baby was not in the bassinet. Instead, her two-year-old daughter was sitting inside it, and the baby was on the floor crying. His onesie had been unzipped and his diaper was off, as if her toddler had been trying to change her baby brother. Amanda remembers saying, What did you do? Loudly enough that the three older kids heard it from the other room. She took the toddler out of the bassinet, picked the baby up off the floor. She was able to soothe him.

She grabbed her phone.

I called my sister She didn't answer. Of course, it was early in the morning. I called their father. He didn't answer. I called the doctor. When they said, If it's an emergency, call 911. I'm like, What am I doing?

She dialed 911, and within 20 minutes, an EMT was checking out the baby. According to the report, the baby was conscious and alert. Pulse was strong. They strapped him into a baby seat and took him by ambulance to Lehigh Valley Hospital, Cedar Crest. Amanda followed, waiting in the hospital for hours as her newborn was assessed.

They let me feed him. Let me hold him. The doctor came and told me that it was almost eight hours later. That he had a brain bleed, and I lost it. And then it went from brain bleeds to fractures, and then I lost it again.

She was terrified, not only about her baby's injury, but about what might happen to her and her children. She texted relatives. She texted friends. She hadn't known her daughter was awake, she wrote. Hadn't heard her at all. I was sleeping, she texted. I feel like a piece of shit. I can't even believe the kids were up at 5: 30. They went to bed at 8: 00. Usually, they will sleep until at least 6: 37 on the weekend. All her fears were spilling out. I feel so sick to my stomach, she wrote. Am I that bad of a person? I failed my children. The people she was texting tried to reassure her. They told her, You're overreacting. Amanda was not comforted. I feel like I'm going to puke. I'll die if they take my babies.

Everybody knows how I am. The littlest thing, I'm like, Oh, my God. Oh, my God. They're going to do this. I immediately panicked because I don't want to deal with these people. I already know how these people are. I've watched another one of my friends. A few people I know have lost their kids. A few of them.

Amanda lives in a rural area north of in town, Pennsylvania. Growing up, she saw her own mom scrutinized by child welfare. And since she herself had become a mother, children and youth caseworkers had scrutinized Amanda, too. When her first child, her daughter, was only a month old, she got a head injury. Amanda's boyfriend said she'd fallen out of her car seat, which he'd been swinging to calm her. Doctors were suspicious of that story. Eventually, Amanda was, too. Child welfare indicated the father for abuse. Amanda separated from him and kept custody of their daughter. Children and youth kept tabs on them for a while. Later on, Amanda met Janio Castillo, who would become her partner. They had three children together, a boy and two more girls, when Janio was accused of harming their youngest daughter. She was also tiny at the time, just two months old. Janio lied at first, but finally admitted that he'd been changing the baby's diaper when her arm got caught behind her as he rolled her from one side to the other. An X-ray showed a fracture, which can happen like that by accident. But a child abuse pediatrician believed the injury was indicative of abuse.

Janio denied he'd hurt her on purpose, but eventually, played no contest to aggravated assault. During all this, Amanda was pregnant with her fifth child, her fourth with Janio. The two of them didn't live together anymore, and she was working full-time at the Criola factory and raising her growing family alone. Caseworkers from children and youth once again coming around, knocking on her door, which of course was stressful. But also this time around, Amanda thought it was unjust because she absolutely believed Janio's story. She still does. She told me he would never hurt the kids intentionally. Janio told us the same, that it was an accident. The pediatrician who made that finding of abuse in Janio's case, Dr. Deborah Ascernio-Jensen. Amanda didn't trust her. And so now, here Amanda was, back in a Lehigh Valley hospital with another injured newborn, about to be assessed by the child protection team. It didn't look good, and Amanda knew it. Amanda She says she asked for a different doctor, anyone but Dr. Jensen. So another member of Dr. Jensen's team took the case, Dr. Rachida Doshi.

Doshi came in. I explained to her what happened, and she said that there's no way it could have happened the way I'm saying that the child could have only gotten these type of injuries from a car accident or from a slam, and not from a shortfall from the bassinet to the floor.

Dr. Doshi was a close colleague of Dr. Jensen. They'd eventually co-author a series of textbooks called Child Maltreatment Assessment. Dr. Doshi found that the injuries to Amanda's baby were caused by, quote, violent shaking with impact, something an adult could inflict, not a two-year-old. I explained the MRI results to the mother, her report says, including the fractures, hematomas, and injury to the bridging veins. I explained to the mother that these injuries occur with tremendous force, and a simple fall would not explain the significant injury, end quote. Dr. Doshi's conclusion seconded by Dr. Jensen, who did a follow-up exam of Amanda's baby, was that he'd suffered, quote, abusive head trauma, near fatality.

So I was asked to leave the hospital. And then we went to court then Monday, and they removed the children.

When you got home from the hospital, when none of the kids were there, I can imagine-I didn't go home. Oh, where'd you go?

I stayed at friends' houses. I couldn't go home. I was all over the place. I couldn't be alone. The case worker called the suicide people on me.

Amanda read that move as a tactic. They'll say I'm unstable, that I have postpartum depression. They'll call the cops on me. Somehow, they'll use it against me. So she dodged their calls and visits. When they finally did make contact, she told them she was fine. All five of Amanda's children were sent to live elsewhere while the county investigated the suspected child abuse. Amanda's youngest, the newborn with the brain bleed and fractures, ended up being fostered by a young couple with no other kids. Her oldest child, a daughter, ended up staying with Amanda's sister for the duration. The middle three bounced around more, sometimes with family, sometimes with strangers. Amanda's contact with her children was restricted, so she couldn't, and still can't, know exactly what happened to them in foster care. Her information is based on what the kids and caseworkers told her and what she observed while she was able to visit with them. We also have caseworker notes regarding the two younger girls, though not for their brother, who was with them for a time. And those notes do track with Amanda's chronology. And that chronology, it's pretty grim. If it were a movie plot, I might even think it was histreonic, a cliched portrait of every imaginable danger of foster care.

But it really happened. In one placement, they witnessed domestic violence. I've read the police report, and it sounds pretty dramatic. Amanda says the kids still talk about it, one parent punching the other, blood, an ambulance showing up. Another placement, apparently the house was never clean. In yet another placement, Amanda's daughters landed in the ER with pelvic pain and visible vaginal irritation and inflammation. Doctors found no signs of sexual abuse, but Amanda was frantic. She was sure her daughters had been molested. As for Amanda's youngest daughter, the toddler, she was struggling so much, was so hard to handle. She was moved something like 10 times, at least. Amanda started to lose count. This first stretch of separation decision, Amanda said it was agonizing. For most of it, she couldn't see her children in person, initially because of COVID, then for legal reasons. So months passed before she was finally allowed to visit them in September of 2020. Mama. You're here.

Hi.

Amanda showed me a video of it. They're in the lobby of a county building, not the warmest of places. So Amanda dressed up as a unicorn to make them laugh. Unicorn. Unicorn.

Hi.

I was trying to make it as easy for them as possible and have that sense of relief that doesn't matter what we're going through, mommy's not going to change. In her darkest moments, Amanda would watch videos of the good times with her kids over and over again. Videos she pulls up on her phone to show me. In one of them, the kids cover the floor with sprinkles and sugar. Look at my floor, it's covered in sprinkles. In another, they make snow angels in uncooked spaghetti noodles they'd spilled across the kitchen floor. There are water bucket pranks and marshmallow fights. As she plays the videos, Amanda is not just smiling. She laughs with her whole body, throws her head back, holds her stomach. It's notable because it's the first time I've seen her laugh like this, both in the video and next to me in real life. She's cracking up.

I would like to play price on them all the time.

Month after month, Amanda visited her kids in a county facility, often costume. One time, she and Yanyo brought a bag of marshmallows to recreate the battles from home. She showed me that video, too. At every visit, she'd listen to her kids ask the same question, unable to give them an answer.

When are we coming home? I want to come home. When are we coming home?

While all this was happening, the Commonwealth of Pennsylvania criminally charged Amanda with aggravated assault for the injuries to her born son. She was facing a total of five felonies and two misdemeanors.

I remember hearing how long I could get in jail.

How long did they say?

Long time. Like 30 plus years. And then they put me in jail, and I've never been in trouble before. That was the worst 14 hours of my life.

She got out on bond and waited. She refused to take a plea. She was adamant she hadn't hurt her son. Anyway, if she pled to anything, even a misdemeanor that involved hurting a child, she damaged her chances of getting her kids back. She wanted a trial, so she waited. Covid slowed down the court system, and there were also the usual delays. Two years passed, Amanda's case got reassigned to a different public defender. Another year passed. And then, late summer of 2023, Lehigh County controller Mark Pinsley, released his report. Dozens of families claim they have been the victims of child abuse reports at the hands of Dr. Jensen. And suddenly, the local news was alight with stories about Dr. Jensen. These families claimed Dr. Deborah Assernio Jensen would falsely accuse them. People were protesting in front of the hospital, demanding Dr. Jensen's resignation. Deborah Jensen's got to go. Hey, hey. Now, the DA's office seemed only too eager to get rid of Amanda's case. They gave her a remarkable offer. If she'd agree to plea no contest to reckless endangerment of a person, not of a child, but of a person, her sentence would be nothing.

No probation, not even court fees. A trial is always risky. So Amanda pled no contest, and it was over. But it wasn't vindication, and it wasn't like she and her children could suddenly go back to normal, she said. Just breazily pick up where they left off. None of this was normal. This whole thing had strangled her life, nearly obliterated her family for almost four years, and then just fizzled. Nothing she'd said or her defenders had said or her children had said had made a difference. Instead, the only thing that seemed to matter was what the doctors said. This is where Amanda's case gets perplexing, because we showed the baby's anonymized medical records to three other child abuse experts, including two child abuse pediatricians, and asked them what they made of the case. None of them agreed with Dr. Doshi and Dr. Jensen's assessment that the baby's injury could only have been caused by an adult. They did not agree with that level of certainty. The two caps said they could see cause for concern. But judging from the scans and the medical narrative, in their view, this case did not bear the classic signs of abusive head trauma.

No hallmarks of rotational injury, no severe retinal hemorrhages, no injury to the neck. And all three doctors independently puzzled over the fact that Dr. Doshi and Dr. Jensen had certified the case as a, quote, near fatality, meaning the baby was in serious or critical condition. They pointed out that, according to the records, Amanda's son never lost consciousness, was alert, and was discharged without needing any life-saving medical interventions. Perhaps most striking, none of them would have recommended that the baby, let alone any of the other children, be separated from Amanda. Instead, it would have been, Let's monitor the family and offer resources that might be helpful, have a case worker investigate further, and see how it goes. The third expert, a pediatrician who specialized in child abuse medicine, went even further. She didn't have concerns about abuse at all, and said if she'd been the doctor on this case, she would have called child services and told them, This was an accident, and that's it. Based on what these doctors said, you can almost imagine on that awful December morning in 2019, Maybe things could have gone differently, and Amanda's life and her kids' lives could have gone back to normal.

Instead, she was stealing herself for a whole new struggle to get her children back home, all five of them. That's after the break. When I first met Amanda, mid-October of 2023, she was just a couple of weeks out from her plea and the end of her criminal case. She wasn't wasting any time. Her first order of business, asking for her kids back. The ones living with Amanda's relatives, they'd be the first to come home.

I'm hoping by the end of the week.

Wow. Okay, that's really soon. So two of them will be home. Hopefully.

Within the next two weeks, hopefully. Hopefully, three of them will be home in the next two weeks.

She's got to paint their bedrooms, put together the new beds she But then, when you look at them, they're all so much bigger now than when they last lived with her.

So I'm trying, but it's mentally exhausting because I have to install cameras on the inside of my house. I have to because children and youth has to do a walk through.

Children and youth does not require that Amanda have cameras inside her house. The cameras are for Amanda. She wants them as an insurance policy because God God forbid, one of the kids gets hurt again. She thinks about this, she says, how if she'd had cameras back when her newborn got hurt, none of this would have happened. All those years, Amanda waited for her criminal case to play out. She was on high alert. She figured she needed a perfect pretrial record if she was going to regain custody. Every single condition of her pretrial supervision, she obeyed to excess. She called in a fenderbender she'd had, since it might count as contact with law enforcement. It does not. She misunderstood the conditions of her release and thought she wasn't allowed to be near children. She was. So for two years, she avoided going anywhere children might be present. Birthday parties, her best friend's wedding, even the supermarket, she wouldn't go. In the eyes of the law, her hypervigilance was a plus. But psychologically, exhausting.

Because I'm afraid it's going to all come back. When I have my kids, if an accident happens, they're going to take them again. So it's not easy at all. I'm scared. I'm scared. I'm not doing anything wrong, but I'm scared. And I see how twisted this system is. It sucks.

And then within weeks, they start to come home. All the kids, except for the baby. Getting him back would be a whole lot more complicated. Before I get to the family reunion, I want to talk for a minute about the family separation, because the effects of that don't just disappear. They can linger, sometimes for a lifetime. Removing a child from their parents is the most drastic intervention the system can invoke. So there's a lot of data about the consequences of doing so, how traumatic it can be every which way, how foster and group homes themselves can be sources of fresh abuse to the children they take in, how outcomes for children in foster care are often dismal for their physical health, brain development, mental health, emotional health. Every bad thing we try to protect children from, if they're separated from their families, they're susceptible. But there's this one law review paper that brought home to me the feeling of removal from the child's point of view. The paper is from 2019 out of the University of Michigan. The lead author is director of the child advocacy law clinic there. When a child is removed and placed in foster care, it says, familiarity is replaced by a pervasive sense of ambiguity, an inherent confusion about what is happening and why and when it will end.

The paper defines six different kinds of ambiguity, basically a set of frightening unanswered questions about what connects you to the world around you. But in this situation, you're not the you listening to this. You're little, maybe really little, 2 or 5 or 10. Asking, Why am I here in this strange house? Is this my bed? Are these my toys? How long do I stay here? And who makes that decision? Who are these people? Who are they to me? Who am I to them? If I'm their child now, am I still someone else's daughter, someone else's sister? Where are my friends and my teachers and my siblings? Where is my mother? Why can I not talk to my mother? The paper calls this Ambiguous Loss, a lack of clarity about where your real family is. Ambiguous loss can traumatize children because they are grieving the loss of a family member who is not dead but is out there somewhere. Parents, too, experience ambiguous loss of their children. They might feel grief, confusion, despair. From what she's told me, Amanda certainly did, and still does. All five of Amanda's children went through this system. Statistically speaking, the ones who stayed with relatives or removed the least or were placed with siblings, they're likely to fare the best.

The ones who weren't as lucky, one of her kids, remember, was moved at least 10 times. They'll likely have it harder. Now, all five of Amanda's children are about bring their piled-up trauma home, where it'll be Amanda's job to figure out how to help them. The next time I see Amanda, her house has transformed. Three months have passed. Her children are back home, all except the baby. Their stuff is arranged neatly around the living room and bedrooms. There's a tall plastic shelving unit in the kitchen with drawers full of their favorite snacks. Amanda is a little on edge. A children and youth caseworker, a young woman named Jonique, is coming over today for what Amanda hopes will be a final visit. Her three oldest children are clear of social services, but her youngest daughter still has an open case with children and youth, and they need to sign off on her return home. Amanda's concerns for the day are twofold. First, the kids' sleeping arrangements. Amanda says, according to children and youth, her son isn't technically supposed to be sleeping in the same room as his sisters. But the three like to sleep together, especially after being separated for so long.

So Amanda allows it. She's hoping her kids won't rat her out. And second, she doesn't want Janique talking to her other kids. She can talk to Amanda's youngest daughter. That's her job. But the other kids, no.

I'll just wait and tell her when she gets here. I already spoke to my attorney about it. My attorney said, No, you are not allowed to talk to them unless there is an adult or somebody present. They are no longer involved with children and youth, and they have enough traumas from you. No.

Hi. Hi. Jonyke arrives, and Amanda, she's solicitous.

Do you want a drink or anything, Jonyke? I'm sorry. No, you're fine. Are you sure you don't want water?

No, thank you. The kids come home from school, and pretty quickly, it's mayhem. Happy mayhem. Them. Yes. They've located some bubble wrap. It's doomed.

And this is from the moment they get home.

Amanda had just bought a behavior chart. Her youngest daughter, the one Jonyke is here to observe and talk to, sidles up to the kitchen table where they're talking. Amanda explains the chart to her.

This is all your tasks you're going to have. Make your bed, brush your teeth.

I'm going to go make my bed wet now. Your bed's already made. Your bed is pushed under.

We will start this tomorrow. Yes, today. No, not today. Today, today, today, today, today.

Her youngest daughter is now six, and she's having behavioral problems. This is the daughter who was moved around in foster care more times than any of Amanda's children. And Amanda is aware that her youngest daughter blames herself for what happened to them, that it's her fault they all got separated for such a long time. So not at all surprising that she'd be having behavioral problems. But I am surprised by how open Amanda is with Jonyke about it, how it's difficult to get her daughter to focus, to listen, almost like she's asking Jonyke for advice. I don't know what else to do. Especially if she's not listening the first, second, third time. She just doesn't.

I don't know. What do I... I could put her in time out. She's I'm going to scream and carry on.

It's like she's loud. And she's a loud screamer, Amanda says. So I don't want people calling the cops on me. Yeah, says Jonyke. Like, that's not far fetched. Jonyke announces she needs to talk to the other kids. Should she start with the oldest? Is that okay? This is Amanda's red line. No talking to the other kids. Her lawyer, Ali, had backed her up on this.

Or do you want to start with them? Do they have a case open? I need to talk to them. Kristen said, since they all live here, I'd have to check in with everyone.

Is that okay?

Amanda folds immediately.

Later, she tells me she doesn't dislike this case worker. She's more observant than most. And Amanda doesn't want her thinking she's putting on a show for children and youth, because she's not, she says. She's got nothing to hide. Though on some level, any time Amanda's had to put her home and her parenting on display, I imagine it feels like a performance, like the contrived nonchalance of driving by a cop, even when you're not speeding. All right. Well, I hope you get home safe. Stay warm. Joni leaves, everyone relaxes. Amanda goes to the kid's bedroom.

You snitched on me. You said you'd all sleep in the same room.

Jonyke can't take us away. Jonyke can't take us away, her youngest daughter says.

They can. I won't let them. You have to behave, okay? Mm-mm.

And then her middle daughter voices the question that hangs over Amanda and all of her children. When is their little brother coming home?

Mom, can we have a look? I'm trying, honey. And Ali's trying. We have to take one step at a time, okay? One step?

This is one step.

Baby steps. That's baby steps. Yeah.

Their baby brother, Amanda's youngest, is not a baby anymore. He's four years old, and he's been living with the same foster family all that time. Because it took so long for Amanda's criminal case to resolve, he got placed in a special program called Splick, subsidized permanent legal custodianship. Under the rules of this program, the parents rights aren't entirely terminated, but there's no expectation that the child will ever return to the biological parents. It's just short of adoption. To get her son back, Amanda will have to file for custody in civil court and win, which won't be easy. The other family wants to keep her son, and Amanda believes they'll fight her for him. The simple fact that she's his biological mother doesn't rule the day in a case like this. Ultimately, a judge will have to decide what's in the best interest of the child. So there's no way around it. Amanda's home, her parenting, her history will be pitted against that of the foster family. Her lawyer, Ali Croshamal, who's also become a close friend, believes if Amanda can show the judge that she's been interested in her son this whole time, asked about him, sent him birthday cards, tried to see him, she has a good chance of eventually winning some measure of custody.

Ali also gave Amanda a deadline, she says. Ali told her, Take a beat to get the other kids settled, but don't wait too long to file. Do it within a year. If you wait longer than that, it's not going to look good in court. A couple of weeks later, I get a call.

Hello?

Amanda?

Yes. Case is closed.

Case is closed?

Case is closed.

After that For a final visit, the case worker signed off on her youngest daughter's return home and closed her file. Oh, my goodness. How do you feel?

Happy. So I want to take the kids out for night and go have fun.

For the first time in many years, children and youth is out of their lives. It also means the decks are cleared for Amanda to file for custody of her younger son. Ali's, You have a year clock, is now ticking. Amanda tells me they might be filing right away on Monday. That call was February second. The next time we spoke was more than four months later in June. We had a lot to catch up on. Amanda wasn't doing great. She'd been so anxious about her childcare situation while the kids were on summer break that she quit her job. Now she was feeling down, not wanting to see certain people she knew. She kept thinking about how some of them would probably always suspect she'd hurt her infant son. Her youngest daughter, who had started therapy by now, wasn't doing well either. She was having uncontrollable outbursts, both at home and in school. It got especially bad right after a recent visit they'd had with her little brother. This thing had happened at Amanda's oldest daughter's softball game. She had taken all the kids who played in the park while Amanda talked to the other parents. And then this one kid came over saying Amanda's youngest daughter had pulled his hair, which Amanda didn't doubt.

Because she had the thing with her hands and pulling people's hair and stuff. Maybe it was too strong of me to say. But I said, I've told you several times now, keep your hands to yourself. I said, I'm going to call the cops. If you don't, it's serious. You could hurt somebody. I tell her how serious it is all the time. All the time. You could really hurt somebody. You will end up in jail. You're little now, and I get that, but you need to understand just because you're little now doesn't mean you're going to be little forever. And you could seriously hurt somebody.

The point of this story, Amanda said was that she felt judged by the other mother for what she said, like this lady was looking down on her. But the real point was something else, something that's been in her head all this time. Amanda is afraid that if her son does come home, her daughter could accidentally hurt him. She had always been obsessed with her little brother from the moment he was born, always trying to hold him. Amanda had told this to her pediatrician, even before the incident. Even then, she worried her daughter might hurt him. Again, not on purpose. She was just so full of energy, so full of feelings. What if her son came home now and her daughter roughhoused with him in a way he didn't understand, or in a way that scared him because he's not used to it? And then And her scenario always came to rest at the worst possible outcome. All the kids get taken, again. The Upshot. Amanda no longer had a job. She didn't have her own car. She was using her landlord's truck to get around. She was worried about how these kinds of deficits can come into play in family court, abuse allegations aside.

So while it's not a crime to be unemployed or without a car, several attorneys have told me they've seen these things work against parents in custody cases. Amanda was also worried about her youngest daughter's mental health, and her middle daughters, too, if we want to add that to the list. So no, she hadn't filed for custody of her son yet.

Maybe I'm trying to look at it from… I don't even know how to explain it. I feel like a piece of shit because I have been filed for him, but I also want to make sure my ducks in a row. And my kids, especially Amanda, are okay.

End of summer, August 2024. Not much had changed, except that Amanda's back had given out, a flare up from an old injury. She was imagining how she'd look to a judge if she filed for custody right now.

They're going to say, Well, what if something happens? If there's an emergency or you're not working and you got problems with your back? How are you going to take care of your kid? All that. I just don't. I don't want to have to answer those questions.

Sometimes it seems like Amanda's reaching for reasons to delay. Ali, the lawyer, is pregnant. I don't want to stress her out. Later, it'd be, Allie has a newborn. She should enjoy that time. I don't want to rush her. Later, still, Allie's assistant's going on vacation. I'll wait till she's back. Like that. But then, Amanda says something undeniably real about her son's foster parents.

I know how I felt when I had my children were up the way from me. I worry about how it's going to make the foster mom and dad feel. It's so hard because I don't want I don't want them to feel like I felt. I don't want to put that on them. But at the same time, that's my son. And it's hard. When these kids see him, it's rough for them after the fact. And it's, Oh, the kids are pulling up.

Oh, okay. You have to go?

Yeah. That's okay. Yeah, because I got to get them situated.

I wasn't the only one asking Amanda when she was going to file for custody. Allie was, too.

Yeah. Well, she told me we need to file. She said she can explain a year why I didn't file, and it's bringing the kids home and readjusting and getting all of them back into therapy and getting a routine. That can all be explained. But she said, beyond a year, you're pushing it.

Amanda knows she's pushing it. November is mostly gone. She's maybe two and a half months from her year deadline. She's going to file, she says. She worries that the moment she does, the foster family will stop facilitating visits. So that's another risk of filing, losing what minimal access she and her other kids currently have to her youngest son. Still, maybe she's almost ready. Every week that passes, Amanda's gathering more data about how it might be if they were all together again, and how it might be if they weren't. They just had a really good visit with him. Everyone got along well. He's playing soccer now.

He said, Can you play soccer with me? I said, I'll try. I don't know how to play soccer. I don't know how to play soccer. I just mess around with the kids.

Yeah. He just wants time with his mom. I don't think he expects you to be good.

I don't think he knows I'm his mom. I don't really think he knows that.

Oh, what How does he call you?

He doesn't call me anything. Sometimes, when we did Urban Air a few times, the other kids were calling me mom. And I think when he did do that, it was like, I don't think he meant to do it. So it was like, because he heard the other kids doing it. I just think it was a slip. And that's how I had it in my head. He doesn't know. I don't think he knows. So I don't want to give myself that false hope.

Amanda stepped outside for a cigarette.

My heart is full when I'm with him. He's like the missing in peace. And I've always felt like that. There's just something about him since the day he was born that completed me. And It's like a high. And then I got home, and I was good for a little bit, and then I just got extremely emotional.

Of course, she wants her son back. Viscerally, emotionally, physically, she wants him home. But more and more, she's realizing there's no way to reunite her family that won't cause terrible pain, including to the baby himself, who turned five last month. Another turn of this impossible screw, those foster parents. They have another son now, born after they took in Amanda's son. In other words, Amanda's son has a little brother, and that little brother has an older brother he's never not known. The longer this goes on, the wider the damage ripples. Out of nowhere, casually, Amanda says something I never imagined she'd consider.

I love my kids, and I just want my kids. I want the best for them. And parts of me thinks, Is it best? Do I leave him? Where is that? Or do I bring him home? So I struggle with that a lot.

How is Amanda supposed to correctly calculate how much pain to cause and to whom? It's the same question the child welfare system is asking in every case, or at least the question is supposed to be asking. The difference is Amanda has no protective bureaucracy or legal code to back her up, no PR department or team of lawyers to defend her decisions, privately or publicly. It's just her sitting on the steps of her house in the chilly mid-November air, thinking and smoking and then snapping too, so she can turn back to the million practical things that any mother of four or five has to stay on top of.

But I'm going to get this couch moved in here Okay.

I should tell you, I don't know exactly how all of this is going to end. Amanda eventually decided she didn't want to keep going with this story. She didn't want to be interviewed anymore. She'd had enough of our questions. She also didn't want to risk that something we said or the quotes we chose could somehow end up harming her in court. But she agreed we could use whatever we'd recorded up to that point. So the last recording I have with Amanda is from early February, 2025, pretty much a year to the day of Ali's deadline. We went to visit in person. The past year had clarified some things for Amanda. She said she didn't regret waiting to file for custody of her youngest. She felt sure her priority had to be the children in front of her, the four who knew her as their mother, who needed help feeling safe again in their own house. If that counted against her in court, so be it. But that clarity didn't make anything easier. She was still profoundly worried about her youngest daughter.

The one night she did, A couple of weeks ago, we took the kids just for a staycation, and brought up the situation and how it is all her fault.

I'm so sorry, Amanda.

And I told her it's not her fault. Accidents happen. And that all that matters is their home now. And they're getting help. And that we are going to fight for their brother. But that I needed to make sure that their traumas and everything they've been through were dealt with first.

She grieved her youngest son. That's the word she used. She said, Every day I grieve him not being here. She grieved the bonds that didn't get to grow between them, and she'd come to a decision of sorts.

As much as I would have loved for him to be home with the others, with how severe the trauma was for the other four children, traumatizing him and taking him away from everything he knows. I don't want that him. I want him to be brought home slowly because that's in his best interest. I don't want to rip him away from all he's known that It's just, to me, it's wrong.

The next week, Amanda filed for custody. Her demands were measured. Like she said, she didn't want to rip him away. She asked for shared legal custody of her son, therapy to help them bond after such a long separation, and partial physical custody on a gradual schedule. Amanda wrote to the court, I just want to build a relationship with my son. My older four children have also stated they miss their brother and want to see him. As Amanda predicted, her son's foster parents are fighting her hard to keep him, attacking her fitness as a mother in all the ways she feared. The case is scheduled for trial this fall. The first time Amanda spoke publicly about what happened to her and her family was at that Lehigh County Commissioners' meeting back in 2023, the same day County controller Mark Pinsley released his controversial report. A report which, when I've asked officials about it, they're dismissive. The Lehigh County executive, Phil Armstrong, he told me he didn't even read it. Instead, he asked his child welfare folks whether there was anything to worry about, and the answers they gave him, he wouldn't tell me exactly what they were, but he says they were, Great, and that he was happy and satisfied.

In the neighboring county, Northampton, where Amanda lives, officials told me Mark's report was misleading and harmful. They worried it would further erode people's trust in the child welfare system. But the shakeup Mark caused with his supposedly wrong headed report, it's had a remarkably fruitful afterlife. Since the report came out, the Lehigh County district Attorney's Office has reviewed every case in which Dr. Jensen testified as a central witness. As a result, one father's 20 to 40 year prison sentence was just reduced by at least half. He's eligible for release this year. Then there are all the lawsuits against Dr. Jensen and Lehigh Valley Health Network. It'll likely take years for those to sort themselves out. As for Dr. Jensen, two weeks after Mark Pinsley's report, she was replaced as Medical Director of its Child Advocacy Center. And six months after that, she retired from LVHN. She's still speaking at conferences, though. I watched a virtual one where she diagnosed a case on the fly during a Q&A. Based on a short description of symptoms and without seeing any records, she declared, You are dealing with abusive head trauma. Here's my diagnosis. It seems to me that everyone involved in child welfare cases that include a child abuse pediatrician.

I mean, caseworkers, doctors, hospital administrators, cops, prosecutors, judges, should take into account the real possibility that the CAP might be mistaken. I don't mean theoretically mistaken. I mean, actually mistaken. I don't say that with hostility. I'm saying it because to me, it It seems reasonable for everyone in the system to acknowledge that science and evidence often aren't clear-cut. Reporting this story, I've seen it again and again. Different doctors looking at the exact same information and coming to different conclusions about what that information means. I'm saying even one pause, one wait a second, might be the difference between a family staying together or being broken apart. I'm saying what Mark Pinsley was saying. When it comes to caps and the they wield, families deserve a second opinion. In recent years, three states, Texas, Washington, and now Georgia, have written that option into law. The other 47 could think about doing this, too. There's this phrase in child welfare circles, the removal calculus. The authors of that Michigan law review paper I talked about earlier, they say you have to get that calculus just right and only remove a child, quote, when absolutely necessary to protect children from serious imminent harm.

What they do not advise is better safe than sorry. That approach, they warn, can cause its own serious imminent harm. And more people than you might think are drawn into this system. One study, using federal data, estimated that nearly 40% of children in the United States will be subject to a child abuse investigation. Nearly 40%. For Black children, specifically, it's even higher at 53%. A bright spot is that some jurisdictions are rethinking Better Safe Than Sorry. One of those places, Northampton, where Amanda's abuse cases played out. The Children, Youth, and Families Administrator there, who grew up in foster care herself, told me their focus is now about prevention and trying to keep families intact by offering them help. It seems to be working. Four years ago, the county had 319 children in foster care. Now, Now, that number has been cut in half. One last thing I thought I'd mention. Not long ago, Dr. Jensen got hired as a consultant to review evidence in investigations of violent crimes against children. The agency she's working for is, evidently, untroubled by the many lawsuits and allegations of misdiagnosis she faces. Dr. Jensen is now a consultant for the FBI.

The Preventionist is hosted, written, and reported by me, Diane Neery. Additional reporting by Ben Phalen and Janel Pfeiffer. It's produced by Janel Pfeiffer and edited by Jenn Guera. Additional editing by Sarah Koenig and Anita Batajou. Fact-checking by Elizabeth Barber and Ben Phalen. Additional fact-checking by Kaitlyn Love. For more reporting from the show, sign up for our newsletter at nytimes. Com/serialnewsletter. Music supervision and mixing by Phoebe Wang. Additional mixing by Katherine Anderson. Sound design by Jonathan Menhivar and Phoebe Wang. Original music by Martin D. Fowler, Dan Powell, and Marian Lozano. Additional music for this episode by The Blasting Company. Martin D. Fowler composed our theme song. Our standards editor is Susan Westling. Legal review from Dana Green. The art for our show comes from A. May Hunt and Pablo Delcohn. The supervising producer for serial productions is Endeye Chubu. Julie Snyder is Serial's executive editor. Our associate producer is Mac Miller. Additional producing comes from Nina Lawsum and Cori Beach at the New York Times. And Sam Delnick is the New York Times Deputy Managing Editor. Special thanks to to the parents in Pennsylvania who we interviewed and to the dozens of people across the country who spoke with us about their own experiences of being separated from their families as children and whose stories informed this episode.

We'd also like to thank Jason Addi, Susan Anthony, Olivia Carzo, Maddie Day, and Emma Hogan for help with our reporting. Thanks to Dr. Stanley Blondeck, Dr. Nadine Burke-Harris, Dr. Martha Burt, Dr. Charles Nelson, Dr. Maya Opendack, and retired Alachua County Sheriff Sadie Darnell. Thanks also to attorneys Kathleen Creamer and Mark Freeman in Pennsylvania, Rosemarie Peoples in Florida, and Chris Gottlieb in New York City. Thanks, too, to Anthony Chiarito and Emma Ketteringham with the Bronx Defenders. In Northampton County, thank you to Maria Torres, Susan Wendalowski, and County Executive Lamont McClure for sitting down with us and talking through the children and youth procedures there. And finally, to attorneys Ali Crosth-Hamel and Tom Bosworth and their law offices. Thank you so much for your time and for all the medical records and documentation you provided for this episode. The Preventionist is a production of serial productions in the New York Times.