This article, the fourth in a series, was published in partnership with the Houston Chronicle.

HOUSTON — It was almost dark when the child welfare worker came for the children.

Two months had passed since Melissa Bright turned her back for a second, then heard the sickening thump of her baby’s head hitting concrete.

It was a short fall, just under 2 feet. The kids had been playing in the sprinkler, trying to cool off in the front yard on that July afternoon. Melissa set 5-month-old Mason on a camping chair before turning to wrangle wet clothes off her 2-year-old daughter.

After Mason fell on the driveway, Melissa scooped him up and ran upstairs, watching his head swell as he wailed. Panicked, she called her husband, Dillon, at work then dialed 911.

© Elizabeth Conley Melissa and Dillon Bright with their children, Charlotte and Mason, in Tomball, Texas. The Brights stayed the night at Texas Children’s Hospital in Houston, praying their son would be OK. The next day, a medical team came into the room. They had reviewed some scans of Mason’s head and had questions: Had the baby fallen a second time? If not, why were there two skull fractures?

The Brights were baffled. They didn’t remember any other fall, and didn’t know what else could cause that type of injury.

Unsatisfied by their answers, a doctor training to become a child abuse pediatrician typed up a disquieting note in the boy’s medical records. “The presence of multiple skull fractures is concerning for a nonaccidental skeletal injury,” Dr. Dhvani Shanghvi wrote. “The single impact fall would not be expected to cause both injuries.”

Mason Bright at Texas Children's Hospital the day after he was admitted in July 2018.

The hospital shared those concerns with Child Protective Services, as required by law, and the agency opened an investigation.

The Brights were swept into a bureaucratic child welfare system that relies heavily on the opinions of doctors who specialize in spotting abuse — sometimes even in the face of contradictory evidence, an NBC News and Houston Chronicle investigation found.

The Brights denied harming the baby and initially cooperated with the state child welfare investigation but grew frustrated as it dragged on for weeks. After Mason returned home and was recovering, Melissa and Dillon heard little from Child Protective Services, other than a text message asking how the baby was doing.

Then on Sept. 19, 2018, a caseworker showed up at their home with an emergency court order. He hated to do it, Dillon remembers the caseworker saying, but the state was taking custody of both children.

In the kitchen, over the baby’s cries, the Brights asked where the children were going. What was the emergency?

Dillon knew they couldn’t fight a court order, not that late at night. So he wrote out instructions for the strangers who would be caring for their children: Charlotte, the 2-year-old, has a dairy allergy. Mason, still nursing, would need formula.

Melissa was angry, and crying.

“Calm down,” the caseworker said, according to a recording of the encounter made by Dillon and provided to reporters.

“No. It’s my children,” she said. “I can’t calm down.”

Charlotte danced and laughed, oblivious as to why she was staying up past her bedtime. The toddler didn’t figure out what was happening until her father started loading her and her baby brother into the caseworker’s car.

Then she began howling, fighting Dillon as he buckled her in. He closed the door and stood in the front yard with his wife.

The girl’s muffled screams faded to silence as the car turned the corner.

© Elizabeth Conley The cement driveway where 5-month-old Mason Bright fell, fracturing his skull.

Short falls, serious consequences

Every day across the country, hundreds of infants are taken to emergency rooms or doctor’s offices after falls. Babies roll off beds or slip out of a caregiver’s arms. Although these moments can be terrifying for parents, research shows that the vast majority of household falls result in only minor injuries.

But sometimes a short drop can be far more serious. Depending on how a child falls and the impact surface, some dropped infants can suffer skull fractures or brain bleeding. In exceedingly rare cases, often compounded by underlying health issues, a short fall can even be fatal.

This presents a challenge for child welfare workers and law enforcement investigators, experts say, because caregivers who’ve been abusing their child sometimes make up a false story about a short fall to explain their child’s injuries.

The federal government estimates about 1,200 babies suffer serious head injuries as a result of abuse each year, including at least 80 whose injuries are fatal.

To separate accident from abuse in these cases, authorities often turn to child abuse pediatricians, a small but growing subspeciality of physicians with training in identifying signs of child maltreatment. These doctors’ opinions can have an extraordinary influence over the decisions of state child welfare agencies, sometimes triggering questionable family separations and criminal charges, the NBC News and Houston Chronicle investigation found.

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Lawyers and medical experts who routinely represent accused caregivers told reporters that they’ve seen some doctors overstate their ability to tell when a child’s injuries are the result of abuse.

Dr. Julie Mack, a Pennsylvania State University radiologist who frequently reviews cases at no charge on behalf of accused caregivers — including the Brights — said doctors have a moral and legal obligation to report to authorities when they suspect a child has been harmed. But she said she believes that, after the initial report is made, child abuse pediatricians and child welfare workers sometimes confuse “a reasonable suspicion” with evidence of wrongdoing.

It’s true, Mack said, that children rarely suffer multiple skull fractures and brain bleeding after common household falls. But each fall is different, she said, and just because something is rare doesn’t mean it’s implausible.

“It’s not a question of statistics,” Mack said. “Statistically, it’s unlikely. That’s not the issue. This is a single person, and it either did or it didn’t. It’s binary. You can’t use statistics to solve an individual problem.”

After a report comes in from a hospital, child welfare investigators are supposed to probe possible explanations and try to confirm or rule out the doctor’s concerns. If a child abuse pediatrician reports that a child’s injuries likely would not have resulted from a single short fall as described by parents, the caseworker should go to the scene and interview other people who care for the child, searching for alternative explanations.

But several current and former Child Protective Services workers in Texas told reporters that opinions from child abuse pediatricians carry significant weight and sometimes drive their decision-making.

Once a doctor declares that a child’s injuries are most likely the result of abuse, state workers often have little choice but to seek to remove the child from the parents or caregiver, said Rhonda Carson, a former child welfare supervisor.

“They will never go against what the medical professional writes down,” Carson said.

Child welfare agencies also are empowered to order follow-up testing and speak directly with treating specialists. In the case of short falls, tests can uncover underlying conditions — such as bleeding disorders and genetic deficiencies — that could predispose a child to severe injuries. But child welfare agencies do not always scrutinize medical records for contradictory evidence or ask for additional doctor opinions, the NBC News and Chronicle investigation found, leaving parents to do it themselves.

In one case from 2014 reviewed by reporters, a child abuse pediatrician in Austin reported that a 7-month-old baby’s injuries — bleeding around his brain and at the backs of his eyes — were too serious to have resulted from a fall from a bed onto carpet, raising the possibility that the child had been shaken and prompting Child Protective Services to take emergency custody.

But the medical report provided to authorities omitted a key element: The parents believed the baby had hit his head on a wooden baseboard before landing on the carpet. And the report from the hospital incorrectly stated that there was no evidence of an impact injury on the baby’s head to support the parents’ story. Multiple doctors had examined the child at the hospital and noted scalp swelling that seemed to indicate the baby bumped his head, just as the parents had described, medical records show.

Despite these inconsistencies, Child Protective Services relied on the doctor’s report as the basis for an emergency removal. The baby remained in the custody of the state and in the care of family members for four months, according to his parents, before being returned home.

In interviews, child abuse pediatricians said they work to rule out underlying medical problems before drawing conclusions and strive to present their findings with precision, making clear when they are not certain whether a child has been abused.

“You have to recognize what you can say and what you can’t say, and do your very best in terms of working with families and protecting children,” said Dr. Cindy Christian, the top child abuse pediatrician at The Children's Hospital of Philadelphia and a leading figure in the field. “I hope doctors can report with nuance.”

In a statement to reporters defending the hospital’s handling of the Bright case, Texas Children’s officials pointed out that the state doesn’t always remove children when its doctors report concerns — sometimes with grave consequences.

“There are cases in which, despite a recommendation of separation by physicians where abuse was suspected, the children remained in their homes and are not alive today,” the statement said. “These are the tragedies we seek to prevent.”

A spokesman for Child Protective Services declined an interview request, saying the agency was constrained by state law from commenting on the Bright case.

© Elizabeth Conley Dillon Bright reads to his son, Mason, before putting him to bed.

An overlooked test result

The Brights didn’t know it, but they were under suspicion almost as soon as they showed up at the hospital early on the evening of July 18, 2018. That first X-ray — roughly two hours after the fall — prompted concerns when it showed both the bigger fracture in the front of Mason’s skull and the smaller hairline fracture in the back.

Texas Children’s doctors also were concerned that Mason had suffered bleeding between his brain and skull, which child abuse pediatricians commonly associate with violent shaking and physical abuse, not short falls.

That night, even before Melissa and Dillon fell asleep in their son’s hospital room, a doctor typed up a note raising the possibility of a “nonaccidental injury.”

The next morning, the Brights were still waiting to find out how severe Mason’s injury was when they sat down with a new team of doctors. It was not the neurosurgeons or hematologist who had been treating Mason. It was the hospital’s child abuse team, though they didn’t realize it at the time.

Doctors put his X-rays up on a screen and showed the second, smaller fracture. How did it happen? one asked.

“You tell me,” Dillon remembers saying. “You’re supposed to be giving me information about my son.”

He realized then, he said, that they were in trouble.

Afterward, Child Protective Services investigators showed up at the hospital asking questions.

Lavar Jones, the caseworker, convinced the Brights to agree to an in-home monitoring plan. Once Melissa and Dillon left the hospital, they’d have to make sure there were always other relatives at home to supervise their interactions with the kids.

For the Brights, the days that followed were a barrage of tests, doctors, questions and anxiety. A neurosurgeon drilled a hole in Mason’s skull to relieve the pressure.

Five days after Mason’s fall, on July 23, Shanghvi, the doctor training to become a child abuse pediatrician, outlined her findings in a statement.

Mason’s retinal bleeding in both eyes, combined with the fractures and the amount of bleeding in his brain, was consistent with abuse, Shanghvi wrote. Dr. Angela Bachim, the attending physician supervising her work as a fellow, signed off on the report after discussing the findings.'

Mason Bright’s injuries

Texas Children’s Hospital doctors reported the following after examining 5-month-old Mason. They said the injuries appeared too severe to have been the result of a single fall in the driveway.

© Robin Muccari

(Source: Mason Bright’s medical records, including a CT scan, an MRI and an ophthalmologist’s sketch)

“While the reported fall could account for one of the skull fractures, it does not explain the other fracture or the extent of Mason’s intracranial bleeding,” Shangvhi wrote. “If nonmobile babies with unexplained injuries are returned into the same care environment in which unexplained injury happened, there is risk for further and more severe injury.”

In response to the last question on the form — Is this child’s condition consistent with abuse and/or neglect? — Shanghvi circled abuse and wrote “yes.”

But the doctor’s report came a day before a key test result revealed that Mason may have suffered from von Willebrand disease, a clotting disorder that can lead to excessive bleeding and injuries that, according to published accounts, are sometimes confused with child abuse. Although the report to Child Protective Services noted the pending bloodwork, the hospital never followed up to provide the results, agency records show.

And Jones, the caseworker, reported in a court filing weeks later that when he asked a Texas Children’s social worker for an update, she told him that there “was no evidence of any blood problem that could explain the excessive bleeding,” directly contradicting notes in the child’s medical record.

Shangvhi and Bachim, both employees of Baylor College of Medicine, a medical school affiliated with Texas Children’s, declined through a spokeswoman to be interviewed. In a statement, the Baylor spokeswoman, Lori Williams, said that, based on the type and severity of Mason’s injuries, the doctors were legally obligated to report their concerns. After a report is filed, Baylor’s child abuse pediatricians encourage child welfare workers to ask questions about complex medical findings, she said.

“Our doctors would have been available to provide any additional information CPS may have requested and needed for clarification,” Williams said.

In response to questions from reporters, Texas Children's officials hired Dr. James Anderst, a child abuse expert in Kansas City, Missouri, to review the hospital’s handling of the Bright case. In a statement provided by the hospital, Anderst said he agreed with the doctors’ assessments of Mason’s injuries, writing, “Both in number and severity, this group of injuries is highly unlikely to result from such a minor fall.”

Anderst and hospital officials also played down the significance of the bleeding disorder, writing that later test results were marginal, raising doubts about whether Mason truly suffered from von Willebrand disease.

But a doctor who specializes in diagnosing blood disorders reviewed the medical records on behalf of reporters and said there was strong evidence that the child suffered from the clotting deficiency. And medical records show that in the weeks and months that followed, Texas Children’s doctors continued to treat Mason for the disease to prevent excessive bleeding during surgeries.

“Regardless,” Anderst wrote, “von Willebrand disease in no way caused or contributed to the child’s multiple skull fractures.”

Based on the seriousness of the doctors’ concerns, Child Protective Services determined days after the fall that an in-home monitor would not be enough to protect Mason and his sister. Instead, an agency program director approved sending the kids to Dillon’s parents in Baytown, Texas, more than an hour’s drive from the Brights’ home in Tomball.

© Elizabeth Conley Photographs of Mason and Charlotte in the Brights' home.

‘Immediate and continuing danger’

Mason’s placement in Baytown was complicated from the start. The Brights run a small business in Tomball that services fire sprinkler and alarm systems. Dillon, now 37, had to work. Melissa, 30, was barred from staying with the children overnight, but she wanted to be there each morning to breastfeed Mason. So she lived out of a suitcase and slept on the couch of an acquaintance who lived nearby.

To comply with the voluntary child safety plan outlined by the agency, the Brights needed people to act as “safety monitors” for them. The monitors had to be vetted and approved by the agency to supervise the Brights’ visits with their children. They needed family and friends willing to go to Baytown, to the hospital, to doctor’s appointments and to babysit Charlotte.

Eventually the Brights asked to move the baby to the home of his great-aunt, Deloris Jester, who lived closer to their home. Deloris and her husband underwent a background check and other screening.

But days passed with no progress.

In the meantime, the lawyers representing Child Protective Services reviewed the case and declined to pursue legal action that could have permanently separated the family. The agency didn’t drop the case, though. Jones instead asked the Brights if they would be willing to complete family-based services, a series of classes designed to help parents keep or regain custody of their children.

About a month after his fall, Mason underwent another surgery to relieve pressure in his head. Afterward, Melissa texted the caseworker: “Mason is doing wonderfully,” she wrote. They were being discharged and would bring the children to Deloris’ house. “Are you okay with that?”

Mason before being discharged in August 2018 following surgery.

“Ok, that should be fine,” Jones texted back, according to messages the Brights provided to reporters.

But when she called him later that day, he said no. He needed approval from someone higher up.

They went back to Baytown and waited.

Six days later, Dillon says he called the caseworker to say that he and Melissa were taking the kids home. The Brights felt that the voluntary plan to keep Mason in Baytown was making it harder for him to recover.

For three weeks after they brought their children home, Melissa and Dillon didn’t hear anything from Child Protective Services.

In the meantime, they received a second opinion on Mason’s injuries from an outside expert. Mack, the Penn State radiologist who voluntarily reviews cases of suspected abuse on behalf of accused parents, wrote a report in early September concluding that Mason’s two skull fractures could have come from the same fall. She highlighted two research papers showing that short falls can result in multiple skull fractures. In one of the reports, from 2012, child abuse pediatricians and biomechanical engineers found multiple skull fractures in 8 percent of infants who were hospitalized after reportedly falling 3 feet or less.

“There is nothing about their location or appearance that precludes the possibility they both arose from a single fall,” Mack wrote of Mason’s skull fractures. “Therefore, it is not safe to conclude that these skull fractures could not have occurred from the mechanism described by Mason's mother.”

In a statement to reporters, Texas Children’s officials questioned Mack’s credibility, calling her “a child abuse ‘denialist’ who testifies almost exclusively for the defense in child abuse cases.” In response, Mack said there have been cases in which she concluded that a child’s injuries did not match a caregiver’s explanation, and as a result, she was not asked to testify.

“Contrary to TCH's claims, I have never denied that child abuse exists,” Mack said, “nor do I routinely come to the conclusion that that the 'diagnosis' of abuse is wrong.”

The Brights called Jones to tell him about Mack’s report, Melissa later testified, but he didn’t return their calls.

When contacted by a reporter, Jones declined to comment.

By mid-September, the Brights’ child safety plan was about to expire, which meant Jones had to update his supervisors at Child Protective Services on what he believed was best for the children. On Sept. 18, Jones texted Melissa to ask how the kids were. She responded with a health update and a few photos of Mason smiling and sitting up in bed.

“He looks really good!” Jones wrote back.

The next day, he walked into Harris County family court and filed an emergency petition asking for custody of the children. The agency said they were in “immediate and continuing danger.”

During the hastily called hearing, Jones told the court that the Brights had violated the voluntary agreement with Child Protective Services. Rather than moving Mason and Charlotte back in with family members, he advocated putting them in foster care.

Moving a medically fragile child from one relative’s house to another posed too much of a risk, he said.

He did not tell the court about the von Willebrand’s test results, which the Brights had shared with him, or the second opinion from Mack. And he didn’t mention that he’d talked to only a hospital social worker about the case, not a doctor.

The Brights might have told the court their side of the story — but they couldn’t because they had no idea the hearing was underway.

A little after noon, a judge approved the removal.

‘I’m not a doctor’

The Brights had gotten the children dressed for bed by the time Jones showed up with the emergency order that evening. Dillon pulled out his cellphone and started recording after Jones explained that he needed to take the children.

“What’s the emergency?” Melissa asked, according to the audio. “Where are our children going?”

“We have to find placement for them,” Jones said.

“Can Deloris come get them?” Dillon asked.

“No, sir,” he replied.

“Can my mom come and get them?”

He shook his head.

“Why?” Dillon asked. “They’ve all been approved.”

“Well, here’s the thing, Dillon,” Jones said, “because there was already a violation of the parental-child safety plan.”

No, Melissa protested.

“You were no longer considering our child’s best interest,” she said.

Dillon asked why they weren’t notified about the emergency court hearing.

“Well, for one, disgruntledness,” Jones said. “I figured it would be combative.”

“It’s our children,” Melissa responded.

What about the bleeding disorder test results? The second opinion from the other doctor? What changed, they asked?

“At the end of the day,” Jones replied, “we still have what we have from Texas Children’s Hospital.”

Melissa cried uncontrollably as Dillon packed the children’s bags. “Please don’t take my children,” she said. Charlotte, who did not yet realize what was happening, tried to comfort her mother.

“We’re happy, mommy. We’re happy,” the toddler said as Melissa sobbed.

“Mommy’s OK,” Melissa said. “Can you give Mommy a hug and make her happy?”

Jones drove away with the children that night and placed them in separate foster homes.

After the sound of Charlotte’s screams faded, the Brights returned, distraught, to their quiet house. Melissa sat awake in Mason’s room, crying and praying.

The next day, they called a lawyer, Dennis Slate, who said he couldn’t believe what he was hearing.

“I knew … that if everything was true, CPS was in trouble,” Slate said. “And then we investigated and it was true.”

Slate said he demanded to speak with an official who oversees Child Protective Services investigations in the Houston region and pointed out that the agency had failed to honor its agreement to place the children with another family member. The children were out of foster care within a few days.

Charlotte returned in a dress that was inside out and backward, her mother said. She had a gash on her face and a black eye. When Melissa asked Jones what happened, he replied, “There is an incident report.”

Charlotte had a gash on her face after she returned from foster care.

The girl also had been allowed to drink milk, despite her dairy allergy, Dillon said, resulting in a painful diaper rash. And Mason was so hoarse, apparently from screaming, Melissa said he was crying but making no sound.

Still, the Brights didn’t have permission to keep the children in their own home. They had to leave them with family and could see them for only one hour per week.

On Oct. 3, 2018, the Brights, their lawyers, child welfare workers and county attorneys went to court for a three-day hearing to figure out whether the state had sufficient reason to keep the children or whether Melissa and Dillon could take them home.

When Jones took the stand, Slate and his co-counsel, Stephanie Proffitt, questioned him about apparent inconsistencies between his earlier affidavit seeking emergency removal of the children and his statements in court that day. They asked him when he knew the Brights had taken the children home, and whether he had been made aware of Mason’s bleeding disorder before signing an affidavit claiming that the child didn’t have one.

Jones acknowledged that the Brights had previously given him medical records detailing the von Willebrand diagnosis and the associated risk of excessive bleeding but said he did not understand what it meant. Instead, he said, he went with what the Texas Children’s social worker told him.

“I had been provided the records,” Jones said, according to a transcript. “But I'm not a doctor, so I can't read this.”

When lawyers grilled Jones about other statements he made in his affidavit, he refused to answer.

“Plead the Fifth,” Jones responded, repeatedly asserting his Fifth Amendment right against self-incrimination.

Patrick Crimmins, a spokesman for Child Protective Services, said Jones was advised by lawyers not to answer some questions. “It was never an admission of wrongdoing,” Crimmins said.

After hearing all the testimony, Judge Mike Schneider rebuked Child Protective Services from the bench.

“It is not possible to look at the facts and imagine that the agency actually felt there was any sort of urgent need for protection to remove the children,” Schneider said.

The judge said the agency “knowingly misled the court” and had “no credible evidence” that the children were in danger.

© Elizabeth Conley Mason and Charlotte outside their Tomball, Texas, home.

In a recent interview with NBC News and the Chronicle, Schneider, who has since retired from the bench, said Child Protective Services needlessly traumatized the Bright children.

“Ironically,” Schneider said, “by the time we got to court, the kids had been injured, but not by their parents, by the state.”

For that reason, he took the rare step of ordering the agency to stay away from the children and ultimately returned them to their parents. A few weeks later, he ordered the agency to retrain its investigators and pay $127,000 in sanctions — the largest such payment in Texas in at least a decade.

Advocating for change

CPS fought the case and the sanctions order but eventually gave up. “With so many other CPS cases pending in Harris County that demand our attention, we have decided to forgo an appeal and to focus our attention on those children and families, and their needs,” Crimmins, the CPS spokesman, said in May.

The $127,000 they agreed to pay did not cover all of the family’s attorney fees, which continued to grow as the state appealed the ruling.

In the months since, the Brights have advocated for changes to the Texas child welfare system. They’ve spoken to several state lawmakers, who now say they are open to exploring legislation that would require Child Protective Services to seek or consider additional medical opinions before taking children from parents.

More than a year later, Melissa’s heart races anytime Charlotte falls and scrapes her arm, or when Mason — now a toddler — stumbles climbing down the stairs. What will the doctors say if they have to rush to an emergency room for stitches or a broken leg?

Will they believe her this time?

She tries to block out memories of the night the state took her children, the frantic search for stuffed animals and formula and Mason’s pacifier — anything comforting that could be shoved in a suitcase.

That night, on the way out to the car, Melissa said the one thing she could think of to comfort her children, the prayer they said together every night before they were taken away, and every night since they have come home.

“Thank you, Jesus.”

© Elizabeth Conley The Brights prepare their children for bed.

Design and development by Jiachuan Wu, Robin Muccari and Joe Murphy / NBC News