The world met the Cerda family two years ago when the ABC reality show

showcased their story -- a generous, but struggling Las Vegas couple raising two daughters with serious immune disorders.

The girls, Molly and Maggie, wore face masks to guard against toxins and germs that might be harmless to healthy kids. The TV program paid to demolish the family's mold-filled house and replace it with an opulent new home that included high-quality air filtration systems, an elevator, solar-heated swimming pool, gourmet kitchen and floor-to-ceiling stone fireplace.

Chuck and Terri Cerda beamed as they viewed the haven, but their joy didn't last long.

They said they couldn't afford the increased cost of operating the larger home. By fall 2009, the house was for sale and the family moved to Oregon, where the parents that television producers found so compelling came under scrutiny.

Several doctors and a hospital social worker began to question Terri Cerda's insistence that her daughters had chronic health problems when tests and examinations indicated otherwise. In January, Dr. Thomas Valvano, an

pediatrician who specializes in suspected child abuse and neglect, reported the Cerdas to state child-welfare authorities, and in February, the state took temporary custody of the two girls.

The ensuing case in Clackamas County Circuit Court told a story much different from the one presented on television.

Six doctors testified that Molly, 10, and Maggie, 8, did not live in constant medical peril, as Terri Cerda claimed.

Valvano went further. The Cerda children, he told the judge, were victims of medical child abuse.

A confrontation

Dr. Sapna Parker, a Sherwood pediatrician, testified about a confrontation after Terri Cerda brought Molly to an emergency room, worried that the girl's coughing, lack of breathing and screaming could be fatal.

A follow-up visit grew heated when Parker explained that if Molly could scream, she was breathing and would be fine. That was the last time Parker saw the Cerdas.

Parker suspected the girls were not as sick as their mother claimed. She called the Oregon Department of Human Services to ask whether there was anything about the family the state felt she should know.

"The story always came from their mother, and it seemed unusual to me that they were not appearing ill," Parker said.

Other doctors testified that they began to believe Terri Cerda isolated her children from other kids, telling them the common cold could be a death sentence. They concluded that she subjected the girls to unneeded medicine and tests, and instilled unwarranted fears that could cause emotional and psychological harm, the doctors said.

The girls were then placed with their maternal grandfather, Jerry McMahan, who temporarily moved from Colorado to Lake Oswego to care for them. McMahan said that during their stay and during his previous visits to the Cerda home over the years, he never saw signs of chronic illness.

They would complain of pain "when it served their purpose," said McMahan, a retired CPA and an ordained minister. Maggie would ask to be carried because her legs hurt. But "when she saw something she wanted to do," he said, "she'd run off and do it."



Home hospital

Terri Cerda, 51, devoted years seeking treatment for her daughters, conferring with a Las Vegas pediatrician and assembling what she described in court as a first-class medical team at the

.

In a YouTube video for the Immune Deficiency Foundation posted in May 2009, Cerda says she and her daughters have "combined immune deficiency disease" and talks about the family's home life. "Our house is a veritable hospital," she says. "We have IV poles; we have immunoglobin; we have breathing machines; we have oxygen tanks."

On camera, Cerda describes providing for the extensive medical needs of her children. "The kids get sick," she says, "and you always wonder if that's the last time."

The girls sometimes wore surgical masks on outings and -- on rare occasions -- used a wheelchair when a lot of walking was required, such as visits to the zoo or museums.

But the doctors, drugs and treatments came at a steep price. In 2008, before "Extreme Makeover," the Cerdas filed for Chapter 7 bankruptcy. They listed assets of $56,789 -- mainly cars, cash and guns -- and debts of more than $233,000, almost half of them unpaid medical bills.

Medical child abuse?

Munchhausen by proxy syndrome

What is it?

A fancy name for a parent or caregiver who invents or exaggerates medical symptoms to gain attention or sympathy.

How common is it?

Gene Evans, Oregon department of Human Services spokesman, said his office sees "very few suspected incidents, maybe one every couple of years."

Does Terri Cerda have the syndrome?

That's a matter of opinion. Portland-area pediatricians and social workers concluded she might, but there is no definite standard for diagnosis. Terri Cerda says that both she and her children have immune deficiency disease and that misunderstandings arise because her children can be well one day and deathly ill the next.

Red flags:

* A caregiver who seems medically knowledgeable, deeply interested in medical details or appears to enjoy the hospital setting

* Children with multiple medical problems that don't respond to treatment or seem to be atypical

* A sick child who improves when the caregiver isn't around

When the Cerdas moved to the Portland-area, they tried to form a new team of medical experts. Terri Cerda took the girls to rheumatologists, pediatricians, pulmonologists and other specialists.

Lab tests revealed some deficiencies or inconclusive results but no serious illnesses.

At a custody hearing in late March, several doctors told Clackamas County Circuit Judge Susie L. Norby that Cerda appeared to be a mother who latched on to a diagnosis and dismissed those who disagreed with her. The doctors said they were unaware of any conclusive diagnosis of severe immune deficiency. One testified that the girls were so boisterous "it was difficult to carry on a conversation."

Cerda testified that her daughters have been in and out of hospitals and clinics most of their lives, sometimes going together for treatment.

The most powerful statement came from Valvano, the child abuse and neglect expert. He reviewed records the state used to make its case and served as an expert witness.

His opinion that the girls were victims of medical child abuse rested on three points: Terri Cerda's pattern of describing symptoms that did not appear to have any medical basis; her history of providing incomplete or inaccurate medical information; and the way she jumped from doctor to doctor, switching when a physician challenged her assertion that the girls were chronically ill, Valvano said.

Experts say such behavior is sometimes also described as Munchausen by proxy syndrome, named for an 18th century German baron prone to exaggeration.

"Claims of immune deficiency arise a lot in Munchausen by proxy cases along with other ailments that are difficult to diagnose," said Dr. Marc D. Feldman, a clinical professor of psychiatry at the University of Alabama, author of "Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder."

Feldman was not involved in the Cerda case and spoke about the syndrome in general.

Medical witnesses for the state said an OHSU social worker talked to Terri Cerda about the possibility that she might be a Munchausen by proxy mom and that Terri Cerda mentioned the social worker's concern to two Portland doctors.

In an interview after the custody case, Terri Cerda acknowledged that Munchausen's by proxy has come up in her visits with health professionals.

She said misunderstanding between parents and professionals can result in good parents being tarred with the label, especially when children suffer from an affliction that comes and goes, leaving them in apparent good health one day and dangerously ill the next.

And some psychiatrists and psychologists agree. They say that doctors and child welfare workers are sometimes too quick to judge.

The defense

When Terri Cerda took the witness stand, she told the court that the girls have a long, documented history of fevers, infections, respiratory and gastrointestinal problems -- all consistent with immune deficiency, she said, and evidence that she wasn't exaggerating their condition.

However, no doctors testified on behalf of the Cerdas.

"We have several hundred pages of medical documents that prove our kids have been diagnosed with immune deficiency disease since they were four years old," Terri Cerda insisted after the court hearing. "We saw doctors that were top notch in the world. The kids have been tested, and you can't lie about lab work."

Asked why those records weren't presented in court, she offered several responses: The medical notes are illegible and hard to interpret. The terminology is complicated. The court refused to admit some defense evidence.

Asked to submit them to The Oregonian for review, Terri Cerda released more than a dozen pages of letters, treatment recommendations and lab analyses. "As you can see, these docs are all stamped as 'exhibits,'" she wrote in an note accompanying the documents. "However, we were not permitted to enter them as evidence."

In a letter dated June 6, 2007, a pediatrician with the

, wrote: "Both children as well as their mother have Primary Immune Deficiency Disease. This disorder leaves them unable to mount a normal response to antigens and causes infections that are difficult to clear. Primary Immune Deficiency Disease is considered a life threatening medical condition."

The pediatrician reiterated his diagnosis in an April 14, 2008, letter documenting his prescription for a medical grade air filtration system: "Both of the Cerda children have Primary Immune Deficiency Disease," he wrote. "The children are homebound as a result of their disorder."

Another physician, the medical director of the laboratory at

, reviewed 2010 test results on both children. "Maggie and Molly Cerda have evidence supporting "Specific Polysaccharide Antibody Deficiency," the director wrote. "Both may be at risk of autoimmune disorders."

The Cerdas' attorney, Mikel Miller, insisted that the couple did not mislead doctors and provided authorities with whatever medical records they had.

"They were trying to provide the best care they can," Miller said. "They're the ones with the most to lose. If a child is yelling, 'I'm dying,' it's hard not to respond to that."



'Obsessive'

Judge Norby found Terri Cerda unconvincing.

She sought treatment against doctors' advice and repeatedly exposed her children to unnecessary intervention, Norby found. She called her behavior "obsessive and unjustifiable."

Chuck Cerda, on the other hand, trusted his wife to make appropriate medical decisions and acted reasonably, Norby said. She found the father, a Department of Homeland Security officer, to be a capable parent who was able to take charge of the children's medical needs.

That meant the girls could go home to both parents.

Within days of regaining custody of Maggie and Molly, Terri Cerda left Oregon and resumed treatment with the children's UCLA and Las Vegas doctors, child welfare workers in Oregon learned. The agency went back to the Clackamas County courthouse, arguing that Chuck Cerda did not believe his daughters were at risk from unnecessary medical intervention.

Clackamas County Circuit Judge Douglas K. Van Dyk denied the state's request to take the children back. On April 4, child-protection workers tried again, and again Van Dyk denied the motion.

Van Dyk allowed state authorities to send medical records to the children's doctors in Los Angeles and Las Vegas, and the Oregon Department of Human Services will notify Nevada's child welfare agency about the case.

Terri Cerda did not attend the most recent hearing.

She and the girls moved back to Las Vegas, said Chuck Cerda. He wants to transfer back there, too.

Life in Oregon was like a bad dream, he said, referring to the family's run-ins with child welfare workers. "My girls are having nightmares. They think they're going to be kidnapped again."

Reporter Natalie Feulner of The Oregonian contributed.

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