Woods’ focus on child abuse

Woods started at Mary Bridge only a few months before reporting Carter to Child Protective Services. She was hired to serve as the medical director of the hospital’s child abuse intervention team in late 2017 after more than a decade in the Army, according to her résumé.

Woods testified in Carter’s case that she became interested in child abuse prevention while serving as a doctor in the military, and along the way, she said she became an expert through firsthand experience. She said she reviewed cases of suspected child abuse at multiple hospitals during her career, including at Madigan Army Medical Center in Washington, where she reports on her résumé that she founded the hospital’s child abuse team in 2016.

In order for physicians to become certified as experts in specific areas of medicine, such as performing surgery or treating cancer, they often must complete immersive, yearslong fellowship training at academic hospitals and pass board exams. But Woods testified that it was not essential for her to attend a child abuse fellowship program or pass a certification exam to become an expert in her field. Woods noted that she helps train those who are completing the child abuse fellowship at Seattle Children’s Hospital and is responsible for training medical residents at Mary Bridge “on all aspects of child abuse.”

Woods and Mary Bridge officials did not answer specific questions about her qualifications to teach child abuse fellows. Officials at Seattle Children’s, which manages the state’s child abuse medical consultation network, did not answer specific questions about Woods’ qualifications.

“We value the different nationally recognized paths in which experienced medical providers can gain expertise in caring for some of our state’s most vulnerable children,” a Seattle Children’s spokeswoman said in a statement. “We fully support the qualifications of our providers who are committed to improving the health and safety of children.”

The field of child abuse pediatrics was established more than a decade ago, part of a nationwide effort to improve and standardize the detection of child maltreatment and improve research on the subject. In 2009, when Woods was two years out of medical school and still completing her required residency program, the American Board of Pediatrics allowed doctors who’d already spent years working informally as child abuse consultants to take the certification exam, and if they passed, they were grandfathered in as board-certified child abuse pediatricians.

Any pediatrician wishing to specialize in child abuse since then has been required to complete a three-year fellowship, during which they receive instruction on the evolving — and sometimes disputed — science that doctors rely on to differentiate accidental injuries from those that are inflicted.

In a series of op-eds written in response to an NBC News and Houston Chronicle investigation into the work of child abuse pediatricians, leaders in the field have argued that skills learned during the three-year fellowship is what makes certified child abuse pediatricians more qualified than other physicians to assess children who may have been abused.

“During their training, fellows develop an understanding of the scientific evidence involving the biomechanics of childhood injuries and the physiologic and psychologic effects of trauma and neglect on a child,” Dr. Amy Gavril wrote in a January article published by the American Academy of Pediatrics. “This training allows [child abuse pediatricians] to diagnose abuse in a scientific manner. They are equipped to differentiate between accidental and inflicted injuries, and have knowledge of medical conditions that may mimic abuse.”

The training also prepares child abuse pediatricians to testify in court and offers guidance on what to say — and what not to say — in reports to child welfare workers.

But in her role as a child abuse medical consultant for Child Protective Services, Woods has made statements or recommendations that appear to go well beyond her role as a doctor, reporters found. In one 2018 case, Woods reported that two young parents didn’t display an appropriate emotional reaction when they learned that their baby had suffered several fractures, and she pointed to them as likely suspects. That goes against the guidance of leading child abuse pediatricians, who say their role is to identify abuse, but not who committed it.

“Both parents remain concerning to me as either could have been involved or either could be protecting the other parent,” Woods wrote in her report to Child Protective Services. “In addition, neither parent behaved in a protective manner when child first presented with injuries.”

In another case examined by reporters, from 2019, Woods reported to Child Protective Services and police that twin babies who’d suffered numerous fractures had to have been the victims of abuse. Woods told Bremerton, Washington, police that the only other possible explanation for the babies’ injuries would have been “a motor vehicle collision,” though it’s not clear what the basis for that statement was. Based on her report, police charged the mother, Baylen Armendariz , with felony child abuse, and Child Protective Services took custody of the children.

Three outside medical experts reviewed the twins’ medical records on Armendariz’s behalf and concluded that their fractures were most likely the result of a mineral deficiency that can lead to weak bones and easy fractures, not abuse. But the children remain in state protective custody and in the care of their grandmother.

Armendariz pleaded not guilty to the criminal charges, and the case is expected to go to trial in the coming months.

Al-Agba, the pediatrician who clashed with Woods in 2018 over her claim that a child’s bruise was likely the result of abuse, said it was insulting and irrational for the state to give more credence to the opinion of a doctor with fewer years of clinical experience and no fellowship training in abuse.

After reviewing the same photos that Woods relied on to determine that someone had hit the 2-year-old child, a police detective agreed with Al-Agba, writing that “the bruising appears to be very inconsistent, almost impossible to be hand, finger, fingertip marks.” The officer added, in reference to Woods’ report, “it is a little difficult for me to understand what the medical professionals are talking about.”

Notes from the Child Protective Services worker assigned to the case indicate that Woods reported having 14 years of experience related to child abuse, and the agency cited that in its decision to formally classify the child’s injuries as inflicted. Fourteen years earlier, Woods would have been in her second year of medical school, according to her résumé.

But when Al-Agba questioned that claim and raised concerns about Woods’ lack of fellowship training with officials at both Mary Bridge and Child Protective Services, she says they brushed her aside.

“If I ask, ‘Does this person have abuse training, or does this person have extensive abuse experience?’ I think that's an important question,” she said. “I don't think that makes me a quack.”

In an interview Thursday, Ross Hunter, secretary of the Washington Department of Children, Youth, and Families, said Child Protective Services relies on Seattle Children’s to vet the expertise of doctors hired across the state to review cases of suspected child abuse. The agency does not review the qualifications of individual doctors or measure the quality or accuracy of their reports, Hunter said.

But based on some of the findings reported by NBC News and KING 5, he said he wants to take a closer look.

“I can't tell you whether the fellowship training that you get to have a particular tag on your diploma actually matters in terms of the accuracy of the outcomes,” Hunter said, then added, “You've raised my interest in looking at how we do that particular contract.”

‘She should be held to a higher standard’

After Carter had been apart from her children for a year, with limited supervised visits and frequent video chats, her custody case went to trial in King County Juvenile Court last April. Judge Susan Amini presided over the proceeding, which included 15 days of testimony and arguments.

The Carters spent more than $300,000, much of it borrowed from family, to fight the case. Woods was the state’s star witness.

Over the course of four days, Woods testified that she believed “all of Ellie’s medical issues” were the result of medical abuse, even though the child was born severely premature and continued to require significant medical care after she was separated from her mother.

Woods claimed that only Carter had ever witnessed Ellie suffer seizures and that the child had since been weaned from anti-seizure medicine, though medical records showed otherwise. Multiple members of the hospital’s medical staff reported observing seizures, which was why Ellie was still receiving anti-seizure medication at the time of trial.

Woods testified that when she reported concerns that Carter had used Ellie’s health problems for her own gain, that “was related to a relationship with the Seahawks that was deemed inappropriate by hospital staff.” But a review of messages and social media postings show that it was members of the hospital’s marketing team who invited an NFL player to visit Ellie in the hospital and promoted the event to the media.

Photographs of NFL star Richard Sherman with Ellie, displayed at the Carter family home. Jovelle Tamayo / for NBC News

And Woods testified that soon after Carter was removed from the hospital by police, Ellie “wolfed down” a McDonald’s Happy Meal, though she later acknowledged during cross examination that she did not witness the event and could not say who had. Other members of the Mary Bridge medical staff testified that they did not believe Ellie would have eaten a whole Happy Meal, as she continued to have difficulty eating in the months after she was removed from Carter’s care.

As for the video that Woods said was proof that Carter was abusing Ellie? Woods testified that the footage showed Carter secretly dumping medication from a syringe after pretending to administer it. The medicine was intended to prevent dangerous blood clots. But when lawyers played the video for other witnesses, including a doctor who supervised Ellie’s care, they said it showed no such thing. Plus, two hospital staff members were in the room at the time and did not report wrongdoing, Amini, the judge, later noted.

With each statement by Woods, Carter said she fought the urge to shout out in court.

“I think just as a doctor, she should be held to a higher standard,” Carter said in a recent interview. “People should be able to expect that she tell the truth. And she just didn't.”

The judge agreed. More than three weeks after the trial ended, she issued her order. In a scathing 26-page report, Amini both dismissed the state’s case against Carter and rebuked the doctor who’d initiated it. Most of Woods’ testimony, the judge wrote, was “without supporting factual basis.” Amini dismissed parts of Woods’ conclusions as “not plausible” and “speculation at best.”

Carter was video chatting with her husband and children while they ate dinner — even during the separation, she always wanted to eat as a family — when her lawyer texted her on June 24.

“We f------ won,” he wrote.

Carter looked up from her phone and screamed. Tears streamed down her cheeks as she shared the news. Spencer stood up from the table and asked if they could come home that night. Ellie ran to her room and started packing her toys.

The next day, for the first time in more than a year, Carter was allowed to pick up her children from school.

She felt like the cloud of suspicion that had followed her for 14 months was finally lifting. Yet, she and her family have struggled to move on.

Ellie, now 6, talks frequently about the time she was forced to spend away from her mother, a period she refers to as “the rules.”

“Well, do you want to know what the rules did when I was in the hospital?” Ellie said one evening last month. “They wouldn't let my mom visit me. They wouldn't let my mom visit me. Even though she was my mom.”

Carter tries to comfort and reassure her, but she, too, lives in constant fear.

“We're just much more fearful than we ever were before,” she said in January. “I think one of the main things that I experience is that if somebody rings our doorbell, I'm scared to answer it, because I don't know if it's going to be somebody coming with more allegations and trying to take my kids away.”