## Facts

- The Commissioner of Social Services of Westchester County filed an Article 10 petition alleging that Lori Z. intentionally harmed her infant daughter, Jessica Z. (born Nov. 10, 1985), by repeatedly administering laxatives.
- The petition alleged repeated laxative ingestion from March 1986 through July 19, 1986, causing severe diarrhea, dehydration, bloodstream infection, and hospitalization, and creating a substantial risk of death or serious impairment.
- Jessica experienced a prolonged, confusing illness that resisted diagnosis and treatment, with recurring hospitalizations and invasive medical interventions, including major abdominal surgery; she nearly died.
- In July 1986, toxicology testing of a stool specimen detected phenolphthalein, a chemical used to make laxatives.
- After the mother’s access to Jessica was restricted, Jessica’s condition improved markedly.
- The fact-finding hearing lasted 14 days and included competing pediatric and psychiatric experts; the Commissioner’s experts supported a Munchausen syndrome by proxy (MSP) explanation, while the mother’s experts challenged MSP or offered other causes.

## Issues

1. Whether the petitioner proved by a preponderance of the evidence that the mother intentionally inflicted physical injury on Jessica by administering laxatives, thereby rendering Jessica an abused child under the Family Court Act.
2. Whether circumstantial evidence and an MSP-consistent pattern could support findings of repeated laxative administration for months where direct toxicological proof existed only for July 1986.

## Decision

- The court sustained the abuse petition and found Jessica to be an abused child.
- The court found intentional laxative administration in July 1986 based on the phenolphthalein laboratory result and the surrounding circumstances.
- The court further found that, based on circumstantial and pattern evidence consistent with MSP, the mother had repeatedly administered laxatives from March through June 1986 as well.
- The court credited the Commissioner’s experts and concluded that alternative explanations offered by the defense did not satisfactorily account for the overall clinical course and improvement after restricted access.

## Legal Principles

- In an Article 10 child protective proceeding, abuse must be proven by a preponderance of the evidence, and the court may rely on circumstantial proof together with expert testimony.
- In suspected MSP/non-accidental poisoning cases, the court may infer intentional causation from a constellation of factors, including prolonged unexplained illness, repeated hospitalizations and invasive procedures, and significant improvement when the caregiver’s access is limited.
- Medical and psychiatric literature may be used to contextualize expert testimony and to assess whether a child’s medical history and a caregiver’s conduct align with a recognized abuse mechanism.
- Limited direct forensic proof for part of the charged period does not preclude findings for a broader period when the cumulative medical history, caregiver behavior, and expert analysis make intentional harm more likely than not.

## Conclusion

The Family Court concluded that the petitioner met its burden to show that the mother intentionally caused Jessica’s severe illness by administering laxatives, relying on a July toxicology finding plus circumstantial, expert-supported MSP pattern evidence to sustain an abuse finding for the broader March–July 1986 period.


In re Jessica Z., 515 N.Y.S.2d 370 (Fam. Ct. Westchester Cnty. 1987)