The Death of Frank Bluestein: A Justified Use of Deadly Force or a Police Execution?

By Denny Griffin (deceased)

In 1980, the Las Vegas Metropolitan Police Department was engaged in an intense investigation of Chicago Outfit made man and enforcer Tony Spilotro. The Outfit was the dominant organized crime family in Sin City at the time, and Spilotro had been keeping an eye on their interests there since 1971. This era was dramatized in the 1995 movie Casino, starring Robert De Niro, Joe Pesci, and Sharon Stone.

Part of the police strategy was to keep Spilotro and his gang under almost constant surveillance. The detectives often conducted their observations overtly, as a method of keeping pressure on the gangsters and limiting their ability to engage in criminal activity.

That June an incident tool place in Las Vegas that had repercussions all the way to Chicago: Metro detectives shot and killed the son of a local labor union official who was a reputed Spilotro associate. The shooting generated accusations of a police execution, multiple civil lawsuits, and murder contracts being issued on the two detectives involved.

In Casino, a scene based on this incident shows a man exiting a vehicle holding a foil-wrapped hero sandwich. The pair of plain clothes detectives tailing him mistake the sandwich for a gun and shoot the man dead. When they realize their error, they plant a “drop piece” to make it appear the victim had been armed and the shooting was justified.

While researching for my book The Battle for Las Vegas – The Law vs. the Mob, this was one of the occurrences I wanted to explore in detail. Sources of information were limited, however. There had been no independent witnesses to the shooting. The only people still living who had been present at the scene were the two now-retired detectives. I was able to interview both of them, and their stories were supported by the results of the coroner’s inquest. I also talked with several of their former co-workers. According to those sources, both officers were professional lawmen, and had been involved in other situations in which they could have fired their weapons had they been pre-disposed to do so. They didn’t.

In the following paragraphs, I’ll provide the account of the shooting and its aftermath that resulted from my research for Battle. After that I’ll introduce information that came to light subsequently, and which provides additional corroboration for that scenario.

The Shooting

On the evening of June 9, 1980, Detective David Groover and Sergeant Gene Smith were conducting another routine surveillance of the Tony Spilotro gang. On that night they were camped outside the Upper Crust pizza parlor and the adjoining My Place bar, located at Flamingo Road and Maryland Parkway. Tony’s pal and right-hand man, Frank Cullotta, was co-owner of the restaurant. Both establishments had become hangouts for the mobsters. Spilotro, Cullotta, and one of their associates were sitting at a table outside the Upper Crust, but nothing exciting was going on. For the two veteran cops, it had all the makings of another uneventful shift.

“We put in a lot of long tedious hours watching those guys. But in that kind of work things could change very quickly, and that night they did,” David Groover said in 2003.

The changes began when a 1979 Lincoln with Illinois license plates pulled into a parking space in front of the eatery. The operator of the vehicle went inside, apparently to order a pizza to go, then came back out and joined Spilotro and the others at the table. They talked for several minutes until the new guy’s pizza was ready. At that point he got back in the Lincoln and drove away. The detectives weren’t sure who this new player was, but it was obvious that he was acquainted with the mobsters. Smith and Groover decided to follow the Lincoln to see what information they could gather about who the driver was and what he was up to.

“As soon as he pulled out onto Flamingo he started speeding, doing eighty or better, and driving recklessly. I was driving our unmarked car and Gene was in the passenger seat,” Groover remembered.

“Eventually, we figured we had enough probable cause on the traffic violations to pull the car over and check out the driver. By that time we were on McLeod near a new housing development called Sunrise Villas, and the Lincoln had slowed to the speed limit. I put the red light on the dash and activated it for the guy to pull over. The Lincoln turned onto Engresso, the street running into the development, went past an unmanned security booth, and stopped several yards beyond. I parked behind him, got out of the car and approached the Lincoln, verbally identifying myself as a police officer and displaying my badge. As I neared the other car, it pulled away at slow speed, stopping again a short distance away. I got back in our car and followed, angling the police car in and again getting out and approaching the Lincoln. This time Gene got out and took up a position by our passenger door.”

At that time, Groover and Smith didn’t know the Lincoln was being driven by Frank Bluestein, a 35-year-old maitre d’ at the Hacienda Hotel & Casino, one of the properties controlled by the Chicago Outfit. Also known as Frank Blue, Bluestein and his girlfriend lived in Sunrise Villas. His father, Steve Bluestein, was an official in the local Culinary Union and had been the subject of a 1978 search warrant as part of the FBI’s investigation of Tony Spilotro.

Groover continued, “This time as I neared the Lincoln the driver lowered his window. I again identified myself and displayed my badge. Suddenly Gene hollered, ‘Watch out, Dave! He’s got a gun.’ I returned to our car and took up a position behind the driver’s door. Gene and I continued to yell at the guy that we were cops and to put down his gun. He never said a word, but instead of getting rid of the weapon, he turned slightly in his seat, opened his door, and started to get out of the car. The gun was still in his hand and aimed toward Gene. Believing the guy was about to shoot, Gene and I opened fire.”

The shots rang out at approximately 11:45 p.m. and several rounds struck Bluestein. He was rushed to a nearby hospital, where he died a couple of hours later. A .22 handgun was recovered at the scene. But as far as the Bluestein family, Tony Spilotro, and attorney Oscar Goodman were concerned, this was not a justified use of deadly force. It was a police execution, with the cops planting a gun on their victim to add legitimacy to their actions.

It was a time that David Groover will never forget. “There was a real firestorm over the Bluestein shooting. We were accused of murdering the guy, planting a gun, and all that stuff. We ran a check on the gun Bluestein had and traced it to his brother, Ronald. The gun had been purchased in Chicago. That pretty much blew the planted-gun charge out of the water. We didn’t release that information right away, though. We waited until the coroner’s inquest to make it public.”

Less than two weeks later, a coroner’s jury ruled the death of Frank Bluestein to be a case of justifiable homicide. The cops were okay in that regard, but the verdict didn’t prevent the filing of numerous civil suits against them. One was a $22 million whopper accusing the cops of violating Bluestein’s civil rights. All of the cases were eventually decided in favor of the police, but the civil- rights suit dragged on for five long years.

As the civil actions were being filed, Groover and Smith knew they had acted appropriately and were confident they would prevail in the end. Other than the annoyance of dealing with the lawsuits, they weren’t overly concerned. But they learned a few months later that whatever was being done to them by the Bluestein family’s attorneys was the least of their worries.

The Contracts

The courts are the legal mechanism for people seeking to redress perceived wrongs. The courts were used to go after the police in the Bluestein shooting case. But after the cops were cleared of any criminal wrongdoing by the coroner’s inquest, some people apparently didn’t feel the pending civil actions would provide the justice they sought. In late February 1981, Metro was informed by the FBI’s Chicago office that they’d picked up credible information that murder contracts had been put out on the lives of David Groover and Gene Smith. The two Intelligence Bureau officers were marked for death and a pair of hit men from Chicago was on their way to do the job. After stopping in Denver to obtain a clean weapon, the would-be cop killers would soon be in Las Vegas.

The news caught Metro by surprise. The mob tries to best the police by corrupting them or outsmarting them, not by killing them. People who prefer to stay below the law’s radar screen rarely order the murders of two cops. It brings down too much heat.

Kent Clifford, former commander of the Intel Bureau, remembers when he first heard about the contracts. “For quite a while after the Bluestein shooting there had been a verbal battle in the press between the department and the Bluestein lawyers. There had also been several civil cases filed, and I thought that was all that was going on. Then we got word that Groover and Smith are going to be killed.

“I went berserk. Spilotro knew my goal was to put him in prison for the rest of his life; I’d told him that more than once. We were adversaries, but there were certain rules we played by. You didn’t put contracts out on cops. And even if Tony didn’t actually order the hits, he damn sure knew about them. Nothing like that was done in Las Vegas without Spilotro’s knowledge and approval.”

Although Clifford, Groover and Smith, believed Tony Spilotro was involved in the threat one way or another, they were quite sure the hit men were acting on behalf of the Bluesteins.

“I moved my family out of state for their protection,” Gene Smith recalls. “Cops were assigned to stay at my house. We were waiting for those guys [the alleged hit men] when they hit town and checked in at the Fremont Hotel downtown. They were under surveillance around the clock. One of the people they met with was Ron Bluestein, Frank’s brother. The supposed hit men were in Vegas for about a week, but only came near my place once. They stopped a couple of blocks away, then left the area. I don’t know what happened; maybe they got cold feet. We eventually confronted them and had a little chat. They headed back to Chicago almost immediately.”

But the police wanted more than to have the potential killers leave town. They believed the Bluesteins were behind the contracts and wanted them held accountable. In an effort to build a case against them, after the hit men arrived in town an application was made to wiretap the phone of Steve Bluestein. The tap was approved, but only after an altercation with the Clark County District Attorney, Bob Miller.

“The DA didn’t like to use wiretaps and I had other issues with him besides,” Kent Clifford said. “When we met to discuss the matter, he asked me why I didn’t like him. I said it wasn’t that I didn’t like him. It was that I had raw intelligence information that he was associating with one of the people who had organized the skim from the casinos. The DA said the guy was an old friend and that there was nothing the matter with them socializing. I argued that in his position as DA, he shouldn’t have that kind of a relationship with an organized crime figure. He said I could think what I wanted, but the association would continue.

“While the wiretap was running we made reports to the judge who had issued the warrant. On the second day of the tap, he told me that a high-ranking member of the DA’s office had called him and asked that the tap be shut down. After our conversation the judge refused the request. The next day a piece appeared in the Las Vegas Sun stating that an informant told them about the Bluestein wiretap. When that article appeared, Bluestein’s phone went dead. Besides Metro, the only other people who were aware of the tap were the DA’s office and the judge.”

The investigation of the Bluesteins failed to result in any charges being filed.

Although the immediate threat to his detectives was over, Kent Clifford was concerned that someone else might show up to make an attempt on the lives of Groover and Smith. In Clifford’s mind, the only way to remove the danger once and for all was to have the contracts lifted. He was also reasonably confident that Spilotro had authorized the hits on his own and his bosses in Chicago weren’t aware of them. But there was only one way to find out for certain. In an unprecedented move, Clifford decided that he needed to go to Chicago and have a face-to-face with Tony’s superiors.

Trip to the Windy City

Commander Clifford took his plan to Sheriff John McCarthy, who agreed that Clifford and another detective could make the trip to Chicago. Distrusting the DA’s office, they decided not to consult with them or inform them of the pending visit. The department would pick up the tab for the plane fare; the officers had to pay for their own accommodations.

Clifford next called the FBI in Chicago and obtained the home addresses of Outfit bosses Joe Aiuppa, Tony Accardo, and Joseph Lombardo. It was time to head east.

In March, Clifford and his previous partner, Galen Kester, boarded a plane for Chicago. The people they planned to talk with were violent individuals, and meeting with them could prove dangerous. Both Clifford and Kester carried handguns in their briefcases in the event things didn’t go well. The cops checked into a motel and were on the road in a rental car early the next morning. Their first stop was at the home of Joseph “Doves” Aiuppa, the current head of the Chicago Outfit.

Kent Clifford recalls that eventful and sometimes frustrating day. “Aiuppa wasn’t home when we arrived; only his wife was there and she wouldn’t let us in. I told her it was very important that I talk with her husband. I left her the phone number for our motel and asked her to make sure he called me.

“Our next visit was to the home of Joseph ‘Joey the Clown’ Lombardo. He wasn’t home either, but his wife invited us into the house and we talked for about ten minutes. We left the same message with her as with Mrs. Aiuppa. From there we stopped at Tony Accardo’s, but he was out, too. Three stops and three misses.”

Not ready to give up, Clifford remembered a man from Chicago who had visited Spilotro in Las Vegas and was known to be mob-connected. He contacted the local FBI office and obtained the office address for Allen Dorfman.

Dorfman ran a business as an insurance broker, but his real forte was obtaining Teamster Pension Fund money to finance the Outfit’s Las Vegas interests. He’d been tried along with Jimmy Hoffa in 1964 for diverting pension-fund money for their personal use. Dorfman was acquitted, but Hoffa was found guilty. The broker was convicted in 1971 of accepting a $55,000 kickback to arrange a Teamster loan and spent nine months in prison. Not long after getting out of stir he was a co-defendant with Tony Spilotro and Joe Lombardo on another pension-fund-related fraud charge. All three got off the hook when the government’s chief witness against them was murdered.

“When we got to Dorfman’s office I walked past the reception desk looking for him. The secretary said I couldn’t do that and I told her to watch me. I guess it was quite an entrance,” Clifford continued. “Anyway, we got to see Dorfman and explained the situation to him. He said to go back to the motel and someone would be in touch.

“That afternoon a lawyer representing the mobsters called. I ran the whole scenario by him and requested a personal meeting with his clients. He said he’d talk with them and get back to me. He called back a while later and said there would be a meeting that evening, but I wasn’t invited. Although that didn’t make me very happy, there wasn’t a lot I could do about it. I told the lawyer to relay a message to his clients just like I gave it to him. I said, ‘If you kill my cops I’ll bring forty men back here and kill everything that moves, walks, or crawls around all the houses I visited today. And that is not a threat, but a promise.’ The lawyer said he’d deliver my message exactly as I gave it. If the contracts were lifted, he said I’d get a phone message saying, ‘Have a safe journey home, Commander.’ If I didn’t get a call, it meant all bets were off.

“I dozed off and around two in the morning the phone rang. A voice I couldn’t identify told me to have a safe trip home. The contracts were lifted.”

Frank Cullotta weighs in

Shortly after Battle was released in July 2006, I had the opportunity to meet Tony Spilotro’s former friend and lieutenant, Frank Cullotta. The two men had a falling out in 1982 and a contract was issued on Cullotta’s life. Facing the likelihood of death at the hands of the mob or life in prison, Cullotta flipped and became a government witness. Now out of the federal Witness Protection Program and living under a new identity, Cullotta was looking for an author to write his biography. We reached an agreement and CULLOTTA was published in July 2007.

While Cullotta and I were working on the manuscript, I asked him about the night Frank Bluestein was killed. I reminded him that the Bluestein family had originally contended that Frank had been unarmed the night he was shot, and a gun was planted on him by the police. After it was revealed that the gun had been purchased by the dead man’s brother, the family altered their position. They then said Frank had never held a gun in his life. Even if the weapon had been in the car, he certainly wasn’t aware of it. The pistol had no doubt been found when the cops searched Bluestein’s car after the shooting.

Following is Cullotta’s recollection of what transpired while Bluestein was at the Upper Crust minutes before his death:

“Tony, I and another guy, were sitting at a table outside the restaurant. We knew the cops were watching us. In fact, we made gestures at them to make sure they knew they’d been detected. It was a game that we played all the time.”

The baiting was interrupted when a white and blue Lincoln pulled in and Frank Bluestein got out of the car. Bluestein was acquainted with the gangsters through his father, Steve. He’d moved into town from Chicago a few months earlier and was working in the showroom of the Hacienda. He went inside and ordered a pizza to go, and then came out and joined Frank and Tony.

After exchanging pleasantries Frank said to him, “I see you’ve still got Illinois plates on your car. Are you going to get a Nevada registration?”

“Someday I will. I just haven’t had the time yet.”

“You’d better get it done pretty soon,” Frank warned. “These fuckin’ cops here are real cowboys. Any time they see a car with Illinois plates they think you’re a gangster from Chicago.”

“You know, I think somebody’s been following me around,” Bluestein said.

“It’s probably the goddamn cops,” Frank told him.

“No, I don’t think so; I think it’s somebody looking to rob me. Anyway, I’ve got a gun in the car. If anybody tries anything I’ll be able to take care of myself.”

“Do yourself a favor. Get that gun the fuck out of your car. I’m telling you these fucking cops are nuts. If they think you’ve got a gun they’ll shoot you,” Frank said.

When Bluestein’s pizza was ready he got up to leave. “Get rid of that piece and get the right plates on your car,” Frank warned again as Bluestein walked away.

About twenty minutes later, the waitress told Tony he had an important phone call. Tony went inside and came back out with a shocked look on his face. He said, “That was Herb Blitzstein [a Chicago criminal who had joined Spilotro in Vegas] on the phone; the cops just killed Frankie Blue.”

Based on Cullotta’s account, Frank Bluestein not only knew there was a gun was in the car, he was prepared to use it if he felt threatened. Is it possible he mistook the cops—who were in plain clothes and driving an unmarked car with Arizona plates—for the robbers he thought were following him?

Many years from now when I get the opportunity to interview Frank Bluestein in the next life, that’s the first question I’m going to ask him.

Interview: Mommy Makes Me Sick; Defining Munchausen by Proxy

 
 
 
 
 
 
With a specialty in Factitious Disorder, Dr. Marc Feldman is an international expert in Munchausen syndrome, Munchausen by proxy, and malingering. He was formerly Vice Chair for Clinical Services at the University of Alabama, Birmingham (UAB), Medical Director of UAB’s Center for Psychiatric Medicine and the Clinical Professor of Psychiatry at the University of Alabama (UA), Tuscaloosa.

Michelle McKee:
The term factitious brings the word “lie” or “liar” to mind and the word “disorder” makes me think of something that is “pathological” or “habitual.” Therefore, Dr. Feldman, what is Factitious Disorder and is this just a ten-dollar term for pathological lying?

Dr. Feldman:
"Pathological lying" refers to lying consisting of a triad of features: it is impulsive or compulsive; it is repetitive; and it typically is ultimately self-defeating (e.g., the lie is exposed and undermines people's trust). It can involve anything--not just illness. One variant that often co-exists with full-blown Munchausen syndrome is called "pseudologiafantastica," or the telling of tall tales about one's personal history that mix fact and fiction. Such lies--the ones that are "a little" true--are the best kinds of lies because they are so difficult, generally, to detect. Pseudologia fantastica can be seen among MbP perpetrators as well.

Factitious Disorder(FD) is the feigning, exaggerating, or self-inducing of physical or psychological signs and symptoms to assume the "sick role." External incentives are absent, which contrasts with malingering, in which the principal goal for the disease enactment is external, and often tangible. Examples of malingering include obtaining opioids, evading criminal prosecution, getting disability monies, avoiding military service, etc.

FD is a mental disorder with its own chapter in DSM-IV-TR; malingering is merely listed in the Appendix as a condition that might warrant clinical attention but is not established to be a mental disorder. If the only way to understand the disease enactment is to invoke psychological processes, then the diagnosis is FD. Technically, FD and malingering cannot co-exist, but in reality they very often do because a person's motives for a piece of behavior can shift over time.

MM: How does Hypochondria differ from Factitious Disorder and Munchausen Syndrome?

Dr. Feldman: Hypochondriasis refers to the preoccupation with having a dreaded disease. These patients are convinced that they are genuinely ill but that doctors and others have failed to diagnose it properly. Some people consider chronic fatigue syndrome and fibromyalgia to be forms of hypochondriasis, but this is a bit controversial. Based on their convictions of illness, hypochondriacal patients may seek medical opinions repeatedly and from numerous practitioners. Hypochondriasis is one of the somatoform disorders, along with diagnoses such as pain disorder, somatization disorder, and conversiondisorder.

Munchausensyndrome is defined by the triad of 1) chronic and severe factitious disorder, 2) pseudologia fantastica, and 3) wanderlust (traveling from place to place to garner new audiences for the deceptions). The professional literature is uniform in stating that Munchausen Syndrome patients are predominantly male, but in my work, women have been more prevalent.
Munchausen by proxy is the feigning, exaggerating, or inducing of physical or psychological ailments in another person, typically by a mother against her child. Men have only rarely been implicated in Munchausen by Proxy maltreatment.

MM: Is Munchausen by Proxy (MbP) a form of mental illness?

Dr. Feldman: Munchausen by Proxy, isn't really an "illness," as I see it. It as a form of child abuse, not something a perpetrator "suffers from." In the same way that a mother doesn't "have" shaken baby syndrome, a mother doesn't "have" Munchausen by Proxy (MbP). However, the media almost always get it wrong, as do child protection agencies and courts.

MM: You say that MbP from your perspective is not an illness but child abuse. Therefore, I have to ask you, is child abuse related to a mental illness or is it a behavior choice.

Dr. Feldman: Child abuse is a behavioral choice, in my opinion, at least in MbP cases (an exception might be a phenomenon such as postpartum psychosis resulting in abuse/death of the child, because then the mother has lost contact with reality). These mothers are not psychotic nor necessarily impulsive; often considerable planning is necessary for them to carry out the deceptions. Some perps may claim that the behavior occurred during psychogenic "blackouts," but I'm not aware of any cases in which this was found to be true.

MM: In MbP the perpetrator makes another sick in order to garner attention for themselves. How do the perpetrators of MbP differ from those caregivers who have been termed “Angels of Death?” Don't both sets of perpetrators seek to garner attention for themselves by inflicting extreme illness to another party?

Dr. Feldman: The Angels of Death and MbP perpetrators have so much in common in many cases that I equated them in my co-edited 1996 book, TheSpectrum of Factitious Disorders. The relevant chapter analyzes numerous Angel of Death cases, calling them "hospital epidemics" of MbP. But some Angels of Death are "merely" homicidal and not particularly attention-seeking, and in those cases, the MbP term wouldn't be appropriate.

MM: To what extent do perpetrators of MbP seek to harm their victims? Do they seek to cause the eventual death of their victim or is the death of the victim counterproductive?

Dr. Feldman: There are some cases--relatively few--in which the MbP perpetrator seems to delight in the bereavement experience, enjoying funeral and burial rituals, etc. I think that's how the Waneta Hoyt case in upstate New York can be conceptualized, and it may also be true for the Marie Noe case in Philadelphia. But generally, the death of the victim is counterproductive because it removes the "object" they manipulate in MbP. Overall, though, it has been estimated that 9-10 percent of MbP victims eventually die, either as a direct result of the abuse or the iatrogenic complications caused by misdirected treatment efforts.

MM: How well informed is the medical community on the signs and symptoms of MbP?

Dr. Feldman: Overall, I think the medical community is inadequately informed. The reason is that MbP is not routinely taught in medical schools or residency programs. In a 1993 study I did with Barbara Ostfeld, we found that child psychiatrists were quite uniformly aware of the phenomenon, but that most family practitioners and social workers--who, after all, are on the front lines in dealing with families--were unaware even of the term "MbP," let alone what it takes to diagnose a case.

MM: I am pretty sure that if I decide that I want to have half a lung removed I can eventually find someone who will be more than happy to come up with a diagnosis to support the procedure and eagerly bill for it. Therefore, how culpable are the doctors who are involved in these cases, they're trained professionals, how can they be so easily duped?

Dr. Feldman: Regarding the apparent ease with which physicians can be duped: this isn't a surprise to me. Physicians are taught nothing about medical deception in medical school or residency. Even as a psychiatric trainee, I never even heard the word "factitious"; it was only after I submitted my first article about a patient who feigned cancer that I heard the term. In the article, I had called it "malingering," and the reviewers pointed out my mistake.

During medical school, a supervisor got angry with me for writing statements such as "According to the patient, she has shortness of breath" or "The patient states he has chest pain." He said that I was demonstrating that I already doubted what I was being told by not stating it as simple fact, and so I had to re-write the entry simply as "She has shortness of breath" and "He has chest pain." Also, doctors are taught (correctly) that the best clue to what is going on with a patient is what the patient and family have to say about it and that we must form an "alliance" with both (particularly in psychiatry, but actually in all fields). We are not taught ever to doubt what is being said. So, again, it doesn't surprise me that doctors can not only be gullible but also wind up being, as one author put it, "professional participants" in MbP maltreatment.

MM: Is there a victim profile for MbP, such as confined to a particular age group, gender, economic background? What about the perpetrator, is there a profile for them?

Dr. Feldman: MbP perpetrators tend to have personality disorders, especially borderline, antisocial, histrionic, and narcissistic personality disorders--the so-called "Cluster B" personality disorders, histories of psychiatric treatment earlier in their lives, histories of substance abuse, and, often, personal histories of factitious disorder that they now seem to want to extend to the next generation.

They may have been abused themselves earlier in life, but this is hard to know because the perpetrators often provide false historical information in a kind of attempt to exonerate or explain away their behavior. Clearly, the problems these mothers have allow them to objectify and dehumanize their children. Occasionally, a perpetrator might have an underlying mental disorder such as major depression or bipolar disorder that fuels their behavior to some extent, and we tend to view those cases as more treatable because mood disorders are quite treatable.

They tend to be in the age range associated with having small children. I think that MbP, like abuse in general, is detected more often in lower socioeconomic families, but I don't have research data to back that up. I rarely encounter African-American perpetrators in MbP cases, and I'm not sure what to make of that.

Regarding victims, they are usually, but not always, pre-verbal or scantily verbal and therefore can't communicate about what's going on. They seem not to have bonded terribly well with the perpetrator, and there can be several reasons for this. One is that, as in abuse in general, there may be something about the child (in the eyes of the mother) that makes him/her "imperfect" and dissatisfying.

Only one study of adult survivors of MbP has, to my knowledge, been published. As you would expect, many of the patients (I think there were 12 in the study) had symptoms of post-traumatic stress disorder. Some avoided even medically necessary care because of their unpleasant memories, but a few became factitious disorder patients themselves, as if to "master" the trauma by making it their own.

MM: How common is MbP?

Dr. Feldman: It has been estimated by one researcher that there are around 1,200 new cases each year in the U.S., but that statistic makes a lot of assumptions that might not all be true. MbP is a form of abuse/neglect that is bathed in secrecy and I have the feeling that most--yes, most--cases are never identified.

MM: What needs to be done to better understand, identify, and treat MbP perpetrators?

Dr. Feldman: It has been very difficult to study MbP perpetrators because most deny their culpability even when faced with incontrovertible evidence, and therefore aren't amenable to research interviews.

It might help if there were a central database of MbP cases that accredited researchers could access in order to study perpetrators and victims more thoroughly. The victims tend not to be available because the focus is on placement once MbP is identified, and so once again study is stymied.

The broader problem, though, is that many jurisdictions still aren't even aware of MbP as a form of child maltreatment, and obviously one can't diagnose something one has never heard of. So, cases slip through the fingers of anyone who might try to study the phenomenon.

MM: What percentage of the population is affected, or believed to be affected, by MbP as victims and as perpetrators?

Dr. Feldman: We have no information to answer this question. Again, it would be very helpful if there were a central repository of MbP data, but it doesn't exist.

Very little formal research into MbP has ever been performed and government and private foundations in the U.S. have never contributed a dime in grant monies for these issues.

MM: Are children the only victims of MbP? What about the same type of behavior by a caregiver against, for example, an elderly individual or someone who is already disabled, would that also be classified as MbP?

Dr. Feldman: Yes, these would also count as MbP cases. We use terms such as "Munchausen by Adult Proxy" to label such behavior, which can have the very same motives as when a child is the victim. We should be aware too, that MbP can be perpetrated against pets in order for the perpetrator to receive attention and sympathy, care and concern, from the vet and/or others.

MM: What should someone do if they suspect abuse through Munchausen by Proxy?

Dr. Feldman: First, they need education about what MbP is and is not. They can quickly get this kind of information from the MbP chapters in my book, PlayingSick. Then, they need to match the facts of the given case to the known features and warning signs of MbP. Once they have this kind of information, they will be equipped to make a sound, organized report to their county child protection agencies. They need to cooperate with the authorities and remain available to assist, if possible. Of course, mandated reporters, such as physicians, must make the MbP report at the time they become suspicious that it is occurring, even in the absence of confirmation.

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