One of the kids on our team is probably suffering the effects of Munchausen syndrome by proxy. The only way this kid could be suffering the problems she has is if her mom is injecting the child's own feces into her IV. She keeps developing new infections, which can only come from her stool, and even swallowing the feces wouldn't cause the symptoms she has. The problem is that we can't surreptitiously put a camera in the room to watch, and having a nurse in the room at all times isn't feasible either, because we're short staffed, and it probably wouldn't make a difference because the mother has succeeded in perpetuating the child's illness while she is in the hospital, so she's pretty good at being sneaky with this. So we can't prove it, we can only treat the child, and she's not going to get better if this continues.
The other problem is that this is a very, very serious accusation, and we can't really make it unless we have proof. And we can't have proof unless someone actually sees the mother doing this. It isn't enough, legally, that when the child's grandmother stayed in her room to give the mother a break, the child got better, only to worsen when grandma left. It isn't enough that she is continually being reinfected with bugs that are susceptible to the drugs we're already giving her. It may prove the diagnosis to us, but that's not enough. At least according to my attending.
I don't like bureaucracy, I don't like feeling guilty no matter which course I choose. I just hope this mother is caught.