The Preventionist, Episode 1: "Creative Financing"

Podcast: The Preventionist
Producers: Serial Productions & The New York Times
Host/Reporter: Dyan Neary
Date: October 30, 2025

Episode Overview

This gripping first episode investigates the widespread, often devastating fallout from a single doctor’s actions in Lehigh Valley, Pennsylvania, focusing on families accused of child abuse after seeking medical help for their children. Reporter Dyan Neary follows county controller Mark Pinsley's quest to uncover the financial and human toll of misdiagnosed child abuse cases, highlighting the powerful, and often unquestioned, role of “child abuse pediatricians.” The story uncovers how one doctor's assessments can lead to the forced separation of families, and how systemic obstacles make such accusations virtually impossible to challenge.

Key Discussion Points & Insights

1. The Catalyst: A Family’s Nightmare (00:33–03:27)

• Dyan Neary attends a public meeting where a young mother recounts the trauma of having her infant son taken after a medical emergency led hospital staff to suspect abuse:
  • A baby chokes on milk, is resuscitated, but following a hospital visit, parents are accused of shaking the baby.
  • The mother describes losing seven months with her child, her milk supply as a nursing mom, and witnessing her son’s milestones only via FaceTime.
• This event is presented as emblematic of a larger, troubling trend—cases where parents are accused of abuse based on hospital interpretations, resulting in children removed from their care.

“I'm a 21 year old mother who lost seven months with her firstborn son. … And I'm a mom who lost everything in less than 24 hours due to one doctor's misdiagnosis. Enough is enough.”
— Young Mother’s Statement (03:00)

2. The “Money Guy” Gets Involved: Mark Pinsley’s Investigation (05:11–12:14)

• Mark Pinsley, Lehigh County’s controller (responsible for fiscal oversight), hears about the issue via a viral TikTok by a lawyer describing a successful fight against a false child abuse accusation.
  • Recognizing a potential misuse of county resources, he contacts affected families and starts digging into the cases and associated county expenditures.
• Mark meticulously documents family cases, confirming details against official files—initially as a skeptical outsider, but growing convinced of systemic failure.

“At first, I just thought that, like, this is two unfortunate souls... And then I started looking in, and it just became very quickly apparent that there was a problem. Very quickly.”
— Mark Pinsley (10:21)

3. Understanding the System: The Role of “Child Abuse Pediatricians” (12:14–16:20)

• Mark discovers that nearly all accusations originate from a specialized doctor: the "child abuse pediatrician" (CAP).
  • CAPs are trained to identify potential cases of abuse from medical findings—a crucial but power-laden function.
• The episode highlights a case where a nurse-mother is forced to divorce her husband (who is later jailed), only for a genetic test at a different hospital to reveal their child’s brittle bone disease, not abuse.

“And wouldn't you believe it, the child has brittle bone disease.”
— Mark Pinsley (16:17)

4. The Financial Angle and Systemic Barriers (16:46–23:05)

• Mark, though powerless to change policy directly, calculates the significant and preventable cost to taxpayers caused by misdiagnoses and overzealous intervention.
  • Up to $30,000 per year per child in foster care; untold millions if lawsuits follow.
• He identifies a highly disproportionate number of Munchausen by proxy diagnoses from Lehigh Valley compared to the state average, with the region accounting for a third of such cases but only 3% of Pennsylvania's youth.

“So something's not right. There's a problem.”
— Mark Pinsley (18:33)

5. Resistance, Retaliation and Report Censorship (23:05–28:24)

• Mark faces strong pushback:
  • County lawyers warn he's exceeding his authority and risks lawsuits.
  • After threatening to publish the report, Mark’s budget is cut, staff positions threatened.
  • He withdraws the initial report under pressure, only to see the staff cuts revoked—suggesting retaliation.
• Ultimately, with legal advice, he redacts sensitive sections, gets staff approval, and times the report’s release to coincide with the finalized county budget for maximum protection.

“That was probably the biggest feeling I felt because I did not want to screw these two employees. ... Like this just felt so wrong. It felt like I wanted to take a shower kind of wrong.”
— Mark Pinsley (26:38)

6. The Public Confrontation: Families Demand Answers (28:57–34:50)

• Mark releases the report to the public and helps organize the families to testify at the Lehigh County Board of Commissioners' meeting.
  • Nearly 100 people crowd the room; thirteen families speak, describing wrenching stories of losing their children to CYS after routine or emergency hospital visits.
  • Several recount being accused of Munchausen by proxy or being banned from seeing their kids with little to no investigation.

“We were immediately banned from the hospital and accused over a weekend of suffering from a psychological disorder by doctors who never met us, expert physicians, multiple psychologists, teachers and school staff. Over 15 witnesses tried to get a hold of CYS to dispute allegations, but none of it mattered. There is no investigation. To this day, we have never had contact with our son again.”
— Testimony from Parent (32:43)

• Speakers express humiliation, trauma, and a deep distrust of the medical system.

7. The (Non)Response: Authorities Remain Guarded (35:17–37:52)

• Commissioner Chairman Jeff Brace issues a formal, lawyerly statement, expressing generalized concern but not addressing Pinsley’s main recommendations or promising change.
• Other commissioners note their personal empathy but stop short of proposing reforms.
  • Mark is frustrated by the procedural, dismissive response, feeling it ignores the lived reality of the families and sidesteps accountability.

“He read a pre canned speech that said, hey, I just wanna let you know, if you guys get reported as child abusers, we have to investigate you. ... It was a nothing comment. It had been vetted, obviously … It basically said fuck you to all the families. That's how I felt and I don't curse very often.”
— Mark Pinsley (37:09)

8. The Broader Crisis: Over-Reporting and Loss of Trust (37:52–End)

• The episode concludes with Dyan reflecting on how—in Lehigh Valley, at least—the dominant issue is not ignoring child abuse, but over-reporting and catastrophic misdiagnosis.
• The power of a single doctor’s word, combined with institutional inertia, has upended dozens of families with little avenue for redress.
• Multiple testimonies point to a single, unaccountable doctor at the network’s center.

“It was as if we were invisible.”
— Grandmother (38:52)

“I ask you, what kind of doctor does this?”
— Grandmother (39:11)

Notable Quotes & Memorable Moments

• “My two month old son was happily drinking milk from his bottle... I never ran so fast up the stairs screaming at the top of my lungs for help.”
  — Young Mother (00:59)

• "So that's what I did. I ran and I won controller. And my goal was to figure out how I could help the people using that position and being creative around financing."
  — Mark Pinsley (05:40)

• “I can't live knowing that America is like that or that Pennsylvania is like that. Like, I have to do something about it.”
  — Mark Pinsley (16:37)

• “If you are taking your child to Lehigh Valley Hospital, you are putting your child and family in danger.”
  — Public Testimony (33:28)

• “For all of us, a lot of the damage is already done. … The children wound up home, but also wound up kind of broken.”
  — Family Testimony (34:33)

• On County Response:
  "It was a nothing comment. It basically said fuck you to all the families."
  — Mark Pinsley (37:09)

Important Timestamps

• 00:33 — Introduction to the Allentown family’s case and the meeting
• 05:11 — Mark Pinsley’s background and initial involvement
• 07:36 — Mark’s first contacts and method of investigation
• 12:14 — Discovery of the “child abuse pediatrician” and their unchecked influence
• 16:08 — The case of misdiagnosed brittle bone disease
• 18:02 — Munchausen by proxy over-diagnosis statistics
• 21:15 — County attorneys warn Mark about overreach
• 24:31 — Consequences for Mark and his staff
• 28:57 — The night of the public meeting, families line up to testify
• 32:43 — Heartbreaking parent testimonies
• 35:17 — Commissioner's tepid response
• 37:52–End — Reflection on institutional inaction and the persistence of families’ trauma

Overall Tone

The episode blends investigative rigor with deeply personal, emotional testimony. Mark Pinsley’s frankness and compulsion to act as “bulldog controller” bring urgency and authenticity, while the families’ voices express an acute sense of betrayal, trauma, and loneliness. Dyan Neary’s reporting is empathetic but unflinching, maintaining focus on the systemic implications as well as individual suffering.

To be continued: The episode ends with Dyan’s pledge to investigate the doctor at the center of these cases.