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THE SPURWINK CHILD ABUSE PROGRAM

17 Bishop Street, Portland, ME 04103 Phone 207-879-6160 or 800-260-6160 Fax 207-871-5668

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MEDICAL EVALUATION

Name: DOB: CA: DOE: CMHC: Program Director:

Mila Malenko 11-29-2006 2.7 7-14-2009 022825 Lawrence R. Ricci, M.D.

Mila Malenko is a 2 year 7 month old female, date of birth 11-29-2006, seen by Lawrence R. Ricci, M.D., at The Spurwink Child Abuse Program in Portland on 7-14-2009. Mila is accompanied for her evaluation by her mother, Lori Handrahan. Also participating in the evaluation today is Spurwink Child Abuse Program administrative assistant Laura Hebert. The original referral came on 7-13-2009 from Dean Staffieri, DHHS Portland supervisor. According to that referral, Mila told Polly Campbell of the Attorney General's office "I tell kitty to tell Poppy not to touch my gina with his big penis." She has made other disclosures saying that her Poppy touches her "gina" or vagina. She will use the word "penis" over and over again. She has stated that her father was putting his penis on her tummy. Mila asked him to stop. She has said "I don't want him to." She also has said that her father puts ice cream all over her and that Mila has to lick it off. In addition to the medical evaluation today, Mila is scheduled for an evidentiary interview here at The Spurwink Child Abuse Program. . Interview with mother: Lori offers the following information today. The family lives in South Portland and consists of Lori and Mila. Lori is 40. She has had one pregnancy and one living child. Mila's father is Igor Malenko. He is 37. He lives in South Portland. He and Lori were together almost two years. They separated in 5-2008. ( Because of what Lori describes as domestic violence involving both her and Mila, for eight months visits were supervised by Kids' Connection. The police were involved on two occasions. Visits became unsupervised in 1-2009. The last visit was on Friday from 12:30 p.m. to 4:00 p.m., with today being Tuesday.

Lori notes that Mila has had chronic yeast infections since visits started. The diagnosis has been vaginitis. Primary care has been with Allison Willette, N.D., and Sarah Ackerly, N.D., C.P.M:, both of Northern Sun Family Health Care. A urinary tract infection was diagnosed two weeks ago. When Mila returned home from a visit two and a half weeks ago,her vagina was red. Mila said "I need to wash my vagina." She said "Put your face in my vagina. Poppy just did that." This statement to mom was spontaneous. She also said "I'm really sad because Poppy puts his penis in my bum." Lesley Devoe, L.C.S.W., has been involved, and she raised some concerns about sexual abuse, apparently in part because of a video made when Mila was a baby showing Mila's father sucking on her fingers. Mom gave me another video of Mila talking about her father's penis. Apparently, this was recorded on Friday. Mila was speaking to her cat .. Polly Campbell of the AG's office has been involved as an advocate for the past year, and she has spoken with Mila. Reportedly, Mila told her "I told my kitty all about when dad touched gina with big penis." The next day, Mila reportedly also told Julie Gray, P.A., at Freeport Medical Center walk-in clinic. Mila does not have a primary care provider currently because of reported conflicts between the parents over whom she should be seeing. Also involved with the family are Jacqueline Campbell, Ph.D., a domestic violence expert from Baltimore; and Beth Fawcett, DtrnS Portland. There was a Child Protective Services report this past Saturday by the AG's office and a nurse. There have been no visits since. The next visit is scheduled for tomorrow. Mila is described as healthy. Her growth and development are normal, indeed, exceptional. Toileting was not a problem. She has no other history of genital or rectal complaints, although last Wednesday when she returned, mom states that Mila's vagina appeared "stuck together." In 7-2009, urinalysis reportedly was contaminated. There was blood in the urine. It was unclear whether it was a true positive culture. Mila did complain of pain with urination. She had a fever and a red vagina. She was placed on antibiotics. Mila has no symptoms currently, although she has had redness. Some of the concerns that Lori expressed to me regarding Igor included: Psychiatric discharge from the Yugoslavian army. His assault at age 16 of another child. His own severe abuse as a child. The video made after Mila's birth showing him sucking her fingers when she was sleeping. His past history of drug and marijuana use.

I did listen to Lori express these concerns as part of the background for this evaluation. However, I must emphasis at this time that the purpose of the evaluation today was to perform a physical examination of Mila to see whether there is an evidence of genital or rectal trauma and to make recommendations regarding future evaluations. I will comment on this further below. Therefore, I made no attempt during this gathering of information to corroborate or refute any of the history that Lori gave me regarding Igor. . Review of records: I had an opportunity to review the medical records from Freeport Medical Center: There is a note from 6-27-2009 when the child reportedly presented with burning and vulvar rash. There was erythema present. Urine was positive for leukocyte esterase. Nitrites were negative. Moderate blood. She was treated with Septra. There is a 7-10-2009 report which notes that the child presented with vaginal redness. At that time, there was erythema on the inner labia. Reportedly that was a follow-up visit subsequent to 6-27-2009 when Mila was diagnosed with the UTI. According to the history, prior to Julie Gray's seeing Mila, the naturopathic doctor, Sarah Willette [it is my understanding that the naturopathic doctors are Sarah Ackerly and Allison Elizabeth Willette] called to speak with her. The naturopathic doctor voiced concern about possible sexual abuse of the child by her father and said that she would see the child again later that afternoon. At the appointment with Julie Gray, Lori reportedly said "Mila, can you tell Julie what you told kitty last night?" Mila replied "I told kitty last night that Poppy touched my gina."

Physical Examination: Physical examination reveals an alert, sociable, cooperative, pleasant 2 year 7 month old female in no acute distress. General physical examination is unremarkable. Mila appears generally well nourished and well developed with no evidence of recent physical abuse or neglect. She is entirely prepubertal. Height 37 in, so" percentile; weight 29lb, 50th percentile. . Video colposcopy was not used for the genital and rectal examination. Video documentation was not obtained, although a magnified light source was used. Urine specimen was not obtained. Gonorrhea and chlamydia cultures were not indicated. Genital and rectal examination were performed in a supine semi-recumbent position on mom's lap. Present in the room during the examination were Mila, her mother, my adrriinistrative assistant, and myself. On an anxiety scale of 0-5, Mila was minimally anxious with a level of 1. Labia majora and labia minora were normal. On labial separation, the hymen did not dilate; on labial traction, the hymen dilated transversely to 3 mm. Hymen was U-shaped, with no breaks or scars. There was no evidence of vaginal discharge or vaginal bleeding. SUlcus was normal. Urethra was normal. Posterior fourchette and fossa navicularis were normal. Anal-rectal area had normal appearance. Perineum was normal. There was normal rectal sphincter tone.

No attempt was made to interview Mila today. She did present as an incredibly articulate 2Y2 year old child who had exceptional verbal skills. Assessment: 2 year 7 month old female who presents with concerns over sexual abuse as noted above. Physical examination today reveals no evidence of recent genital or rectal trauma. Of course, the absence of specific physical findings in no way indicates that such abuse could not have occurred. Plan: Findings were discussed with mom. Recommendations at this time include ongoing DHHS follow-up and an evidentiary interview for Mila here at The Spurwink Child Abuse Program. Addenda: I subsequently spoke with Dean Staffieri, DHHS Portland, on a couple of occasions. On 7-14-2009, he stated that his staff was just starting to assess the case. It is currently in front of the Maine Supreme Court over family matter issues regarding custody and visitation. Elizabeth Stout was the previous Guardian ad Litem, and Judge JeffMoskowitz was the previous judge in the case in Maine District Court. According to Dean Staffieri, Beth Fawcett, DHHS Portland, has tried to interview Mila but was unsuccessful. I subsequently had communications with mom; her attorney at that time, Ken Altshuler; dad's attorney, Michael Waxman; and the co-director of this program, Joyce Wientzen, L.C.S.W. We agreed that, given Mila's developmental level, that we would try to interview her and that Ms. Wientzen would undertake this interview. As part ofthis evaluation, Ms. Wientzen would also speak with both parents. This was subsequently arranged.

~-~-~-.'M-.-D.-----Pro gram Director The Spurwink Child Abuse Program

Date signed: 8-17-2009

LRRlmay cc: Lori Handrahan, mother Polly Campbell, Office of the Attorney General, Augusta Beth Fawcett, Department of Health & Human Services, Portland Allison Willette, N.D., Northern Sun Family Health Care, Topsham