A woman who was on probation for feeding her toddler son pain pills in California now faces felony assault charges for doping her infant daughter with a near-lethal dose of morphine in Oregon.
Police said Sara Rose Dillard, aka Sara Rose Lubin, drugged her 2-month-old daughter June 4 in an alleged attempt to get attention from the child's father.
The infant was immediately rushed to the critical care center at Doernbecher's Children's Hospital in Portland and survived.
But it took several weeks for officers to unravel Dillard's past and her previous conviction of Willful Cruelty to a Child under the last name of Lubin in Los Angeles. In the previous conviction, Dillard was also accused of creating a medical emergency to get the attention of her child's father.
Messages to Dillard's lawyer, Dean Smith, were not returned Friday, and ABCNews.com could not find a listed number for Dillard.
Dr. Marc Feldman, author of the book "Playing Sick," said the previous conviction, coupled with Washington County police reports, would lead him to guess that Dillard was suffering with a disorder called Munchausen's syndrome by proxy.
"There's little doubt, in my opinion, that it's a Munchausen's syndrome by proxy case," he said.
The Cleveland Clinic describes the disorder as "a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick."
People with Munchausen's syndrome by proxy are most often women, frequently mothers, and "intentionally harm or describe nonexistent symptoms in their children to get the attention given to the family of someone who is sick," according to The Cleveland Clinic.
"I know a lot of people have asked about Munchausen's syndrome, but she hasn't been diagnosed by a professional," said Sgt. David Thompson, spokesman for the Washington County Sheriff's Office in Oregon.
Thompson said police are considering it an unusual case of child abuse.
This June, Dillard brought her infant daughter to St. Vincent's Hospital in Portland with what she said was a high fever, according to police reports.
Nurses didn't find signs of a high fever, but the staff chose to monitor the infant girl overnight. The next morning, a nurse checked the child's vital signs and said that the baby was barely breathing and had a low heart rate while Dillard was "presumably" sleeping in the same room, police said.
Dillard allegedly tried to explain the incident by saying she had a prescription for morphine and that it must have been transferred into her breast milk. She gave a voluntary a sample of milk, but doctors found such a high level of morphine that they were suspicious that the drug was added afterwards, according to the police.
The baby survived the scare, but since the dose was so high, officers charged Dillard with endangering the welfare of the minor, placing a controlled substance on the body of another person, and first-, second- and third-degree assault, Thompson said.
"Assault one has a minimum sentence of eight years," Thompson added.
Dillard faced four to six months in jail after her conviction in California, and when she was released, she transferred her probation to Oregon. Sgt. Thompson, of the Washington County Sheriff's Office in Oregon, believes she was able to find work as a medical assistant at Oregon Pediatrics because she began using the last name Dillard instead of Lubin.
"What could have easily happened was if they did a background check and they did a criminal check with that name the conviction wouldn't show up," Thompson said.
Psychiatrists and hospital workers who monitor child abuse say "medical abuse" can be some of the most difficult cases to detect -- and the most difficult to prove.
"We usually have a few suspected Munchausen by proxy cases ongoing all the time," said Allison Scobie, director of the Child Protection Program at Children's Hospital Boston.
"A child can remain in the care of their parents, and then we have a suspicion of what could be called medical child abuse," she said. "That's also what we call Munchausen's. Being able to intervene and convey that to authorities can be a very protracted process."
Scobie, who runs the Child Protection Program at Children's Hospital in Boston, has seen a wide spectrum of "medical abuse," from parents dousing their children's diapers with juice and calling it blood, to a mother so insistent that her child was in pain that she convinced doctors at a nearby hospital to operate on the appendix.
"But when it came out, the appendix was perfectly healthy," said Scobie.
She said it can be difficult to prove a case of medical abuse even when doctors suspect it because cases of Munchausen by proxy often start with a real medical condition that the parent then begins to exaggerate, or manipulates into a more serious situation.
"It can take years because sometimes this happens quite gradually," said Scobie. "But it's actually one of the most lethal forms of child maltreatment."
Feldman, the author of "Playing Sick," said up to 9 to10 percent of all Munchausen by proxy victims die as a result of the medical abuse. Often the perpetrators are in such denial they will not admit guilt even when presented with videotapes of them poisoning their victims.
"Unfortunately, the penalties for Munchausen by proxy behavior, when it's perpetrated by a woman, tend to be minimal, they tend to be slaps on the wrist," said Feldman, who added that 95 percent of the cases tend to be women.
To make matters worse, psychiatrists say they have a hard time understanding Munchausen's syndrome, and therefore can't catch it or treat it.
"We have no idea how common it is," said Dr. Thomas Wise, chairman of American Psychiatric Association's Council of Adult Psychiatry and professor at Johns Hopkins University School of Medicine in Baltimore.
"They [people with the disorder] don't have schizophrenia or bipolar disease. These are lonely, very disturbed people," said Wise.
He also said doctors have noticed that the Munchausen by proxy commonly coincides with a serious personality disorder, "but what it shows is how we really don't understand the full spectrum of personality disorders."
Wise's best advice in cases of Munchausen by proxy is for people to protect others and separate children or people who need care from the perpetrator.
"With the Oregon case, it absolutely boggles one's mind that it [the previous conviction] had no effect on her," said Wise. "It shows how resistant people are to this treatment."