Authorities have exhumed the bodies of a son and foster child of Cynthia Martinez Lyda of San Antonio to conduct autopsies into their mysterious deaths. A judge has banned her from contact with two of her other sons, who landed in the hospital with unexplained ailments. One was left disabled. A son born in December was taken from her custody under a court order. Lyda has been diagnosed with a rare disorder – Munchausen's Syndrome by Proxy – that causes a mother to injure her own children. Stories by Express-News reporter Rick Casey this week describe the family tragedy.

At first, the videotape is hard to decipher. You aren't used to looking at a hospital bed through a camera hidden in a ceiling vent. But as you get oriented, you see a woman seated by the bed of a baby who is hooked to a mass of wires and tubes.

The woman is eating. Occasionally she fusses with the baby. She looks around, as if to make sure no one is watching. Then she disconnects a feeding tube that runs through the boy's abdomen into his stomach. She puts her mouth to the tube, and forcefully blows into it. The baby, 8-month-old Joseph Martinez, had been lying still, apparently asleep. He starts writhing. His face distorts in what appears, on the soundless screen, to be a scream. The woman calmly reconnects the tube and leans back. The baby quiets down and lies still on his side. A few minutes later, the woman looks around again. No nurse or attendant has responded. Again she unhooks the stomach tube. Again she blows into it. Again the baby writhes in pain.

The woman, Cynthia Martinez Lyda, then 28, is Joseph's mother. Lyda declined through her lawyer to be interviewed. But in a court record she said she blew into the tube to dislodge a blockage.

Since that taping on Nov. 30, 1994, the tight, troubled world of Cindy Lyda and her former husband, Air Force Tech. Sgt. David Martinez, has come undone.

David, who had thought of his wife as a difficult person but a dedicated mother, was confronted with the tape by agents of the FBI and the Air Force Office of Special Investigations, which had installed the hidden camera at Wilford Hall Medical Center at Lackland Air Force Base on a doctor's suspicions.

Martinez was told his three sons would be taken from him if he could not protect them from Cindy. He filed for divorce. David, a medical technician now working in the pediatric ward at Luke Air Force Base in Arizona, cares for the children with the help of his parents.

As part of the divorce, made final in May 1995, District Judge John Specia of San Antonio banned Cindy from any contact with two of their three children. She is allowed only supervised visits with her oldest son, 10-year-old Anthony, who has never suffered the symptoms that afflicted his younger brothers.

Specia's ruling was based on, among other evidence, a diagnosis by University of Texas Health Science Center psychiatrist Dr. Patrick Holden that Cindy Lyda has Munchausen's Syndrome by Proxy. This is a rare disorder in which mothers and other child-care givers cause illness and trauma in children to gain admiration as devoted and even heroic caretakers.

The couple's second son, Aaron, died at 25 months of age in a Phoenix hospital in 1990, when the family was stationed at a nearby base. Detectives in suburban Mesa, where the now-closed base was located, are investigating his death. They also are investigating the subsequent death of a foster child, Joshua, who was placed with the Martinezes and died shortly before they moved to San Antonio in early 1993. Both bodies were recently exhumed as part of the investigation.

The youngest of the four Martinez sons, Joseph, who appeared in terrible condition when his mother was videotaped blowing into his stomach, recovered with remarkable speed after she was banned from contact with him. Within months, he had all tubes and wires removed, was off medications, and was thriving.

Now he is a playful, mischievous 3-year-old. The only evidence of his trauma: scars at the base of his throat and on his stomach, and a delayed development of speech, from which therapists expect him to recover.

Joseph's 5-year-old brother, Daniel, also was hospitalized at Wilford Hall. He suffers from severe brain damage caused by cardiac arrest while in the hospital. He is described inelegantly as being "in a vegetative state." The cause of the cardiac arrest is still undetermined.

No charges have been filed since Air Force investigators videotaped Cindy Lyda in her son's hospital room two and a half years ago. Family members and some law enforcement officials are outraged. John Martinez, David's father, who is spending his retirement caring for Joseph and brain-damaged Daniel, has threatened to go to Congress and to the media if no action is taken. Detective Don Ryan of the Mesa Police Department, bluntly called the federal prosecutor handling the San Antonio end of the case "a slug."

Ryan, whose small-city police department has the burden of investigating deaths that took place four and six years ago – with evidence almost entirely circumstantial – can't understand why the federal government hasn't moved on a case for which it has a videotape.

But Assistant U.S. Attorney Demetrius Bivins of San Antonio says he has been actively pursuing the case. "This thing isn't sitting around in boxes," he said. He said he wants to wait until the investigations in Arizona are completed before he decides whether to file charges in connection with injuries to Joseph and Daniel. "We want to do it right," he said.

Last Christmas, Cindy checked into Methodist Hospital and the next day delivered a premature baby by Caesarian section.

Only through a fluke – a chance encounter with a pediatric nurse from Wilford Hall at a social event – did child protective officials learn of her pregnancy just three weeks before the birth.

Officials acted with dispatch. Unbeknownst to Cindy or her new husband, 27-year-old former Marine Paul Lyda, child protection officials monitored the birth and immediately filed for custody of the baby, Gideon Lyda.

In filing for state custody, officials cited this line from psychiatrist Holden's report: "Children left in the care of a parent with this syndrome are likely to be harmed and may die as a result of the parent's behavior."

Gideon Lyda is currently in foster care. Cynthia Martinez Lyda has never held him.

Paul, a computer networking specialist, and Cynthia, who had worked for a dentist, reportedly are both unemployed now. According to Paul's mother, Josephine Lyda, they live separately with friends from Harvest Fellowship Community Church, where they both met.

Cindy Lyda defended her actions on the stand in the trial of her divorce from David Martinez. In a lengthy, complex defense of blowing into little Joseph's stomach tube, she said she was doing it to clear the tube, an action nurses performed with syringes. She said the tube was blocked because the doctor had ordered a flow rate that was too rapid.

She also said she put gauze into a feeding-line adapter to slow the rate, without telling doctors or nurses. And she said she covertly left a syringe cap under the baby, causing him to cry to get medical attention.

She said she secretly put formula in Joseph's stool before it went to laboratory testing, saying she didn't trust the laboratory and was doing it to check on its results. She indicated she did these things because she did not trust the lab technicians, nurses and doctors.

At one point John Economidy, her ex-husband's attorney, said, "So all three of those, everybody is lying except you?" "Yes," she answered.

Twenty-twenty hindsight may not be perfect, but sitting in an Italian cafe in a strip center near Luke Air Force Base, Tech Sgt. David Martinez talks like a man cured of blindness.

"I can't believe how stupid I was," he says several times over the course of two, two-hour interviews.

Martinez repeats a story he has gone over many times, the story of a 10-year marriage plagued by chronic illnesses and unexplained deaths.

A medical technician who now works in a pediatric unit, he is still stunned at how little he saw.

David Martinez joined the Air Force because his father gave him an ultimatum. David had dropped out of high school and worked construction, making good money.

He would work for a while, then party till he ran out of money, and work some more. His father, John, told him he had three choices: go back to school, leave home, or join the service.

Once enlisted, he easily earned his GED and showed an aptitude for medicine. Soon he was being trained as a medical technician.

His first assignment was Wurtsmith Air Force Base in Michigan, and it was there he met Cynthia Hedem. Thin but very pretty, she presented herself both as someone interested in his profession – she had been in a nursing program as a high school senior and would take nursing-related courses at a nearby college before they were married – and as someone who needed his help.

She told him she had leukemia. Later he would learn it was anorexia.

She also told David her father had sexually abused her. She would later admit to a court-appointed psychiatrist that this was a lie.

David asked her to marry him despite the fact he had learned of her eating disorder.

"I was very stupid," he recalled. "It was like I had to help her."

Maria Martinez, his stepmother, raised David since he was five. His mother had died in a car wreck in Los Angeles with 3-year-old David in the car.

"He was not very street-wise," she said. "It was our fault. We raised them (David and his older brother Frank) with an emphasis on responsibility and honesty. The problem is, they believed everybody else is that way. It was very easy for this girl to get him. He was a sitting duck."

At one point in the courtship, Maria said, David told Cindy he was not ready for a commitment. He was, after all, only 21. David didn't recall that exchange, but he confirmed the event Maria said followed.

David was working the emergency room one night when Cindy came in suffering from an overdose of pain pills.

Remembering what he now regards as a gross act of manipulation, David once again says, "I feel so stupid."

They married in March 1985, and within months David persuaded Cindy to check into Ohio State University Medical Center for treatment for her eating disorder.

"She seemed better, but it seemed important to get her away from her family," he said, describing her mother as overbearing and hypercritical – a description Cindy echoed years later to University of Texas Health Science Center psychiatrist Patrick Holden.

To ease the situation, David asked for and was given a humanitarian transfer. He was sent to Pease Air Force Base in Portsmouth, N.H.

The following year, Anthony was born after an uneventful pregnancy, weighing 7 pounds, 8 ounces.

"That was the best time with her," David recalled. "Things were great for the first year. There still were problems with her eating, but not significant. I was so happy, we talked about having more children."

It didn't take long. Sixteen months after Anthony was born, in February 1988, Aaron came. He was a month early, weighing 5 pounds, 6 ounces. He had hyaline membrane disease, a not uncommon condition for newborns that makes breathing difficult. Aaron was transferred to Boston Children's Hospital for several weeks, and then sent home healthy.

"He gained weight like crazy," David recalled. "He was a little porker."

For several months, things were normal.

"One day, I think it was in June, I got a phone call at work," David remembered. "All these things seemed to happen while I was at work, looking back."

It was Cindy. Aaron had an apnea spell – an unexplained period in which he ceased breathing. A doctor gave the Martinezes an apnea monitor, an electronic box attached to wires that are strapped to the child's chest and record breathing and heart rates. If either one dips below a preset rate, a shrieking alarm goes off.

Looking back on his little boy's seizures and other traumatic events, Air Force Tech. Sgt. David Martinez remarks on something he never noticed at the time.

"All the things happened while I was at work, looking back," he said. He never witnessed any of the seizures his wife described.

And he wasn't there when Aaron, his number two son, died of cardiac arrest in 1990 at the age of 2.

David and his young wife, Cindy, were living in New Hampshire when Aaron, then about 6 months old, had his first apnea episode, a cessation of breathing.

It was, as he said, "just the beginning" of a mystery that would eventually involve not just Aaron, but two of his younger brothers and a foster child.

"She would call me at work and say, "He's trembling. I think he's having a seizure," " David recalls. "We had EEGs done, but they showed nothing remarkable."

Doctors put Aaron on medication. Then he started losing weight. The seizures continued. There was more medication. Nothing worked.

David was as confused as the doctors. Neither he nor his wife were medical illiterates. He was a medical technician. His wife had studied nursing before they married, and read everything she could get her hands on.

"They wanted to put a G-tube into his stomach," David remembers, referring almost in a daze to the operation in which a hole was cut in his boy's abdomen to put a feeding tube through to his stomach. "We already had an NG tube at night, a feeding tube that slid down through his nose."

David was reluctant, but Cindy was pushing for the G-tube, he said.

Now Cindy Lyda, David's ex-wife has declined through her lawyer to be interviewed for this series.

"I was working my Air Force job, plus a part-time job and going to school," David said. "So I really trusted her, and relied on what she was telling me."

David was describing the classic husband's role for Munchausen's Syndrome by Proxy. Medical literature describes this as a disease in which child care-givers, usually mothers, produce illnesses in their babies to get sympathy for themselves and to appear heroic.

Fathers in MSBP cases are typically absent a great deal because of their jobs, giving the mother both the need for attention and the opportunity to manipulate her child's condition.

Cindy Martinez Lyda has since been diagnosed by a San Antonio psychiatrist as having Munchausen's Syndrome by Proxy. She has been banned by a court order from contact with her three youngest children.

Authorities in San Antonio and Arizona are investigating the deaths of one of the Martinez's sons and of a foster son, as well as a cardiac arrest that left their third child in a vegetative state.

But in 1988 and 1989 nobody – least of all David – suspected anything.

If they weren't suspicious, the doctors were stumped – doctors at Dartmouth, at Boston Children's Hospital, and Dr. Saunders Anderson at Pease AFB, who was Aaron's pediatrician and David's boss.

Finally, Saunders found an Air Force specialist back at Williams AFB near Phoenix, David's home town, who might be able to help. Aaron, his older brother, Anthony, and Cindy were flown in a "flying hospital" from Scott Air Force Base in Illinois, and David was given a transfer in record time.

But Aaron only got worse, despite treatment at the base hospital and at Phoenix Children's Hospital.

"There were terrible vomiting episodes," said David. "He'd have these ‘seizures’ and be in an almost comatose state by the time I got home."

Cindy was describing more and more severe apnea episodes at home, leading doctors to recommend a tracheotomy, a hole in Aaron's throat through which he could breathe.

"I was against it, but Cindy was amenable. Sure enough, he gets a trach."

Aaron continued to lose weight, so in addition to his G-tube and tracheotomy, he was given a central line, a thin tube that delivered nourishment and medication to an artery near the heart. He was put on a ventilator when he returned home.

All of this, yet tests were normal.

"On a Sunday night I was at work in the small hospital," remembers David. "I was in charge of the medical/surgical floor. Our quarters were nearby. At 6 p.m. she calls, crying.

" ‘Aaron stopped breathing,’ she said. I said start bagging him (a forcing of air from a bag into the trachea). I'll be right there. I ran out, yelling to a nurse to call for help."

The door waswhen David arrived. He recalls Cindy sitting on the floor. Anthony, then 3 1/2, was sitting up on the sofa, scared.

"Aaron is lying on his back, dead. I tried bagging him. He was pulse less. The police came. I picked up Aaron and we went to the emergency room. We started code and got his heart beating. We got a helicopter and flew him to Phoenix Children's Hospital. But after four or five days, I was told he was brain dead. So we disconnected the ventilator."

At Cindy and David's request, no autopsy was performed.

"I couldn't picture one more thing being done to him," David said. Now he regrets it. Cause of death was listed as "undiagnosed neuro-degenerative disease."

It was a time not only for grieving, but for Anthony. The older son had been without a mother for most of Aaron's two-year illness. She had spent much of the time at the hospital, sleeping in Aaron's room, leaving him alone rarely. And when Aaron was at home, she took care of him in what she called her "mini-hospital."

But rather than comfort herself with Anthony, Cindy stunned her husband and their friends with a plan. She wanted a foster baby. Not any foster baby, but a severely sick baby, maybe a drug baby, whose parents didn't want him. A baby who needed her and her medical expertise.

Within four months after Aaron died, Joshua joined the family. He had a chromosomal abnormality, an undersized heart and oversized lungs.

When David and Cindy Martinez took in a sick foster baby just months after their 2-year-old son died, some of their friends were very upset.

Karen Holtz had gone to high school with David. Her husband, Tim, was and remains David's best friend. Their middle son, Casey, then 4, was the same age as and played with the surviving Martinez son, Anthony.

"When I found out they were getting a foster child, I told my husband I couldn't have anything to do with the family," Karen said.

Her concern was that her family had been through the trauma of Aaron Martinez's lengthy sickness and death, and the prognosis for Joshua, the foster child, was not good. And they were concerned for Anthony.

"We told David, Anthony needs as normal a life as he can have," she recalled. "He said Cindy felt like she needed to help a kid that was fully involved (severely ill) like Aaron was, a kid whose own parents couldn't handle it. We said, ‘Davie, it's one thing when it's your own kid. Don't put Anthony through this.’"

Joshua was about 6 months old, and wasn't expected to live long. He had a chromosomal abnormality that made him appear to be a Downs Syndrome child, with a tiny body and a slightly misshaped head.

"A little elf," in David Martinez's affectionate description. David had agreed to care for the child for just a month, but he grew attached to him.

Shortly after they took in Joshua, Cindy became pregnant again. It was a difficult pregnancy.

Their new son, Daniel, was born even earlier than Aaron had been. Like Aaron, he was born with hyaline membrane disease, which made breathing difficult. When he came home, it was with an apnea monitor, and a tube placed through his nose for feeding.

Cindy later said in their divorce proceedings that David had witnessed apnea spells with Daniel. David denies it.

"I witnessed the alarm going off," he said. "But it could have been set to go off at a relatively high breathing rate. I never witnessed apnea itself."

As Daniel's condition became more serious, tracking Aaron's, Joshua deteriorated. The family was transferred to Lackland AFB in San Antonio from Arizona's Williams AFB, which was closing.

Joshua, because he was a foster child, was to be turned over to another family. Not long before the move, however, he died of cardiac arrest.

David was assigned to the neo-natal intensive care unit at Wilford Hall Medical Center at Lackland.

One day, he was called to the emergency room. By the time he arrived, Daniel already had a gastro-intestinal tube cut through his abdomen into his stomach. And the top of his stomach had been tied off to tighten the hole to prevent persistent vomiting. He had just had a severe apnea spell.

"He was all gorked out," David recalled. "Cindy says, ‘He needs a trach. He needs a trach!’ I said, ‘No!’ He spent a week in the pediatric ICU in a coma. The doctors couldn't figure out why."

It wasn't until the next time Daniel was in the hospital that he got, at Cindy's insistence, a tracheotomy, David said. When he came home, it was with a central line as well, a tube to an artery near the heart for nourishment.

"He had everything Aaron had," David said.

He said Cindy complained about the treatment Daniel was given by doctors and nurses. He believed her. Cindy stayed with Daniel all the time. Doctors were still unable to diagnose any definitive problem.

One night in August 1993, Daniel had a cardiac arrest.

Daniel was on an apnea monitor set to go off if he stopped breathing. David said Cindy told him the alarm did go off, waking her up. She shook Daniel, then started to "bag him," pushing air from a bag into the hole in his throat.

Soon, hospital personnel started full resuscitory procedures. But by the time Daniel regained his breathing and heart rate, he had suffered severe brain damage. He was put in the intensive care unit, where his brain continued to swell from lack of oxygen. He was having a seizure.

"The doctors looked at me, their eyes seemed to say, `Let's let him go,' " David recalled. "I said, `We can't. Cindy would be so hurt.' Now I wish we had."

Now 5, Daniel remains in a vegetative state.

After brain damage from a cardiac arrest at Wilford Hall Medical Center left his third son in a vegetative state, Tech. Sgt. David Martinez was so outraged by his wife's stories of inept treatment that he wanted to sue the hospital.

Cindy Martinez had virtually lived at the hospital with Daniel, who suffered the brain damage, just like she did with their previous son, Aaron.

Like Daniel, Aaron had suffered from "undiagnosed neuro-degenerative disease." Aaron died, but not before Cindy made herself an expert in his condition and treatment, David Martinez said.

The couple divorced in May 1995. Cindy, who since has remarried, lost custody of the children. Through a lawyer, she declined to be interviewed.

At Wilford Hall, Cindy acted almost like one of the staff, discussing developments in proper medical terminology, arguing with doctors and nurses, and working on computers at the nurses’ station.

Based on the stories she told, David was eager to get an attorney. At first she resisted, he said, but then she agreed. They went to the prominent firm of Tinsman & Hauser, where an attorney was appalled by their story. But after several months went by, they were told he wouldn't take the case.

David wanted something besides a lawsuit. He wanted a vasectomy. After Aaron’s death, he had asked the treating doctor if the problem might be in his or Cindy's genes. The doctor said no. Now, after Daniel had suffered the same mysterious disorders, David figured the doctor was probably wrong.

But when he told Cindy he wanted the procedure, "She fought me like crazy. She said she would use a contraceptive. But shortly after Daniel came home, she wound up pregnant."

"I'm totally against abortion," David remembered, "but I wanted an abortion now. She said no, she wouldn't do it."

Joseph was born in March 1994, the most premature of all the children, weighing only about two pounds. It was a couple of months before he came home. Like his brothers, he had a feeding tube through his nose, and an apnea monitor.

David had arranged to take a course in Houston to help his career. His parents had lent him the money and he didn't want it forfeited. While he was gone, Joseph was checked back in the hospital. When David returned, Cindy made a confession.

"David, I've done something I shouldn't have done," he remembers her saying. "I poured some formula in his stool."

When he asked why, she said she didn't believe the medical tests that said the stool was normal. She wanted to trap the testers.

Soon Joseph had all the symptoms – and all the tubes and lines – his older brothers had.

At some point, according to an investigative report, "Mrs. Martinez stopped focusing her energy on Daniel, and in fact, wanted the doctors to issue an order that Daniel not be resuscitated. It was particularly unusual because she was asking the physicians to do that without consulting with her husband."

There was a split among hospital staff. Some saw Cindy as a caring, very capable mother. Others grew suspicious. Finally, after finding unexplained bacteria associated with fecal matter in Joseph's blood, Dr. Keith Kerr, head of the pediatric intensive care unit, brought in the Air Force Office of Special Investigation.

Using an excuse to move Joseph temporarily out of the room, the OSI installed a hidden camera on Nov. 23, 1994, in a ceiling vent. For more than a week, the room was monitored around the clock by agents and medical technicians. Finally, on Dec. 2, Cindy did something that set the alarms off.

After looking around the room, she disconnected the tube that went into the 8-month-old infant's tiny stomach. Then she blew into it, causing Joseph to writhe. After letting him calm down, she did it again.

The next day, a Saturday, David picked up Cindy at the hospital and took her to a soccer game in which their oldest son, Anthony, was playing. During the game, David's beeper went off. He called his sergeant, and was told to report immediately.

David took Anthony to a friend's and dropped Cindy off at the hospital, where he picked up his sergeant. The sarge directed him to the OSI building. There an OSI agent and an FBI agent started asking questions about his dissatisfaction with the hospital. David thought they were investigating rumors he had heard about a crooked doctor. He got upset as he started repeating the complaints Cindy had made.

"They let me spill my guts for an hour," he remembered. Then they told him they suspected it was his wife who was making his kids sick.

"The sickest feeling I've ever had hit me. I got very belligerent. I jumped up into their faces and yelled, `Prove it! Prove it!' "

The agents sat David down and showed him the tape.

He went into a sort of shock. They took him back to his house, where agents were ransacking the place. They took diaries, medical records, they inventoried medicines. And they took his hunting guns.

"They were afraid I would kill her."

The base commander wanted him committed to the psychiatric ward for the same reason, David said. But after examining David, a psychiatrist refused to sign the order.

Meanwhile, Cindy was being interrogated for hours. She denied everything. She had an explanation for blowing in the tube. She said it was blocked. She also had explanations for other strange events that turned up: for putting formula in Joseph's stool, for putting a syringe cap under him (causing him to cry during a doctor's visit), for putting gauze in his feeding line.

She would even have an explanation for something that would happen over the next few months after she was banned from contact with Joseph: his near miraculous recovery. He had, she said, simply outgrown his problems.

It had been two years since Cynthia Martinez had been caught by a hidden video camera at Wilford Hall Medical Center blowing into a feeding tube in her 8-month-old son's stomach.

As a result of that and other evidence, she had been banned from contact with her two youngest sons, and could have telephone contact only and supervised visits with her oldest son, Anthony.

Her ex-husband, Tech. Sgt. David Martinez, had obtained a divorce and was transferred from San Antonio to Luke Air Force Base in his native Phoenix. There he lived with his parents, who helped take care of the three boys – Anthony, Joseph and 5-year-old Daniel, who had suffered severe brain damage from a mysterious cardiac arrest while alone with Cindy.

Officials in Phoenix have also exhumed the bodies of the Martinezes' second son, Aaron, and of a foster child as part of an investigation into their deaths.

Maria Martinez, David's stepmother and a confidante to 10-year-old Anthony, was disturbed by the telephone calls her grandson received from Cindy.

"She would tell him Jesus doesn't believe in divorce, that she and David were still married, that she wouldn't date anybody because she already had a family."

Then the Martinezes received a call from Josephine Lyda, a computer services sales representative in San Antonio.

Josephine Lyda was just getting to know the woman her son, Paul, was going to marry.

She was, by instinct, wary. It wasn't just that the fiancée, who met her son at a fundamentalist church, was seven months or so pregnant. It was something more than that.

One of the things that bothered her was that her future daughter-in-law kept telling her she needed to take a course in infant CPR. Her babies, the young woman said, were always sick. Nonsense, said Josie Lyda. The new baby's going to be fine.

Then came the family barbecue last Dec. 6 at her brothers' place near Bandera Road and Loop 1604. The occasion was a send-off for a cousin returning to California.

Early in the evening, one of her brothers came over to Josephine and asked what she knew about the fiancée. Was her last name Martinez?

"I immediately felt sick at my stomach," Lyda said. "He said, `See that girl in the green sweatshirt? She knows her. She wants to talk to you.' "

Josephine instinctively told him to have her come discreetly into the house, not to let Cindy see her.

The young woman in the green sweatshirt was a friend and neighbor of Josephine's brothers. She was also a pediatric nurse at Wilford Hall.

In short order, she told Josephine of the videotape of Cindy and her baby, of the diagnosis of Munchausen's Syndrome by Proxy, of the divorce and the court order banning her from contact with her younger sons.

That night, a Friday, the nurse contacted Child Protective Services. By Monday, Cindy Martinez was back to being a highest-level case.

For weeks Josephine Lyda and her brothers had to keep it a secret. They had a hollering debate over whether to tell her son Paul, a 30-year-old computer network specialist. Josephine insisted on secrecy. Her first concern was the baby. What if Paul told Cindy and she fled?

The wedding took place a week later, Dec. 13. Josephine posed for pictures with her new daughter-in-law, somehow not showing on her face that she knew the young woman's secret.

(Later she would learn that Cindy had shared at least a version of the secret with Paul. She told him of her earlier children, but said they were taken away by her ex-husband's wealthy and powerful parents, who didn't like her and who controlled the machinery of government.)

Less than two weeks later, on Christmas Day, Cindy Martinez Lyda arrived at Methodist Hospital. The baby came the next day, premature.

This time, however, child protective agents were at the hospital and made sure Cindy had no contact with the baby. A court order was obtained to put Gideon Lyda in a foster home.

Cindy has been allowed to visit Gideon, but not to touch him. At nearly 5 months of age, he has yet to exhibit any of the symptoms her three previous children showed.

When they learned of Cindy's pregnancy and impending marriage, Maria Martinez and her son David decided to tell young Anthony.

"Anthony needs to be able to defend himself from that woman," Maria says passionately. She said Anthony confronted his mother, and told her he didn't want to talk to her for a while. He said he would call her when he was ready.

Later Anthony, the only Martinez child never to have suffered seizures, apnea, and chronic vomiting, the only Martinez child to have escaped tracheotomies, stomach tubes and central lines, was riding alone with his grandmother in the car.

When Anthony asked if he would get sick like his mom, Maria Martinez recalled, "I said `No, not likely.' Then he asked if he would get sick like her when he grew up."

A UT Health Science Center psychiatrist appointed by a judge to Cynthia Martinez Lyda quoted nurses as saying that despite her extraordinary knowledge of hospital machinery and techniques, she did nothing on one occasion when her son stopped breathing, but "simply called for nurses to come in and help."

Based on this and other evidence, Dr. Patrick Holden concluded that "the toxic influence causing (her son's) `illness' was her presence and her interventions.

Psychiatric reports on parents come with such psycho data as references to mom's and dad's intelligence, emotional stability, and relationships with their own parents. The reports, after all, are designed to help the judge or jury decide who will get custody of the children.

But the psychiatric report on Cynthia Martinez Lyda, filed in a Bexar County Court as part of her divorce from Air Force Tech. Sgt. David Martinez, features more.

Dr. Holden, assigned by District Judge John Specia to evaluate Cindy, had medical records of three of her children who had been hospitalized with undiagnosed neurological problems. One had died, another was severely brain damaged.

He had interviews with the pediatric intensive care unit chief at Wilford Hall Medical Center and with the ICU nursing staff.

He had logs and notes of the Office of Special Investigation, the Air Force's version of the FBI.

And he had the videotape taken by a hidden hospital room camera of Cindy blowing into the feeding tube that had been inserted through the abdomen into the stomach of her youngest child, 8-month-old Joseph.

Holden's task was to decide whether some doctors and nurses were right in suspecting Cindy of having Munchausen's Syndrome by Proxy, a disorder in which mothers surreptitiously make their children sick in order to play the public role of heroic caretaker. So Holden had to be more than a shrink. He had to be, in part, a detective.

His findings were enough to cause Judge Specia to ban Cindy from contact with her two younger children – 5-year-old Daniel, who had been brain-damaged after a cardiac arrest suffered while alone in a Wilford Hall room with her, and Joseph, now 3, who was the baby on the videotape.

Cindy described to Holden a happy childhood, until her mother contracted breast cancer. Cindy was in 8th or 9th grade at the time. She said her mother then became jealous and overbearing.

When her mother died three years ago of lung cancer, Cindy did not go to the funeral. Her husband, David Martinez, had offered to sit with their sick son in the hospital, but Cindy dispatched him to the funeral instead.

Cindy described her father in glowing terms, but Holden notes that Cindy early in her marriage falsely told her husband her father had sexually abused her. "This was a fairly angry act toward the father and suggests she may have had significant and unexpressed resentment toward him."

While psychiatrists can speculate on the significance of conflicts between children and their parents, it is Holden's interviews with Dr. Keith Kerr, the chief of the pediatric ICU at Wilford Hall, and the nursing staff that bears most clearly on the Munchausen diagnosis. Here are some of Holden's highlights from those interviews:

"(Cindy) appeared to be a friendly woman who nonetheless had several other features. She could become quite incensed, particularly when she felt like she was having to share the spotlights with others. For example, on one occasion she was angry that her family was not being featured in the base newspaper when another family with a sick child was featured there."

"The nurses felt that at times she had excessive control in the unit and gave as (an) example the fact that she wore scrubs, sat in the nurses' station, went into other patients' rooms freely and touched and handled the equipment."

"They also indicated that she made changes on the ventilators, something which was not allowed. They believed that she apparently interfered with discharge planning by calling the home care company and, in essence, confusing the home care company regarding discharge planning. On a few occasions, she apparently made some changes on her own on equipment, feedings, etc., without input from physicians or nursing staff."

"She also would get laboratory results off of the computer, again, in violation of the rules."

"They reported that Mrs. Martinez was very knowledgeable about medical care and seemed very focused on the medical and clinical issues with her children. She exaggerated the meaning of symptoms that Joseph had post-operatively, even when the nurses reported that these were normal post-operative behaviors. . . . They felt that she usually exaggerated symptoms and described things in terms of a catastrophe."

"She seemed quite knowledgeable about the equipment and, in fact, showed the nurses on a couple of occasions how to do certain things with the equipment, including how to turn the alarm off. In spite of the fact that she was knowledgeable and very comfortable with medical terminology, she at times did things which were out of character and unexpected. For example, on one occasion when Joseph stopped breathing and was lifeless, she just simply held him and did not begin bagging (forcing air from a bag through his tracheotomy). She was quite capable of bagging him by that point as she had seen it done and done it herself several times. She simply kept calling for the nurses to come in and help."

"She also would get laboratory results off of the computer, again, in violation of the rules."

"Mrs. Martinez's relationship with the staff was very cozy at times, but at other times she split the staff. She reported to the doctors on more than one occasion during morning rounds that Joseph had had a number of episodes of apnea (cessation of breathing) and bradycardia (cessation of heartbeat). This led the physicians to get angry at the nurses because the nurses had not reported any of these episodes during the night to the on-call doctor. A later review of the nurses' notes indicated that there had been no apnea or bradycardia spells during the night." (Computerized monitoring equipment also showed there were no such spells at times that Cindy reported them.)

"When she talked about Joseph and her other children, she focused on the different symptoms that each of the children had. She seemed to focus little attention on their personalities and abilities."

"It appears she began to believe that her knowledge and abilities were equivalent to or better than those of the staff. She pressed the staff to pursue treatment and diagnostic procedures such as a tracheotomy (the cutting of a hole through the throat into the windpipe to assist in breathing). She did not show the typical parental reluctance to agree to such treatments and procedures."

"She was extremely reluctant to leave the hospital, even when her husband was willing to take her place so she could take a break. She attributed this reluctance to leave to her reluctance to leave her children alone in the hospital. However, staff noted that she spent a lot of time in the nursing station and visiting other parents rather than in the room with her son."

Perhaps the most compelling paragraph in Holden's report was this: "She was generally angry and frustrated when the health care team did not accept her input about medical decisions. After the staff at Wilford Hall did not accept her judgement about Joseph's gastrointestinal status, she surreptitiously manipulated his gastrostomy tube as demonstrated on videotape, creating physical symptoms in him which if undiscovered would have likely prolonged his debilitated state, his status as a sick child and her status as a caretaker of sick children. She did not appear to appreciate the harm caused by her acts except as they affected her.

"When she was banned from his bedside and prevented from coming in contact with him, the equipment and his medical care, Drs. (Keith) Kerr (chief of the pediatric ICU) and Richard Morris (a chief pediatric neurologist) now at Duke University) report that his various symptoms and signs of illness disappeared. He began to demonstrate remarkably healthy functioning in his gastrointestinal, pulmonary and neurological system.

"It appears that the toxic influence causing his `illness' was her presence and her intervention."

That is the heart of the case. Based on it, Judge Specia banned her from contact with her two youngest sons from her first marriage. Also based on it, Magistrate Peter Sakai has granted temporary custody to the state of a son born to her last Dec. 26.

Cindy has been given a court-appointed lawyer, Laura Galvan Davis, in her fight to regain custody of a the youngest child. Davis argues that Holden is, by his admission, not an "expert" on Munchausen's Syndrome by Proxy. He has been involved in five or six cases in San Antonio over the past 10 years, and has co-authored a paper on the subject.

For the courts' purposes, Holden was listed as an expert.

Meanwhile, two years after Dr. Holden's report, two criminal investigations remain underway.

Police in Mesa, Ariz., are probing the 1990 death of Cindy's son Aaron, and the 1993 death of foster child Joshua. Detectives there say they are frustrated by the almost entirely circumstantial nature of the evidence. They are critical of the U.S. Attorney's office in San Antonio, which has jurisdiction over the events at Wilford Hall, where Daniel became brain-damaged and Cindy was secretly videotaped blowing into Joseph's abdominal feeding tube.

Demitrius Bivins, the assistant U.S. attorney in charge of the case here, insisted that the case "is not sitting around in boxes," but "is being aggressively pursued." He said, "We want to make sure we do it right."

He was asked whether, given the three states and multiple jurisdictions in which the events under investigation have taken place, it wouldn't be good to get all the key investigators and prosecutors together in a room to map out strategy, discuss how they can help each other, and assign responsibilities.