FORT LAUDERDALE, Fla. - With 200 hospitalizations and 40 surgeries in her 8 years, Jennifer Bush became a symbol of out-of-control health care costs, even earning a visit with Hillary Rodham Clinton.

Now, authorities who received a tip say Kathy Bush made her daughter sick by putting feces in her feeding tubes. She also is accused of persuading doctors to perform unneeded surgeries on Jennifer.

"The allegations are that this is a case of 'Munchausen's by proxy,' in which a parent intentionally induces or inflicts injury upon their child to gain attention," says Broward County Assistant State Attorney Dennis Nicewander.

The girl was placed in state custody on Monday. On Tuesday, a circuit judge ruled that she should remain there. Bush, 38, who had sought publicity and donations for Jennifer, will answer charges April 29 of aggravated child abuse and fraud for allegedly obtaining unnecessary medical services. Bush has said Jennifer's medical bills cost $3 million.

Prosecutors say that during the solicitations, the Bushes bought a $19,000 pool, two cars and a $25,000 motorcycle.

Bush and her lawyer vehemently deny that she made the girl sick, categorizing the state's case as a "witch hunt." Her husband, Craig, 44, is not charged.

Jennifer has had her gall bladder, appendix and part of an intestine removed, and prosecutors say doctors took her mother's diagnoses at face value. Once a secretary to Jennifer's former pediatrician, Kathy Bush was fired in 1993 for stealing money, the arrest warrant says.

The Florida case spotlights a once obscure psychological disorder that has spawned a TV movie, a mystery novel and more than 200 reports in medical journals.

"We know it's not rare," says Oakland, Calif., psychiatrist Herbert Schreier, who wrote Hurting for Love about the condition. "This woman fooled the media, she fooled the president's wife, she fooled the Congress, and . . . many, many doctors."

Bush's case has a precedent. Yvonne Eldridge of Walnut Creek, Calif., was honored by first lady Nancy Reagan for caring for 40 foster children. She was later charged in the deaths of three youngsters in a Munchausen's case. Her child abuse trial begins next month.

The cases pose a dilemma for lawyers. "Debate today centers around whether the prosecution should even bring up the syndrome," says Ryan Rainey, an assistant U.S. attorney in Washington, D.C. "It gives the jurors sympathy, and an excuse to say, 'Well, this woman is sick.' "

Experts say more than 90% of offenders are mothers with medical knowledge. Techniques can be monstrous. Some have blocked their children's air passages with food. Children's food has been laced with laxatives to induce chronic diarrhea.

"These are pretty cagey women," says Robin Wilkinson, an Orlando prosecutor of a woman who poisoned her two children. One died. "The nurses usually love them. They're there all the time, they're sleeping in the child's room."

Joy Byers of the National Committee to Prevent Child Abuse, says "The fact is, some parents, . . . are unwilling or unable to be loving parents."

By Deborah Sharp, USA TODAY