wow... that is a strong letter and accuses you not taking interest in your child medical condition and not giving the medication. If this is not true then I would think that the doctor can be sued.  I am sure that you agree that the medications need to be given within a reasonable time (a missed dose is after 4 hours from the prescribed time) and if the medications are stopped or long term (several doses are given very late or not on schedule) then the CAH can be affected to the point where the child can be VERY ill and can die. I think it is child abuse!!! But often the doctors are not clear on how important it is to give the medications and the affects of not giving it on time. Doctors do not give clear instructions on the stress doses either. And there is conflicting information about when to give the stress doses. SOME (including the adult endo and nurses that I know) think that sol-cortef is just for vomiting and the ped endo has told me and given me written instructions other wise but if I call doctor in her practice they give conflicting information.

Most  ped endo think that emotional stress requires extra cortef. Anyone some that has a toddler with CAH knows that they seem to be emotionally stress out all the time and if we gave them extra medication every time they were having a bad hair day... they would take the entire jar of cortef in one day. As for giving the injection for a muscle strain or bone out of joint or whatever. My three year had a strain and the doctors said not to give the injection and he was fine. He did not go into shock. We monitored his blood pressure and everything and he was fine but I would not have just dismissed it. I took him to the ER as soon as he told us that his arm hurt. My other son had a broken collar bone (hair line break).. and did not need an injection because it was not a serious break. Of course we monitored the blood pressure and just in case doubled the oral dose because of the pain. We followed up with more x-rays after a couple of days too. Watched for other problems (infection, etc)