Perhaps no crime staggers the mind, or turns the stomach, more than the murder of a baby, and so it is not a surprise when law enforcement comes down hard on the presumed killers. Often enough, these are men and women accused of having succumbed to sudden rage or simmering frustration and literally shaken the life out of a helpless infant who would not stop crying or would not fall asleep.
Shaken baby syndrome has been a recognized diagnosis for several decades, though many medical professionals now prefer the term abusive head trauma. It is defined by a constellation of symptoms known as the triad: brain swelling, bleeding on the surface of the brain and bleeding behind the eyes. For years, those three symptoms by themselves were uniformly accepted as evidence that a crime had been committed, even in the absence of bruises, broken bones or other signs of abuse. While many doctors, maybe most, still swear by the diagnosis, a growing number have lost faith. Not that they doubt that some babies have been abused. But these skeptics assert that factors other than shaking, and having nothing to do with criminal behavior, may sometimes explain the triad.
Has the syndrome been diagnosed too liberally? Are some innocent parents and other caretakers being wrongly sent to prison? Those questions, at the complex intersection of medicine and the law, can stir strong emotions among doctors, parents and prosecutors. They shape this first installment in a new series of Retro Report, video documentaries that explore major news stories of the past and their enduring consequences....
But the dominant issue was child abuse. Shaken baby syndrome is but one aspect of this phenomenon. It is a topic in which statistics can be elusive because reported episodes may not reflect the full extent of the problem. That said, a report issued in April by a division of the Department of Health and Human Services estimated that in 2013, more than 1,500 children in the United States, or four a day, died from various forms of abuse or neglect. Nearly three-fourths of the victims were under the age of 3. (Various studies over the years have suggested that a serious threat to a small child’s well-being is the presence of the mother’s live-in boyfriend.)...
In the Woodward trial, a key prosecution witness was Dr. Patrick Barnes, a neuroradiologist then at Children’s Hospital in Boston, now at Stanford University. “I was adamant that it had to be child abuse, shaken baby syndrome,” Dr. Barnes told Retro Report.
But after the trial, he rethought his testimony and in effect became a penitent. He is now convinced that the diagnosis has been invoked too readily in criminal cases and that other causes might explain any bleeding and brain swelling. They include infections, earlier injuries from accidental falls and even strokes that occurred in utero. Other doctors who share his outlook question whether just shaking an infant, without resorting to other forms of violence, could in fact produce the triad’s telltale signs. Testing that thesis, though, may verge on the impossible: Who in the name of responsible science is about to shake a roomful of babies to see what happens?
Without question, Dr. Barnes said, abuse exists, “and we have to do our duty to protect children.” But families need protection, too, he said, and in some criminal cases, “there is no doubt that errors have been made and injustices have resulted.” Were he able to testify again in the Woodward trial, he said, he would say that the medical findings do not confirm abuse and that the baby’s injuries “could have been accidental.”
One of the more exhaustive studies of shaken baby syndrome’s legal ramifications was conducted by The Washington Post and journalists from the Medill Justice Project at Northwestern University. In March, they published their analysis of about 1,800 abuse cases across the country that had reached resolution since 2001. Far more often than not — 1,600 cases — the result was a conviction. But the researchers found that in 200 cases, a substantial number, charges were dropped or dismissed, defendants were acquitted or convictions were overturned.
Not that the medical establishment is starting to line up on Dr. Barnes’s side. Far from it. Dr. Robert W. Block, a former president of the American Academy of Pediatrics, stands firmly by the diagnosis, telling Retro Report that abusive head trauma is supported by decades of observation.
The divisions within the medical world run so deep that they pain a towering figure on this issue: Dr. A. Norman Guthkelch, a British doctor who in 1971 found a connection between baby-shaking and brain injury. “There are cases where people on both sides, both of whom I admire equally, are barely able to speak to one another, and that’s a shame,” Dr. Guthkelch, who turned 100 this month, told NPR in 2011. Yet he, too, has come to believe that the syndrome is applied too loosely in some criminal cases.
The Supreme Judicial Court is soliciting amicus, or friend-of-the-court, briefs from interested parties as it considers appeals in two cases of men convicted of child abuse based on findings of shaken baby syndrome, or SBS, and abusive head trauma, or AHT....
ReplyDeleteBoth men are represented by David Hirsch, a Portsmouth, N.H., lawyer who, in Millien’s case, is zeroing in on the same physician who provided the damning but later discredited diagnosis against McCarthy, Dr. Alice Newton. Newton also provided the diagnosis in a Middlesex County case in which charges were dropped last year against a Malden man accused of killing his 6-month-old son.
Now the medical director of the child protection program at Massachusetts General Hospital for Children, Newton held a similar position at Boston Children’s Hospital when she made the diagnoses in the Millien and McCarthy cases...
Melinda Thompson, McCarthy’s lawyer, says Middlesex County has relied on Newton and other physicians who are using an outdated protocol in charging people under the SBS and AHT diagnoses. It’s not an idle claim. She used to work as a Middlesex prosecutor.
Thompson said that in both of the cases before the SJC, like McCarthy’s, there was a rush to judgment — that the physicians told the prosecutors what they needed to charge someone with a crime, but there was no serious consideration of underlying health issues of the children who turned up with brain injuries.
“In Aisling’s case, Dr. Newton never put pen to paper,” Thompson said. “We asked for her notes. But there were none.”
In Millien’s case, Hirsch contends in his filing that Newton contradicted her original diagnosis at an appeal hearing.
A growing cadre of defense attorneys are withering in their criticism of Newton. Newton has her defenders, among them some prominent pediatricians. Another of her prominent defenders, Dr. Eli Newberger, suggests that Newton is being unfairly pilloried by defense lawyers.
“She is a dedicated and serious science-oriented person,” Newberger said...
“Part of the problem is outdated science,” Judson said. “Practice and testimony in courts have not kept up with the science.”
Newberger and Dr. Patrick Barnes, who both testified on behalf of Middlesex prosecutors in the 1997 case against Louise Woodward, a 19-year-old British nanny convicted of killing an 8-month-old Newton boy in her care, have gone their separate ways on the science.
Barnes says he can’t stand behind the testimony he gave in Woodward’s case, and in more recent years has testified on behalf of defendants, saying the SBS and AHT diagnosis is sometimes wrongly made in cases where underlying health issues can cause the same symptoms.
Newberger is dismissive of the revisionist views that defense attorneys are increasingly tapping.
“On the clinical testifying roster are a whole lot of people who will cut their consciences for money,” Newberger said. “They’re hired out as defense whores. I just find this vile.”.That kind of talk underscores the emotions on both sides, and Thompson, McCarthy’s lawyer, finds the accusations from those who most often testify on behalf of the prosecution hypocritical. She said all of the medical experts who took part in McCarthy’s defense did so free of charge.
“People who are challenging the science are being vilified,” Thompson says. “When you resort to character assassination, what does that say about your argument?”
https://www.bostonglobe.com/news/nation/2015/09/12/nanny-case-could-have-broad-effects-child-abuse-prosecutions/doika7FUTM8W8wg0O84v7L/story.html
Massachusetts Governor Charlie Baker has defended the two-and-a-half year delay in clearing Irish nanny Aisling Brady McCarthy of all charges in the death of one-year-old Rehma Sabir in 2013.
ReplyDeleteThe governor has faced criticism over the state's handling of the case.
“My view is, it’s better they change their position if they believe the original position was wrong than simply stick with their old diagnostic,” he told the Boston Herald.
Baker said the medical examiner’s office had “to get the answer right.”
He added that the case predated “everybody in our administration.”
McCarthy, who spent the two-and-a-half years in prison, said what prosecutors did to her “was scandalous.”
“My worst nightmare is finally over,” she said.
McCarthy arrived home in Ireland at Shannon Airport on Wednesday morning, the Daily Mail reports.
“The police and (Dr.) Alice Newton, they just decided right away that I had killed the child. That couldn't be further from the truth. I loved her and cared for her, ten hours a day, five days a week,” said McCarthy...
Last week, Middlesex District Attorney Marian Ryan announced that the murder charge was being dropped because the medical examiner issued an amended ruling changing the manner of death from “homicide” to “undetermined.”
The district attorney said the medical examiner found Rehma had prior medical issues and may have had some type of undiagnosed disorder.
McCarthy’s lawyer, Melinda Thompson said: “Ms McCarthy was put in jail for two-and-a-half years over a crime that never occurred. Not just a crime that she did not commit, but a crime that did not occur.”
http://www.irishcentral.com/news/Mass-governor-defends-close-to-3-year-delay-in-clearing-Irish-nanny-of-charges-.html
A prominent, but increasingly controversial child-abuse expert believes that a 3-month-old baby was shaken by an angry Gloucester father hard enough to cause a brain bleed and other substantial injuries.
ReplyDeleteBut a defense expert testified on Monday that Dr. Alice Newton overlooked other possible causes of the infant’s subdural hematoma, retinal bleeding and head swelling, including what he believes is a hereditary condition.
Dr. Joseph Scheller, a Baltimore pediatric neurologist hired by Daniel Green’s lawyer, said he believes the infant’s brain bleed was caused by pressure from excess spinal fluid that collected in the area between the brain and the skull, a condition called benign extra-axial fluid collection...
Prosecutors and police point to evidence that Green was increasingly unhappy in his marriage and frustrated with the baby, who was born prematurely at 35 weeks, as proof that, while alone with him on the afternoon of Nov. 27, 2012, he violently shook or threw the infant.
Newton, who at the time ran the Boston Children’s Hospital Child Protection Team, concluded that the infant’s injuries were a classic case of shaken baby syndrome, now called abusive head trauma.
It’s a conclusion, Newton testified, based on “clinical experience and judgment.”
But Green and his defense lawyer, Joseph Collins, say it’s the wrong conclusion.
http://www.gloucestertimes.com/news/local_news/defense-questions-shaken-baby-claim/article_d8990094-ad28-5483-aee2-96577162dcdd.html
A 2 year old girl fell from a 4-5 foot slide at her babysitter's, generating devastating and fatal brain injury. The death note indicates, "The medical examiner was notified, and due to the mechanism of injury not matching the degree of injuries, she was taken to the medical examiner for autopsy." A memorial notice has an afterthought. "A year later and still not even an apology from our babysitter...I hope she and all other child abusers rot in hell."
ReplyDeletePictures of injuries to 14-month-old Mason Hess show signs of shaken-baby syndrome so classic that one of them will be on the cover of an upcoming medical journal, a pediatric ophthalmologist testified Tuesday at the trial of a baby sitter accused of murdering the child...
ReplyDeleteLevin, who is chief of pediatric ophthalmology and ocular genetics at Wills Eye Hospital, described retinal hemorrhages in Mason's right eye that were too numerous to count, "like you took a paint brush with blood all across the retina."
Levin also described a blood blister at the edge of the toddler's retina.
"When you have blood in the edge of the retina, very few things cause that," he said. "Statistically, it's a much, much higher chance that it's child abuse rather than an accident."
And the pictures showed blood in the white of Mason's right eye, he said.
"That's very, very unusual," Levin testified. "The white of the eye has no blood vessels so it doesn't bleed.
"In shaken babies we see bleeding there because we see the eye is being pivoted," Levin explained. "I'm not aware of any natural disease that causes it, but we see it in the eyes of those who died of shaken-baby syndrome."
Prosecutors have argued that Mason was fatally injured when Heale violently shook him in her home on Aug. 28, 2012. Mason first was taken to Community Medical Center in Toms River that day and later flown to Children's Hospital of Philadelphia, where he died four days later.
Heale told a number of people that Mason went limp after choking on applesauce, but prosecutors allege that is not what killed the boy.
http://www.usatoday.com/story/news/nation/2015/04/01/toddler-shaken-baby-syndrome/70799466/
In a ruling that could have statewide significance, a judge reversed the 2001 murder conviction of a New York woman who was accused in the shaken-baby death of a toddler in her care.
ReplyDeleteIn a decision released Tuesday morning, Judge James Piampiano ruled that the science used to convict René Bailey of Greece has changed significantly since her trial.
The ruling marks the first time a shaken-baby conviction has been overturned in New York on the basis of changing science. Lawyers have won a handful of reversals in other states in recent years.
"The newly discovered evidence in this case thus shows that there has been a compelling and consequential shift in mainstream medical opinion since the time of the defendant's trial," Piampiano wrote in his 28-page decision.
A motion such as the one brought by Bailey's attorney must show that new evidence has arisen that was not available at the time of the trial. Piampiano ruled that the changes in science constituted such new evidence...
Dozens of people in the Rochester area have been prosecuted for injuring or killing young children by shaking them violently or slamming them down, and at least a dozen are in state prison. Some of them admitted their abuse before sentencing, though others, as Bailey did, protested that they had done nothing wrong.
At Bailey's trial, prosecutors had argued that a fatal head injury suffered by 2 1/2-year-old Brittney Sheets could only have been caused by abuse at the hands of Bailey, who cared for the girl and several other children in her home day care center.But Bernhard, who represented Bailey pro bono, argued before Piampiano earlier this year that a growing number of physicians and scientists have come to believe injuries such as those that killed Sheets can be caused by other factors, such as accidental falls or certain illnesses.
Bailey had insisted to police that Sheets had jumped off a chair and struck her head on the floor....
Bailey, now 55, is incarcerated at Albion Correctional Facility in Orleans County. Doorley said prosecutors will ask that Bailey remain jailed pending an appellate ruling or a new trial.
http://www.usatoday.com/story/news/nation/2014/12/17/shaken-baby-ruling-could-set-precedent-in-ny/20520601/..
One of those experts, Dr. Peter Stephens, testified Thursday that he has examined the medical and autopsy records of Brittney's death and believes a fall was the likely cause.
ReplyDelete"There is now general agreement that short distance falls can kill — maybe not commonly, but they can," said Stephens, a forensics pathologist.
Plus, he said, there was corroborating evidence of a fall, such as Bailey's claims and the claims of a young boy who also indicated that he'd seen Brittney fall from a chair 18 inches off the ground.
"My opinion is that Brittney died of massive brain swelling (from) rapid impact," Stephens said...
In her cross-examination, Ackerman succeeded in getting Stephens, a retired pathologist, to note that he has performed only one autopsy in the past 13 years, that he is not a pediatric physician, and that he did not give great weight to trial testimony in 2002 that Bailey gave differing versions of what happened at her home.
Ackerman also highlighted research determining that the likelihood of a short-distance fall leading to a fatality is less than one in a million.
"Less than one in a million still (is) not zero," Stephens answered...
Stephens is one of at least 10 expert witnesses likely to be called to the stand by Bernhard, a New York Law School law professor who represents Bailey pro bono. Her legal team is also assisted by other attorneys with practice in shaken-baby cases and law school students.
In an opening statement, Bernhard said that "this conviction was based on uncorroborated medical evidence."
http://www.usatoday.com/story/news/nation/2014/04/17/shaken-baby-debate-back-in-courtroom-/7848725/
Thousands of Americans are behind bars, convicted of shaking babies to death — and some experts now say the science that put them there is blurry.
ReplyDeleteSince 2000, at least 11 Mississippians have been convicted in such cases with two of them sitting on death row. Jeffrey Havard is one of them....
Nine days before Christmas 2003, prosecutors and defense lawyers selected a jury for the capital murder trial of Jeffrey Havard, the 22-year-old boyfriend of Chloe's mother, Rebecca. In his opening statement, Assistant District Attorney Tom Rosenblatt told jurors that the pathologist who did the autopsy would "testify for you and how he confirmed the nurses' and doctors' worst fears this child had been abused and this child had been penetrated, and the child had died (of) what he refers to as shaken-baby syndrome."
Defense lawyer Robert Clark told jurors the child had slipped from Havard's arms after giving her a bath, her head striking a toilet. "Jeffrey did not intend to kill this child," he said. "This was an accident."
All the doctors concluded Chloe had died of shaken-baby syndrome, and so did pathologist Dr. Steven Hayne, who performed the autopsy in the case.
"The type of injuries that you can see that parallel these are in motor vehicle crashes, falls from significant heights and the like," Hayne testified.
The jury deliberated 40 minutes before convicting Havard of capital murder. Havard's mother and grandmother begged for jurors to spare his life, but jurors concluded he deserved death.
Mississippi Democratic state Rep. Kevin Horan said he would like to see a review of the cases in this state that have relied on shaken-baby syndrome.
Horan, a former prosecutor who handled the appeal of a man convicted in a shaken-baby case, said, "Most of the shaken-baby cases are legitimate. They're not really shaken baby, but blunt force trauma...
At the request of The Clarion-Ledger, New York pathologist Dr. Michael Baden read the autopsy report in the 2002 death of Chloe Madison Britt and examined other evidence in the case.
"There is no autopsy or scientific evidence to support a diagnosis that Chloe died of shaken-baby syndrome," Baden said.
Havard's description of accidentally dropping the baby is "entirely consistent" with the injuries found, Baden said...
Sexual assault was the underlying felony charge against Havard that enabled authorities to pursue the death penalty against him.
"I didn't think there was a sexual assault," Hayne said of his 2002 autopsy of Chloe. "I didn't see any evidence of sexual assault."
During Havard's capital murder trial, doctors, nurses, the sheriff and others told jurors about evidence they saw of sexual assault.
Harper said he is satisfied abuse took place.
Havard is seeking a new trial, citing scientific studies and new evidence.
http://www.usatoday.com/story/news/nation/2014/01/19/science-questioned-in-shaken-baby-conviction-/4642923/
In 1999, Vega was indicted for allegedly beating to death his girlfriend's 3-year-old son, Xavier Collado, at a Kissimmee Econo Lodge on U.S. Highway 192...
ReplyDeleteHe told officers he left the room to make a phone call relating to a drug deal using the public phone downstairs. As he returned, he says he saw Xavier lying unresponsive on the landing of the stairwell, with a bruise on his forehead...
But the star witness for the prosecution in the case was Dr. Shashi B. Gore, then District 9 medical examiner for Orange-Osceola County. Gore performed the autopsy on Xavier, ruling the death a homicide by "subdural hemorrhage due to closed head trauma due to blunt force trauma," according to an autopsy report. Gore testified during the trial that because he observed the inside of Xavier's top lip was torn, he knew the child was "manhandled," saying a single fall could not produce that same injury, only some sort of blunt force.
The state also brought in Christopher Cooper, a nine-time convicted felon, who told the jury Vega confessed to the savage beating within an hour of meeting him in jail. The state maintained Xavier's death was from a rough manhandling of the child's facial area.
A jury took three hours to convict Vega, by then 21, and he was sentenced to life in prison..
Then in 2012, Dr. Douglas Radford Shanklin, a pathology professor at the University of Tennessee, offered to look at the case for the defense free of charge. He found several irregularities in Xavier's autopsy and came to a different conclusion than the one put forth by Gore. Based on photos of Xavier's sister and the autopsy, Shanklin believed Xavier had contracted a bacterial infection from his sister, who was photographed with lesions on her face. Vega says he remembers going to the store in those days with the kids and buying Neosporin for the girl's face. Shanklin says the infection traveled to the boy's brain, turning into bacterial meningitis, which made him weak enough to collapse as it spread. Shanklin found a high count of white blood cells in the hospital report for Xavier, which he interpreted to mean the boy was fighting off an infection before he was admitted. Shanklin also pointed out in his report a forensic slide of Xavier's brain, which showed what he called "a classic, textbook illustration of bacterial meningitis, which has spread deeply." Shanklin added that meningitis is seriously under-diagnosed in emergency rooms, and that Dr. Gore may have been influenced by the premature call from hospital staff to say it was a child abuse case...
Vega filed appeal after appeal without much result, until finally, in 2014, a breakthrough. Florida's Fifth District Court of Appeals reversed and remanded an evidentiary hearing for Vega based on Shanklin's work.
"We conclude, based on the unique facts of this case, that the findings and conclusions set forth by Dr. Shanklin's report constitute newly discovered evidence," court documents said, "to the extent they support an allegation that the testimony of the medical examiner at Vega's trial was knowingly and patently false (or, at a minimum, given in reckless disregard for the truth)."
http://www.orlandoweekly.com/orlando/16-years-after-he-was-charged-with-the-death-of-an-osceola-county-child-giovanni-vega-fights-to-prove-his-innocence/Content?oid=2429858
The cited paper by Greenes and Schutzman is misrepresented. This study of young children who were admitted to the hospital after detection of intracranial injuries revealed 19 children who had no neurologic symptoms, 7 of whom had subdural hematomas. However, Plunkett failed to indicate that 18 (95%) of the 19 children had a large scalp hematoma and skull fracture, injuries that are contact in origin. The visible scalp hematoma would have provided evidence to their caretakers that an injury had occurred. None of the 19 children deteriorated in hospital, although 1 had a post-traumatic seizure, which was well controlled with anticonvulsant therapy. All were discharged in good condition. Two-week follow-up of all cases revealed no subsequent deterioration.
ReplyDeleteThis contrasts sharply with the dismal outcome noted in follow-up of infants who have suffered abusive head trauma. In Bonnier et al.’s study, 13 children diagnosed with abusive head trauma with a presumptive mechanism of shaking were followed for 5 to 13 years. Of these children, one died in the acute period, five were quadriplegic, blind and severely retarded, and one had delayed onset of epilepsy; all of these were diagnosed within the first year after injury. These children continued to be profoundly impaired during the follow-up period, and one suffered delayed death. At autopsy of this child, 10 separate tears were noted in the brainstem and cerebral hemispheres. Five of the six children who were felt to be “normal” in the first year after injury had been identified as having significant disability by school age: two were hemiparetic; five were mentally retarded; and three had severe behavioral disorders. Only one still appeared to be normal. The extremely high morbidity and mortality are not unexpected with severe diffuse brain injuries caused by high inertial loads.
from: Spivack B. Fatal pediatric head injuries caused by short-distance falls. Am J
Forensic Med Pathol. 2001 Sep;22(3):332-6. This is a commentary on Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol. 2001 Mar;22(1):1-12.
Greenes DS, Schutzman SA. Occult intracranial injury in infants. Ann Emerg Med 1998; 32: 680–6.
Bonnier C, Nassogne MC, Evrard P. Outcome and prognosis of whiplash shaken infant syndrome: late consequences after a symptom free interval. Dev Med Child Neurol 1995; 37: 943–56.
Anthony Brooks: This is the second time in a year that the Massachusetts medical examiner has reversed its finding in a baby’s death, and we’ve been reading that in the United States, 16 convictions have been overturned since 2001, including three last year. So does this raise questions about the diagnosis of shaken baby syndrome? What are your thoughts on that?
ReplyDeleteDr. Robert Sege: To me, it doesn’t raise the question at all. If you think about it, there are people who are falsely accused of murder, robberies, all kinds of things and the justice system is not perfect. So in a situation where we have hundreds and perhaps a thousand infants a year who experience shaken baby syndrome, the fact that 16 convictions over a multi-year period were overturned lets me know that the justice system worked, and that people get a fair shot at getting their story told…
I’m very happy that we live in a country with a judicial system that looks at things skeptically and tries to make sure that justice is done. It doesn’t change anything about whether or not shaken baby syndrome or abusive head trauma exists. Sadly, it does.
I want to read you one quote from Gregory Davis, the chief medical examiner in Birmingham, Alabama, and board chair of the National Association of Medical Examiners. He told the Washington Post:
“You can’t necessarily prove [shaken baby syndrome] one way or another … Neither side can point to compelling evidence and say, ‘We’re right and the other side is wrong.’ So instead, it goes to trial.”
Do you disagree with that?
I actually do, and I think part of the issue is that many cases of abusive head trauma never make it to trial, sometimes because the police and the prosecutors can’t figure out who the perpetrator was, but often — and I’ve certainly seen this — because someone confesses. It’s a very sad situation, but frequently a person just reaches the end of their rope. They’re frustrated, the infant won’t shut up, they don’t mean to cause harm or death but they just can’t stand it anymore.
So I think that with all due respect to the medical examiner, most of these cases don’t make it to trial. So I don’t think that — as opposed to someone like me, a child-abuse pediatrician who actually sees these babies — I don’t think the medical examiner has the broadest possible experience and can say something like that.
So despite what we’re reading about this particular case, this idea of shaken baby syndrome or abusive head trauma, it’s based on pretty good empirical research, it sounds like…
Yes, there are hundreds of articles in the medical literature by radiologists, pathologists, medical examiners, pediatricians, ophthalmologists, social workers — all describing this and describing all the details that you might want to know about it. But this has been seen so often and there are so many articles about it that it’s very difficult for anyone to say that this syndrome doesn’t exist.
Based on your experience, how common are infant deaths as a result of abusive head trauma?
There are kind of two answers to that. One is that they’re uncommon and that’s great, because although babies can be frustrating, most adults can control themselves and that’s not a problem. But having said that, it’s one of the leading causes of death for infants after things like birth defects. It’s unfortunately way more common than it should be. And we’re doing a lot at the American Academy of Pediatrics and elsewhere to try to help parents so they don’t get to that point of just frustration that seems to lead to this.
http://commonhealth.wbur.org/2015/09/boston-nanny-shaken-baby
Paul Day took the stand at his murder trial Wednesday to tell jurors he didn't mean to hurt his infant son while performing emergency life-saving techniques in 2009, and he didn't mean to confess when talking to police five days later.
ReplyDeleteDay, 44, is charged with first-degree murder in the death of his son, Anubis, who prosecutors say was shaken into a coma on June 11, 2009, and died from his injuries nearly three years later.
Medical experts testified that Anubis' injuries were inconsistent with the account Day gave. Anubis sustained brain trauma that former Broward Deputy Chief Medical Examiner Darin Trekla said was consistent with shaken-baby syndrome.
During his interrogation, Day eventually admitted shaking Anubis out of frustration with the baby's incessant crying. But on the stand, he retracted his statement and said he was only repeating Detective Michael Vadnal's accusations because he felt guilty about being unable to help his son.
"Did you purposely hurt your son that day?" defense lawyer Marquin Rinard asked.
"No," Day said.
But he said the baby's mother, Monika Tomaszewska, had expressed frustration with the boy the day before, declaring that she wanted to drop him off at a fire station. Day also said the baby's mother threw Anubis on the bed, causing him to cry.
Tomaszewska denied those allegations on the stand earlier this week.
http://touch.sun-sentinel.com/#section/-1/article/p2p-84708008/
Pearson said he learned from another IMH physician the infant had bilateral subdural hematomas, or hematomas on both sides of the brain, and a skull fracture, which he told law enforcement when they arrived.
ReplyDelete“Infants don’t get subdural hematomas without some significant trauma,” he said.
Joseph Scheller, a pediatric neurologist in Maryland, suggested there was an alternate reason for the bleeding around the infant’s brain: a chronic condition in which his head collected a layer of fluid due to growing faster than expected. A complication of this condition was hemorrhaging, he said; small blood vessels could break and tear, leaking some blood, and retinal hemorrhaging discovered in the infant’s eyes could be explained by the pressure build-up in the infant’s head.
“I did not see evidence that (the infant) was a victim of trauma,” Scheller said.
Under the questioning of prosecuting attorney Peggy Trent, Scheller acknowledged he was being paid to give testimony at the trial.
http://www.laramieboomerang.com/news/local_news/article_8da70b80-52bf-11e5-8178-bb9219dacf1b.html
(The trial referred to in the preceding comment resulted in acquittal.) Over the course of the four-day trial, jurors heard testimony from a variety of witnesses, including medical professionals, the infant’s parents and members of law enforcement, and viewed evidence such as the bassinet where the infant slept, text messages between Jennings and the child’s mother and scans of the infant’s brain.
ReplyDeleteJurors also saw a recorded interview between Jennings and Detective Sgt. Robert Terry of the Laramie Police Department, in which Jennings says she did not shake the infant. After being questioned by Terry, she says it’s possible she might have placed the infant in the bassinet too hard by dropping him from height of a few inches, and the infant could have hit his head in the process, though she did not see this happen.
On Friday, prosecuting attorney Peggy Trent drew upon the testimony of medical professionals from Children’s Hospital Colorado and Ivinson Memorial Hospital, several of whom physically examined the infant and determined the injuries were “non-accidental.” She asked jurors to reflect on the credibility of the defense’s medical professionals, who attributed the bleeding to a chronic condition in which an infant has excess fluid between the skull and brain, causing small blood vessels to tear with minor trauma.
Furthermore, Trent said, the infant was healthy and reaching developmental milestones prior to Nov. 5, and Jennings “minimized” what happened the day in question.
“She voluntarily admitted to the fact that she was sorry that he got hurt in her care, and that she was the one who hurt him,” Trent said.
But defense attorney Nancy Mullin continued to attest to her client’s innocence, calling the state’s arguments “speculation” and “conjecture.” She pointed out several medical professionals testified the injuries could have occurred anytime within a seven-day timeframe and the boy’s two subdural hematomas might have developed at different times.
The boy’s condition worsened while he was at IMH, Mullin said, indicating the development of subdural hematoma symptoms was an “evolving process.”
“I still have no idea what the state is alleging Ms. Jennings did,” she said.
http://www.laramieboomerang.com/news/local_news/article_013b809a-538c-11e5-83fe-73d1fde626eb.html
Inside, a visibly relieved Riego thanked his public defender, Graham Bosworth, and was ordered immediately released from Jefferson Parish Prison, where he’s been held for almost four years since admitting to investigators that he shook Madison Nicole Hughes while caring for her at the home of the child’s mother’s family on Annette Drive in Marrero on Jan. 26, 2012.
ReplyDeleteTo convict him, the jury needed to find Riego’s actions were, at minimum, criminal negligence showing a gross deviation from a reasonable standard of care.
Riego, 42, was alone in a bedroom with his daughter and allegedly told investigators he shook her because she stopped breathing after he rolled over on her.
The next morning, Hughes’ face was cold to the touch, and Riego told the girl’s mother to call 911 before he left for Mobile, Alabama, with the mother’s father. The child was rushed to the emergency room and died three days later from injuries to her brain consistent with shaken-baby syndrome...
Prosecutors said his decision to leave for Alabama the next morning was evidence of his callousness, and they pointed to Riego’s confessions to investigators and later to family members while in jail. A cellmate also testified that Riego told him he was drunk and on pills that night and that he shook the child to stop it from crying.
“No baby has ever died from crying,” Fortunato told jurors. “I wish he would have just let Madison cry instead of doing what he did.”
Bosworth, however, said Riego shook the child because she was having trouble breathing and was being treated for a respiratory infection at the time.
He pointed to testimony from a witness who heard Madison cry and then saw Riego get a bottle from the kitchen and return to the room just before the crying stopped. He also noted the girl’s grandmother admitted to the police that she had shaken the child the following morning shortly before Hughes was taken to the hospital...
“This is a man who loved his daughter and made a poor decision because he was scared,” Bosworth said.
He said Riego’s confessions on the phone while in jail were the words of a man who believed he was responsible for his child’s death.
Bosworth said the testimony of the cellmate wasn’t credible because he was only looking for a deal and, when he couldn’t get one, took the stand only because he faced additional jail time if he didn’t.
http://www.theneworleansadvocate.com/news/13716298-172/marrero-man-acquitted-in-2012
McCarthy was accused of killing Rehma Sabir in January 2013. She was charged after Alice Newton, a prosecution medical expert, concluded (as she did in the Wilson case) that the 1-year-old had suffered injuries, including severe bleeding in the back of the eyes, which indicated abusive head trauma, also known as shaken baby syndrome.
ReplyDeleteAfter McCarthy was jailed without bail, prosecutors sought the opinion of Dr. Alex Levin, an eye specialist, on whether the injuries to the baby’s eyes indicated abuse. In a series of phone calls starting in August 2013, Levin expressed hesitation about coming to that conclusion. He told prosecutors he had found less severe retinal hemorrhaging, and repeatedly raised the possibility that the baby’s injuries might have been caused by something other than abuse — an immune disorder called Job Syndrome — according to a court document.
Ethics rules require that prosecutors share information like that with the defense in a timely manner. District attorneys hold many more cards than defense attorneys in criminal cases, and they’re held to very high standards. They’re supposed to make their cases on the merits, and not by sitting on evidence that could benefit the accused.
“Their job is not just to win,” said David Rossman, a professor of law at Boston University who was briefly a prosecutor in Middlesex County. “Their job is to do justice, and that means even if they are morally certain a person did it, and there is a piece of evidence in their hands that in the eyes of a reasonable, objective person would make it seem less certain the defendant is guilty, they’ve got to turn it over.”
That obligation was there, even if prosecutors disagreed with the doctor. Even if Levin had been an unhinged quack, and not, as he is, a nationally known expert who has regularly delivered findings of abuse in shaken baby cases...
The best prosecutors would have shared that information right after the first phone call. But, prosecutors on the McCarthy case kept it to themselves: not only after that first phone call with Levin, but through several more over the course of a year. This even after defense attorneys, who learned of Levin’s work by happenstance, asked for it repeatedly.
It’s hard to imagine prosecutors could have been unaware of the information’s significance...
Folger had been in on some of the calls with Levin, too. Yet, even as the Wilson case was unraveling, Folger and other prosecutors didn’t share Levin’s speculation about the immune disorder with McCarthy’s defense attorneys.
Nor did they share the information after a large crack appeared in their case against the nanny: In December 2013, a judge threw out an assault and battery charge against McCarthy, finding insufficient evidence to support the charge that she caused the bone fractures central to prosecution claims that she had abused the baby.
Instead, after finding a reference to him in files from the medical examiner, McCarthy’s attorneys learned Levin had been consulted in January 2014. They repeatedly requested Levin’s report, notes, and any exculpatory evidence. District Attorney Marian Ryan said prosecutors revealed in August that Levin had considered an alternative cause of death. But they did not turn over the more extensive — and more clearly exculpatory — notes from his conversations with prosecutors until January 2015, after Judge Maureen Hogan ordered them to do so. It had been 16 months since the first phone call with Levin...
It’s impossible to say for sure what would have happened if McCarthy’s attorneys had had the Levin information sooner. Judge Hogan found that, while prosecutors failed to fulfil their obligations, their actions did not constitute grounds for the case to be dismissed, or harm McCarthy’s chances of a fair trial.
But McCarthy’s attorneys are convinced she would not have sat in prison for more than two years if prosecutors had done the right thing.
https://www.bostonglobe.com/metro/2015/10/17/abraham/dqBNlxrC78t6X3f44QfYIN/story.html
Bux said the human head is the most mysterious part of the body from a doctor’s point of view and that there are not nearly enough studies about how injuries impact the brain for doctors to be confident about some things. Jarvis asked if that was because opinions about how some head injuries are caused can change over time and used the example of shaken baby syndrome. Bux said that is such a case. With previous witnesses, the jury heard Jarvis talk about the number of people who were sentenced to prison based upon the belief that they had caused fatal brain injuries in babies simply by shaking them. Jarvis said that studies now say the child must also be struck by something or the child’s head must shake something. He said that is an example of the way science can change with regard to legal theories.
ReplyDeleteThe medical examiner pointed to the long-held theory that the world was flat as another example of a once widely held belief that proved to be wrong. Bux said he agreed with the first M.E. the jury heard from about the fact that Breanna suffered a skull fracture that led her brain to swell to the point that oxygen was shut off and the brain quit working.What he didn’t agree with, he said, was her timeline. Bux then answered a number of questions from Jarvis about what that M.E. should, in the defense’s opinion, have done to correctly gauge the timeline for Breanna’s injury
- See more at: http://heralddemocrat.com/news/local/jurors-hear-second-medical-examiner-boyce-case#sthash.gyonxELU.dpuf
Shaken baby syndrome, or abusive head trauma, is a subject that’s long been plagued by controversy, with debates over whether certain brain injuries can be caused by shaking alone, whether short distance falls can be deadly, and whether there can be long stretches of time between when a child is injured and when the symptoms become apparent.
ReplyDeleteAnd the controversy doesn’t appear to be subsiding...
Judson said strong supporters of the shaken baby diagnosis often mischaracterize those on the other side of the debate.
“Nobody is trying to say that shaking isn’t abuse or can’t hurt a child,” she said. “The debate is really about whether, when confronted with a patient that has a particular set of findings, in the absence of other evidence, that a physician can reason backwards to the conclusion that the child had to have been abused.”
Others say the medical field isn’t as divided on the science as the legal community, and that physicians and investigators are careful not to rush to judgment.
“I’ve worked with child abuse doctors, a lot of them, for 10 years, and I find that they get to abusive head trauma as a last resort,” said Nicole Rooney, a prosecutor in the Family Protection Unit of the San Diego County District Attorney’s Office.
She said autopsies of children can take months to complete because the doctors look for birth traumas or pre-existing medical conditions that could be mistaken for signs of abuse, and they take into account a parent or caregiver’s explanation of what happened to the child.
“There’s definitely suspicions along the way,” Rooney said. “You get a baby in the E.R., and (caregivers) say the baby rolled off of the couch and has all of these injuries. These are doctors that see thousands of patients every week and they know that doesn’t happen.
“So their red flags go up.”...(continued)
(continued) Blake, who consults with defense lawyers on shaken baby cases, said the original theories about shaken baby syndrome have been contradicted by evidence-based research.
ReplyDelete“Short falls can kill children; they can cause subdurals and retinal hemorrhages,” she said.
Other research has shown that some children get subdural hematomas, a collection of clotted blood inside the tissue, but don’t show symptoms of the brain injury until later — a concept known as a lucid interval. So when a child stops breathing or loses consciousness, the last person who had the child may be blamed, even if he or she didn’t inflict the original injury.
“I call it the hot potato problem,” Blake said.
He has testified as an expert for the defense on multiple occasions in cases with allegations of abusive head trauma in children, and he has said a variety of medical conditions can affect a baby’s brain in ways that look like evidence of child abuse.
These “medical mimics” include infections and blood-clotting disorders.
Dr. Marilyn Kaufhold, interim medical director of the Chadwick Center at Rady Children’s Hospital in Kearny Mesa, acknowledged that nonaccidental trauma isn’t the only cause of bleeding in the head, and she said doctors test for coagulation problems or other medical issues that may look like abuse on an MRI or CT scan.
Kaufhold said a small percentage of children do get skull fractures as a result of short distance falls, but they usually don’t also have bleeding on the brain, nor do they slip into unconsciousness.
A 2008 article published in the journal “Pediatrics,” reported the annual risk of death resulting from short falls affecting infants and young children as less than 1 in 1 million.
“Babies do fall and they can get injured, but they don’t get these kinds of head injuries,” the doctor said...
Other research has focused on rare cases in which the defendants confessed to the crime. A French study published in 2010 compared perpetrators’ statements with medical documentation, and concluded that abusive head trauma is “frequently related to violent shaking.”
Several of the perpetrators included in the study admitted violently shaking the victims on multiple occasions, usually to get the child to stop crying...
The reporters examined 1,800 resolved cases since 2001 that involved shaking. In many cases, there were allegations of shaking and some other form of abuse, such as beating or hitting the child against a hard surface.
The journalists found that about 1,600 cases resulted in convictions, a higher rate than that of other violent crimes. The study identified about 200 cases in 47 states that ended when charges were dropped or dismissed, defendants were acquitted or convictions were overturned.
Out of 57 fatal child abuse cases prosecuted in San Diego County since 2001, 22 involved accusations of abusive head trauma, according to the District Attorney’s Office. Of those cases, all but three resulted in convictions. Two cases were dismissed and one ended in a not-guilty verdict.
“Generally, we get very good results from these prosecutions,” Rooney said.
http://www.sandiegouniontribune.com/news/2015/oct/15/shaken-baby-prosecution-convictions/
Case ME. Accidental traumatic head injury in infants and young children. Brain
ReplyDeletePathol. 2008 Oct;18(4):583-9.
Abstract
This article will discuss accidental head injuries in infants and young children. The first category of injury is the crushing head injury. Static forces applied slowly to the head result in multiple fractures of the skull and contusions and lacerations of the brain resulting from the bone fragments striking the brain. This article will discuss the subject of short falls in young children and the resulting head injuries. Because falls are frequent events in early life, many cases have been collected and many papers written on the subject. Study of these cases is informative about the injuries likely to occur in these falls. Most often, only a minor contact injury such as scalp bruise or laceration results. In a 2 to 3% of falls, a simple linear skull fracture occurs and the majority of these are uneventful in terms of neurological deficit or intracranial bleeding. In about 1% of the fractures, an epidural or subdural hemorrhage occurs. Each of these forms of contact hemorrhages will be discussed and illustrated. While these are relatively rare injuries, it is essential that they can be identified as consistent with an accidental mechanism so that an erroneous diagnosis of inflicted injury is not made.
Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics. 2006 Aug;118(2):626-33.
ReplyDeleteAbstract
OBJECTIVE:
Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known.
PATIENTS AND METHODS:
Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1-25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2).
RESULTS:
Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage.
CONCLUSIONS:
Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury.
Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman
ReplyDeleteB, Krous HF. Annual risk of death resulting from short falls among young
children: less than 1 in 1 million. Pediatrics. 2008 Jun;121(6):1213-24.
Abstract
OBJECTIVE:
The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.
METHODS:
A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.
RESULTS:
The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.
CONCLUSIONS:
The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.
A senior British pathologist whose research has identified innocent causes for symptoms previously thought to be caused solely by child abuse is facing a disciplinary hearing over her work. The charges relate to her role as an expert witness in court cases involving non-accidental head injury (NAHI), formerly known as “shaken-baby syndrome”.
ReplyDeleteWaney Squier, a consultant neuropathologist at the John Radcliffe Hospital in Oxford, is the second “shaken baby” expert witness in five years whose work has been called into question by the UK General Medical Council. Hearings examining Squier’s case began on 5 October in Manchester. Marta Cohen, a pathologist at Sheffield Children’s Hospital, was summoned in 2010 and later cleared of any wrongdoing.
Squier appeared as an expert witness in several court cases between 2007 and 2010 involving allegations of NAHI. She is one of several researchers worldwide who have challenged a long-standing assumption in such cases: that a triad of symptoms – haemorrhages on the surface of the brain, haemorrhages in the retinas, and a swollen brain – is unequivocal evidence of abusive behaviour.
Through their research on the brains of dead infants, Squier and her colleagues have discovered that these symptoms can occur through innocent causes, including difficulty breathing and infections.
Squier is now being brought before the UK Medical Practitioners Tribunal Service’s fitness to practise panel. The summary of her charges alleges she gave evidence outside her field of expertise, failed to be objective and unbiased when delivering evidence in court, and failed to pay “due regard to the views of other experts”.
“It is alleged that Dr Squier’s actions were misleading, irresponsible, deliberately misleading, dishonest, and were likely to bring the reputation of the medical profession into disrepute,” says the summary. The hearing began yesterday and is expected to last six months.
Squier has not spoken publicly about the hearing, but other pathologists have described the case as a “witch hunt” aimed at preventing her appearing as an expert witness in future.
The GMC would not disclose its reasons for pursuing the case against Squier, but transcripts of a talk in 2010 at the Eleventh International Conference on Shaken Baby Syndrome/Abusive Head Trauma in Atlanta, Georgia, by Detective Inspector Colin Welsh of the Metropolitan Police reveal the Met’s deep frustration at losing child abuse cases, listing defence expert witness testimony as the “top of the list” of reasons for losses in 2008 and 2009.
A spokeswoman for the Metropolitan Police said this week that following a high-profile acquittal of a defendant in a “shaken baby” case in 2008, prosecution bodies met with the Metropolitan Police to discuss how to manage the impact of contradictory expert witness evidence. Following these discussions, a now-defunct body called the National Policing Improvement Agency sent a report “regarding two doctors” to the GMC.
https://www.newscientist.com/article/dn28291-expert-witness-on-shaken-baby-syndrome-faces-misconduct-charge/
Maternal grandmother Neddy Reed said her grandson, Calin Samora, has “shaken baby syndrome” and that the Oct. 4, 2013, incident left her grandson in a medically induced coma for three days. Today, he is “severely disabled” with permanent brain damage and with vision and other health problems. She said the incident also left him with severe seizures that happen “so often you can’t even count them.”
ReplyDelete“On a good day, he may have 20 to 30 (seizures),” said Reed, who is an Oxnard resident.
In addition, Calin, who turned 2 years old in July, does not yet walk or talk and has daily therapy sessions, such as vision therapy, child development therapy and physical therapy, Reed said...
Sharon Beth Marshall, a Woodland Hills defense attorney who is representing Rezonable, said the case has nothing to do with shaken baby syndrome.
“This was an accident not a crime, and you don’t rope someone into the criminal justice system unless it’s deserved,” Marshall said.
“It’s devastating that this happened ... for everybody.”...
On Oct. 4, 2013, Rezonable was babysitting the children of Loretta Samora at the family’s Winnetka home when the babysitter knocked on the door of Samora’s home office and said there was an emergency, family members said in a statement.
Samora ran out to find her son “totally limp and gasping for air,” the family said. She then called 9-1-1 and waited for paramedics. At the hospital, they were told Calin had an 8mm subdural hematoma on his brain and his eyes were full of blood.
Rezonable initially indicated the family’s then-21-month-old daughter had injured the child but then changed her story, Reed said.
Marshall said her client informed police that the incident was an accident though she declined to state when that happened. While her client’s story did change over time, Marshall said that was “explainable and understandable.”
http://www.dailynews.com/general-news/20151006/evidence-to-be-presented-in-winnetka-shaken-baby-case
Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J
ReplyDeleteForensic Med Pathol. 2001 Mar;22(1):1-12.
Abstract
Physicians disagree on several issues regarding head injury in infants and children, including the potential lethality of a short-distance fall, a lucid interval in an ultimately fatal head injury, and the specificity of retinal hemorrhage for inflicted trauma. There is scant objective evidence to resolve these questions, and more information is needed. The objective of this study was to determine whether there are witnessed or investigated fatal short-distance falls that were concluded to be accidental. The author reviewed the January 1, 1988 through June 30, 1999 United States Consumer Product Safety Commission database for head injury associated with the use of playground equipment. The author obtained and reviewed the primary source data (hospital and emergency medical services' records, law enforcement reports, and coroner or medical examiner records) for all fatalities involving a fall. The results revealed 18 fall-related head injury fatalities in the database. The youngest child was 12 months old, the oldest 13 years. The falls were from 0.6 to 3 meters (2-10 feet). A noncaretaker witnessed 12 of the 18, and 12 had a lucid interval. Four of the six children in whom funduscopic examination was documented in the medical record had bilateral retinal hemorrhage. The author concludes that an infant or child may suffer a fatal head injury from a fall of less than 3 meters (10 feet). The injury may be associated with a lucid interval and bilateral retinal hemorrhage.
The Innocence Project also presented testimony from pathologists and pediatricians that Gabriel had a hemorrhage caused by a mildly traumatic birth or a rare and often fatal liver disorder. Both conditions present effects similar to abusive head injuries, the lawyers said.
ReplyDelete“He did not suffer abuse,” Dr. Joseph Scheller, a pediatric neurologist in Maryland, wrote in the 2012 appeal. “He died from a rare but real medical condition.”
The state has argued that the head injury is consistent with shaken-baby syndrome that could only have occurred while Gabriel was in the care of his father. Wilkes, now 44 years old, was convicted of deliberate homicide in 2009.
http://billingsgazette.com/news/state-and-regional/montana/supreme-court-orders-shaken-baby-case-be-reconsidered/article_6ebcc713-7e1e-5ec5-a421-91db466d013f.html
Dr. John Pluckett told jurors that the injuries to Amy May's head couldn't have been caused by simply rolling off a couch and hitting a coffee table, which is what Curtis Jones alleges happened July 22, 2004, but were still consistent with a low impact fall.
ReplyDeleteJones, 28, was 17 years old when prosecutors allege he caused the head wound which led to the infant's death. The prosecution rested their case Thursday morning and the defense began by tackling the state's suggestion that Jones had caused the fracture to the baby's skull.
Pluckett told defense attorney Gary Mitchell that a "sentinel event" or a result of treatment of her head trauma, caused her death...
On Thursday, Pluckett testified that treatment for the brain swelling may have caused the infant's heart to stop, causing brain death. He also explained he believed the injuries noted during her autopsy in her genital area were not injuries at all, but are attributable to extreme hydration during treatment as well.
"It is necessary to explain some of the injuries Amy had as part of therapeutic intervention," Pluckett said. "In terms of the manner of her death, whether it's an accident or homicide, I cannot tell you."
During cross examination by the prosecution, Pluckett did say the bruises noted on the child's back were not typical of toddler injuries and that the mark on her cheek may have been a human bite mark, but too small to be from an adult and confirmed a report he submitted to the defense suggested the child may have been battered.
http://www.currentargus.com/story/news/crime/2015/11/05/defense-begins-case-jones-trial/75252398/
The nanny convicted of child abuse in the death of an infant has been sentenced.
ReplyDeleteJudge Mark Ashford handed down a 70-year sentence for Sarah Cullen, 25, on Monday morning.
Cullen was found guilty in March of intentional child abuse resulting in death in connection with the 2013 death of 4-month-old Cash Bell.
According to a police interview, Cullen gave different accounts of how the baby was injured. She eventually said she slipped, causing the baby to fall down the stairs.
She said the baby wasn't crying, but he was lying on the floor with clenched fists. Cullen said she panicked, held him and he fell asleep. Cullen said it wasn't until later that Bell began exhibiting signs that he was severely injured.
Cullen's ex-boyfriend also testified Cullen called him and said Bell wasn't breathing. He said he went the house, called 911 and took them to the hospital. He claims Cullen never mentioned what happened.
Bell died from severe skull fractures a few days later.
Prosecutors said Cullen's failure to act after Bell's fall and her multiple versions of what happened showed her lack of credibility.
http://www.ketv.com/news/nanny-sentenced-for-child-abuse-in-4montholds-death/25932342
The Nebraska Supreme Court upheld the sentence Friday of Sarah Cullen, the woman convicted in 2013 of killing a 4-month-old baby in her care.
Cullen was a nanny for Cash Bell when the child suffered two skull fractures and other injuries consistent with Shaken Baby Syndrome.
Cullen argued her sentence of 70 years to life was excessive, and she also appealed on grounds that the jury should not have heard about previous injuries Cash Bell suffered while in Cullen's care
http://www.ketv.com/news/former-nanny-loses-appeal-in-babys-death/36306246
My name is Gil Binenbaum, and I'm a pediatric ophthalmologist at The Children's Hospital of Philadelphia. I'm just going to tell you a little bit about a study we recently published in JAMA Ophthalmology about vaccinations and retinal hemorrhage.[1] The background for this study was that vaccinations have been proposed, at times, as an alternative cause of retinal hemorrhages in children who are being evaluated for child abuse. We wanted to know whether vaccinations do, indeed, cause or are associated with retinal hemorrhage because this would obviously affect the interpretation of ocular findings in young children being evaluated for child abuse.
ReplyDeleteWe reasoned that if vaccinations caused retinal hemorrhage, then when we looked in the eyes of children at the age that they're getting vaccinations, which is in the first 2 years of life (also the age at which children most commonly experience abusive head trauma), we would commonly see retinal hemorrhages. We also thought that if vaccinations caused retinal hemorrhage, we would see a temporal association between the actual vaccination injection and the retinal hemorrhage.
We conducted a retrospective study that included over 5000 outpatient children having eye examinations for a variety of reasons—eye crossing, red eyes, tear duct obstruction, etc—at our hospital. Again, these are outpatients and not inpatients. We looked at the incidence of retinal hemorrhage in the children who were at an age where they were receiving vaccinations. Then we secondarily looked at a subset of these children whose vaccination records we were able to easily access because their primary care provider was part of our primary care network. That group of patients comprised about 2200 children.
In the total group of 5000 patients, we found a total of nine children with retinal hemorrhage, all of whom had actually been seen previously as inpatients and been diagnosed with abusive head trauma based upon nonocular findings, such as bruises or fractures. These children had other signs of trauma, and there had been an unambiguous diagnosis of child abuse. There were no other children with retinal hemorrhage in the study, so the incidence of retinal hemorrhage in the total population of children in our study was about 0.17%, very low.
Among the children for whom we had vaccination records, we found no association between retinal hemorrhages and receipt of a vaccine in the prior week, 2 weeks, or 3 weeks. Based upon these findings, we concluded that retinal hemorrhages are not caused by vaccinations because retinal hemorrhages are very uncommon in young children at the age they're getting vaccinations. There was no temporal association between vaccinations and retinal hemorrhage.
http://www.medscape.com/viewarticle/852719?nlid=91245_491&src=wnl_edit_medp_wir&uac=60196BR&spon=17&impID=884911&faf=1
Binenbaum G, Christian CW, Guttmann K, Huang J, Ying GS, Forbes BJ. Evaluation of Temporal Association Between Vaccinations and Retinal Hemorrhage in Children. JAMA Ophthalmol. 2015 Sep 3:1-5.
ReplyDeleteAbstract
Importance:
Vaccinations have been proposed as a cause of retinal hemorrhage in children, primarily as part of a defense strategy in high-stakes abusive head trauma cases. If vaccination injections cause retinal hemorrhage, this consideration would affect the evaluation of children for suspected child abuse.
Objectives:
To describe the prevalence and causes of retinal hemorrhage among infants and young children in an outpatient ophthalmology clinic and to test the hypothesis that, if vaccination injections cause retinal hemorrhage, then retinal hemorrhage would be seen frequently and be temporally associated with immunization.
Design, Setting, and Participants:
Retrospective cohort study between June 1, 2009, and August 30, 2012, at The Children's Hospital of Philadelphia pediatric ophthalmology clinics among 5177 children 1 to 23 months old undergoing a dilated fundus examination as an outpatient for any reason. Children with intraocular surgery or active retinal neovascularization were excluded from the study.
Main Outcomes and Measures:
The prevalence and causes of retinal hemorrhage, as well as the temporal association between vaccination injection within 7, 14, or 21 days preceding examination and retinal hemorrhage.
Results:
Among 7675 outpatient fundus examinations, 9 of 5177 children had retinal hemorrhage for a prevalence of 0.17% (95% CI, 0.09%-0.33%). All 9 had abusive head trauma diagnosable with nonocular findings. Among a subset of 2210 children who had complete immunization records and underwent 3425 fundoscopic examinations, 163 children had an eye examination within 7 days of vaccination, 323 within 14 days, and 494 within 21 days. No children had retinal hemorrhage within 7 days of vaccination, 1 child had hemorrhage within 14 days, and no additional child had hemorrhage within 21 days. There was no temporal association between vaccination injection and retinal hemorrhage in the prior 7 days (P > .99), 14 days (P = .33), or 21 days (P = .46).
Conclusions and Relevance:
Retinal hemorrhage was rare among outpatients younger than 2 years. Considering both immediate and delayed effects, no temporal association existed between vaccination injection and retinal hemorrhage. Vaccination injections should not be considered a potential cause of retinal hemorrhage in children, and this unsupported theory should not be accepted clinically or in legal proceedings. Ophthalmologists noting incidental retinal hemorrhage on an outpatient examination should consider a child abuse evaluation in the absence of other known ocular or medical disease.
At 6 p.m. Thursday William Allen Davenport walked out of the Cumberland County Justice Center a free man for the first time in five years. The legal cloud of the death of his infant child hanging over him was removed.
ReplyDeleteA jury of seven men and five women deliberated just under an hour and a half before returning not guilty verdicts to first-degree murder and aggravated child abuse in the November 2010 death of Davenport’s seven-week old daughter, Destiny.
The jury also rejected finding Davenport guilty of three lesser offenses to the two indicted charges.
There were dozens of exhibits — photos, reports and medical records — entered into evidence during the three-day trial, with the state introducing testimony from two doctors who said the cause of death was inflicted head trauma and the manner of death to be homicide.
Cookeville defense attorney Doug Dennis countered on the last day of testimony with his own expert witness — a Memphis medical examiner with credentials in nearly half a dozen fields, including neuro-pathology. That witness testified natural medical issues associated with what Dennis termed a very difficult pregnancy resulted in the tragic premature death of the child.
At the end of the day, the jury believed the Memphis doctor’s testimony over that of a former assistant state medical examiner and a Chattanooga doctor who treated Destiny and has treated children for some 36 years...
With both doctors, Dennis hammered away with questions asking if the brain damage was not caused by the difficult pregnancy and problems that developed after birth.
Davenport had told investigators that he had been told that his little daughter had experienced a more rapid skull growth than normal, with sutures in the skull overlapping. The father also told investigators that the baby was having trouble keeping formula down and was constantly spitting and throwing up over the seven weeks of her life...
This set the stage for Dr. Chancellor to testify, giving a contrasting theory of what caused the child’s death. She told the jury that she reviewed all medical records and realized Destiny had no pulse or oxygen to the brain “for many minutes,” and that she believed the cause of death was aspiration on the formula the baby had been fed, causing lack of blood and oxygen to the brain.
She disagreed with the state medical examiner’s finding, stating that the lack of oxygen and blood supply to the brain caused by excessive swelling caused the bleeding found during the autopsy and also caused the aspirations that may have been ongoing since birth.
“I found no findings leading toward abuse,” Chancellor told the jury...
In closing remarks, Knight told the jury that Destiny’s injuries “are here to speak for her.” She claimed Davenport had been under physical and financial stress in his role as “Mr. Mom.” Davenport, who was off work due to injuries from a traffic crash, took care of the child while his wife, Toshia, worked.
“What if she had been left alone to just cry it out?” Knight asked the jury. The state theory was Davenport just snapped.
Hatch argued to the jury, “Something happened to her and that something was William Allen Davenport.” He added that investigators and prosecutors did not rush to judgment but came to the conclusion that the child died from inflicted head trauma.
“Follow the evidence, from the 911 call to the autopsy,” Hatch said.
Dennis argued that Destiny suffered from medical difficulties from pregnancy to the difficult birth and continuing during her short seven-week life. He noted that it was Davenport who repeatedly took the child to a Sparta pediatrician and to the health department during those seven weeks, trying to find a cause for the child’s rejection of her formula.
http://www.crossville-chronicle.com/news/local_news/davenport-not-guilty-on-all-counts/article_d859b2da-8713-11e5-8c15-0b61224de4ec.html