Wednesday, March 16, 2016

Shaken baby syndrome 5

A senior British doctor, who has been an expert defence witness for parents accused of killing their children, has been found guilty of multiple charges that include giving misleading evidence in court.

The Medical Practitioners Tribunal Service said that Waney Squier, a consultant pathologist at John Radcliffe Hospital in Oxford, UK, had failed to work within the limits of her competence, failed to be objective and unbiased, and failed to heed the views of other experts. In many of the cases investigated, her actions were deliberately misleading and irresponsible.

The MPTS had considered Squier’s work as an expert witness in six child abuse cases and one appeal in which parents faced charges of non-accidental head injury, formerly known as shaken-baby syndrome.

Squier is prominent among several researchers worldwide who have challenged a long-standing belief that a trio of symptoms of head injury provide unequivocal evidence of abusive behaviour. Squier has argued in the scientific literature and in court that the symptoms in question – haemorrhages on the surface of the brain, haemorrhages in the retinas, and a swollen brain – can have innocent causes, such as choking or other difficulties in breathing. These symptoms, they say, can also arise from the birthing process itself.

Michele Codd, chair of the tribunal, gave examples of where the panel felt Squier’s court evidence had strayed outside her field of expertise. These included offering opinions on biomechanics in relation to injuries from falling, pathology of the eyes, and paediatric medicine.

“The tribunal is in no doubt that you have been a person of good character and have not acted dishonestly in the past,” Codd told Squier. “[But] it found that in your written and oral evidence you were dogmatic, inflexible and unreceptive to any other view,” she said. “The furthest you were prepared to accept any criticism was to state either that you had made a typing error or that you could have been clearer in what you had said in your reports or evidence. The tribunal was not able to accept large tracts of your evidence.”

But several prominent researchers support Squier’s work. “The impact of her research in blunting the false prosecution of innocent caregivers is beyond value or measurement to those impacted,” said Steven Gabaeff, a practitioner of emergency medicine in the US for 35 years and a diplomat emeritus of the American Board of Emergency Medicine, in his submission to the tribunal.

“This is clearly a witch hunt against a physician who has done society a great service by levelling the playing field for parents and caregivers who face allegations of child abuse when their infant presents with unexplained brain injury,” says Marvin Miller, professor of paediatrics at Wright State University in Dayton, Ohio, in a submission to the tribunal supporting Squier. “Regarding her professionalism, she has unimpeachable integrity.”…

The UK General Medical Council, which brought the charges against Squier, will make a final decision by 24 March on whether she should lose her licence to practice. A spokesperson for the GMC told New Scientist that full details of the case will be published at the conclusion of the proceedings.

No one doubts that frenzied shaking can cause the triad of symptoms, but only after severe accompanying damage to the neck. A baby’s head striking a solid surface would also cause such damage but then there would be other evidence of an impact. For these reasons, there is increasing pressure for the triad not be used as evidence of guilt in the absence of any other evidence of child abuse. In the UK, the Royal College of Pathologists last December cautioned against viewing the triad as “absolute proof of traumatic head injury in the absence of any other corroborative evidence”….

“I suspect there will be no one in England willing to dispute allegations of shaken baby syndrome now the finding against [Squier] is unfavourable,” says Edward Willey, a forensic pathologist in St Petersburg, Florida. “Opposition is eliminated.”…

At a 2010 conference on child abuse, in Atlanta, Georgia, Colin Welsh of the Metropolitan Police – now retired – gave a talk in which he listed defence expert witness testimony as “top of the list” of reasons for losing cases in 2008 and 2009.


  1. The tribunal was considering six cases in which Dr Squier, 67, a consultant neuropathologist, provided evidence, including the deaths of four babies and a 19-month-old child.

    In all of the cases the 67-year-old took the view that brain damage caused was not due to inflicted injuries, the panel in Manchester was told.

    It was said that her views on shaken baby syndrome were in contrast to the opinions of the 'majority of experts' in the field.
    She gave expert evidence that the injuries involved were either not consistent with non-accidental injury, or were more likely to have been caused by some other means.

    The panel found she misrepresented research to support her views and had brought the reputation of her profession into disrepute.

    Her minority view on shaken baby syndrome is in contrast to the opinions of the majority of experts in the field who argue the so-called triad - swelling of the brain, bleeding between the skull and brain, and bleeding in the retina - is a strong indicator of trauma.

    The panel heard Dr Squier disagreed with those opinions unless there was other evidence of external or internal injury.

    In earlier evidence, she explained to the panel she had previously gone along with accepted thought on the syndrome until about 2000 when she became aware of a study by Dr Jennian Geddes of babies thought to have died from non-accidental head injuries.

    She told the panel the study found no evidence of mechanical disruption of nerve fibres in the brain, which questioned whether trauma had taken place at all.(continued)

  2. (continued)Dr Squier, represented by Sir Robert Francis QC, denied misconduct but the panel, sitting in Manchester, ruled against her on the vast majority of allegations she faced.

    In its ruling, the panel stated: 'The tribunal notes that your opinion on the mechanisms of AHT (abusive head trauma) changed after the publication of Dr Geddes's hypotheses. It found that in your written and oral evidence you were dogmatic, inflexible and unreceptive to any other view.'

    It added: 'The furthest you were prepared to accept any criticism was to state either that you had made a typing error or that you could have been clearer in what you had said in your reports or evidence.'

    The panel also noted that Dr Squier had, in its consideration, made 'an outrageous and untruthful assertion' that she had gone to an operating theatre 'and asked the surgeon to try and damage the arachnoid (a protective membrane that covers the brain and spinal cord); it is extremely difficult'.

    Opening the case last October for the General Medical Council (GMC), Tom Kark QC said Dr Squier's conduct was affected by her 'preconceived and blinkered approach'...

    In most of the cases, Dr Squier - who had not actively worked in paediatrics for more than 40 years, the panel noted - was the sole expert instructed on one side of the litigation.

    The panel was told she had given evidence in between 150 and 200 cases since the mid-1990s involving either medical negligence or cause of deaths in early months and years of life...

    Following Friday's ruling, human rights lawyer Clive Stafford Smith said: 'Shaken baby syndrome is not a medical diagnosis to be treated but, almost uniquely, it's a doctor's opinion that a crime has been committed...

    'Justice demands that a doctor who honestly holds views supported by scientific evidence be permitted to give testimony that challenges the hypotheses of others. After all, Galileo Galilei was forbidden from saying that the Earth revolved around the Sun 400 years ago. Unfortunately it took until 1982 before Pope John Paul II conceded the Catholic Church had been wrong.

    'Setting aside the devastating personal impact on Dr Squier, I am most troubled by the effect of this process on the delivery of justice in this country and around the world. Hundreds if not thousands of parents or carers have been condemned, or lost custody of their children, when the medical profession has diagnosed a crime. Today, unqualified though they may be, the panel announced that the GMC will brook no scientific dissent.'

    Read more:

  3. On Friday, I witnessed something akin to a reenactment of the trial of Galileo, precisely four centuries after the original. Dr Waney Squier faces being struck off by the General Medical Council (GMC) for having the temerity to challenge the mainstream theory on shaken baby syndrome (SBS).

    For years, the medical profession has boldly asserted that a particular “triad” of neurological observations is essentially diagnostic of SBS. Since the Nuremberg Code properly prevents human experimentation, this is an unproved hypothesis, and there has been rising doubt as to its validity.

    I am convinced that Squier is correct, but one does not have to agree with me to see the ugly side to the GMC prosecution: the moment that we are denied the right to question a scientific theory that is held by the majority, we are not far away from Galileo’s predicament in 1615, as he appeared before the papal inquisition. He dared to suggest that the Bible was an authority on faith and morals, rather than on science, and that 1 Chronicles 16:30 – “the world is firmly established, it cannot be moved” – did not mean that the Earth was rigidly lodged at the epicentre of the universe. It was not until 1982 that Pope John Paul II issued a formal admission that the church had got it wrong.

    Shaken baby syndrome is almost unique among medical diagnoses in that it is not focused on treating the child. If an infant has bleeding on the brain (a subdural hematoma), the doctor wants to relieve the pressure – it is of little relevance how the infant came about the injury. SBS is, then, a “diagnosis” of a crime rather than an illness, and when a brain surgeon comes into the courtroom and “diagnoses” guilt, the defendant, mostly a parent, is likely to go to prison – or worse.

    I have defended a number of emotionally charged capital cases where doctors have opined that a child had to have been shaken by an angry parent because it was “impossible” for the triad of neurological sequelae to result from an accident – it “had” to be caused by shaking. Many American doctors adhere to a bizarre notion that an infant cannot suffer a fatal head injury from a fall of less than three storeys. While we cannot drop a series of infants on their heads to test this, it would appear to be plain folly. The velocity of a five-foot fall means a child’s head can hit the ground at roughly 15mph, which is faster than most people – short of Usain Bolt - can sprint. I invited a series of neurosurgeons to run headlong into a hardwood wall in one courtroom, so we could see what happened to them. They politely declined, and stuck to their silly theory.

  4. Dr Waney Squier, a leading researcher on so-called “Shaken Baby Syndrome” and an established expert witness, has been judged by the Medical Practitioners Tribunal Service to have deliberately misled the court and misrepresented academic literature. Dr Squier – who was represented by Clodagh Bradley QC – is one of a minority group of experts who contend that “the triad” of injuries (brain swelling, intra-cranial bleeding and retinal bleeding) which the majority state are self-evident of SBS can actually have non-criminal/accidental causes. Dr Squier has submitted this opinion in around 200 criminal and civil cases since the 1990s. The controversy around SBS is not new. Clive Stafford Smith – founder of Reprieve – writes that Dr Squier’s conviction, which will likely lead to severe punishments for her, is “akin to the trial of Galileo” and “a very dark day for science [and] justice”, pointing out that only one member of the panel had any “meaningful” medical qualifications (a retired psychiatrist).

  5. Geddes JF, Tasker RC, Hackshaw AK, Nickols CD, Adams GG, Whitwell HL, Scheimberg I. Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'? Neuropathol Appl Neurobiol. 2003


    A histological review of dura mater taken from a post-mortem series of 50 paediatric cases aged up to 5 months revealed fresh bleeding in the dura in 36/50, the bleeding ranging from small perivascular haemorrhages to extensive haemorrhage which had ruptured onto the surface of the dura. Severe hypoxia had been documented clinically in 27 of the 36 cases (75%). In a similar review of three infants presenting with classical 'shaken baby syndrome', intradural haemorrhage was also found, in addition to subdural bleeding, and we believe that our findings may have relevance to the pathogenesis of some infantile subdural haemorrhage. Recent work has shown that, in a proportion of infants with fatal head injury, there is little traumatic brain damage and that the significant finding is craniocervical injury, which causes respiratory abnormalities, severe global hypoxia and brain swelling, with raised intracranial pressure. We propose that, in such infants, a combination of severe hypoxia, brain swelling and raised central venous pressure causes blood to leak from intracranial veins into the subdural space, and that the cause of the subdural bleeding in some cases of infant head injury is therefore not traumatic rupture of bridging veins, but a phenomenon of immaturity. Hypoxia with brain swelling would also account for retinal haemorrhages, and so provide a unified hypothesis for the clinical and neuropathological findings in cases of infant head injury, without impact or considerable force being necessary.

  6. Geddes JF, Whitwell HL. Inflicted head injury in infants. Forensic Sci Int. 2004 Dec 16;146(2-3):83-8.


    There is scant neuropathological information in the child abuse literature; even the best reviews include assumptions based on the findings of a few inadequate early studies. Our recent series of 53 fatal cases (Brain 124 (2001) 1290, 1299 [1,2]) demonstrated age-related patterns of brain injury and showed the substrate of severe encephalopathy in the infants to be hypoxic brain damage, not diffuse traumatic axonal injury ('DAI'), as had previously been thought. About one-third had craniocervical injuries, particularly in the brain stem, suggestive of stretch injury to the neuraxis. Our interpretation was that this finding implied a mechanism of injury--brain stem damage from stretch injury to the neck with resultant apnoea--that could account for the clinical scenario in many cases, and for which violence would not necessarily be required. Since publishing this study we have turned our attention to the subgroup of infants who die without objective signs of injury, such as skull fracture or impact, whose carers are accused of abuse, usually, "violent shaking", on the pathologic findings alone. Given the striking discrepancy that there often is in such cases between the relatively trivial findings in the brain and the accusations of violence, we have been looking at the pathogenesis of the typical intracranial bleeding. A histologic study of dura from 50 paediatric autopsies, none of whom had suffered a head injury, has led us to propose that the subdural and retinal bleeding in such cases may well have a physiological aetiology, rather than being caused directly by trauma.

  7. “There is little more agonising for a parent or carer to lose a small child, let alone then be accused of their death when they believe they have done nothing wrong.”...

    ‘In the past decade, we have learned that much of what we thought we knew about SBS was wrong,’ she says.

    She believes she will ultimately be vindicated by science and says that verdicts being handed down in many shaken baby cases are profoundly disturbing.

    ‘Of course I know that some people harm babies and regularly see evidence of inflicted injury, but I am convinced we can virtually exclude shaking as a cause of death in babies unless, as well as bleeding in the brain, we have additional evidence of trauma, such as serious damage to the neck. If you shake a baby so hard that it dies, it is the neck that is going to show the damage, not the brain.’...

    But Dr Squier’s detractors insist her evidence allows baby killers to walk free.

    For the past 30 years Dr Squier has devoted herself to researching the pathology of infant brains, including the controversial area of SBS, also known as Abusive Head Trauma.

    A consultant at Oxford’s John Radcliffe Hospital, she is one of Britain’s most experienced experts in her field and internationally respected – last week she was awarded the 2016 Champion of Justice Award by Innocence Network, an international organisation that works to overturn wrongful convictions.

    Such is the importance of her case that the BBC’s flagship documentary series Panorama features Dr Squier and the international debate over SBS in its programme tomorrow evening.

    Meanwhile, she told this newspaper: ‘Some pathologists want to remain in an unchallenging comfort zone of an outdated theory.

    ‘Yet my views are based on the incontrovertible evidence provided by the tissue I see daily on the microscope slides and informed by research and critical examination of the scientific literature.

    Read more:

  8. To tell whether a baby has been injured or killed by being shaken, the courts use three hallmark symptoms: bleeding and swelling in the brain and retinal bleeding in the eyes. Along with other evidence, those standards are used to convict caregivers of abusive head trauma, both intentional and unintentional, that can result in blindness, seizures, severe brain damage or death.

    But in recent years a small cadre of experts testifying for the defense in cases across the country has called into question whether those symptoms actually indicate abuse. Though they are in the minority — disputing the consensus of child abuse experts, pediatricians and an extensive evidence base — they have gained traction in the media and in courtrooms by suggesting that shaking a child cannot cause these injuries. Instead, they argue that undiagnosed medical conditions, falls or other accidents are the cause.

    So researchers have developed and validated a tool doctors can use to distinguish between head injuries resulting from abuse and those from accidents or medical conditions. The method, described in the journal Pediatrics on Monday, asks doctors to check for six other injuries, each of which increases the likelihood that a head injury resulted from severe shaking, blunt force or both.

    "It is vitally important that abuse head trauma is diagnosed accurately so that the team looking after the child can ensure that they receive appropriate support and are protected from further harm," lead study author Laura Elizabeth Cowley, a doctoral student at the Cardiff University School of Medicine in the U.K., said in an email.

    "However, it is also important that accidental head injury cases are not wrongly diagnosed as abusive," she continues, "because this can have devastating consequences for the families involved."

    The tool itself is simple: listing rib fracture, seizures, long-bone fractures, bruises on the head or neck, periods of not breathing called apnea and bleeding in the retina of the eyes. The more of those a child suffers, the more likely the case resulted from abuse...(continued)

  9. (continued)

    Twelve cases mistaken for abuse involved substantial injuries from a car accident or other situations in which a pediatrician would probably not use this tool...

    "Part of the challenge is that there is no gold standard for making a diagnosis of child abuse — you can't do a blood test," said Cindy Christian, chair of both Child Abuse and Neglect Prevention at The Children's Hospital of Philadelphia and the American Academy of Pediatrics' Committee on Child Abuse and Neglect. "It's always going to be a clinical diagnosis with social investigation. A bruise is a bruise. A broken bone is a broken bone. A subdural hemorrhage is a subdural hemorrhage. There are certain injuries that are much more highly correlated with abuse, and there aren't very many things that cause these together."...

    In 2009, the AAP reclassified "shaken baby syndrome" as abusive head trauma to be more inclusive of all the ways a child's head can be injured through abuse, including but not limited to violent shaking.

    Doubters of shaken baby syndrome exploited this shift in terminology to claim that shaking alone could not cause the triad of injuries often used in court cases — brain swelling, subdural hemorrhaging (bleeding between the brain and its outer membrane) and retinal bleeding. One of those doubters is Jan Leestma, a neuropathologist from Chicago who has testified for the defense in dozens of court cases on abusive head trauma.

    "The idea that you can shake a baby and cause subdural brain hemorrhage — you can't without an impact," Leestma said. "I don't mean to say there's no child abuse — of course there is — but shaking as abuse is a straw man. It probably can't produce the kinds of things that people say it can."

    Yet a strong body of research shows that shaking can injure infants and toddlers and cause these symptoms. A study in which perpetrators confessed to shaking the child showed that violent shaking, on average about 10 times until the baby stopped crying, could cause all these symptoms, even when three-quarters of them involved nothing more than shaking.

    The real straw man argument is the idea that diagnosing abusive head trauma relies solely on those three injuries and can lead to false accusations of abuse, said Bob Sege, division director of Family and Child Advocacy at Boston Medical Center and a member of the AAP Committee on Child Abuse and Neglect.

    "At a personal level, our first reaction is really hoping it's not child abuse and to go through all the other possibilities to make it be something else, but sometimes you can't," Sege said.

    When a child comes in with those symptoms, pediatricians conduct a thorough physical exam to look for other injuries, get a full history from the parents and look for inconsistencies in caregivers' stories. They also often enlist other experts, such as radiologists, ophthalmologists and child abuse specialists, to look at the evidence.

    "There are certain bleeding problems and very rare metabolic diseases that might cause some of these symptoms," Sege said. "They're unfortunately very uncommon compared to child abuse, which is not as uncommon as I wish it was."

  10. Cowley LE, Morris CB, Maguire SA, Farewell DM, Kemp AM. Validation of a Prediction Tool for Abusive Head Trauma. Pediatrics. 2015 Aug;136(2):290-8.



    Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.


    Consecutive children aged <36 months admitted with an intracranial injury, confirmed as abusive or nonabusive, to 2 sites used in the original model were ascertained. Details of 6 influential features were recorded (retinal hemorrhage, rib and long -bone fractures, apnea, seizures, and head or neck bruising). We estimated the likelihood of an unrecorded feature being present with multiple imputation; analysis included sensitivity, specificity, and area under the curve, with 95% confidence intervals (CIs).


    Data included 133 non-AHT cases and 65 AHT cases, 97% of children were <24 months old. Consistent with original predictions, when ≥3 features were present in a child <36 months old with intracranial injury, the estimated probability of AHT was >81.5% (95% CI, 63.3-91.8). The sensitivity of the tool was 72.3% (95% CI, 60.4-81.7), the specificity was 85.7% (95% CI, 78.8-90.7), area under the curve 0.88 (95% CI, 0.823-0.926).


    When tested on novel data, the PredAHT tool performed well. This tool has the potential to contribute to decision-making in these challenging cases. An implementation study is needed to explore its performance and utility within the child protection process.

  11. The hearing focused on six cases heard outside Oxfordshire, between 2007 and 2010, including the death of four babies and an 18-month-old child, in which Squier said that brain damage had not been caused by inflicted injuries despite her lack of expertise in the field.

    Her actions were described by the panel as "deplorable" and irresponsible.

    Ruling that Squier's fitness to practice was impaired, the tribunal in Manchester said: "You have breached a fundamental tenet of the medical profession, by providing deliberately misleading and dishonest evidence in the courts.

    "Your integrity cannot be relied upon in view of this tribunal’s findings of dishonesty."

    It added that during the tribunal Squier, 67, had also "seemed unable to accept any of the criticisms directed towards you might have had a scintilla of justification" and that she had continued to be dishonest during the hearings.

    It added: "In the light of these factors, the tribunal cannot be satisfied there will be no repetition of your misconduct.

    "And in any event, it considers the gravity of your misconduct is such that public confidence in the profession and the regulatory process would be undermined if a finding of impairment were not made in this case."...

    During the hearings it was said that Squier's views on 'shaken baby syndrome', when brain damage is caused, were not those of most experts in the field because she disputed its existence.

    The tribunal found she had "deliberately and dishonestly misled the courts" by putting forward theories she had not backed up with evidence, giving evidence outside her own expertise and by "cherry-picking" research to support her "polarised view".

    However, it said: "The tribunal is in no doubt that you have been a person of good character and have not acted dishonestly in the past. This is confirmed by a large number of witnesses."

    But it added: "Your actions may be capable of remediation, although dishonestly is by its nature difficult to remediate, but it has determined that you have not demonstrated that you have taken any appropriate remedial steps."

  12. A doctor who disputed the existence of "shaken baby syndrome" has been struck off for giving "misleading and dishonest" evidence in court.

    Dr Waney Squier, 67, was erased from the medical register for misleading courts in cases where parents were accused of killing their children.

    The Medical Practitioners Tribunal Service (MPTS) made its decision on Monday.

    The doctor, who works at Oxford's John Radcliffe Hospital, can appeal...

    She disputed the existence of shaken baby syndrome - brain trauma caused by violently shaking an infant - and in each case said the evidence was not consistent with non-accidental injury and was more likely to be caused by other means.

    In its summary, the MPTS said: "You deliberately and dishonestly misinterpreted, misstated and misquoted research literature to support your own opinions."

    The decision added that her attitude to her colleagues was "shocking, openly displaying your disdain for their expertise and opinions".

    In summarising the "aggravating factors" which led to Dr Squier's erasure, the MPTS added the evidence she gave was in "serious cases" and "had the potential to subvert the course of justice".
    Dr Squier previously told the BBC Panorama programme she was "devastated" after the MPTS ruled that she had misled courts and gave irresponsible evidence.

  13. The plight of parents wrongly accused of injuring their children has been a recurring theme in this paper over the past 15 years. During this time the seemingly impregnable case against them that their child’s injuries are ‘characteristic’ of abusive trauma has become increasingly uncertain. This is particularly the case with Shaken Baby Syndrome (SBS) – the contention that the combination of bleeding under the skull, swelling of the brain and retinal haemorrhages can only be due to violent shaking. On the contrary it is now well documented that the same triad of injuries can follow (as the accused parents protesting their innocence have maintained) a low level fall from a bed or sofa or an episode of choking.

    Many might thus be understandably perplexed that last Monday the General Medical Council (GMC) invoked its severest penalty of erasure from the medical register against Britain’s leading Paediatric Neuropathologist Dr Waney Squier, whose testimony in the courts has helped secure the exoneration of dozens of parents. The GMC’s decision is based on the findings of a medical tribunal that her testimony to the courts in six cases was “dogmatic and inflexible”, that she had selectively cited the findings of studies to support her argument that injuries were not deliberately inflicted and that, the Tribunal said, "in your evidence to the courts and before this tribunal you demonstrated time and again that you would lie to support your own propositions, or to avoid conceding a point, showing little respect for your colleagues."

    Subsequently a group of 25 prominent lawyers, pathologists, paediatricians and neurologists rallied to her defence, asserting, in essence, that she is a victim of a campaign to discredit her. “The case of Dr Squier is indicative of a troubling pattern”, they argued in a letter to a national newspaper, “where the authorities inflict harsh penalties on those who fail to toe the establishment line.” She has, by this account, paid the ultimate price of the loss of her professional reputation for articulating the uncomfortable truth that the validity of prevailing scientific theories might be in error. Certainly from now on it will be much more difficult for those who share her well-founded scepticism about SBS to testify on parents’ behalf for fear they too might suffer a similar fate.

  14. We are concerned that Dr Waney Squier, perhaps Britain’s foremost scientist in the field of paediatric neuropathology, who has been a consultant at the John Radcliffe hospital for 32 years, was struck off the medical register by a General Medical Council panel on Monday, based on her testimony in so-called shaken baby syndrome (SBS) cases (Report,, 21 March). She was accused of various things, including showing too little respect for the views of her peers.

    Every generation has its quasi-religious orthodoxies, and if there is one certainty in history it is that many beliefs that were firmly held yesterday will become the object of knowing ridicule tomorrow. Whether this will be the fate of SBS, time will tell. However, the case of Dr Squier follows another troubling pattern where the authorities inflict harsh punishment on those who fail to toe the establishment line.

    It is a sad day for science when a 21st-century inquisition denies one doctor the freedom to question “mainstream” beliefs. It is a particularly sad day for the parent or carer who ends up on the wrong end of another doctor’s “diagnosis” that an infant was shaken, when the child may have died from entirely different, natural causes.

    [25 signatures]

  15. A California man convicted of murdering his infant daughter failed to show that the shaken-baby-syndrome theory used by prosecutors at his trial is scientifically invalid, a federal appeals court ruled Monday.

    A three-judge panel of the 9th U.S. Circuit Court of Appeals rejected Alan Gimenez's latest effort to overturn his 1992 conviction. A jury convicted Gimenez after medical testimony revealed what some doctors say is a telltale sign she had been shaken: brain swelling and bleeding inside her skull and behind her eyes.

    Gimenez, who was paroled in June after nearly 24 years in prison, argued that the three symptoms are no longer considered a clear indication of abuse. His case was among a spate of recent challenges to "shaken baby syndrome" diagnoses that include a similar trio of symptoms without evidence of neck injuries.

    Gimenez showed there was a vigorous debate in the scientific community over the three-symptom shaken baby syndrome diagnosis but not a repudiation, 9th Circuit Judge Alex Kozinski said.

    Gimenez's attorney, George Schraer, said the court did not go into detail about the nature of scientific discussion surrounding so-called triad-only shaken baby syndrome diagnoses.

    "I think if they had gone into that in more detail, they would have realized that it is not as even-sided as they're suggesting," he said.

    He plans to appeal.

    Gimenez took his daughter, Priscilla, to the hospital on August 10, 1991 after she vomited and showed signs of a seizure, according to his attorneys. She died a few days later, just 49 days old.

    Doctors who have reviewed her medical records for the defense since Gimenez's conviction concluded she likely had bleeding in her skull since birth, and died of a stroke-like blood clot, Gimenez's attorneys said.

    Prosecutors stood by the shaken baby syndrome theory used in Gimenez's prosecution and cited a rib fracture on Priscilla's body and a tear under her tongue as additional evidence of abuse.

    Kozinski at the end of the 9th Circuit's ruling left the door open to another legal challenge by Gimenez, saying he may be able to get "relief" from his conviction in the future as "forensic science continues to evolve."

  16. A group representing 1,800 pediatricians in Massachusetts is calling on Governor Charlie Baker to launch a review of the state medical examiner’s office, after it changed its determination on three infant deaths in the past two years.

    The letter from the Massachusetts chapter of the American Academy of Pediatrics suggests the medical examiner’s office is allowing defense medical experts to have outsized influence, prior to trial, in cases involving “shaken-baby” death investigations. In the three cases, child fatalities originally deemed to be homicides were later changed to be of “undetermined” cause.

    “Publicly available information questions whether individual examiners may have been influenced by participating attorneys and paid reports from defense medical experts,” according to the letter obtained by the Globe. “Sadly, these extraordinary and alarming events call into question both the capacity and independence of our medical examiner’s office.”...

    The changed rulings from the medical examiner’s office — involving three separate state pathologists — caused prosecutors to halt two of the three murder prosecutions. They dropped charges in 2014 against Geoffrey Wilson, a Malden father who had been accused of killing his infant son, Nathan. They also dropped charges against Aisling Brady McCarthy, a nanny from Ireland accused of murdering 1-year-old Rehma Sabir of Cambridge.

    Prosecutors are still pursuing murder charges against a Burlington child care provider, Pallavi Macharla, who is accused of killing a baby girl from Burlington, Ridhima Dhekane. Middlesex District Attorney Marian Ryan said even though the state pathologist this year backed off her initial homicide ruling, prosecutors have enough evidence to go forward. This evidence includes the medical testimony of chief medical examiner Dr. Henry Nields, who Ryan said supervised the autopsy of that baby and will support the original assessment that the death was a homicide...

    The doctors’ group is asking the governor to “initiate a review to determine the root causes of recent events and begin a longitudinal process for supporting, improving and maintaining the ME Office’s ability to reliably and accurately assess questions of fatal child abuse.”...

    In the letter to the governor, the pediatricians’ group raised concerns that recent controversy over shaken-baby cases is leading the public to potentially believe that “well established science is in question.”

    A study last year found the national conviction rate in shaken-baby cases remains high, though more vigorous challenges to these child-abuse allegations have led to cases being dropped.

    The study, conducted jointly by the Washington Post and Northwestern University’s Medill Justice Project, found that out of some 1,800 cases going as far back as 2001, about 1,600, or 89 percent, led to convictions, a rate higher than for other violent crimes. Still, there were 200 other cases over that time period that did not lead to convictions, including cases where charges were dropped or dismissed, or the defendant was acquitted or the convictions overturned.

    In its letter to Baker, the pediatricians’ group said the latest decisions out of the medical examiner’s office makes them concerned that Massachusetts will become a state that doesn’t see clearly the tragic regularity of “shaken-baby” deaths. It called on the governor to make sure that the medical examiner’s office has “sufficient expertise in child abuse injuries to reject controversial and unscientific alternate cause theories.”