Thursday, November 12, 2015

Shaken baby syndrome 4

“If you have a story that’s just not hanging together, think about it. Maybe it’s abuse,” said (Alice)Newton, who previously ran the Boston Children’s Hospital child-protection unit for seven years.

After toiling in relative obscurity for nearly two decades, Newton has recently emerged as one of the state’s most controversial pediatricians, admired by many but reviled in some legal circles as a messianic physician who is too eager to see a dark side in the parents and caretakers who bring ailing — or dead — children into the emergency room.

In the past few years, her medical judgment has been openly questioned in three high-profile cases, two of which involved shaken-baby abuse charges that were later dropped. The third involved her role in filing medical abuse charges against parents of a Connecticut teenager on grounds that they were seeking overly aggressive and inappropriate care for their daughter. She has received threatening calls and letters, and has taken some security precautions.

Her critics don’t mince words. Melinda Thompson, attorney for an Irish nanny who was recently released after the shaken-baby charges against her were dropped, referred to Newton as a “maniac” who recklessly misuses her medical power.

“She has become more of a prosecutor than a doctor,” said Thompson, who represented Aisling Brady McCarthy. “I think it’s shocking that she’s heading a child abuse team at a major hospital.”

But many pediatricians and child advocates defend Newton as a highly respected physician who fearlessly speaks the truth as she sees it. Jetta Bernier, executive director of the Massachusetts Citizens for Children for more than 30 years, said Newton is among the best in her field and “does not shoot from the hip.”

Newton’s supporters also see something more insidious at work, which threatens the state’s ability to stop harm to vulnerable children.

They say Newton’s critics are part of a vocal niche of the nation’s defense bar, committed to attacking the medical community’s ability to identify child abuse, especially shaken-baby syndrome. Not just in Massachusetts, but in other parts of the country, these tactics have been successful, leading to scores of criminal cases being dropped or overturned in the past decade.

Dr. Cindy Christian, former head of the child abuse committee of the American Academy of Pediatrics and a pediatrician at Children’s Hospital in Philadelphia, said she and others are feeling compelled to speak out against what they see as an ominous trend in child abuse prevention, including the scapegoating of highly competent pediatricians...

“Sometimes it feels like good versus evil,” she said in her small office, which she shares with another staffer, in an administrative building blocks from MGH. “My only motivation is to make sure that the child doesn’t suffer further abuse and there’s justice for children and families.”

Child-abuse specialists say that, conservatively, several hundred infants a year nationwide are victims of shaken-baby syndrome, which is also called abusive head trauma. Over the past decade, Newton’s testimony about shaken-baby syndrome has helped convict numerous defendants, including a day-care provider from the North Shore, an East Bridgewater father, and a Woburn man. This summer, her testimony helped convict a father charged with shaking his infant son, causing permanent neurological damage, while in a Danvers hotel room that took in the homeless...

Christian, as part of her work for the American Academy of Pediatrics, said she does not know the specifics of the McCarthy and Wilson cases, but knows that medical experts hired by the defense in these cases typically offer a wide array of possible alternate explanations for abuse. She called it the “maybe, maybe, maybe” strategy. However, she said, few can do what seasoned child-abuse medical experts can do, and say that these constellation of symptoms have no other logical explanation but abuse. “Legal justice is not the same as science,” she said.


  1. Newton found that the girl had the “triad” of symptoms associated with shaken-baby syndrome — brain bleeding, brain swelling, and retinal damage — and numerous Children’s Hospital specialists agreed, including ophthalmologists and neurologists. Newton said she also found signs of past abuse, including healing bone fractures — on the spine and limbs — and significant bruises near one ear, and had systematically ruled out other causes.

    Within 24 hours, Newton had a point of view: that the girl had died of a violent act committed a few hours before she was brought to the emergency room, and that she was likely the victim of ongoing abuse in the week or months prior to that, due to her healing bone fractures...

    “When we see blood around the brain, especially in a child without a cause for bleeding . . . then we automatically worry that there’s been a trauma that’s unexplained and so it does bring up the issue of abuse,” she said in a transcript of pretrial testimony.

    But the nanny’s defense lawyers passionately fought back, and accused Newton of relying excessively on the triad of symptoms and ignoring other possible causes, a methodology that they say has been discredited by numerous medical specialists who have successfully helped overturn many child-abuse prosecutions.

    “This is a Shaken Baby Syndrome (SBS) prosecution,” her attorneys wrote at the start of a brief to exclude Newton’s testimony. “That means it is a prosecution based on a scientific hypothesis that has crumbled over the last decade.”

    The defense said Newton, among other shortcomings, failed to take seriously that Rehma had been tested at Children’s a month before her death for a rare bleeding condition called von Willebrand disease, and even her own parents said Rehma bruised easily. (Court records suggest Newton did consider von Willebrand disorder, but was told by the child’s hematologist that the baby did not have a confirmed case of it; and even if the infant did, it would have been a mild version and not likely to cause catastrophic brain bleeding.)

    In perhaps the defense’s most compelling argument, McCarthy’s lawyers noted that one of the hospital’s specialists dated the bone fractures as most likely occurring a month before Rehma was brought to the emergency room — a time when the child was out of the country with her parents and the nanny wasn’t caring for the child. (Newton has said healing bone fractures are hard to date with such precision, and court records show doctors also offered a wider time frame for the fractures, from roughly a couple weeks to a couple months, during which the nanny was with Rehma.)

    Two months ago, prosecutors announced they were dropping shaken-baby charges against McCarthy. They reported that Dr. Lindstrom, the medical examiner in the nanny case, had changed the manner of death for 1-year-old Rehma from homicide to undetermined, and they no longer felt they could prove their case beyond a reasonable doubt.

    Lindstrom, in her findings, wrote that she was convinced that new information from attorneys raised the possibility that Rehma had “some type of disorder that was not able to be completely diagnosed prior to her death,” and she cites von Willebrand disease. She also said the girl’s death could have been “related to an accidental injury in a child with a bleeding risk or possibly could have even been a result of an undefined natural disease.”

    Newton said she got the news through a phone call from the prosecutors’ office. She said she sat in shocked silence in her office, having once seen the trial as a chance to educate the public about the realities of shaken-baby syndrome. She said she respects the criminal justice system, but maintains that she accurately interpreted the baby’s medical data in front of her.

    “I become the voice of the child,” she said.

  2. A grieving mother has spoken of her heartbreak after her baby son was shaken to death by his father.

    Baby-killer Liam Laverick, 25, was jailed for eight-and-a-half years on Thursday after being convicted by a jury of the manslaughter of his son, Tommy-Lee Laverick-Whitworth.

    The fragile infant, who measured 52cm from head to foot and was just 27 days old, lost his battle for life in hospital two days later.

    He died from a "catastrophic brain injury".

    There was grief and anger as the foreman of the jury brought Laverick's 11-day trial at Hull Crown Court to an end, after ten hours of deliberation, with a single word: "Guilty."

    Having spun a web of lies and deceit since his terrible act on September 23 last year, Laverick could not resist a last cruel outburst at the baby's mother, his former partner Kelly Whitworth.

    He shouted "F****** child beater" from the dock as she left the court in tears.

    She later revealed someone had called her "murderer" in the street.

    Miss Whitworth was blameless and had left Tommy-Lee sleeping "peacefully" in his cot in the sole care of his father.

    Prosecutors said Laverick shook the baby in anger because his crying disturbed his sleep.

    Read more:

  3. A local man convicted of child abuse will be released from jail next week and his supporters are planning a gathering to welcome him to freedom. Joshua Burns of Brighton has served nearly a year-long sentence in the Livingston County Jail after being convicted of second-degree child abuse. Controversy has swirled around the case which involved his daughter, Naomi. Burns and his wife, Brenda, have maintained his innocence and claim the incident was an accident. However prosecutors strongly felt it was a case of child abuse and doctors that testified in the criminal trial suggested shaken baby syndrome, which a jury concurred with. Burns will be released during the early morning hours on Tuesday, December 8th, and his friends and family are hoping to greet him in the jail lobby with an encouraging show of support. Brenda Burns tells WHMI she has spoken to her husband about his release and he has mixed feelings of joy and sadness. Joshua will not be able to see Naomi at the release due to probation restrictions. He will have contact with her for the first time later that day at a counseling session with Family Counselor Doris Viola and a social worker. Brenda says Josh plans to be extremely careful not to violate probation and there are upcoming battles, including the process to appeal his conviction. She says the gathering at his release will be peaceful and the first thing she plans to do is hug and kiss him.

  4. After 8-month-old Jay Hudson Bassett was rushed to a Worcester hospital on Thanksgiving, 2012, Medeiros, his maternal grandmother, quickly fixated on the bruise above his left eye. As the once-playful boy lay unconscious, Medeiros began a mantra of grief that hasn’t stopped to this day: “Something isn’t right.”

    Police records show that UMass Memorial Medical Center hospital initially linked Jay’s death to Sudden Infant Death Syndrome — but Medeiros hounded authorities to look more closely. Eighteen months later, in May 2014, her worst fear was confirmed: The Office of the Chief Medical Examiner ruled Jay’s death a homicide caused by “blunt trauma” to the head and neck, inflicted by others.

    Now, three years after Jay’s death, no one has been charged, and the investigation remains open. Jay’s parents, Hailey Corrente and Marben Santiago, were with the baby when he stopped breathing, police records show. They cut ties with Medeiros shortly after the child’s death and moved out of state. The couple, who have a new baby boy, declined to answer questions about Jay when a reporter visited last spring and left several phone calls and text messages over the last six months.

    While there is no evidence that Corrente and Santiago are suspects in the open police investigation, Medeiros believes that, at the very least, Jay’s parents know what happened. And she believes the long delay to make a death ruling seriously undermined the investigation...

    The young couple may have wanted to move on, but their past followed them as they settled into a second-floor apartment with their new baby on a residential street in Lakewood, Ohio...

    Last spring, a New England Center for Investigative Reporting reporter knocked on the couple’s shuttered apartment and left a letter requesting comment when nobody answered. Corrente came downstairs a few minutes later to read the note after the reporter drove away. Santiago, later reached by phone, declined to comment.

    Medeiros, meanwhile, speaks to anybody she can about her grandson. Her home is filled with Jay’s pictures, her closet stuffed with his toys and clothes, his death certificate clipped to her refrigerator.

    She said the district attorney’s office provides no information. A local police officer has told her privately that without more information, the investigation is stalled. She worries incessantly about Jay’s little brother, now nearly two years old.

    “I want justice for Jay,” said Medeiros. “I have to speak for my grandson Jay because nobody else will.”

  5. The Michigan Innocence Clinic at the University of Michigan Law School will represent Joshua Burns for an appeal of his second-degree child abuse conviction.

    Caitlin Plummer, an attorney for the Michigan Innocence Clinic, said the clinic has filed a motion requesting that Burns be immediately released from the Livingston County Jail on bond pending his appeal.

    “We believe he was wrongly convicted of child abuse,” Plummer said. “We have filed a motion for bond pending appeal.”...

    A jury convicted the 39-year-old Burns of second-degree child abuse for injuries to his then-11-week-old daughter, Naomi Burns, whose injuries included seizures, hypothermia, hypotension, bradycardia, apnea and retinal hemorrhages.

    Naomi, now 1, slipped off Burns’ lap in March 2014 as he ended a phone call from his wife and he grabbed her face to keep her from striking a coffee table or the floor.

    Burns and his wife claim Naomi’s medical issues were caused by birth trauma, while an assistant prosecutor told the court she believes the defendant is not telling the whole story, implying the child possibly struck her head on the table...

    According to court documents, Burns’ appeal attorneys plan on raising numerous claims on appeal, including ineffective assistance of counsel and improper exclusion of a doctor’s emails regarding the significance of Naomi’s retinal hemorrhages.

    In that email exchange, Dr. Alex Levin in Pennsylvania indicated that it was unknown what thrombocytosis might do in reference to Naomi’s retinal bleeding and it “could be considered to throw the retinal findings into question,” according to the Burns’ family website,

  6. (see above) The following are my opinions, to a reasonable degree of medical certainty:
    -Naomi had one definite intracranial condition, and one possible additional condition. The first was chronic subdural fluid collections. It is not clear when these originally developed, but she was born via an emergent c/section and she was noted to have a 'caput' (scalp swelling from birth trauma) as a neonate. Chronic subdural fluid collections are not evidence of significant or abusive trauma and can develop in otherwise normal infants.
    -Naomi's subdural fluid collections are apparent on her MR scan of 3/18, and these collections were responsible for her head circumference increasing at a greater than expected rate between 1/22 and 3/7. Children with this condition can develop small acute subdural and subarachnoid hemorrhages as a result of minimal or minor head trauma. According to the history in the record, Naomi did suffer a minor bump on the head on 3/15...

    -Naomi was found to have retinal hemorrhages on 3/26. These are not specific for abusive hemorrhage, and can happen in the setting of subarachnoid hemorrhage (as Naomi had) and with increased intracranial pressure (as Naomi had due to her subdural fluid collections) and with repeated vomiting (as Naomi had on 3/16, 3/17, 3/18 and during her hospitalizations)...

    -Naomi did not have evidence of external injury or broken bones-these findings plus the lack of injury to the brain substance make abusive head injury very unlikely.
    To summarize then, Naomi, to a reasonable degree of medical certainty, was not a victim of abuse. She suffered seizures in March of 2014 as a result of a medical condition.

  7. The undisputed narrative is that Kelly was watching Kaiden at the day care she operated out of her home on Jan. 18, 2011, when Kaiden became unconscious. Kelly took Kaiden to the apartment of a neighbor who is a registered nurse and who gave Kaiden CPR. Paramedics arrived after a 9-1-1 call placed by the neighbor’s husband, and Kaiden was taken to St. John’s Hospital in Springfield, then to OSF Saint Francis Medical Center in Peoria. Kaiden died in Peoria on Jan. 20, 2011...

    Kelly’s defense attorney, John Rogers of St. Louis, countered that Kaiden had a history of recurring medical problems which point to a stroke. Rogers said the “triad” of symptoms common to “shaken baby” cases – bleeding of the brain, swelling of the brain and bleeding of the retinas – cannot actually be caused by shaking a child.

    That defense is becoming more common in cases where prosecutors allege someone shook a child. “Shaken baby syndrome” is a theory often used to connect certain child deaths to abuse, but medical experts are split on whether shaken baby syndrome is a plausible theory. That uncertainty has meant inconsistent verdicts in similar cases around the nation.

    In 2012, a Springfield father was found not guilty of aggravated battery after he was accused of harming his daughter by shaking her. A medical expert at that trial testified that the triad of symptoms the child exhibited was due to an apparent seizure. However, other cases have seen caregivers spending decades behind bars when courts rejected their assertions that prior medical conditions – not abuse – caused the triad of symptoms. In most such cases, the last person who spent time with an affected child is the main suspect.

    Shea testified that he was “impressed” by how clean and organized Kelly’s apartment was when he arrived, adding that there was no blood visible at the scene. Shea said when he interviewed Kelly, she went from upset to “catatonic” to “invoking the Lord’s name.” Under questioning by Milhiser, Shea said he didn’t originally think he was at a crime scene, but he changed his mind when Kelly pointed to two different spots when asked at separate times where Kaiden allegedly fell. Shea did not include that discrepancy in his official report, prompting questions from Rogers on cross-examination.

  8. The entire appeal of Jibba Jabber dolls was the oddly delightful and distinct sound they made as you held them by their necks and shook them... which, unfortunately, also resembled choking or strangulation. Later on, the manufacturer, Ertl, began including inserts in the doll's packaging discouraging Shaken Baby Syndrome. The toy was also recommended for adults as a stress reliever.

  9. For the third time, the state Medical Examiner’s Office has abandoned a finding that the death of an infant in Middlesex County was linked to violent shaking, a shift that will lead to the release on bail of a woman accused of murdering a six-month-old girl in Burlington in 2014.

    Pallavi Macharla has been held without bail in Middlesex County since March on a first-degree murder charge, but on Monday Supreme Judicial Court Justice Margot Botsford reduced bail for the Burlington woman to $25,000 cash.

    Middlesex District Attorney Marian Ryan’s office and defense attorney J. W. Carney Jr. endorsed the change in light of the medical examiner’s office’s revised finding.

    Carney said he expects Macharla to post bail soon. She continues to face murder charges as the medical examiner’s office continues its review of the case.

    After Macharla’s indictment, prosecutors said in court papers that the medical examiner concluded retinal hemorrhaging discovered during the autopsy indicated “significant force’’ comparable to falling from an 11-story building, a high-speed car crash or a crushing injury to the head.

    But the medical examiner has now backed off the conclusion that the hemorraghing explains how the infant was fatally injured in March 2014 while being cared for by Macharla in her Burlington home, where she was allegedly operating an unlicensed day care program, according to Carney and prosecutors.

    Carney said a specialist hired by the defense concluded that the child died from natural causes. That finding compelled the medical examiner’s office to review its own conclusions.

    Carney, speaking in Boston after a brief hearing before Botsford, said Macharla continues to insist she played no role in the child’s death.

    “She is a meek, gentle, compassionate person,” Carney said.

    Middlesesex Assistant District Attorney Katharine Folger said the medical examiner is still convinced that the infant’s death was a homicide, not a natural death.

    The medical examiner’s office has reconsidered “one prong” of the ruling, it “remained firm that the infant died of blunt force trauma,’’ Folger said.

    Earlier this year, Ryan’s office dropped first degree murder charge against Aisling Brady McCarthy after the medical examiner’s office reviewed its initial conclusion of violent shaking as the cause of death for 1-year-old Rehma Sabir.

    Brady McCarthy, an Irish native who was working in the US as a nanny and living here illegally, was deported to Ireland.

    In 2014, Ryan’s office dropped a first-degree murder charge against Geoffrey Wilson, who had been accused of shaking his six-month old son to death in his Malden home in 2010. Carney represented Wilson and drew on medical experts who concluded the child’s mother and grandmother had a rare genetic disorder that made the infant prone to bleeding from minimal movement.

  10. After 17 years in prison for an infant's death at her San Diego daycare center, Suzanne Johnson is in the forefront of legal challenges to "shaken baby syndrome" as courts catch up with medical advances in understanding the mechanisms of childhood brain trauma.

    A judge last month agreed Johnson deserved to be considered for a new trial in a case that hinged on the syndrome, a 1970s-era forensic diagnosis long accepted as sufficient to convict caretakers accused of harming and even killing babies.

    Appeals such as Johnson's are occurring with greater frequency at both the federal and state level, said Deborah Tuerkheimer, a Northwestern University law professor who wrote a book on the subject. But legal bids to reverse guilty verdicts are long and grueling, the outcome far from guaranteed, Tuerkheimer said.

    "Criminal convictions are final, and science moves on," she said.

    "Abusive head trauma" - a newer, broader term - is the leading cause of fatal child abuse in the United States, according to the U.S. Centers for Disease Control and Prevention, and conviction rates are higher than for other violent crimes.

    Of 1,800 resolved cases since 2001, roughly 1,600 resulted in convictions, the Washington Post reported in 2015 after a year-long investigation.

    Because the accused are typically trusted caregivers or parents, the consequences of a wrongful conviction are especially devastating, not only for defendants but for their children and spouse.

    "We are shredding families," said Seattle-based lawyer Heather Kirkwood, who has filed appeals on behalf of several people convicted in such cases.

    For decades, pathologists, pediatricians and courts recognized a distinct set of internal head injuries - brain swelling, bleeding on the surface of the brain and behind the eyes – as proof of death by deliberate shaking, even in the absence of other overt signs of violence.

    But medical consensus has shifted in recent years and research now shows such injuries can be caused by accidental falls from a short height, or even medical conditions such as blood-clotting disorders and latent trauma from a difficult birth, which can manifest weeks later.

    Johnson, now 71, remains in prison while her bid for exoneration is pending. Defense lawyer Alissa Bjerkhoel said she is hopeful prosecutors will ultimately concede the case...

    Sentenced to 25 years to life in prison for causing injuries that killed 6-month-old Jasmine Miller in June 1997, Johnson insisted the baby suddenly collapsed hours after an accidental fall from a high chair.

    Jurors, however, accepted prosecutors' explanation, backed by several medical experts, that the child died from violent shaking and a blow to the head deliberately inflicted by Johnson in a fit of rage over the baby's crying.

    In their petition to overturn the conviction, however, Johnson's lawyers presented new medical expert opinion that the baby was probably badly hurt by slipping out of her high chair, damage likely compounded by latent head injuries the infant presumably had suffered in a previous accidental fall from her parents' bed weeks before she died.

    They also introduced the fact, not presented at trial, that paramedics trying to revive Jasmine forced a breathing tube down the baby's esophagus rather than her windpipe, an error that likely contributed to or ensured her death.

  11. Last week, the girl’s parents, Nada Siddiqui and Sameer Sabir, filed a wrongful death lawsuit against their former nanny, Aisling Brady McCarthy, five months after Middlesex County prosecutors dropped murder charges against McCarthy.

    The charges against McCarthy were dropped after she spent more than two years in jail awaiting trial for a death that the medical examiner said she couldn’t even classify as a crime.

    The official cause of death of Rehma Sabir is undetermined, and the medical examiner, Dr. Katherine Lindstrom, said she wasn’t even sure if the baby had died from inflicted trauma.

    In bringing a wrongful death suit against McCarthy, Rehma Sabir’s parents are asserting that their child died at McCarthy’s hands, and are putting forth theories and evidence that were put aside or discredited during a series of pre-trial hearings at which McCarthy’s lawyers, Mindy Thompson and David Meier, were able to peel away the prosecution’s case until there was nothing there...

    "If the parents were there, they would have questioned the case and the prosecutors. Just listening would have changed their perspective.”

    But they weren’t there. Even if a civil case requires a burden of proof that is less than the criminal standard of beyond a reasonable doubt, the lawsuit against McCarthy seems to go over old, unsubstantiated ground...

    When I interviewed her there last month, McCarthy said she wanted to sue Dr. Alice Newton, who made the initial diagnosis that led to her arrest, and Middlesex County prosecutors, not to get money, but to expose a system that allows people to be accused of murder on evidence that doesn’t stand up to scientific scrutiny...

    “What she wants is the Middlesex DA’s office and Alice Newton to stop doing this to people. To the extent that Aisling is talking about this, it’s to help educate people and make sure that no one goes through the living hell she went through. She’s never spoken badly of the parents.”

    And there’s the rub. The wrongful death suit against McCarthy puts her and her lawyers in the awkward position of pointing out that the parents, or people they visited when they took their daughter abroad against a doctor’s advice, were just as likely to have caused injuries to Rehma as McCarthy was. And the madness of being put in that position is that the medical examiner’s findings don’t support either of those conclusions.

  12. On a November morning in 2013, Erica Hammel learned over the phone that her 1-year-old son Wyatt was near death -- hospitalized with a skull fracture and brain damage after being violently shaken by a woman trusted to care for him.

    Hammel would later learn the woman had twice been convicted of child abuse -- a revelation that led the Michigan mother to fight for a state-wide child abuser registry, which, if passed, would be the first of its kind in the nation.

    Wyatt, now 3, survived -- having undergone four brain surgeries -- but has significant impairment. Hammel said she believes a public registry with instant access to prior offenses -- much like that of a sex offender registry -- would have prevented her son's ordeal.

    "She had been convicted twice of child abuse in the past and I had no idea," Hammel said of her son's abuser, Rachel Edwards, who was living with Hammel's ex-husband in a rental home in a Detroit suburb at the time of the incident...

    "Having this type of law would prevent others from going through what my son did," Hammel said of the bills -- collectively known as "Wyatt's Law" -- which are currently under consideration by the Michigan state legislature...

    Edwards pleaded no contest to second-degree child abuse in Macomb County Circuit Court and was sentenced in February 2014 to 33 months to 10 years behind bars in Wyatt's case. Her first parole hearing is scheduled for March 2017.

    Just days before Edwards attacked Wyatt, she drugged a 3-year-old boy with Seroquel, a medication used to treat bipolar disorder. She was later found guilty of fourth-degree child abuse in that case. In 2011, she pleaded no contest to third-degree child abuse after hitting the same boy, leaving marks on his body. Both convictions allowed her to get probation...

    For Wyatt, each day is a challenge. The 3-year-old, who loves Mickey Mouse and listening to music, has major cognitive impairment and is partially blind in his left eye. He has difficulty chewing solid food, suffers from headaches and is forced to wear braces on his legs.