http://www.philly.com/philly/news/20071027_The_mystery_of_Lucas_death.html

The mystery of Lucas' death
By Tom Avril

INQUIRER STAFF WRITER

It was her first day back at work - a full slate of faculty meetings -and Lisa Mullenax might as well have been at home. That was where her mind was. She had spent the summer falling in love with her baby, Lucas, but now it was August, back to work to pay the  mortgage. As the meetings droned on, the young teacher consoled herself that school was just two minutes away from home in State College, Pa. The baby was with his father, Alejandro Mendez Vargas, a tender spirit who was so good with Lucas that her mother teasingly called him "Mr. Mom."

It would be OK.

But then, as Lisa was getting out supplies for her Spanish classroom, her return to daily routine suddenly crumbled. Someone was running up to her, screaming. Her neighbor's daughter? Nothing made sense. Lisa heard the girl say Lucas was not breathing. An ambulance had taken him to the hospital.
Lisa started to cry and ran down the hall. She raced home to get her husband - but why was Alejandro talking to the police? At the hospital, the doctors asked if Lucas had been in an accident. Did someone shake him? More stern-faced police arrived. And then her baby was being helicoptered to a bigger hospital 80 miles away.

Six days later, he was dead.

And the doctors and police believed that one of his parents had killed him.

A romance abroad

Lucas seemed like such a healthy baby.

He had chubby, dimpled cheeks, a soft hint of a smile. He had blue eyes from his mother and a hint of gold in his skin from his father, a native of Costa Rica.
That's where Lisa and Alejandro had fallen in love. Lisa, a junior-high Spanish teacher in State College, was chaperoning a group of students on a 10-day "eco-tour" of the Central American nation. Alejandro was their guide.

They didn't hit it off so well at first.

The burly, smiling guide greeted the young teacher warmly - too warmly, she thought. Reserved by nature, the tall, slender woman was unsure of his intentions and gave him a frosty greeting in return. Talking to his bus driver later, Alejandro rolled his eyes. Ten days with the standoffish schoolteacher.
"It's going to be a long one," he said. But by the end of day two, she started to smile at his jokes. After the children went to sleep at the hotel, the teacher and the tour guide stayed up for hours, talking. She liked his lighthearted nature, and how children seemed to gravitate toward him.

Later that year and the next, the two flew back and forth to visit each other. They got married in Pennsylvania in November 2001. The baby was born  n May.
They called him Lucas, a name they took from a Latin word for light. But childbirth was hard on Lisa. It was a natural delivery, and Lucas weighed 91/2 pounds. She had needed a blood transfusion. She was slow to warm to motherhood. But Alejandro plunged right in, having taken care of a daughter from a previous marriage. Every night, he woke up with Lisa at feeding time to change the diaper and rock the baby back to sleep. At dinner, he couldn't bring himself to put Lucas down; he didn't want him to cry. "You still have to eat!" his mother-in-law would lecture, watching his food get cold.

"I can hold him and eat," Alejandro would insist. By three months, Lucas was a robust 16 pounds. As far as their pediatrician could tell, he was fine. A vital vitamin The human circulatory system has an elaborate network for repairing itself - whether from major wounds or from the small internal bleeds that are happening all the time, unnoticed, inside our tiniest blood vessels. The process involves more than 80 chemical reactions. If you draw it as a flowchart, it looks like a plate of spaghetti.

When an injury occurs, platelets stick to the exposed collagen in a torn vessel wall, forming a loose, temporary plug. The plug must then be held in place with a mesh made from a protein called fibrin. The production of this mesh depends on four clotting factors, which in turn are dependent on a molecular matchmaker known as vitamin K. The vitamin attaches a sort of chemical trailer hitch to these clotting factors so they can stick in place and accelerate the
production of fibrin, said James Harper, a pediatric hematologist at Children's Hospital in Omaha, Neb. This attachment process takes place in the liver.

Babies are typically given a shot of vitamin K at birth, as Lucas was, and later they get it through their mother's milk or formula. Eventually, bacteria in their intestines can manufacture it. Yet in Lucas' body, his parents would learn, something had gone badly awry.

Emergency

On the morning of Aug. 27, 2002, Lucas was spitting up more than usual, and acted fussy. Lisa thought he seemed lethargic lately, and he'd had diarrhea.
That afternoon, on Lisa's first day at school, her husband sat the baby in his lap and tried to calm him by playing music on the computer. Then he put Lucas down on a bed to rest, and left the room briefly. When he came back, something was wrong. Alejandro rushed to a neighbor's house, carrying Lucas in his arms. The baby was barely breathing, his skin clammy and ashy-gray. His eyes rolled back in his head, and milky fluid came out of his mouth. The neighbor called 911, then tried mouth-to-mouth resuscitation. Lucas vomited. State College police arrived and took over, one officer trying to clear the child's airway and later doing chest compressions when paramedics showed up.

An ambulance took the baby to Centre Community Hospital in State College. His father stayed behind to answer questions from police. In the emergency room, doctors found retinal hemorrhaging in Lucas' eyes. His fontanel - the soft spot on the head where a baby's growing skull has not yet closed - was bulging, indicating some kind of pressure on his brain. He had no reflexes. A chest X-ray revealed a fracture in the lower left rib, and what the doctors thought was calcium forming between the ribs and sternum. It was evidence, they believed, of multiple healing fractures.

Evidence of abuse.

They shared their suspicions with police, who searched the family's three-bedroom house that afternoon. Two days later, a doctor analyzed a repeat X-ray and saw something odd: There was no evidence of calcium formation after all. He concluded that, with the exception of the one fracture, the previous findings were "artifactual" - inaccurate. And later analysis would determine that the one fracture was old - with no connection to the baby's sudden collapse.

But by that time, Lucas had been helicoptered 80 miles away, to Geisinger Medical Center in Danville - home to a level-one trauma center with special accreditation for pediatric cases. The diagnosis of child abuse was well on its way.

Death and doctors

Physicians coined the term shaken-baby syndrome in the early 1970s to describe a collection of symptoms that included retinal and brain hemorrhages, but not necessarily any external signs of head trauma. The internal bleeding and other damage are thought to occur from a whiplash effect, made possible because an infant has weak neck muscles and a head proportionately larger than an adult's. Some researchers and judges have begun to question whether shaking alone - without impact against a hard surface - is enough to kill a baby. This can't be proven by shaking an actual infant, so  researchers study lifelike models. But the mainstream medical view is that shaken-baby syndrome is all too real, and sometimes deadly - the tragic result when a caretaker simply becomes too frustrated to cope with a wailing infant.

One symptom attributed to shaking, called retinoschisis, is said to involve jelly inside the eye that is attached to the retina. If the eye is shaken back and forth, the jelly moves one way while the outer part, including the retina, moves in the other direction. Blood vessels tear, and the retina is pulled away from its accustomed position, developing unnatural "folds." Some doctors have maintained that such folds can be explained only by shaking; that certainty is now in question.

Two days into Lucas' stay at Geisinger, doctors recorded that he had this problem in his eyes. The rib fracture worried them, too, though tests suggested it was not new. And he was bleeding inside his brain. The baby's parents maintained a bedside vigil - when they were allowed. Child-welfare officials had decreed the couple could not see Lucas without medical staff present.

As a nurse stood by watchfully, Lisa sobbed at the baby's bedside while Alejandro held a tiny limp hands and kissed Lucas' forehead. They insisted that no one had abused the baby. That there had to be a medical explanation. "I know there is a disease that can cause these symptoms," Lisa told a doctor. "I'll need to call Cleveland Clinic to find out."

Geisinger staff considered that possibility. One test looked for a bleeding disorder called Von Willebrand disease. The results of that test were negative.
They also gave Lucas vitamin K - a common practice when coagulation disorders are suspected - though not right away. Early on his second day in the hospital, Lucas suddenly went downhill. His lungs filled with blood, and his heart rate plummeted. Six hours later, after working to revive him, doctors gave him 1 milligram of the vitamin, and his clotting ability improved somewhat -suggesting he might have a deficiency. But ultimately, the physicians concluded that only child abuse explained his symptoms. The law required them to report their suspicions to authorities, and they did.

The grim progression of the various doctors' opinions can be seen in their handwritten notations on the baby's hospital chart.

Aug. 27: "Possible shaken baby."

Aug. 29: "Probable shaken baby."

Aug. 30: "There can be no doubt whatsoever that this child is a victim of child abuse."

Three days later, Lucas died.

Awaiting blame

With Lucas gone, Lisa and Alejandro couldn't imagine going back to live in their house in State College. isa took a leave from work, and the couple went to live with her parents in Hartstown, Crawford County, not far from Lucas' grave. On top of their grief, they knew an arrest could come any day. But the District Attorney's Office in Centre County wasn't sure which parent to blame. Investigators took more than 11 months to make up their minds. They reviewed the medical records, consulted with doctors, and spoke to people who knew the young couple. They asked Lisa and Alejandro if either thought the other was responsible for the baby's death. Neither did. Finally, prosecutors took the case before a special state advisory board of medical and legal child-abuse experts, formed by the state attorney general in 1988 to help evaluate cases.

They asked: Did the child's injuries occur while he was in his father's care? Or could they have been inflicted earlier in the day, before his mother left for school? Members of the board said that whatever had happened, it had occurred on the father's watch.  On Aug. 11, 2003, Lisa and Alejandro went swimming at her parents' house and went upstairs to change. Suddenly, the police were everywhere. Lisa's father remembers at least 10 cars: one cruiser at each end of the curved driveway, others in the street, officers with rifles out by the barn.

Prosecutors had taken an unusually hard line: Not only did Alejandro  shake Lucas, he meant to kill him. Alejandro was arrested on a charge of first-degree murder. Lisa was hysterical as her husband was led away. Be strong! she cried out in his native Spanish. But police told her to be quiet, or else they'd arrest her, too. Alejandro was held without bail. The next month, the District Attorney's Office announced it would pursue the death penalty.

An Amish case

D. Holmes Morton became a doctor to heal children. He never dreamed he'd spend so much time tangling with prosecutors. Then, two days before Christmas in 1999, Sara Lynn Glick died. The youngest of eight children of an Amish couple who lived north of Harrisburg, the 4-month-old baby suffered from bleeding in her brain and right eye. When the Plain People have a medical problem, they turn to Morton. He works in a sturdy, wood-framed health clinic that they built for him in the middle of a Lancaster County alfalfa field, where both cars and horse-drawn buggies are parked outside.

Once a pediatrician at Children's Hospital of Philadelphia, Morton was drawn to Amish country by the prospect of treating rare genetic diseases that occurred in these insular communities. The mustachioed West Virginia native would become famous for this work, last year receiving a $500,000 MacArthur Foundation award - sometimes called a "genius" grant. After consulting with doctors at Geisinger Medical Center, prosecutors suspected that Sara's mother had committed abuse, perhaps shaking the baby in frustration. The girl's seven brothers were placed in non-Amish foster homes, provoking angry disbelief in the Plain community - a group leery of outside intrusion even in normal circumstances.

Despairing, Sara's parents asked Morton to take a look. Because of the bleeding, the doctor wondered if the child had had a clotting disorder, perhaps due to a lack of vitamin K. If so, the baby's blood would contain abnormal proteins that would otherwise have been used up in the clotting process. So Morton sent a sample of the baby's blood for a test called PIVKA- II - protein induced by vitamin K absence. In a healthy person, PIVKA-II levels are at or close to zero, as measured in nanograms of the protein per milliliter of blood.

Sara's level was over 100.

Morton then enlisted the help of Lucy Rorke-Adams, a renowned neuropathologist at Children's Hospital of Philadelphia. She examined the pattern of bleeding in the baby's brain, and concluded it could not have been caused by shaking. The doctors suspected the real problem was a disorder in the baby's
liver, which would prevent her from using vitamin K, meaning she could not make use of key clotting enzymes.

Morton called on Charles Hehmeyer, a Philadelphia lawyer who represented children with metabolic disorders. He agreed to represent the Glick family without pay. In a closed-door hearing, Morton convinced prosecutors that the facts did not support a diagnosis of child abuse. Sara had died of a vitamin K deficiency and a rare liver disease. It took months, but in the end, Sara's parents were not charged, and her siblings came home.

For Lisa and Alejandro, the wait would be much longer.

Seeking a fighter

Every day her husband was in jail, Lisa prayed for help. She visited him repeatedly, sometimes with relatives in tow, despairing as she thought of him surrounded by robbers and drug dealers. She flew to Costa Rica to beg officials there for help. She started a "Free Mendez" Web site, and someone made up Free Mendez lapel pins, which family and friends wore to a preliminary hearing.

But she needed more than pins. She needed ammunition, so she began a daily routine of searching the Internet. Lisa found a California toxicologist who agreed to review the case. He concluded Lucas had died from a variety of factors, including an adverse reaction to vaccines. Prosecutors did not place much stock in his report, nor did Alejandro's attorneys. One attorney started to pursue a medical defense but withdrew after the couple disagreed with him on strategy. The court then appointed two attorneys because the couple could no longer afford to hire their own, having sold their house to help pay more than $40,000 in legal and expert fees.

Aware that prosecutors had initially suspected the baby's mother, the court-appointed attorneys urged Alejandro to save himself by pinning the blame on her. He refused. Back at home, Lisa fixated on one promising detail in the toxicologist's report: Six days after her son died, when doctors and prosecutors were already convinced it was a homicide, the hospital received the results of a lab test that had been done in Colorado. It was a PIVKA-II test. The lab said a normal value would be between zero and 3.5. Lucas scored a 22.7.

Lisa did more online research, and she learned about another case in which the test had played a key role: the death of Sara Lynn Glick. She read about Morton, the doctor who had helped the Amish family, and tried to reach him by phone. No luck. Months later, in early 2005, still doing research, she came across the Glick case again - and noticed something that chilled her.

Lucas and Sara had died at the same hospital.

Lisa decided to contact Morton again, only this time, she wrote him a letter. Within days, there was a message on her answering machine. It was Morton, speaking in the West Virginia drawl that she would come to know well. She called back. The doctor said: "I want everything overnighted."

A legal gamble

At a glance, Holmes Morton and Charles Hehmeyer don't seem to have much in common. An amateur pilot, Hehmeyer wears suits and handles multimillion-dollar medical-malpractice cases from his Rittenhouse Square office.

Morton favors the tweed-and-bow-tie look, sometimes jeans, and likes to ride the two miles from home to his country clinic on his white 10-speed bicycle. But both men are blunt-spoken, with a fondness for lost causes. And when they believe they are right, both are as unyielding as granite. The two met on a case in the late 1990s, then worked together again for the Glick family. When Morton learned about Alejandro, he turned to Hehmeyer, who agreed to take the case pro bono, as he had for the Amish family.

On the medical side, again Morton sought the expertise of Rorke-Adams, the prominent neuropathologist from Children's Hospital. Hehmeyer and a colleague, A. Roy DeCaro, made a motion in Centre County Court to dismiss the most serious charges. They didn't believe Alejandro should be charged with anything, but at the very least, they saw no evidence of first-degree murder. Judge Charles C. Brown Jr. agreed, and the death penalty was out. But  a charge of third-degree murder was still on the table. If the case went to trial, Lucas' father risked up to 20 years in prison before being eligible for parole.

It was time for a gamble.

The defense team wanted the case to go once again before the attorney general's advisory board - the one whose findings had led prosecutors to arrest Alejandro. Only this time Rorke-Adams and Morton would present the facts. But the committee hears cases at the request of prosecutors; defense  attorneys are not even allowed in the room.

DeCaro, a former federal prosecutor, said it was a bad idea, but Hehmeyer wanted to go for it. "It was either extremely enlightened or extremely dumb," Hehmeyer said. Assistant D.A. Lance Marshall considered the request. He was leery of Morton and viewed him as a media hound, having seen the glowing
articles in national magazines about his work among the Amish. But if the defense wanted to tip its hand before the trial, allowing its medical experts to lay out its theory of the case, why not?

The meeting was on.

The puzzle

A mere shortage of vitamin K is not necessarily enough to kill someone. Nor does having a vitamin K problem mean a child can't be abused - or killed. Morton knows this. Yet he insists that some instances of suspected child abuse are not what they seem, and not just because of vitamin K. The Harvard-trained doctor speaks across the country, reminding physicians that certain rare metabolic and bone disorders also can be mistakenly diagnosed. Some are prevalent among his Amish patients, others in the general population. He is spending some of his MacArthur grant on this quest, and his bluntness has earned him a reputation as a maverick. Some physicians worry that defense attorneys will exploit Morton's views to shield guilty clients, but he is winning admirers.

"He's rocked the boat, which is OK," said David Turkewitz, chairman of pediatrics at York Hospital. "He's doing it for the right reason." Turkewitz, president of the Pennsylvania chapter of the American Academy of Pediatrics, said he doubted many parents were in prison because a rare medical condition had been interpreted as child abuse. But he credits Morton for hammering the point that some of these conditions are not so rare as was once believed. Shaken-baby syndrome has been estimated to occur in up to two dozen cases per 100,000 infants. In babies ages 2 to 12 weeks, meanwhile, studies suggest that unexpected bleeding due to a vitamin K deficiency occurs 1.4 to 7.2 times per 100,000 births.

That's about 60 to 300 U.S. babies a year.

"If we send all those parents to prison, that's not very good medical practice," Morton said. "What does our legal system allow? Does it strive to put as many people as possible in jail so we don't miss any cases?" Still, the abnormal result of Lucas' PIVKA blood test wasn't enough for Morton to tell if Alejandro was innocent.

Bone and brain

Like most babies, Lucas was given a dose of vitamin K at birth. Later on, babies rely on vitamin K made by the mother's intestinal bacteria and transferred through breast-feeding. Yet Lisa told Morton that she had taken potent antibiotics for  mastitis, a breast inflammation; he figured this had reduced her - and Lucas' - ability to make vitamin K.

Morton and Rorke-Adams spent hours poring over Lucas' records, piecing together how the baby died. They also enlisted a neuroradiologist to look at the brain scans, and another radiologist and a pathologist to look at the rib fracture.

They found some unusual things. There was some evidence of new bone formation, indicating the break was weeks old. But the growth was  abnormal: The broken edges of the fractured rib had not rejoined and were rounded. Morton suspected that the break had happened during delivery, and that healing had been slow because vitamin K plays a role in bone repair. Broken bones during delivery are unusual, but Lucas was a big baby, and the birth was difficult.

In any event, the fracture did not happen the day Lucas' father was taking care of him, an opinion shared by Geisinger physicians. And if Lucas had been shaken hard enough to die, Morton's team felt, the edges of the rib fracture likely would have caused bruising in the surrounding tissue. This did not happen.
Then there was the brain. This was the specialty of Rorke-Adams - a legend in the field, having taught legions of neuropathologists in Philadelphia since the 1960s.

When Lucas was admitted to Geisinger, an initial CT scan revealed thin subdural hemorrhages - blood just beneath the brain's tough outer layer, or dura. A serious problem, and a possible indication of abuse. But two days later, Rorke-Adams saw, a second scan showed matters had gotten much worse. There was more subdural bleeding, and new areas of bleeding inside the brain, in the frontal lobes. Moreover, the bleeding in Lucas' eyes got worse after an initial
inspection, and his retinas developed folds that apparently were not present upon admission.

Rorke-Adams has testified across the country in child-abuse cases -for the prosecution. This time, she didn't see evidence of a crime. In her report, she wrote that Lucas' downward spiral after hospitalization was "not consistent" with what she normally saw in an  abused child. She also noted that the baby's liver and lungs had been unusually heavy. Later analysis found iron deposits in both organs - evidence of some unspecified disease, she and the team decided. Lucas didn't have the same illness as the Amish girl, Sara Lynn Glick, but his liver, like hers, seemed to have trouble absorbing vitamin K. And he had an inadequate supply of the vitamin to begin with.

Rorke-Adams wrote: "It is clear that he died because of the bleeding disorder and hence the manner of death is natural." Morton went further. With an impaired clotting system, he argued, Lucas' body could not handle the hours of in-and-out pressure from being hooked up to a ventilator. That was why his lungs began to bleed on day two in the hospital, Morton reasoned.

Hospital records showed that Lucas got a first dose of vitamin K at 9 a.m. that day - more than 17 hours after he was admitted, and about six hours after his lungs began to hemorrhage and his heart rate crashed. The bleeding lessened after the vitamin dose, but by then, Morton wrote, the baby had suffered irreversible brain damage. If the vitamin had been given soon after admission, he contended, Lucas would be alive today.

The impact of the vitamin dose was enough to tell Morton that a bleeding disorder was at work. But there was also the PIVKA-II test, which came back six days after Lucas died. It's an unusual test, performed by only a few labs in the country, and it takes time. But it is considered the most specific way to pinpoint a vitamin K problem. Clearly, Morton wrote, Lucas had a problem. "The opportunity was missed," Morton wrote. "The infant died of a  treatable bleeding disorder." Lisa had been saying that all along. But she worried that the legal system wouldn't agree.

The showdown

The attorney general's board met in November 2005 in Harrisburg.

Morton and Rorke-Adams presented their case.

Then came Paul J. Bellino, a Geisinger pediatrician and specialist in  diagnosing abuse, along with Samuel Land, an independent pathologist  who had ruled Lucas' death a homicide. Committee proceedings are not public. But in Land's written report, he concluded that Lucas had died of blunt-force trauma to the head. He wrote that while there was no sign of external trauma, the hemorrhaging and the rib fracture meant Lucas had been killed.

Bellino's report stated that it wasn't clear if the baby's head had struck a hard surface, as Land concluded, but that the internal injuries had been as bad as those that would occur in a high-speed, head-on car crash. Bellino cited the rib fracture, assorted bruises, and the brain and retinal hemorrhages, which he said cannot occur spontaneously in a child. "Given these findings, there can be no explanation other than this child was the victim of shaken-baby syndrome," Bellino wrote. Neither Land nor Bellino was made available to comment on the case. But Geisinger's chief medical officer, Bruce H. Hamory, said in a July 9 interview that he supported Bellino and his hospital colleagues in their findings.

"I'm certain there is a slight tendency on the part of experienced pediatricians everywhere, if there is an error to be made, to err on the side of a report" to the authorities, Hamory said. "And that's because of a concern for the safety of children." Asked if his Geisinger colleagues might have been wrong, Hamory said the cases of both Sara and Lucas were well within the bounds of what should be reported as suspected abuse, though he said the hospital  accepted the district attorney's decision to drop charges in the Amish case.

"I think in any instance, there is always a chance that somebody could be wrong, whether that's Dr. Bellino or Dr. Morton or whoever. That's why, at the end of the day, there is a legal proceeding." Prosecutors are not doctors, but in cases with little else but medical evidence, they must take their cue from them. The state must make black-or-white decisions when the medical experts may span the spectrum of gray.

"This is such a tough area," said Michael Repka, a professor of ophthalmology and pediatrics at Johns Hopkins University. "You want to do no harm to anybody. Unfortunately, the burden is to report the suspicion and let the authorities straighten it out." Bellino did not merely report a suspicion. He agreed to be an expert witness, and in his report he made some statements that are not  universally accepted - specifically, that intracranial and retinal  hemorrhages never occur spontaneously in children. "People who work in this field will always think about why else do  you get bleeding in the retina? And one of those is vitamin K" deficiency, Repka said.

Likewise, spontaneous bleeding in the brain can occur if someone has a coagulation or liver disorder, though it is not usually fatal. It may be triggered by the knocks and bumps of everyday life. During the closed-door presentation by the dueling doctors, Lisa was a wreck. She waited and waited for Hehmeyer to tell her what had happened. Finally, that night, she called him, but the news wasn't promising. Some committee members hadn't been convinced.

She felt sick.

"I thought they were going to see the truth," she said. "I thought Alejandro was going to be out of jail the next day." A decision Yet Marshall, the prosecutor, was wary of going to trial. He would have to prove Alejandro was guilty beyond a reasonable doubt. And he knew Morton and Rorke-Adams were heavyweights.

"The last thing I wanted was Holmes Morton or somebody being able to write in the New England Journal of Medicine that vitamin K deficiency is a legitimate defense for shaken baby," he said. The next day, Nov. 10, Marshall called Hehmeyer. He was offering a deal. Alejandro had been in jail for more than two years without bail. If he would plead guilty to involuntary manslaughter, he could go free. It was a big retreat from the state's initial quest for the death  penalty.

But the defense attorney suspected his client wouldn't go for it, and  upon calling him in jail, found he was right. "I'm not going to take any deals," Alejandro said. The prosecution and the defense negotiated some more, and another deal was offered: Alejandro could go free if he pleaded no contest. He would admit no wrongdoing, yet in the eyes of the law, it would be a conviction.

Sitting in his cell, Alejandro mulled it over. If he didn't take the deal, the Costa Rican immigrant would go on trial before a jury from rural Centre County - not likely to be a sympathetic audience, he thought. So far, a prosecutor and a judge couldn't even get his last name right - referring to him incorrectly by his mother's last name, Vargas, instead of Mendez or Mendez Vargas, in keeping with the Latino convention.

And he was missing his life. His grandmother had died while he was in jail.

Lisa cried when she heard about the offer. She didn't want him to take it; she thought he should stand up for himself. But her father, Ron Mullenax, said: "Lisa, you can't tell him what you want." "What do you want me to do?" Alejandro asked her, from the jail telephone. "I can't tell you," she replied. "I'm not the one who's going to spend the rest of my life in jail for something I haven't done." He decided to take the deal.

Science and the law

Lisa feels many emotions when she allows herself to think about the last five years: outrage, heartbreak, longing for the time when Alejandro would wake up at night with Lucas, gently coaxing him back to sleep in his arms. One thing she doesn't feel is vindicated. Her husband is free, and yet he is not. Alejandro got out of jail Nov. 22, 2005, but two years later, the couple, both 33, are living apart. Wary of the U.S. legal system, Alejandro moved back to Costa Rica and
went to work again at an eco-tourism company. Had he stayed in Pennsylvania, he would have been under court-ordered supervision until his probation ended - just a few weeks ago.

He was here legally before, but worries it would be tough for him to come back even for a visit, given that he has the equivalent of a conviction on his record. And he certainly does not want to live here. "They took my son, they took my wife, they took everything I had," Alejandro said of his accusers.

Lisa stayed in Pennsylvania teaching so she could save money to move to Costa Rica someday and rejoin her husband. She visits when she can afford it, and had hoped to move there this fall. But that hasn't happened. It's clear the ordeal has been a strain."I don't know if it's going to happen or not," said her father, Ron. "We love him like a son, you know." Alejandro does not regret taking the deal. "I didn't do anything," he said, sitting in his parents' living room,
a photo of Lucas on top of the TV. And if he had been found guilty, he added, "I would never see the light for a long, long time." Lisa can't fault him for wanting to be free. But part of her wishes he had taken his chances with a jury.

"What it ended up doing was ultimately making me have - it's awful to say - a little bit less respect for him for selling himself short," she said. She said she thought others had been wrongly accused of shaking babies, and she stays in regular contact with a network of people who have spouses in prison. She still wants someone to suffer consequences for what happened to her family, some sort of finding that Alejandro did no wrong. Prosecutor Marshall said that wasn't going to happen, though he said the original first-degree-murder charge - which was not his decision -was a reach. "We had no evidence of motive," Marshall said. "Why would he want to kill his baby?" Still, he said there was no chance that doctors Morton and Rorke-
Adams were right.

"If I thought they might be right, then we would've dismissed the charges," the prosecutor said. "You've heard the maxim that the simplest explanation is most often the correct one? To me, this kid had all the classic symptoms of shaken baby. That just seemed to be the easiest explanation." In the eyes of Morton and Hehmeyer, the hospital not only made a mistake and accused a parent of the unthinkable, it did so twice. "What angers me about this story is that it happened at Geisinger, where it had happened once before," Hehmeyer said. "And what angers me is that the D.A.'s Office did not let him off. They offered him this choice which was not a choice. He lost two years of his life." Bleeding disorders are uncommon, but emergency-room physicians are supposed to keep them in the back of their minds.

Hamory, Geisinger's chief medical officer, doesn't dispute that Lucas had certain symptoms that an underlying disease can cause. Despite the results of the PIVKA test, he said, the symptoms as a whole spelled abuse.

"It's the constellation of findings," Hamory said.

Most hospitals rarely use the PIVKA test. But Turkewitz, president of the state pediatrics chapter, said he thought Morton's efforts would cause it to become more standard. "We're learning more and more about the subtleties of vitamin K," he said. "The message is: Every case, you really have to approach it  with an open mind."

Medical science is forever shifting, and the answers are not always clear-cut. In forensic science, specifically, research has called into question techniques once unanimously accepted: eyewitness accounts, lie detectors, analysis of arson scenes. But the judicial system doesn't wait for the messy process of science to reach its conclusion. No one can wait that long, because it never ends. Instead, society requires that science render a yes-or-no answer on the spot. Here, the question was whether science could spare a young family's anguish.

Unfortunately for Lisa and Alejandro, the answer was no.

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Contact staff writer Tom Avril at 215-854-2430 or tavril@phillynews.com.
 

http://www.chron.com/disp/story.mpl/metropolitan/6617198.html
New results of autopsy spur plea
Woman sent to prison in baby’s death based on doctor’s report is seeking release
By LISE OLSEN
HOUSTON CHRONICLE
Sept. 14, 2009, 7:18AM

MOORE AUTOPSY PROBLEMS:
Dr. Patricia Moore, a former associate medical examiner in Harris County, was repeatedly disciplined for failing to follow procedures and for favoring the prosecution in 1998 and 1999, Harris County personnel records show. She left Harris County in 2002 for personal reasons, but her work on children's autopsies here continues to be challenged:
• New innocence claim: After a baby's 1998 death was reclassified from homicide to undermined causes last year, family and an attorney for 53-year-old former baby-sitter Cynthia Cash recently filed an appeal claiming innocence and seeking her release.

• Mother freed in 2005: Moore's original autopsy called 2-month-old Brandon Lemons' 1999 death a homicide, but it was reclassified years later as “undetermined.” The new report suggested that the baby may have died from lack of oxygen because of a medical error. Lemons' mother, Brandy Briggs, was subsequently freed.

• Mother cleared in 2004: Prosecutors dropped charges against another woman originally accused of reckless injury to her newborn after Moore's autopsy was challenged and the baby's cause of death was changed to undetermined.

• Other cases questioned: Trenda Kemmerer, a woman convicted in 1997 in another child's death remains in prison, though the child's autopsy was changed and Moore reprimanded for failing to show objectivity in the case. And Moore herself changed the results of a Montgomery County child's autopsy in 2007.
The Harris County Medical Examiner's office has quietly rewritten the results of a 1998 autopsy, prompting renewed innocence claims on behalf of a baby sitter sent to prison nearly a decade ago for allegedly shaking a 4-month-old infant hard enough to cause fatal injuries.

The original autopsy classified the baby's death as a homicide and was used by prosecutors as a key piece of evidence against Cynthia Cash, now 53, a former nurse convicted of fatal injury to a child after 4-month-old Abbey Clements died after being rushed to the hospital from Cash's home. But the modified autopsy report made public in a new appeal calls the cause of death “undetermined” and found no evidence of “trauma” in the postmortem exam. Those changes came five years after local officials announced a review of problematic autopsies conducted by a former Harris County associate medical examiner, Dr. Patricia Moore. Moore, who declined requests for comment, left Harris County in 2002 but still works for Southeast Texas Forensic Center, a Conroe-based company that provides forensic work for six counties.

It is at least the fourth time Harris County officials have reclassified a child's autopsy that Moore originally labeled as a homicide. Two women have been cleared in other cases — including Brandy Briggs, who was jailed at 19 after rushing her baby to the hospital and who spent several years in a prison isolation cell before being freed in 2005. Dr. Luis Sanchez, head of the medical examiner's office, did not respond to Chronicle questions about Cash's case or whether he has finished an audit he promised to conduct after finding problems in the Briggs case.

After learning about the new autopsy results, Cash's husband contacted Briggs' attorney, Charles Portz, to file an innocence claim on her behalf. The pending appeal asks for her release or a new hearing — though Cash now has only six months left to serve on her seven-year sentence for felony injury to a child. The case is being considered by Harris County District Court Judge Mark Ellis, who oversaw the original trial a decade ago.

Assistant District Attorney Lynn Hardaway said prosecutors remain confident about their case based on other “evidence presented at trial from doctors who thought she was a victim of shaken baby syndrome.”
Conflicting opinions
Abbey Clements received three vaccinations at a checkup a few hours before Cash, her baby sitter, claimed to have found the baby blue in her crib after a nap. Cash had kept Abbey and her brother along with her own son and five other children. Abbey died at Texas Children's Hospital. Doctors there later testified that though she did not have any external injuries, she suffered swelling of the brain and retinal hemorrhages — injuries they described as consistent with so-called shaken baby syndrome.

A neurologist expert for the defense testified at trial that he found none of the broken bones, external bruises or other injuries considered to be classic signs of shaken baby syndrome and the girl likely suffered an extremely rare fatal reaction to vaccines. Dr. Richard M. Hirshberg also reviewed the new autopsy and repeated his argument for Cash's appeal: “It's my firm belief now as it was during the Feb., 5, 1999, trial that this defendant is innocent.”

The modified autopsy issued in February 2008 says “a diagnosis of trauma cannot be substantiated,” though no other cause of death was determined. The report also says that doctors who testified in Cash's trial made some “erroneous” conclusions, wrongly describing bleeding patterns found in the examination of the child's brain as evidence of trauma.

The revised autopsy, however, also says it could not substantiate claims made by defense experts that the baby likely died from anaphylactic shock — a severe allergic reaction to vaccines. Such rare reactions are well documented in medical literature but generally occur soon after a vaccination is administered. Paul Clements, Abbey's father, said he had been briefed on the new results but said “one ME changing an autopsy still doesn't change what we think happened because of all the other evidence presented at the trial.”

Clements said he also bases his conviction that Cash was guilty on his experience of seeing his daughter “right after it happened and discussing it with the doctors in the hospital. They had never seen a baby shaken as badly as Abbey.” Cash's husband, Ken Cash, and her attorney, Portz, both claim that Cash never would have been indicted if the autopsy had been conducted correctly in the first place. “All I want for her is justice,” said Cash, who sold his house to help pay legal fees and raised their young son on his own after his wife was imprisoned. “They railroaded her in that autopsy report. She is innocent.”
The Harris County District Attorney's office, however, opposes the appeal.

“The Court of Criminal Appeals held that a claim of actual innocence based upon newly discovered evidence should not be overturned lightly and the burden on the defendant who has had error-free proceedings is exceedingly heavy,” the prosecutor's answer in the case says, later continuing: “There is considerable evidence in the record to support the ... conviction.”

http://www.madison. com/wsj/home/ local/index. php?ntid= 116360&ntpid=3
Shaken baby case back in court after 10 years
DEE J. HALL
608-252-6132
dhall@madison. com
When Audrey Edmunds went to prison 10 years ago, doctors who testified against her said they were certain that 7-month-old Natalie Beard was killed and that Edmunds was to blame. On Thursday, the same Dane County Circuit Court judge who sentenced the Waunakee day-care provider to 18 years in prison heard testimony from three physicians rebutting the conclusion - used to convict Edmunds - that Natalie died of "shaken baby syndrome." Natalie died not long after being dropped off at Edmunds' house in apparent good health on Oct. 16, 1995.

The experts said the symptoms they once thought were proof of shaken-baby syndrome - hemorrhages and specific injuries to the brain and bleeding in the eyes - have in the past decade been linked to dozens of other causes, including accidents, illness, infection, old injuries and congenital defects."There are no studies that substantiate that shaking and shaking only produces this triad of injuries," said Dr. Patrick Barnes, a pediatric neuroradiologist at Stanford University. He added later in the hearing, "I'm embarrassed to say I testified to that in the past." Something as mundane as an ear infection - which Natalie had shortly before her death - could spread to the brain with life-threatening consequences, he said.

"A simple ear infection a week before this scan could be the cause of what you see here," Wisconsin Innocence Project attorney Keith Findley asked, pointing to CT scans of Natalie's head. "That's right," Barnes replied. Edmunds is represented by the University of Wisconsin Law School's Innocence Project, which is seeking to convince Judge Daniel Moeser to grant her a new trial. The prosecution is led by Dane County Assistant District Attorneys Mary Ellen Karst and Shelly Rusch. Moeser heard the first of two days of testimony from defense experts this week, which will be followed by a two-day evidentiary hearing put on by the prosecution in late February. Edmunds, a 45-year-old mother of three, has consistently maintained her innocence. As many as two dozen of her supporters packed the sixth-floor courtroom during the seven hours of testimony. Edmunds, whose hair was once stylish and blond, is now a simple brown shoulder-length cut tinged with gray.

Barnes said that for the first 15 years of his career he mostly testified against parents and day-care providers in shaken- baby cases, even writing a chapter in an influential textbook that detailed the classic signs of shaken babies. But for the past 15 years, Barnes said, he mostly has testified for defendants because he's convinced the evidence now shows shaken-baby syndrome - in the absence of an impact to the baby, such as hitting a wall - is more myth than science. Better imaging has allowed physicians and scientists to see more of what goes on in the brain, he said. "What we found when (magnetic resonance imaging) came along was that what we had previously been diagnosing (as shaken-baby syndrome) were wrong. We were wrong on the pattern of injury," he said, "and on the timing." Also testifying was Dr. George Nichols, a forensic pathologist from Louisville who served for 20 years as a medical examiner for Kentucky and who now runs his own medical-legal consulting firm. Nichols said he "went to the other side" after he was asked by a prosecutor in Kentucky to sit in on a shaken-baby case. He said he initially thought a defense witness, forensic pathologist Dr. John Plunkett of Minnesota, was a "first-class nut."

But Nichols said after reviewing the literature cited by Plunkett - some of it written by neurologists and specialists in fields outside medicine such as biomechanics - he changed his mind. Nichols said the literature showed, among other things, that if infants could be shaken hard enough to be injured or killed, they would have severe injuries to their necks - injuries Natalie didn't have. Ten years ago, Nichols said, he would've suspected Edmunds too, because Natalie was in apparent good health when dropped off and because of the nature of her injuries. But not now. "What I was taught and what I accepted was there would be a shake and there would be an immediate loss of consciousness, " Nichols said. "That is false." Today, the defense is expected to call three more witnesses, including Dr. Robert Huntington, the Dane County pathologist who testified against Edmunds in 1996.

Murder charge dropped
Baby sitter had been suspected in death of infant.
By LARRY WELBORN
The Orange County Register
WESTMINSTER– A baby sitter clung to her attorney and sobbed today as she hustled to her car after a prosecutor dismissed a murder charge against her for the death of a 4-month-old infant. "I just want to thank my attorney and my family," Lorrie Mae Stoddard blurted out as she dashed out of the courthouse.
She clutched on to defense attorney Paul S. Meyer and said "I need to get out of here," as Meyer told her, "It's over. It's over." Stoddard, 54, was arrested, charged with murder and jailed briefly until she could post $1 million bail after the initial autopsy report indicated that Noah Samuel Gusto died Oct. 17, 2006, from brain injuries consistent with "shaken baby syndrome." But Deputy District Attorney Sonia Balleste asked that all charges be dismissed today because later examinations revealed that Noah did not die from being shaken, and that two of the three brain injuries took place before Stoddard started caring for the child. "We have insufficient evidence to proceed," Balleste told Superior Court Judge Richard Pacheco when she moved to dismiss charges. Pacheco granted the motion and exonerated bail.
Contact the writer: (714) 834-3784, or lwelborn@ocregister.com
 

http://www.berkeley.edu/news/media/releases/2001/11/27_baby.html

UC Berkeley expert on head impacts sets out to change way society deals with possible shaken baby syndrome
27 November 2001
By Robert Sanders, Media Relations
Berkeley - Mechanical engineer Werner Goldsmith of the University of California, Berkeley, is on a mission to reform the way doctors and prosecutors view the thousands of suspected cases of shaken baby syndrome each year. An often fatal set of symptoms caused by violent shaking of an infant or young child, shaken baby syndrome can be difficult to diagnose because frequently there are no external signs of abuse. Most of the damage is in the brain. Backed by decades of research on the effects of head impacts, and as author of the only book on the subject of impacts, Goldsmith nevertheless sees a rush by pediatricians, social workers and prosecutors to brand many parents and caregivers as child abusers when the injuries were more likely caused by a fall.
"Anyone who abuses a child deserves the full fury of the law," said Goldsmith, a professor of the graduate school at UC Berkeley. "But people should know the truth. The brain injuries that lead many prosecutors to file charges of child abuse can also be caused by falls or even result from chronic bleeding in the brain."
To get his message out, Goldsmith is traveling around the country educating the medical community as well as lawyers and child welfare caseworkers about the complexities of establishing a cause of child brain damage. He also counsels numerous lawyers and testifies as an expert on head impacts at trials, where he sees first-hand the rush to judgement.

"A child in someone's care dies by natural causes or accident and the district attorney files charges claiming shaken baby syndrome," he said. "Suddenly, the caregiver is faced with life in prison." His message to doctors and lawyers is not to assume that a child with bleeding in the brain and the eye is automatically the victim of child abuse. Doctors typically look for these symptoms, called subdural hematoma and retinal hemorrhage, respectively, plus brain swelling or edema. Such symptoms could result from an accident or, under certain circumstances, from a chronic condition. Doctors and medical examines need to look for other signs of abuse, in particular, neck damage, he argues.

"I am absolutely convinced that in order to do serious or fatal damage to an infant by shaking you have to have soft tissue neck damage," Goldsmith said. "Yet, in 95 percent of cases, medical examiners do not look at the neck in autopsy. They look at the stomach, the abdomen, the head, but the neck is neglected." The main problem is that very little research has been done on the effects of head impacts in infants and small children. Goldsmith, whose 1960 book, "Impact: The theory and physical behaviour of colliding solids," will be reissued next month by Dover Publishers, has written more than 50 papers on the biomechanics of head and neck injury. Yet, though he pioneered the application of biomechanics to head injury, he has conducted no studies of infants. Only one such study has been done, in 1987, and that employed a doll whose head was stuffed with wet rags.

To remedy this lack of basic data, within a few months he plans to embark on a preliminary study with UCSF neurosurgeon Geoffrey Manley, MD, PhD, using professional crash test dummies instrumented with devices to measure the types of forces an infant would sustain during shaking and other types of abuse.
"I have a very strong feeling that, given how little we really know about the mechanical issues involved in head injury, there may be people who are convicted of crimes they are not guilty of," said Manley, chief of neurotrauma at UCSF. For now, Goldsmith hopes to make an impact on the overly aggressive approach of many pediatricians to suspected shaken baby syndrome. Though most doctors look for brain edema, subdural hematoma and retinal hemorrhaging, many other types of trauma produce similar symptoms, he said. In fact, bleeding in the brain normally increases pressure, leading to swelling and retinal bleeding. So anything that causes intracranial bleeding, in particular falls, can display this trio of symptoms.

A fall backwards from three feet onto a hard surface, like concrete, can produce nearly 180 Gs of acceleration - 180 times the force of Earth's gravity - enough to cause a subdural hematoma, Goldsmith calculated. Shaking a child once a second through a range of one foot produces only 11 Gs, at the most. "There is an order of magnitude difference between shaking and falling," Goldsmith said. "From the point of view of the brain, shaking is a much, much milder form of braking than a fall." One dogma often espoused by doctors is that short distance falls do not cause serious harm. However, videotapes demonstrate that falls from as little as 32 inches can cause fatal brain damage in infants and toddlers. To complicate matters, between 5 and 10 percent of children are born with undiagnosed subdural hematomas, and 30 percent are born with retinal bleeding, Goldsmith said.

"If you get a rebleed, you may get something that looks like shaken baby syndrome," he said. Because of such uncertainties, Goldsmith urges physicians and prosecutors to look for more certain evidence of shaking, specifically damage to the neck. "You should be able to show neck damage to prove shaken baby syndrome," he said. Goldsmith also urges doctors to talk to biomechanical engineers to get an understanding of the forces involved in accidental falls versus child abuse. The ultimate goal of Goldsmith and Manley is to build a sufficiently lifelike baby dummy containing a skull, dura (a tough membrane that lines the skull and envelops the brain) and brain whose properties are very similar to the real thing. The dummy studies planned for January will provide some of the data they need, and help them apply for a grant from the National Institutes of Health for further studies.

"The infant neck, particularly before the age of one, is dramatically different from the neck of, say, you or me," Manley said. "The same is true of the head, which in infants is soft and compliant - they haven't formed sutures yet. "We don't believe that these crash test dummies are sufficient to represent the actual biology of the infant head and neck, so we are going to use the preliminary data to write a grant to develop a much more realistic model." In addition, Goldsmith and graduate student Ken Monson are working with Manley to obtain fresh cerebral arteries and veins from surgery patients for measurement of their mechanical properties. Despite the fact that arteries and veins are embedded in the brain like a net, no one has considered them in models of how the brain responds to impact. In the late 1960s, Goldsmith was chair of a committee at NIH, the Head Injury Model Construction Committee, that for four years oversaw research to construct a model of the adult head and brain. Unfortunately, funding dried up in the 1970s, and the research project was dropped. "Well over 50,000 people die from head injuries each year. Finding out the causes and procedures is very difficult.

SMH.com.au

http://www.smh.com.au/news/national/doubt-cast-on-test-for-shaken-baby-syndrome/2006/03/02/1141191796950.html

March 3, 2006

A KEY sign used to diagnose shaken baby syndrome is more common than previously thought and may occur with a wide range of illnesses and injuries, says a US expert who believes his findings may make it harder to convict parents or carers of child abuse.

Bleeding inside the eyes, or retinal hemorrhage, was present in almost 20 per cent of 60 babies who had died from a range of causes, said Patrick Lantz, of the Wake Forest University Baptist Medical Centre in North Carolina.

He found a similar proportion of hemorrhages in 17 toddlers in post-mortem eye examinations, and the bleeds were also present in older children and adults.

"We found that number and location of hemorrhages of the retina aren't always proof of child abuse," said Dr Lantz, who presented his findings at a conference of the American Academy of Forensic Sciences in Seattle last week. "We've found more hemorrhages in non-abuse cases than in abuse cases, but most doctors don't look in the eyes unless they suspect child abuse."

The babies he found with retinal bleeding had died during birth, or from sudden infant death syndrome, suffocation, head injury, heart disease or meningitis. Nine deaths were from natural causes or accidents.

But the director of forensic pediatrics at Sydney Children's Hospital, Kieran Moran, said Australian doctors would not diagnose abuse purely on the basis of bleeding in the eyes.

The director of forensic medicine at Westmead Hospital, Peter Ellis, said it was already established that other conditions could cause the hemorrhages.

Shaken baby syndrome is said to occur when a baby is shaken vigorously, causing the brain to move within the skull, damaging blood vessels, nerves and brain tissue. Doubt has been cast recently over how it is diagnosed, after court appeals in Britain.

Julie Robotham

Pamela Rowse tries to villify Dr. Uscinski by calling him a "Maverick". This is the all too common approach by those that don't have substance to back their arguments. Perhaps Pamela Rowse should assist Dr. Uscinski in surgery and could therefore witness a subdural hemorrhage rebleed; with minimal or no trauma (spontaneously). You know, the varying densities seen so often on CT scans of these "abused brains" that illustrates old an new hemorrhage. You know, the kind Steiner and ilk claim are indicative of a history of repetitive abuse. Perhaps she and Steiner can then explain why a study a few years old found 9% of babies to have subdural hemorrhage (Whitby E. et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 2004 363: 846-51). This study only to be trumped by another, just published, which found up to 26% of infants aged 1 to 5 weeks had varying sizes and locations of intracranial hemorrhages:
http://www.unc.edu/news/archives/jan07/neonates013007.html Now add in all the preemies or babies with complicated pregnancies, birth and medical histories with the fact that these hemorrhages can rebleed and you end up with a host of misdiagnosed abuse victims and torn apart families.

This is just the tip of the iceberg of the vast amounts of medical information that is ignored and not ruled out as a differential diagnosis by the child abuse experts. Let's have a glimpse at the "father of SBS"…Dr. Caffey. I'm sure Pamela Rowse knows of him. Perhaps Pamela can answer the questions in this link:

http://www.bmj.com/cgi/eletters/328/7451/1309#65204

And those questions don't even address the fact that Caffey misused Ommaya's whiplash studies on monkeys, when he extrapolated Ommaya's data to his own. The unbelievable part is how gullible the medical community was as they bit Caffey's articles…hook-line-and-sinker. I could list upwards of 20 studies that show short falls can be fatal and result in subdural hemorrhage, retinal hemorrhage and brain swelling. And, yes many of these have lucid intervals. Perhaps Pamela Rowse can tell us how a baby can be shaken with forces equivalent to a 35 mph motor vehicle accident or a multi-story fall, but have no neck trauma; let alone other overt signs of trauma. Recent biomechanical studies prove this issue which is really only common sense (Bandak 2004, Ommaya—Goldsmith 2002 etc.).

Lastly, Pamela Rowse instructs us to visit the National Center on Shaken Baby Syndrome so we can be "up to date". There are some serious problems with this one such as: 1) Dr. Chadwick—listed as a member of the Inernational Advisory Board—is about as polar as they come. Chadwick's "studies" of short falls are commonly cited by SBS proponents. Unfortunately there is no discussion of the biomechanics of the falls; the behaviors prior; during and following the falls; the part of the body impacted; differences among impacted surfaces; did something brake the fall; was it a free fall; was it  translational or rotational; where is the medical history ...?  Chadwick's study had a fatality of several stories that was found outside a multi-story window, but no one knew how the infant got there. Chadwick, himself, states that his data is absurd in that it shows short falls are more likely to be fatal than long falls. The  double standard is clear as he claims the care-takers descriptions of falls are biased and unreliable, but then accepts whole heartedly their descriptive "confessions" as scientifically reliable. Confessions likely borne out of lengthy and threatening interrogations. I have seen this type of medicine dubbed as Confession Based Medicine (CBM) (Chadwick DL, Chin S, Salerno CS, et al. Deaths from falls in children: How far is fatal? - J Trauma 1991;13:1353-55). Then in 1994, Chadwick is quoted in an article stating "given the availability of prompt and appropriate medical care, falls contribute minimally to deaths in childhood. Death from a fall is now considered very unlikely when the fall is less than 20 feet, and accumulating experience may soon extend that." (Chadwick DL. Falls and Childhood Deaths: Sorting Real Falls From Inflicted Injuries. The APSAC Advisor 1994 Vol, 7 No, 4:24-25). For more information on Chadwick and other members of the International Advisory Board (i.e. Mary Case and her debunked "position paper") listed on dontshake.com, visit http://freekenmarsh.com/ You will find Chadwick as the main child abuse "expert" discounting the facts that the child, who had a pre-existing medical condition, fell onto a brick fireplace hearth. Chadwick thought this was rubbish and proceeded to send Ken Marsh, an innocent man, to prison for 20+years for killing a boy, he loved, via SBS. Well, Ken Marsh is now free thanks to good Dr's like the ones Pamela Rowse calls Mavericks.

dontshake.com also has a judge (Honorable Rodger Dotson) on the Governing Board. Now if that doesn't seem like a conflict of interest, I'm not sure what is.

dontshake.com also provides a link to a response signed by Robert Reece (another International Advisory Member) and 105 cosignators. But it fails to also show all of the rapid response letters and a letter which counters their letter and is signed by 41 doctors and scientists. That is how well dontshake.com is objective, keeps you "up to date" and tells you the "other side of the story". I would like to thank the author of this article as it is a rarity these days to see an article with objectivity that goes against what some perceive as the popular choice (which is often found to be laced with dogma).

Comment by Camille — April 25, 2007 @ 02:32PM
 

Experts debate shaken baby findings
(Apr 27, 2007)
When seven-month-old Natalie Beard's body arrived in the autopsy room, there were no outward signs of physical abuse. No broken bones, bruises or abrasions. But behind her pretty brown eyes and beneath her fine dark-brown hair, there was chaos. Both retinas were puckered and clouded red. And there was acute bleeding outside and beneath the brain's outer membrane -- the kind of bleeding most often associated with a burst aneurysm. The membrane had filled up like a balloon, squeezing Natalie's brain until the pressure induced what adults have described as a "thunderclap'' headache.
To forensic experts, these were classic signs that Natalie was shaken to death

The common wisdom in such "shaken-baby'' cases was that the last person with the child before symptoms appeared was the guilty party. A Wisconsin jury convicted babysitter Audrey Edmunds -- herself a mother of three young girls -- of first-degree reckless homicide and sentenced her to 18 years in prison.
But in the decade since her conviction, Edmunds' lawyers say, many experts have studied the physics and biomechanics of shaken-baby syndrome and have concluded that shaking alone could not have produced Natalie's injuries without leaving other evidence of abuse. Among those now questioning the diagnosis is Dr. Robert Huntington, the forensic pathologist whose testimony helped put Edmunds away. If the trial were held today, Huntington said recently, "I'd say she died of a head injury, and I don't know when it happened . . . There's room for reasonable doubt.'' Some judges in other cases have broadly agreed.

Last year, a judge in Manatee County, Fla., barred use of the term "shaken baby syndrome'' because of its possible prejudicial influence on jurors.
In two separate cases, Circuit Judge Lewis Nicholls of Kentucky decided he could not admit expert testimony on a theory whose foundation may amount to "merely educated guesses'' about the cause of death. "The best the court can conclude is that the theory of SBS is currently being tested, yet the theory has not reached acceptance in the scientific community,'' Nicholls ruled. "To allow a physician to diagnose SBS with . . . no other evidence of manifest injuries, is to allow a physician to diagnose a legal conclusion.''

The American Academy of Pediatrics declares shaken baby syndrome to be a "clearly definable form of child abuse.'' The National Institute of Neurological Disorders and Stroke says SBS bears a "classic triad'' of signs -- brain hemorrhaging, retinal hemorrhaging and brain swelling. Because of a baby's relatively heavy head and weak neck muscles, shaking "makes the fragile brain bounce back and forth inside the skull and causes bruising, swelling, and bleeding, which can lead to permanent, severe brain damage or death,'' the institute says.

An estimated 1,500 cases of shaken baby were reported in the United States last year. But more than 30 years after the term was first used, there are still skeptics within the medical community. "It doesn't exist,'' contends Dr. John Plunkett, a pathologist who began openly questioning shaken-baby syndrome 10 years ago. "You can't cause the injuries said to be caused by shaking, by shaking.'' Pediatrician Robert Reece, who is on the international advisory board of the National Center on Shaken Baby Syndrome, says while he believes shaking alone can cause death, the term has no place in a courtroom. The term "implies a mechanism of injury that I don't think we can prove in court,'' says Reece, who uses terms such as "abusive head trauma'' or "inflicted traumatic brain injury'' in court testimony. Like many other medical examiners around the country, George Nichols was a believer in shaken-baby syndrome. But reading Plunkett's research changed his mind.

In a 2001 article in the American Journal of Forensic Medicine & Pathology, Plunkett concluded that an infant could suffer a fatal head injury from even a short fall, and that symptoms might not immediately follow the injury. He also concluded that there were other, accidental sources for one of the "classic'' signs of shaken baby syndrome. In a 2003 study at the University of Pennsylvania, researchers found that vigorous shaking of a "biofidelic'' model of a baby produced "statistically similar'' results to a fall from 30 centimetres onto concrete, or concrete with a carpet pad. Other studies have suggested that the hemorrhaging and swelling thought to prove shaking can have myriad causes, from dehydration and infection to oxygen deficiency.

On Oct. 16, 1995, Edmunds was caring for her two daughters and another child when Cindy Beard dropped off her daughter, Natalie. Edmunds had been caring for Natalie for about five weeks. Natalie had had an ear infection and had vomited in recent days, but her parents say she was feeling better. Edmunds says Natalie was unusually fussy that morning and refused to take a bottle. Edmunds, who was five months' pregnant, says she put Natalie down with a propped bottle and went to tend to the other children. When she went back to retrieve Natalie, the girl was crying and limp, her face slick with regurgitated formula. At the 1996 trial, Huntington testified it was "highly probable'' that Natalie was injured within two hours of being treated. That would mean the fatal injury occurred while Natalie was in Edmunds' care.

What changed his mind was a later case involving a child with injuries similar to Natalie's. That child had a "lucid interval'' of more than 15 hours before the onset of symptoms, leading Huntington to acknowledge that Natalie could have been injured long before she was dropped off at Edmunds'. The Wisconsin Innocence Project's Keith Findley, Edmunds' lead attorney, cited other studies in which there were lucid intervals of 24 hours between injury and death. Nichols, the former Kentucky medical examiner, testified recently on Edmunds' new trial request. It was his conclusion that Natalie had some kind of choking event, and that a lack of oxygen to the brain resulted in fatal brain injury. The appeal judge ruled that the new evidence actually supported the prosecution's case and denied Edmund's request.
 

http://www.bmj.com/cgi/eletters/328/7451/1316?q=y


Shaken Baby Syndrome - We NEED a DIAGNOSTIC PROTOCOL - WE NEED to get
it RIGHT! 5 August 2004

Donna L Meads-Barlow,
Mother and Company Director
Sydney, NSW 2113
Send response to journal:
Re: Shaken Baby Syndrome - We NEED a DIAGNOSTIC PROTOCOL - WE NEED to
get it RIGHT!

As a mother who went through the agony of temporarily loosing custody of my infant son, and nearly loosing custody of him forever, because it was wrongly claimed, he had been shaken, I understand how other similarly charged parents' feel and suffer. I am therefore morally obliged to do whatever is possible to prevent this happening to other parents and carers unnecessarily.

In Australia, health workers, and others, are legally compelled to notify authorities, such as The Department of Youth and Community Services and the police, when there is evidence or suspicion of abuse – and this includes what has become known as `shaking'.

Unfortunately, few individuals understand the complexity of the issues involved. Often, from the beginning, a decision is made that the `cause' of the problem is `shaking', and there is no need to proceed through what should be the routine of what is known as a `differential diagnosis'. This involves a consideration of all
possible causes, the collection of evidence and the performance of an array of special medical investigations.

Unfortunately this procedure is rarely followed. Worse still, as recent cases demonstrate, prosecuting witnesses sometimes deliberately withhold information, invent information, become extremely careless, break many of the rules relating to the collection and interpretation of evidence – and escape relatively unharmed when one compares their fate with the sufferings of those falsely, or wrongly, accused and charged.

In medical journals throughout the world the vastness of information that is pertinent to the pathologies found in so-called `shaken babies' is impressive. This should be collected, carefully considered, and made `compulsory reading' for all those involved in the investigation of cases. I have no doubt that, if this is done,
justice will be served, and we will emerge from one of the darkest pages in the history of medicine into a better understanding of the nature of infant illnesses.

To begin, I suggest that the following investigations be considered:

Case history - including family history, pregnancy, labour, birth, and continue to the time of collapse, recovery or death.

The number of medical consultations, including those with nurses and specialists.

Reasons for these consultations.

Feeding, and gastrointestinal problems, including diarrhea

Antibiotics administered and reasons for why

All medications administered, Reasons why. Were there side effects or potential side effects? Were parents properly counseled about this?
All medications administered and reasons why. Was counseling about side effects provided to the parents?

Vaccine history including batch numbers in case some were known to be `hot' batches. That is known to have produced excessive side effects.

Eardrums. Inspect on admission, and daily. If an infant dies both middle ears should be inspected during the autopsy and swabs taken to enable tests for bacteria and viruses. At the same time, if excessive fluid is present some should be collected and tested for endotoxin levels

Perform and record electroencephalogram, electrocardiogram, CT scan, MRI, brain ultrasound, Ophthalmic investigations, including retina, Retcam (retinal photographs), head circumference (repeat daily", pupil size, record and repeat as necessary.

Neurological observations.

Skeletal survey – if possible.

Endotoxin levels in blood, and, if prudent, in the CSF.

Look for 'toxic' strains of gut bacteria. These produce excessive amounts of endotoxin. If an autopsy is performed light and electron microscope studied may reveal the presence of toxic strains and the damage done to the gut.

Look for abnormal gut viruses

Genetic testing of patient, parents, and siblings.

When `fractures' exist, light and electron microscope studies of bones, including epiphyseal and fracture areas. This is recommended because, sometimes, fractures can be due to bone disorders related to the effects of endotoxin and an increased utilization of Vitamin C.

Extensive coagulation/bleeding profiles, including (despite some difficulties) platelet functions, capillary fragility, and bleeding time.

Blood levels of Vitamin C and histamine

Von Willebrand factor

Factor x111

Vitamin K levels.

D-dimer levels – to the end-point.

Liver and kidney functions

Bruise should be carefully examined, during life and autopsies – despite known difficulties. This includes (during autopsies, cutting into the areas, and light and electron microscope examinations.

Glutaric acid levels.

Some of these tests are expensive and laboratories will need to establish the necessary facilities. The alternative is to jail some innocent individuals for long periods and destroy their families. If the doctors involved in the investigation of cases do not agree to do these tests, and satisfactory reasons for such actions are not produced, charges of negligence should be set in motion.

Parents claiming to be innocent should be entitled to know why these tests are not being done. During the 2001 International Conference on the Shaken Baby Syndrome, in Sydney, I asked Dr Ryan, who often gave evidence as an expert for the prosecution, why extensive tests were not done and he answered, in a packed lecture theatre, `Its too expensive'. My response was, `Then why are the parents and family not offered the opportunity to have these tests performed at their own costs?' There was no answer.

Clearly, if parents and carers are innocent, and doctors and authorities claim that the cause of the pathologies is `shaking', the only option available is to demand that tests be done. Furthermore, if tests are not done quickly, at the time of admission, as time goes by the presence of some causes may be absent or masked.

Despite the fact that retinal haemorrhages alone are not necessarily diagnostic of `shaking', experts have been allowed to offer the opposite opinion without demonstrating that all other possible causes have been eliminated. This is medical and legal lunacy. The claim that certain `types' of retinal haemorrhages are diagnostic is also a falsehood.

A PERSONAL NIGHTMARE

I was 5 months pregnant with my son, Codey, when our daughter developed diabetes.

At the 6 months stage I was found to have borderline gestational diabetes, and iron deficiency.

Codey's birth-date, after an induction, was on February 28, 2000. He was artificially fed, and then quickly developed gut problems. His paediatrician found it necessary to change the formula 3 times in the first 2 months.

Progress was not normal. May 5, 2000, developed cold/flu

May 8, 2000, vaccinations – DPT, Polio, and HIB

Mid May 2000, Nasal congestion, trouble breathing – chest checked.

Early June 2000, Bronchiolitis and productive cough.

Mid June 2000, Bronchiolitis, fever, productive cough.

Antibiotics administered

June 21, 2000, Back to GP, a level of distress, concern about cry –query pneumonia, inflamed eardrums.

June 21, 2000, attends paediatrician. No improvement on antibiotics. Chest X-ray, otitis media. For check with GP in 6 days.

Deteriorates, extremely high temperature, crying, and severe coughing.

June 26,2000, Grand mal seizure. Admitted to hospital.

1st admission High temperature on arrival of ambulance.

Blood taken for tests on day of admission. These showed a leucocytosis, reactive thrombocytosis, high platelet count, high white cell count, and high glucose level. Intravenous drip. Antibiotics administered intravenously. Panadol and painstop administered frequently, alternatively.

Discharged June 30, 2000 – on augmentum for 8 days. Panadol and painstop continued.

Between June 30 and July 11, continues to have fevers, crying, back arching, little improvement. Antibiotics, panadol and painstop continued.

June 11, 2000, taken to GP. Given the `4 month' DPT/polio and HIB, DPT/polio and HIB boosters

High temperature followed, arched back, crying. Panadol and painstop prescribed by paediatrician.

July 12, second admission. Another seizure. Hospital records show `Post vaccination febrile convulsion'.

Managed with pulmonary resuscitation, and high flow oxygen. Likely cause for seizure was said to be fever - post vaccination. At this point Codey was not weighed. An overdose of antibiotics was administered intravenously. Next morning the consulting physician stopped this medication. 

24 hours after admission Codey was diagnosed as a `shaken baby'.

Immediately, all tests were stopped. The authorities were called in, and we began a roller coaster ride that threatened to destroy our family.

Codey was removed to unknown foster care. – A day we will never forget!

August 4, similar presentation to that of July 12. Foster carer could not be located. Codey was hungry, and no formulae was available. Codey had a rash on his back, was unsettled, crying, and had loose, green and offensive stools.. A list of what was not done is as follows:

No blood tests

No liver tests

No ECG

No EEG

No MRI No CT scan

No brain ultrasound

No eye examination

No measurement of head circumference

No neurological monitoring

No pupil scale record

No skeletal survey

No intensive coagulation/bleeding studies.

13 months of court battles followed. Legal fees were $150,000. The effort involved was huge. It was as if we spent 25 hours a day and 8 days every week researching the literature so that we would at least understand what was going on in Codey's little body. What we found was certainly not pretty. It was, in reality, a nightmare of unbelievable proportions.

The cause of what happpened? It was not something that we had done. It was not something that that was unknown. It was `the system' that indoctrinated doctors, and others, in a way that closed all the doors to understanding and fed poison into the minds of those who were supposed, because of their special skills and training, to know better.

We know that Codey was never shaken.

We know that statements like, `Codey was a previously well baby', were ludicrous to the extreme. We know that only standard coagulation/bleeding profiles were done at admission, and never repeated. We have reasons to believe that medical negligence contributed to the pathologies.

We know that the diagnosing paediatrician (who provided the evidence that was relied on for the diagnosis of `shaking') later admitted that he should have carried out extensive coagulation tests, inclusive of testing for Factor X111 abnormalities.

The Department of Youth and Community blamed the hospital for errors. The hospital blamed that department.

Codey is now home and reunited with our family unit. He is safe, well, and has never been vaccinated again or prescribed antibiotics.

Our family believes in, and praises, the immunization schedule. However, we also believe that, for some children, immunizations can cause a number of side effects, (as stated in the TGA records), specifically when combined with other toxins and illnesses.

We also know that, today, as I write, sadly, there are innocent Australian families currently caught in the system and while in the system (ie, the Children's Court) no-one can, and will, assist or intervene – even though those charged are innocent. The cry of HELP falls on deaf ears. There is no support, nowhere to turn! Hundreds of thousands of tax payer's dollars, could be saved if SBS diagnosing physicians took greater care. I know. I have been there!

A few weeks ago in England, news-papers headlined, `Scotland Yard changes tact over suspicious baby deaths' (Sandra Laville, Wednesday July 14, 2004, The Guardian). I was delighted to read this, and learn that UK authorities are progressing towards the reversal of unlawful convictions for what was stated to be the ultimate crime – shaking a baby to death.

Wrongly accused mother's like Angela Canning's, Sally Clark and Trupti Patel, have, at last, through the efforts of a handful of dedicated individuals, been freed, physically and mentally, from terrible accusations.  The English authorities have stated, in response to criticism, that they now intend to `get it absolutely right, and that these investigations are something which need expertise and particular skills'. I quite agree!

I believe that it is possible to shake a baby to death. I also know that, often, there are causes for the pathologies that have nothing to do with inflicted trauma.

BOTTOM LINE

We NEED a DIAGNOSTIC PROTOCOL - WE NEED to get it RIGHT!

If authorities do not agree with what I have stated, particularly because there is a huge amount of supporting literature, they could be, and should be, regarded as being negligent. If they refuse to perform adequate tests, not pay adequate attention to case histories, and simply farm out the problem to individuals or organizations that are not properly qualified to handle the issues, they should be compelled to provide reasons for such actions – or face legal actions. They should not be allowed to wash their hands and walk away.

References:

1. Greenwald MJ, Weiss A, Oesterle CS, Friendly DS Traumatic retinoschisis in battered babies. Ophthalmology 93(5):618-625, May 1986

2. Vanderlinden RG, Chisholm LD Vitreous hemorrhages and sudden increased intracranial pressure. J Neurosurg. 1974 Aug;41(2):167-76

3. Tomasi LG, Rosman NP Purtscher retinopathy in the battered child syndrome Am J Dis Child. 1975 Nov;129(11):1335-7

4. Pollack JS, Tychsen L Prevalence of retinal hemorrhages in infants after extracorporeal membrane oxygenation. Am J Ophthalmol. 1996 Mar;121(3):297-303

5. Goetting MG, Sowa B Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 85(4):585 -588, April 1990

6. Weedn VW, Mansour AM, Nichols MM Retinal hemorrhage in an infant after cardiopulmonary resuscitation. Am J Forensic Med Pathol. 1990 Mar;11(1):79-82

7. Adetona N, Kramarenko W, McGavin CR. Retinal changes in scurvy.Eye. 1994;8 ( Pt 6):709-10

8. Bloxham CA, Clough C, Beevers DG. Retinal infarcts and haemorrhages due to scurvy. Postgrad Med J. 1990 Aug;66(778):687

9. Biousse V, Mendicino ME, Simon DJ, Newman NJ The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998 Apr;125(4):527- 44.

10. Biousse V, Newman NJ. Intracranial vascular abnormalities. Ophthalmol Clin North Am. 2001 Mar;14(1):243-64

11. Beratis NG, Varvarigou A, Katsibris J, Gartaganis SP Vascular retinal abnormalities in neonates of mothers who smoked during pregnancy. J Pediatr. 2000 Jun;136(6):760-6

12. Budenz DL, Farber MG, Mirchandani HG, Park H, Rorke LB Ocular and optic nerve hemorrhages in abused infants with intracranial injuries. Ophthalmology. 1994 Mar;101(3):559-65

13. Weissgold DJ, Budenz DL, Hood I, Rorke LB Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake. Survey of Ophthalmology 39(6):509-512, May-June 1995

14. Gutman FA Evaluation of a patient with central retinal vein occlusion Ophthalmology. 1983 May;90(5):481-3

15. Iijima H Gohdo T Imai M Tsukahara S. Thrombin-antithrombin III complex in acute retinal vein occlusion. Am J Ophthalmol. 1998 Nov;126 (5):677-82

16. Granel B Disdier P Devin F Swiader L Riss JM Coupier L Harle JR Jouglard J Weiller PJ. Occlusion of the central retinal vein after vaccination against viral hepatitis B with recombinant vaccines. 4 cases Presse Med. 1997 Feb 1;26(2):62-5

17. Fledelius HC. Unilateral papilloedema after hepatitis B vaccination in a migraine patient. A case report including forensic aspects. Acta Ophthalmol Scand. 1999 Dec;77(6):722-4

18. Miller E Waight P Farrington CP Andrews N Stowe J Taylor B. Idiopathic thrombocytopenic purpura and MMR vaccine. Arch Dis Child. 2001 Mar;84(3):227-9

19. Kumagai K Nishiwaki K Sato K Kitamura H Yano K Komatsu T ShimadaY. Perioperative management of a patient with purpura fulminans syndrome due to protein C deficiency. Can J Anaesth. 2001 Dec;48(11):1070-4

20. Russell-Eggitt IM Thompson DA Khair K Liesner R Hann IM Hermansky -Pudlak syndrome presenting with subdural haematoma and retinal haemorrhages in infancy. J R Soc Med. 2000 Nov;93(11):591-2

21. Marshman WE Adams GG Ohri R. Bilateral vitreous hemorrhages in an infant with low fibrinogen levels. J AAPOS. 1999 Aug;3(4):255-6

22. Hattenbach LO Beeg T Kreuz W Zubcov A Ophthalmic manifestation of congenital protein C deficiency. J AAPOS. 1999 Jun;3(3):188-90

23. Kaur B, Taylor D Fundus hemorrhages in infancy. Survey of Ophthalmology 37(1):1-17, July-August 1992

24. Mei-Zahav M, Uziel Y, Raz J, Ginot N, Wolach B, Fainmesser P Convulsions and retinal haemorrhage: should we look further? Arch Dis Child. 2002 May;86(5):334-5

25. J. F. Geddes, R. C. Tasker, A. K. Hackshaw, C. D. Nickols, G. G. W. Adams, H. L. Whitwell and I. Scheimberg (2003) Neuropathology and Applied Neurobiology 29, 14-22 Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'?

26. J. F. Geddes, J Plunkett. The evidence base for shaken baby syndrome. We need to question the diagnostic criteria BMJ 2004;328:719- 720 (27 March), doi:10.1136/bmj.328.7442.719

27. NH Thomas, JE Collins, SA Robb and RO Robinson Mycoplasma pneumoniae infection and neurological disease Archives of Disease in Childhood, Vol 69, 573-576

28. Caffey J. On The Theory and Practice of Shaking Infants. Its Potential Residual Effects of Permanent Brain Damage and Mental Retardation. Am J Dis Child 1972; 124:161-69.

29. Ganesh A, Jenny C, Geyer J, Shouldice M, Levin AV. Retinal hemorrhages in type I osteogenesis imperfecta after minor trauma. Ophthalmology. 2004 Jul;111(7):1428-31.

30. Berrocal AM Scott IU Flynn HW Jr Walker-Warburg syndrome: congenital neurodysplasia and bilateral retinal folds. Ophthalmic Surg Lasers Imaging. 2004 May-Jun;35(3):256-8.

31. Divizia MT, Priolo M, Priolo E, Ottonello G, Baban A, Rossi A, Silengo MC, Lerone M. How wide is the ocular spectrum of Delleman syndrome? Clin Dysmorphol. 2004 Jan;13(1):33-4.

32. Mosin IM Vasil'eva OIu Skripets PP Iaroslavtseva EV Avuchenkova TN Iziumova EB, Shakarova EA Shuleshko OV Neuro-ophthalmological and radiological signs of Aicardi syndrome Vestn Oftalmol. 2004 Mar- Apr;120(2):15-20.

33. Lee WB O'Halloran HS Grossfeld PD Scher C, Jockin YM Jones C. Ocular findings in Jacobsen syndrome. J AAPOS. 2004 Apr;8(2):141-5

34. Gardner HB. Hypoxia leading to intracranial problems may be a retinal haemorrhage. Neuropathol Appl Neurobiol. 2004 Apr;30(2):192

35. Ahmad OF Hirose T. Severe retinopathy in a child with hypoplastic left heart syndrome. Am J Ophthalmol. 2004 Mar;137(3):566-7

36. Pierre-Kahn V Roche O Dureau P Uteza Y Renier D Pierre-Kahn A Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003 Sep;110(9):1718-23

37. Gable EM Brandonisio TM Ocular manifestations of Donohue's syndrome. Optom Vis Sci. 2003 May;80(5):339-43 38. Donohoe M Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966-1998 - Am J Forensic Med Pathol. 2003 Sep;24(3):239-42

39. Clemetson CA. Child abuse or Barlow's disease? Pediatr Int. 2003 Dec;45(6):758

40. Geier MR, Geier DA Neurodevelopmental disorders after thimerosal- containing vaccines: a brief communication. Exp Biol Med (Maywood).
2003 Jun;228(6):660-4

41. Vahedi K, Massin P, Guichard JP, Miocque S, Polivka M, Goutieres F, Dress D, Chapon F, Ruchoux MM, Riant F, Joutel A, Gaudric A, Bousser MG, Tournier-Lasserve E Hereditary infantile hemiparesis retinal arteriolar tortuosity, and leukoencephalopathy Neurology. 2003 Jan 14;60(1):57-63

42. Gaetz M. The neurophysiology of brain injury Clinical Neurophysiology, January 2004, vol. 115, iss. 1, pp. 4-18(15)

Competing interests: None declared

 

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=490025&in_page_id=1770

Is this doctor responsible for parents being falsely branded as child abusers?
by SUE REID - More by this author »

Last updated at 00:55am on 27th October 2007
Lawrence Alexander suffered a difficult childhood. Neighbours pointed at him in the street. He was inexplicably bullied at school. When he invited his few friends home for tea, they nearly always refused. His family moved from Cornwall to Sussex and then to Shropshire. In every fresh place, there were whispers.  His parents lost their jobs and the only member of his extended family who sent birthday presents was his father's sister, Aunt Nina.

At 13, Lawrence began to ask why his upbringing seemed different to everyone else's It is only today, nearly eight years on, that he knows the full truth: his parents had been wrongly accused of one of the worst crimes imaginable — deliberately harming him as a baby. As a result of the allegation made by children's doctor David Southall, the family became social pariahs. A bundle of papers in Lawrence's NHS records followed him to every new GP and new school, repeating the claim that his parents had hurt him.

The accusation has scarred his life and theirs.

Lawrence has never before told his deeply shocking story.

The 21-year-old is central to a Government inquiry into Dr Southall, which could establish once and for all his links to one of the worst scandals in British medicine for years. The doctor has been praised as a pioneer by colleagues, while vilified as arrogant and dangerous by patients. He has also been in trouble over remarks he made concerning the case of Sally Clark, the mother who was given two life sentences for the murder of her two children before being released after medical evidence emerged to prove she was innocent. Dr Southall, who had never met Sally, accused her husband of the murders, a totally unfounded allegation which led to the paediatrician being declared guilty of professional misconduct and barred from child protection work for three years.

The present inquiry, overseen by Attorney General Baroness Scotland, wants to find the answer to a crucial question: were Lawrence's parents — and many others — falsely smeared as child abusers so that Dr Southall could put their children into care and use them as guinea pigs in deeply contentious medical experiments, which many would argue were also deeply immoral? In the 1980s and 1990s, under the aegis of Dr Southall, thousands of sick children were given breathing tests — called 'sleep studies'. The experiments, authorised by hospital ethics committees, were carried out despite the doubts of worried parents. Incredibly, it is now alleged that some of the tiny babies were forced to breathe poisonous gases and deprived of oxygen. The results of these tests were stored by the paediatrician in 4,500 secret files. But the true nature of the experiments — to discover the cause of cot-death — is only coming to light now the children involved are grown-up.

The Attorney General's officials have asked to see the Southall files. They want to know what they contain and if they were produced at court hearings at which parents were falsely accused of child abuse. The suspicion is that justice may have been perverted by the paediatrician because vital evidence in the files — which established that the children he diagnosed as victims of parental abuse had never been harmed but were, in fact, genuinely sick — was deliberately hidden from criminal court judges. Meanwhile, the Mail can reveal that police forces in the Midlands, Wales and London are also investigating evidence to discover if Dr Southall's experiments, dating back three decades, harmed children.

Officers in Doncaster plan, if necessary, to examine the death certificates of babies who died while in his care. The General Medical Council (GMC) is also due to resume a hearing in a week's time into Dr Southall's fitness to practice, following a series of complaints by parents of children treated by him. Dr Southall, who denies any wrongdoing, has worked at the Royal Brompton in London, University Hospital of North Staffordshire in Stoke and hospitals in Wales, the Home Counties, Doncaster, Rotherham and Barnsley. One Welsh mother, who says her son was brain damaged by Southall's research, told the hearing earlier this year: "He treated my son like a laboratory rat." As for Lawrence Alexander's parents, one of the cases being examined at the GMC hearing, they always objected to their son being involved in Dr Southall's sleep study tests. But when they refused to co-operate, Janet and Robin Alexander were accused by Dr Southall of pretending their son was ill.

Although they say there was not a shred of evidence, the little boy was made a ward of court. It meant the tests could be done without his parents' agreement, and Lawrence himself narrowly escaped being put into care or adopted. This week, Lawrence said: "I believe that my loving mother and father were labelled as child abusers by Dr Southall because they tried to stop his experiments on me. "The appalling slur blackened their names. Yet the idea of my caring parents being child abusers is laughable. They never even smacked me." Today, Lawrence lives in Ludlow, Shropshire, with his 61-year old father, a former television reporter, and mother, a 49-year-old former nurse. Tragically, he is 80 per cent physically disabled. At the age of 14, he was struck by a muscle weakness which led to his body sustaining severe cell damage only ever seen before in cancer patients completing chemotherapy. He says: "I want to know how my health has been ruined. Is it because of the tests I underwent as a small child? "We now know that the so-called 'sleep studies' carried out by Dr Southall involved giving babies noxious gases, including carbon monoxide.

"Babies were deprived of oxygen. I want to know what implications this has had for my health." Dr Southall, who has always refused to comment on his work or research to the Daily Mail, has repeatedly been at the centre of controversies. His involvement with Sally Clark, who died earlier this year, is all the more bizarre because he had nothing to do with the inquiry into her children's deaths. After watching a television documentary on the couple, he simply phoned the police with his theory that her husband, Steve, was the killer. Meanwhile, concern has grown about his experiments on children.  Bill Bache, the solicitor for Angela Cannings — another mother accused of infanticide, jailed and then freed on appeal — has written to the Attorney General and the Department of Health estimating that "10,000 people have been affected by the actions of Dr Southall".

He fears that behind this number lurks a potential scandal of gigantic proportions. Mr Bache is so concerned that he says the Government should look into Dr Southall's work over a 25-year period. In a letter to the Department of Health he says Dr Southall "may have caused death or very serious bodily harm, including irreparable brain damage" to children. Mr Bache believes parents were told by the doctor that he would report them to the police and social services if they didn't co-operate with his experiments. "There is evidence… that he carried out these threats and, as a result, there have been convictions [of parents] for murder and grievous bodily harm, while children have been placed in care or adopted," he says. His concerns are supported by Lib Dem MP John Hemming, who told the Commons: "Many of the parents of the (Southall) babies who were choked, given carbon monoxide and had their breathing damaged in other ways did not give consent to the experiments."

The Alexanders were no exception. Lawrence first became ill seven weeks after being born. He would often stop breathing or turn blue: signs of sudden infant death syndrome or cot death. At first, doctors thought he was epileptic and he underwent numerous brain scans. At five months, he was referred to the Great Ormond Street Hospital for Sick Children in London. His mother says: "We were told Dr Southall, who was a cot-death expert who worked not far away at the Royal Brompton hospital in Chelsea, could help Lawrence. "However, we were suspicious when we met him there in January of 1987. He looked like a research student. "Now we know that he was not qualified as a child doctor at the time, but was a senior lecturer in paediatrics." Lawrence was transferred for one month to the Brompton hospital, where his parents always slept beside him overnight. Dr Southall insisted on exhaustive tests. Janet says: "We quickly became suspicious that Dr Southall was using our son as a guinea-pig and we told him that we were going to take our child home."

It was then that the paediatrician invited Janet and Robin to a meeting to discuss Lawrence's progress. Instead, to their horror, they realised that they had stepped into an ambush. "We found social workers from Kensington and Chelsea Council and their solicitors, sent by Dr Southall," recalls Janet. "One social worker told me: 'You need help as parents. There is nothing wrong with your child.' "It suddenly clicked that we were in a dangerous situation. They were saying we made up Lawrence's illness. "'There was no logic. They asked me to sign papers giving them the legal right to care for Lawrence. "I had no choice but to do what they said. I was afraid I would lose him for ever." Janet was told the hospital — and, of course, Dr Southall — was now in charge of Lawrence's care. Crucially, they would no longer be allowed to see him at night. It meant that he was left unattended by his parents from evening to the following morning and Janet was forced to stop breastfeeding.

Although they did not know it at the time, Dr Southall had accused them of suffering from Munchausen's - Syndrome by Proxy (MSBP) — a disorder where parents are said to fabricate an illness about their children to draw attention to themselves. The theory was devised by another paediatrician, Professor Sir Roy Meadow.. He was found guilty of professional misconduct two years ago for giving "misleading and incorrect" testimony as an expert witness in the case of Sally Clark, who was also wrongly accused of suffering from MSBP.

He has since retired.

But what of Lawrence Alexander?

During the past year, he has been searching for his own childhood medical records, which prove he was enrolled in Dr Southall's sleep studies at the Brompton Hospital. So what exactly happened during those nights 20 years ago when his parents were barred from seeing him? Was Dr Southall carrying out experiments on him which amounted to child abuse — the precise crime the paediatrician accused his parents of having committed on their only son?
Significantly, Lawrence's records of the time show clearly that he had a life-threatening illness. He was suffering from various ailments, most significantly gastro oesophageal reflux (a condition that causes breathing problems and which is linked, inextricably, to cot death.) Yet nothing was done to cure him. Indeed, Dr Southall told social workers: "His parents have pursued the belief that he is seriously ill… they must now accept that their child is healthy."

The Alexanders fought back against Dr Southall. They sought legal advice and took their case to the High Court. In late February 1987, a judge in London told them they could return home to Cornwall with Lawrence, but that he should remain the subject of an interim care order. It was only eight months later that they regained the right to look after their son without the interference of the authorities. They never again saw Dr Southall, who is still working as a paediatrician in Staffordshire, although he is barred from child protection work. Yet the stigma of being child abusers remained — even after they changed their surname by deed poll to try to escape the past. Both sides of the couple's families — apart from the loyal Aunt Nina — refused to speak to them after they were branded abusers. "Wherever we moved, people seemed to know," recalls Janet. "Robin was pointed at and called a paedophile. We could not even find jobs in a supermarket. "Our car was broken into, the house burgled, we received offensive literature and abusive phone calls. The classic paedophile treatment. "At one school, when Lawrence was 12, the bursar said we could not enter the premises. "The GP had told the teachers we were child abusers.

"Lawrence began to be bullied when word got out, and had to leave despite his brilliant academic progress. It broke his heart." From then on, his parents educated him at home. Then, six years ago, he became desperately ill — losing two stone in as many months. He lay in a darkened room listening to Radio 4. Today, he cannot eat normal food and rests most of the day. No-one really knows what is wrong with him. This week, Lawrence said: "It is impossible to imagine how my life would have been without Dr Southall's intervention. "All he has done for my family is bring us grief, poverty, danger, isolation and now, I fear, ill-health. "I am not a bitter person, but I hope and pray that there is a proper inquiry into this doctor, his accusations against innocent parents and his invasive experiments. "I say that for my own sake and thousands of other children just like me. "The opening of his secret files will be just the start.'
 

Imagine you are an Editor of a medical journal, rightly or wrongly, considered to a world leading journal. Assume you knew parents were being sent to jail on the basis of an unproven medical theory called "Shaken Baby Syndrome" used to blame the parents. Imagine you are sent information suggesting children may instead be suffering reactions to medical treatment.

Should you allow full debate on such a topic in your journal so that the issues can be aired and a better understanding be gained more widely in the medical world?

Here is one or a number of remarkable contributions from Dr Michael D Innis on this subject which the British Medical Journal and Editor Tony Delamothe have steadfastly ignored and refuse to publish:-"Editor,

With regard to the merger of Post Graduate Medical Education under one authority Sir Graeme said, "The merger will ……… deliver real benefits for patients and the public, as well as for the medical profession."

Benefits and protection for patients and public, especially in the area of false accusations of child abuse, is laudable and long overdue. He can begin by asking doctors not to ask a parent to explain the bruise on the back or a spiral fracture of the femur of a 3 month old child.

How can one expect a 20 year old distressed and bewildered mother to say :

“You know doctor, there are several Vitamin K dependent proteins in the body which require to be carboxylated by the enzyme gamma-glutamyl carboxylase before they become functional. Without Vitamin K these proteins, some of which control haemostasis and prevent bruising, and others which control mineralization of bone and prevent fractures, cease to be carboxylated and and hence bruises and fractures are likely to occur[1].

And what is more doctor, last week you gave my baby an antibiotic for his cough. That could have destroyed the Vitamin K 2 forming bacteria in his gut thereby adding to his problem of a lack of Vitamin K to protect him from bruises and fractures. That is my explanation doctor. I hope you can understand it and don’t report me to the police or social services, they may take my baby away kill all my dreams.”

Michael Innis

Reference:

1. Innis MD. Vitamin K Deficiency
Disease Journal of Orthomolecular Medicine March 2008. "
 

http://www.wigantoday.net/wigannews/Appeal-decision-victory-for-mum.3919847.jp

Appeal decision victory for mum


WRONGLY CONVICTED: Lorraine Allen

A crusading Wigan solicitor has won a high profile battle to help a mother wrongly convicted of shaking her baby to death.

Mike Pemberton, manager of the crime/special cases department of Wigan solicitors Stephensons, has secured the right to appeal over the government's denial of compensation for time wrongly spent in prison for the woman later cleared of any wrong-doing. His victory will be featured on the BBC's Inside Out programme next week. The decision is being seen as a test case that will be used for similar victims of miscarriages of justice. Lorraine Allen - formerly Harris – was convicted of the manslaughter of her four-month-old son, Patrick, in 2000, after prosecution experts claimed the only explanation for his collapse was violent shaking or shaking plus impact.

Hers was one of the high-profile "shaken-baby" cases. She was sentenced to three years imprisonment and a child born while she was serving that sentence was taken away from her and placed for adoption. However, Ms Allen's conviction was quashed in 2005, after fresh medical evidence proved it to be unsafe. As a victim of a miscarriage of justice, she applied for compensation but this was refused by the Home Secretary because her claim, it was argued, did not meet  the statutory criteria. But she has now learned she will be able to appeal against a previous decision that barred her from claiming compensation. Mr Pemberton, a specialist in human rights and judicial review cases, who is based on Library Street, Wigan, said: "This has been a long road for Lorraine. Nothing can rectify the loss of her son Patrick, the subsequent miscarriage of justice and adoption of her second child as she began her sentence. However, this appeal allows her continued hope that some kind of just closure will be obtained and allows her to deal with the traumatic events she has endured."

Her story will be aired on TV on April 1.

Beyond reasonable doubt
Waney Squier
March 13, 2008 10:30 AM

http://commentisfree.guardian.co.uk/waney_squier/2008/03/beyond_reasonable_doubt.html

Sally Clark, Trupti Patel, Angela Cannings and now Keran Henderson, all subjects of intense public attention, all women accused of killing babies, all convicted on the basis of controversial medical evidence, in particular shaken baby syndrome (SBS).

There is no doubt that women do kill babies and that infants suffer horrific injuries at the hands of those entrusted with their care - as a pathologist, I see these sad victims all too often. Abused infants may have bleeding around the brain and in the eyes - the hallmarks of SBS - but most also bear signs of the violence which killed them, fractures, bruises, burns, malnutrition or neglect.

Almost 40 years ago, shaking was proposed as the mechanism by which these internal injuries could be caused without leaving signs of violence. This hypothesis was based on road safety research on whiplash in adult monkeys. But similar tests on infant "crash test dummies" have consistently failed to support this. Indeed, these tests have shown, as have studies on real-life road accident victims, that whiplash causes infants to suffer broken necks rather than bleeding around the brain.

So flimsy is the evidence to support shaken baby syndrome that the diagnosis has been disallowed in two states in America, and in Canada there are calls for 142 SBS cases to be reviewed.

If shaking is not responsible for these infant deaths, what is? In fact, we often simply do not know. For doctors to say: "We don't know, so it must be shaking," is not acceptable. It is our responsibility to do everything in our power to find out.

In 2001, Geddes showed that most of these babies do not have traumatic tearing of the nerve fibres in their brains; rather, they are starved of oxygen. Lantz, in 2006, showed that bleeding behind the eyes also occurs in babies with other, natural diseases.

One likely cause is impact to the head which may be inflicted but, equally, may be accidental. Tests have shown that falls from as low as 1-2 feet generate far greater force than even the most violent shaking. Another cause may be insufficient oxygen supply to the brain when a baby stops breathing during choking, a fit or overwhelming infection.

It isn't a coincidence that these babies are typically very young, weeks or months after birth, for which nature has prepared them with large blood lakes in the membranes surrounding the brain, that regress in the first year of life. We don't fully understand their function, but there surely is one. We do know that about a quarter of normal newborn babies have bleeds around their brains and eyes, resembling mild versions of "shaken baby syndrome".

Nor is it a coincidence that "shaking" and cot death affect the same age group. While the latter are, by definition, found dead, the former are found dying and often vigorously resuscitated, the brain being deprived of an adequate oxygen supply for a considerable time, and eventually kept alive on a ventilator. This combination of events most likely causes the immature brain to swell and its coverings to bleed.

As a pathologist, I am able to reflect on each case in detail while studying the cellular processes in these damaged brains. This is a luxury not afforded to the paediatrician whose primary responsibility is the safety of the baby and its siblings.

Early reporting of suspected abuse is mandatory, but there must follow a period of exhaustive, but sensitive, investigation in order to respect the basic tenet of our judicial system: innocent until proved guilty. And that proof must depend on objective scientific evidence, not belief or even widely accepted opinion.
 

http://www.safetylit.org/citations/index.php?
fuseaction=citations.viewdetails&citationIds%5B%
5D=citjournalarticle_92617_23

"Journal Article
Cervical soft tissue lesions in the shaken infant syndrome: a case
report.
Porzionato A, Macchi V, Aprile A, De Caro R. Med Sci Law 2008; 48(4):
346-9.
Affiliation: Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Italy.
 
(Copyright © 2008, Barnsbury Publishing)
Cervical soft tissue lesions have rarely been described in the shaken baby syndrome; they include ruptures of intervertebral discs and haemorrhages in the ligamenta flava, and in the interspinal and sternocleidomastoid muscles. We present here the autopsy case of a 30-month old girl who suffered an assault with multiple injury mechanisms, i.e., beating, sexual abuse and shaking trauma. External examination of the neck did not reveal bruises or excoriations, but cervical dissection showed haemorrhagic infiltration of the clavicular head of the sternocleidomastoid muscle, carotid region, posterior musculature of the pharynx and oesophagus, and retro-pharyngeal/oesophageal spaces. These findings were ascribed to the repeated violent movements of shaking trauma. The case presented confirms the occurrence of cervical soft tissue lesions in the shaken baby syndrome and reports injuries which have not previously been described. In suspected cases of shaken baby syndrome, particular attention must be paid to the examination of cervical soft tissue structures."

 

Study Split in Shaken Baby Syndrome

MACON - There are many cases of child abuse each year, but one form of child abuse is a hot topic.
www.komu.com/satellite/SatelliteRender/KOMU.com/ba8a4513-c0a8-2f11-0063-9

Doctors and lawyers question the validity of Shaken Baby Syndrome. Experts worldwide, from England to Japan, are taking a second look at cases that put people in prison for shaking a baby. Some medical professionals and lawyers say there's just not enough known about Shaken Baby Syndrome to make convictions.

A Macon woman spent four years of her life surrounded by the fear of something she says she didn't do.

"At first I was just terrified. Completely terrified," Kathy Hyatt said.

Everything changed for Kathy Hyatt four years ago.

"I would just sit on my couch and look out the window and think the police were going to come get me," Hyatt said.

Prosecutors accused her of shaking a baby in her care. From day one Hyatt denied it.

"I would never hurt that baby. I loved her. I mean, I took care of her from the time she was little bitty, just barely born up until that time. I mean, she was like my own child. She took her first steps in this room," she said.

There was only one thing Hyatt could do.

"I just started researching on the Internet and tried to find out what this whole world of Shaken Baby Syndrome was about," Hyatt said.

Hyatt found a world full of controversy. She and her husband have stacks and stacks of articles that question the science behind it.

"The red blotches are blood that normally should not be there," MU Mason Eye Institute ophthalmology professor Dr. Joseph Giangiacomo said as he showed a digital picture of an eye with retinal hemorrhaging.

Prosecutors across the country use him as an expert witness. He says there are two key signs doctors look for: retinal hemorrhaging and cerebral hemorrhaging, or bleeding in the eye and in the brain.

Are these two signs enough for diagnosis?

"It takes, you know, the history - the history as far as giving a reproducible, consistent response. Who is watching the child? What's the environment like? Could you explain this from a fall in a high chair? No," Giangiacomo said.

"The amount of force that it takes from just shaking a child to cause a cerebral hematoma hemorrhaging is so significant that if a person just shook a child without impact to the head that the amount of force required would actually end up decapitating the child before you'd see those signs or injuring the neck first," Hyatt's attorney Kirk Zwink said.

"It has to take some type of momentum where the head is unsupported and it's wallowing...boom and boom. And this is an acceleration, deceleration, and you're doing this whooping back and forth," Giangiacomo said as he motioned with his hands.

Hyatt's lawyers ask doctors for one thing: research.

"They take it as a matter of faith and what's disturbing to me is that once they get it in their head, you can't shake that. There's no science behind it. I wouldn't even call it a theory, Shaken Baby Syndrome, I would call it a hypothesis," Zwink said.

"But if you're looking for an experimental model to prove or disprove this, it's very hard," Giangiacomo said.

A split in the science world that Kathy Hyatt still investigates. She was found not guilty in January. She belongs to support groups and forwards information she's found to people across the world going through what she went through. She had many character witnesses for her trial.

"She had over 200 character witnesses that we had endorsed to possibly use in the trial, and, you know, there again with that history there would be somebody that would at some point have seen something that would indicate that she could lose her cool with a child, but there wasn't anything like that," Hyatt's attorney Rick Tucker said.

Hyatt said her friends and family always supported her.

The baby in Hyatt's case is five years old and still lives in the Macon area.


Another Shaken Baby Case: Audrey Edmunds

Audrey Edmunds was accused of shaking seven month old Natalie Beard on October 16, 1995. In 1996, Edmunds was sentenced to 18 years in prison. She always maintained her innocence. The expert witnesses in her case later said the child's symptoms could be linked to other causes. The Wisconsin District IV Court of Appeals granted Edmunds a new trial in March 2007, after she'd been incarcerated for ten years. Edmunds walked free in February of 2008 after a decade behind bars. She's now in her forties and has three grown daugthers.

Reported by: Lisa Russell
Posted by: Becca Habegger


Published: Friday, May 8, 2009 at 10:09 PM
Last Updated: Friday, May 8, 2009 at 11:29 PM

 

http://www.irishtimes.com/newspaper/ireland/2009/0717/1224250848594.html
 
Friday, July 17, 2009
Parents given apology over their baby's death
PAMELA DUNCAN
A FIVE-MONTH-old baby who died at a Dublin hospital two years ago in what doctors suspected to be a case of shaken baby syndrome was found to have died of natural causes by the Dublin City Coroner’s Court yesterday.

The parents were given an apology by a senior doctor at the hospital.

The coroner’s court heard that Rebecca Whyte died of a rare form of brain haemorrhage, the symptoms of which were in keeping with those associated with shaken baby syndrome. Rebecca Whyte, Springdale Road, Raheny, Dublin, was admitted to Temple Street Children’s Hospital on August 26th, 2007. She died at the hospital on August 28th. State Pathologist Prof Marie Cassidy carried out a postmortem examination on August 29th.

Prof Cassidy told the court that the baby appeared well-cared for and well nourished. She found no evidence of injury to the head or other trauma to the infant. Prof Cassidy told the coroner’s court that the haemorrhage in this case was “far more significant” than would normally be expected in a case of shaken baby syndrome. She said the post-mortem findings were not consistent with shaken baby syndrome and concluded that there may have been an underlying abnormality in this case. Dr Francesca Brett, consultant neuropathologist at Beaumont Hospital, said the death occurred due to an underlying vascular malformation. The baby’s father Mark Whyte told the coroner’s court that Rebecca had been “her usual happy self” in the week leading up to her admittance into hospital.  The family had spent the week on holidays in Galway with members of their extended family.

However, after they returned to Dublin on August 26th, Rebecca refused to take her bottle and began to scream. At about 9.30pm, she had “a fit of some sort”. Her parents rang for an ambulance and she was brought to Temple Street Children’s Hospital where she was admitted with queried meningitis.The inquest heard that the baby had a number of seizures while in hospital. A cranial ultrasound and a lumber puncture were carried out on her. The day after Rebecca was admitted, Mr Whyte and his wife Suzanne O’Toole were informed by Dr Owen Hensey, a consultant paediatrician that their daughter’s condition was in keeping with shake injuries. Dr Hensey told the coroner’s court that gardaí and social workers were contacted as a matter of protocol because, in his opinion and that of three other clinicians at the hospital, Rebecca’s condition was consistent with shaken baby syndrome.

Dr Bryan Lynch, consultant paediatric neurologist at the hospital, said that it was “appropriate to consider a non-accidental injury due to shaking” in the case. Dr Hensey denied he had accused Rebecca’s parents of child abuse. However, after he had concluded his evidence, he apologised to Mr Whyte and Ms O’Toole on behalf of himself and the hospital. Det Sgt Patrick O’Toole, then of Coolock Garda station, told the coroner’s court that Rebecca’s parents and extended family had co-operated fully in the investigation into Rebecca’s death. He said that it was his opinion that he formed an opinion early on in investigation that the baby was well treated and cared for. The Dublin City Coroner, Dr Brian Farrell recorded death by natural causes. “There is no evidence of cerebral trauma or “Shaken Baby Syndrome” despite the radiological and clinical findings of subdural haemorrhage and retinal haemorrhages,” Dr Farrell said. Dr Farrell added that he would write to the relevant statutory and other relevant bodies in relation to this case to ensure that a similar situation did not arise in future. “I will write in a neutral way setting out what happened to baby Rebecca so that something positive may come out of this tragedy,” he said. “We will try to do better in the future if we can.”
This article appears in the print edition of the Irish Times

Soldier acquitted of causing son’s death
Oct 21 2009 12:00AM By Melissa Braun Sun Staff Writer
It took three hours of deliberation and a “not guilty” verdict to pull a Fort Rucker soldier from what he described as the “hell” of his life for the past year.

Spc. Dedrick Fisher walked away Thursday night as a free man. A Fort Rucker court-martial panel Oct. 15 found Fisher not guilty of all charges related to the death of his son Dedrick Jr. Fisher was found not guilty of involuntary manslaughter and the lesser-included charges of negligent homicide and battery of a child under the age of 12.

Fisher had been under watch by Army officials after his infant son, Dedrick Jr., died at Dale Medical Center in Ozark Feb. 2 as a result of injuries he sustained three months earlier. At that time, Fisher was accused of shaking his infant son, which caused several brain and retinal hemorrhages that resulted in his death. A court-martial panel convened Oct. 13 to determine Fisher’s future in the United States Army and whether he would be a free man. For almost two days, government prosecutors called witnesses who presented evidence that Fisher had lost his temper and turned his aggression on his son. With his head bowed and making little eye contact, he listened as military police and doctors describe the trauma he allegedly inflicted on his son. He showed little reaction as investigators testified Fisher had even admitted to shaking his son, citing a written statement where Fisher said, “My son is damn near dead because of me.” After two days of listening to evidence against him, Fisher took the stand and recalled the events in November of last year when his son’s health roller–coasted out of control.

Fisher said he was feeding his son when he began choking. “I said, ‘You need to slow down,’” he explained, adding that when the child whined a second time he gave him the bottle again. “He started choking bad,” Fisher said. He testified that he patted his son on the back and then placed him on the couch. He left the child to go into the kitchen, not realizing his child’s health was quickly deteriorating. Moments later, his wife realized Dedrick Jr. was not breathing and his heart had stopped beating. The next few hours, Fisher said, were “a blur.” From finding medical help to seeing his wife in handcuffs as they were interviewed about what happened to their son, Fisher said his temper continued to rise.

“My wife was getting emotionally tortured over this, my daughter was at someone’s house I didn’t know, my child was in the hospital sick and I was like (thinking) they (investigators) are not going to let us out of here until they get what they want,” he said, adding that is the reason why he admitted to shaking his child when he didn’t. “I told her (Fisher’s wife) that when we got out of there we were going straight to Birmingham (to Children’s Hospital where the infant had been transferred) and we are going to PCS (request for transfer) out of this post.”

During questioning from the Judge Advocate General government prosecutors Capt. Christopher Coy and Capt. Shawn Tate, Fisher continued explaining what he had given a false confession to the alleged crime.

“He (military police investigator Chief Warrant Officer 3 Raymond Massey) kept on asking me the same questions over and over and I just gave him what he wanted to hear,” he said, adding that the confession changed his life. “I look at all these folks giving their kids a yank like that (how he allegedly picked up his child) and look at me, going through all this and I didn’t even do nothing.”

After three days of testimony from Fisher, law enforcement and medical personnel the verdict ultimately hinged on expert testimonies.

Dr. Ronald H. Uscinski, a world-renowned neurosurgeon from Georgetown and an expert witness for the defense, testified that Fisher did not cause his child’s brain trauma. “I do not believe that the findings on the diagnostic studies and histories indicate the child was injured on the day in question,” he said. He said the infant, instead, died from brain trauma, a chronic subdural hematoma, he suffered at the time of his birth. The injury, he further explained, was caused by overlapping sutures in the child’s brain that occurred as he was pushed through the birth canal and damaged a portion of his brain. Symptoms of the injury manifested in Nov. 2008 –– the day Fisher went under investigation for abusing his son, Uscinski said.  Uscinski explained that through his work as a neurosurgeon he no longer believes in Shaken Baby Syndrome.

“It is against the laws of physics. Human beings cannot shake a baby hard enough to cause that kind of brain trauma,” he said. “You cannot shake a baby this size hard enough (to cause these internal injuries) without breaking its neck.” Dedrick Jr. had no injuries to any bones including his neck. The infant’s retinal hemorrhages, he said, could have been caused by an increase in blood pressure when the hematoma began to bleed once again, but also said they could have been caused by CPR pressure. During his time as a neurosurgeon, Uscinski said he is also unaware of any situation in which the shaking of an infant was witnessed and also resulted in a subdural leak, which he says caused the death Dedrick Jr. Prosecution witness Dr. Melissa Peters, of Children’s Hospital in Birmingham, testified that Dedrick Jr., did suffer isolated injuries in November that caused traumatic  brain injury sever enough for him to live the last two months of his life connected to breathing and feeding tubes.  Peters said she first saw Dedrick Jr. while he was in the Intensive Care Unit. Peters said the infant had bruises on his arm, suffered hemorrhages in two locations above the brain but inside the skull, and that he also had more than 50 multi-layered retinal hemorrhages consistent with shaking injuries. As a pediatrician at the Children’s Hospital, Peters said she is very familiar with injuries a child suffers as a result of being shaken. “This child had evidence of severe head injury,” she said.

She also explained that the infant’s birth records signified a normal birth and that overlapping sutures are somewhat common. In her examination of Dedrick Jr., Peters said her findings were “consistent with acute head trauma which could have involved shaking.” His injuries were not consistent, she further explained, with normal child care or play. Retinal hemorrhaging, she said, would not be expected from a subdural leak, despite Uscinski’s testimony otherwise. Uscinski did not personally exam the child, but relied on tests results, including two CT scans. Fisher’s attorney, Victor Kelley, asked the panel to weigh the experts’ testimonies and remember Uscinski specializes in neurology unlike Peter, who he called a “child advocate.” “It is just not right to be here to begin with,” Kelley said. “If they (investigators) had gotten the right information (medical diagnosis) to begin with we wouldn’t be.” He asked the panel to also remember that if there was any reasonable doubt in their heads about Fisher’s guilt, they must acquit. Only a majority consensus of the six-member panel was needed for a verdict.

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