Boston Cases Refocus the Spotlight

Justina Pelletier thrilled to be returning home

Justina Pelletier, now reunited with her family

Nearly twenty years after the trial of British au pair Louise Woodward brought shaken baby syndrome into the headlines, the case of Irish nanny Aisling Brady McCarthy has raised the subject again in Boston, where reporters are still fresh from a different controversial diagnosis by the same child protection team.

Last week McCarthy’s attorneys filed a motion arguing not only that the science around shaken baby syndrome is falling apart but also that the physician who diagnosed the abuse has been wrong before about infant shaking. Then journalists made the connection with the high-profile case of teenager Justina Pelletier, who returned home to her parents in June after a long, bitter, and public struggle with Boston Children’s Hospital.

Aisling Brady McCarthy, from the BBC coverage, http://www.bbc.com/news/world-europe-24569976

Aisling Brady McCarthy, accused of shaking an infant, from the Middlesex District Attorney’s Office

McCarthy, who is in the U.S. illegally, has been in jail since she was arrested in January of 2013, a week after reporting that 1-year-old Rehma Sabir had simply fallen unconscious in her care. The girl died in the hospital two days later.

Although doctors found no bruising, grip marks, or other external signs of assault, Rehma was diagnosed as the victim of a violent shaking based on brain swelling and bleeding inside her head and behind her eyes, the same symptoms found in Matthew Eappen, the infant who quit breathing while in the care of Louise Woodward in 1997.

Last week’s Boston Globe coverage offered this perspective on the abuse diagnosis, from a physician not involved in the case:

“Bleeding in the back of the eye rarely happens absent abuse,” said Robert Sege, medical director of the Child Protection Team at Boston Medical Center.

Sege said abusive head trauma is a leading cause of death of infants, and its existence is a “settled scientific fact,” according to the American Academy of Pediatrics.

During a grand jury hearing in 2013, prosecutors argued that McCarthy had inflicted both the brain injury and a number of “compression fractures” found in Rehma’s spine, but a bone specialist for the state later concluded that the fractures were 3 to 4 weeks old, meaning they happened while the girl was out of the country with her family, not in McCarthy’s care. When the bone evidence emerged, defense attorneys filed an unsuccessful motion to have the charges dropped, and the case has been crawling through the courts since.

McCarthy’s defense attorney Melinda Thompson, a former prosecutor, says her work on this case has convinced her that shaken baby syndrome is not a reliable diagnosis. “I was a prosecutor in that office for seven years,” she wrote in an email, “I never prosecuted child abuse cases and never thought about SBS cases. I should have. I am appalled that this can happen. I won’t stop until Aisling is free.” bostonChildrens

In the petition filed last week, Thompson and co-counsel David Meier argued that Rehma had a complex medical history, including a bleeding disorder, which Dr. Alice Newton at Boston Children’s Hospital did not consider before making the abuse diagnosis. The petition also cited the case of Geoffrey Wilson, accused in 2010 of shaking his 6-month-old son to death. The state medical examiner has recently derailed that prosecution by amending the cause of death from homicide to undetermined. The shaking diagnoses in both Wilson’s and McCarthy’s cases were made by Dr. Newton.

Justina with her mother and two of her three sisters

Justina with her mother and two of her three sisters

“Medical Child Abuse”

Justina Pelletier’s parents brought their daughter to Boston Children’s Hospital on the advice of Dr. Mark S. Korson, a metabolic disease specialist at Tufts Medical Center who had been treating Justina for mitochondrial disease, a rare and little understood condition that includes muscle weakness and digestion problems. Her health was failing, and Dr. Korson wanted her to see her long-time gastroenterologist, who had moved from Tufts to Boston. But the child protection team at Boston Children’s, led at the time by Dr. Newton, concluded that the girl’s symptoms were psychosomatic, triggered in part by her family’s insistence on receiving what they considered “unnecessary medical treatment.” The courts accepted the doctors’ diagnosis of “medical child abuse” and removed Justina from her family. The hospital then placed Justina in a locked psychiatric unit and allowed her only one supervised visit and one supervised phone call each week with her family.

“No one was on my side there,” Justina told Mike Huckabee at Fox News in a televised interview after her release. “No one believed me there. They all thought I was faking.”

ERThe relationship between the Pelletiers and the hospital remained hostile, and in March of 2014 a judge granted permanent custody to the state of Massachusetts, in an opinion that criticized both the Pelletiers for their refusal to cooperate with Justina’s new treatment plan and the state of Connecticut, where the family lives, for its failure to get involved.

Justina’s health did not improve, though, and in May of 2014 she was transferred to a residential treatment program in Connecticut, closer to her family. The staff at the new facility found the Pelletiers “cooperative and engaged,” and in June the same judge authorized Justina’s return home. The order returning custody to the Pelletiers did not explicitly reject the diagnosis of “somatoform disorder,” or illness caused by psychological issues, instead noting that “circumstances have changed” since Justina became a ward of the court.

Since her release, Justina, her family, and their advocate Rev. Patrick Mahoney have made a number of public appearances, including a Congressional address and a televised press conference, and the case has been offered as an object lesson by both alternative health care activists and the mitochondrial disease community.

When attorneys for Aisling McCarthy filed their motion in the shaking case, Boston Herald columnist Peter Gelzinis apparently hit a nerve with an opinion piece noting that the Pelletier outcome had tarnished the credibility of the diagnosing physicians: His column triggered a cascade of public comments about false allegations of child abuse in Massachusetts.

Unlike the infants Matthew Eappen and Rehma Sabir, Justina Pelletier was 15 years old when she arrived at Boston Children’s Hospital, old enough to tell doctors that her parents were not abusing her. She already had a diagnosis of mitochondrial disease from a reputable institution, and she continued to insist that her symptoms were real, while her health continued to unravel. “They didn’t care,” she told Mike Huckabee, “They were saying that I was improving, which I was not.”

Some medical conditions, like cancer or tuberculosis, can be confirmed by testing. The tests might have a known error rate, the likelihood of a false positive or a false negative, but guidelines and data are available. There is no test, though, to confirm or reject either shaken baby syndrome or medical child abuse. Doctors are relying on what they’ve been taught about the conditions, supported by their clinical experience, which of course incorporates the opinions of their peers and courtroom outcomes.

According to press reports, there is also no definitive test for mitochondrial disease, which mired the Pelletier case in uncertainty from the beginning. Before the case resolution, Brian Palmer at Slate speculated in an essay emphasizing the ambiguities:

Linda and Lou Pelletier may be the innocent victims of an all-powerful hospital that followed a misdiagnosis to its painful and damaging end. Or perhaps they are sick people who have tortured their daughter with unnecessary medical procedures. They could even be both—the parents of children with mitochondrial disease often suffer from the same disorder, which can cause emotional and psychiatric problems.

In the Pelletier case, time offered a test of the doctors’ hypothesis: After sixteen months of psychiatric care and separation from her family, Justina’s legs are so weak she uses a wheel chair to get around, and her parents say she has regressed academically.

But time has few opportunities to prove or disprove a diagnosis of inflicted head trauma. Infants who survive presumed shaking assaults routinely suffer from seizures and other neurological complications:  The common knowledge is that these problems are a result of the assault, and not a clue to an alternative explanation for the initial collapse. Similarly, infants diagnosed as shaken often arrive at the hospital with both old and fresh bleeding in their brains. Child abuse physicians conclude that these children have been shaken in the past and then again just before they became symptomatic—although I’ve never understood why this explanation doesn’t interfere with the presumption of immediate symptoms.

In rare cases, the medical records ultimately reveal an underlying condition—like sickle cell disease in the case of babysitter Melonie Ware or Menkes syndrome in the case of Tammy Fourman—but no one knows how many other disorders might cause the brain bleeding and swelling that’s routinely ascribed to shaking, and as the McCarthy motion points out, doctors seldom test even for the known causes.

So the courts are left to arbitrate between the doctors who believe they can know from the brain findings that a child was shaken and the caretakers who claim innocence. I can only hope that further research and improved technology offer better answers soon, because I believe that innocent people are being accused and benign families torn apart by sincere physicians working with a theory that pushes well beyond the limits of what’s really known.

The McCarthy motion asks for a hearing to scrutinize the science behind shaken syndrome under the “Daubert-Lanigan” standards that govern expert testimony. If that hearing happens, I hope the Boston press will stay with the story.

August 15 update: Geoffrey Wilson’s family, in the other local shaking case, has offered to open their medical records to McCarthy’s defense: team: http://bostonherald.com/news_opinion/local_coverage/2014/08/shaken_baby_defendant_offers_to_share_evidence_with_nanny

copyright 2014 Sue Luttner

If you are not familiar with the debate surrounding shaken baby syndrome, please see the home page of this site.

6 Comments

Filed under abusive head trauma, AHT, parents accused, SBS, shaken baby syndrome, Uncategorized

6 responses to “Boston Cases Refocus the Spotlight

  1. Excellent essay, Sue.

    To anyone reading, I am absolutely certain for multiple reasons that the family I am helping, and who I know personally AND live with, DID NOT SHAKE THEIR BABY! There is literally NO evidence for it at all, beyond the existence of a subdural hematoma and some retinal hemorrhages. But the hematoma had a membrane ON BOTH SIDES of it, indicating a slow bleeding to which the body had time to respond by forming a membrane. And the retinal hemorrhages were not seen until 6 days after the baby arrived at the hospital, had undergone brain surgery and was being weaned from a intracranial pressure relief system by gradually increasing the level of pressure he experienced before the valve would open.

    What I noted from the medical notes and what I think is significant is that the day before his retinal hemorrhages were seen, it was noted that the patient “did not tolerate” the increased pressure of the weaning, so the cut off level was set lower again. Isn’t it possible that increased intracranial pressure, combined with other problems this child may have had, combined with trying to recuperate from surgery precipitated the formation of his retinal hemorrhages? For further argument that these hemorrhages were NEW bleeding and not from some event which happened 6 days earlier, when the photographer came to document the hemorrhages seen, the counted number was literally double those seen only 16 hours earlier.

    The “expert” witness for the prosecution, it turns out, is the same woman who testified in the McMartin Preschool case that “all those children were abused.” From the court transcript in our case, it was extremely evident to me when she was talking about the physics of shaken baby, as I am a chemistry/physics teacher and can tell when students understand or don’t understand what they’re talking about, that she did NOT know what she was talking about and that she was bluffing. The fact that there was a membrane formed ON BOTH SIDES of the hematoma and the fact that there was no damage of any kind to this child’s body, spine or skin, and the fact that the retinal hemorrhages were not seen until 6 days after surgery were completely ignored and not even addressed by this “expert.” Nor were the unusually high or low blood numbers addressed. She talked about “probability” that the child had been shaken merely because of the EXISTENCE of the hematoma and the retinal hemorrhages. She claimed that she was sure to 85%. Really? Convict someone and take away their baby and label them an abuser for the rest of their life because of a “probability” of 85% that abuse happened? WHERE in Dependency Court were the protections that even criminals get? What punishment can be worse than literally taking away someone’s child permanently based on a “probability of 85%”?

    The “judge,” who was really a commissioner, decided that he believed her story more than those of the two expert witnesses we had, one of whom had poured over and collated ALL the medical data from this child’s birth to the present into a thorough 55-page report on all of the child’s data points, including weight, height, blood numbers and other measured things, which led him to conclude without doubt that the child had a medical problem and had NOT been shaken, and another who had a different area of knowledge about the structure of capillaries in children with facial birthmarks and had our baby, who said that because of missing indicators of abuse on the child’s body combined with his analysis of the bleeding in the child’s head, he, likewise, was quite certain that the child had not been shaken.

    The “judge” completely ignored THEM and believed HER. Furthermore, he said, (and I both heard this with my own ears and confirmed it in the court transcript!) “that even a gentle shaking can cause these types of problems.” REALLY? How much science does this “judge” know?

    The extreme evil of this idea that shaken baby can be diagnosed upon the mere existence of two symptoms, without ANY indication that abuse had, indeed, taken place is unfathomable. This family uses NO drugs. They have no family violence. They all work hard and are not even on government welfare. I know them because I live with them. AND the baby was not a screamer. He was an unusually happy baby. Even the foster mother acknowledged that. The supposition that the parents were “under stress and not doing well and didn’t know how to manage their anger” is complete speculation. Yet this is what the court supposed, because, in their minds, since the baby was shaken, based on the medical “evidence,” then there must have been a screaming kid. And there must have been stress in the family. And there must have been anger and impatience. And someone must have lost his temper. ALL without a shred of evidence! Based purely on the existence of a hematoma and some retinal hemorrhages. And they call this science?

    Look at Justina Pelletier’s case. They were so insistent that they were “right” that they put this 15-year-old intelligent minor and her family through HELL for more than one year based on their idea that they knew better, that she did NOT have the mitochondrial disease and that she was really being abused by her family. REALLY? They even at one point terminated Justina’s parents’ parental rights. And they put a gag order on the father. Thank the Lord that he still spoke out!

    Doesn’t this indicate that the system of the hospitals, Child “Protective” Services and the Courts is terribly broken? Doesn’t this indicate that we need to raise some holy hell? We have to change this!

    What I notice about the program for the upcoming conference of the National Center for Shaken Baby is that they have sessions to specifically address those who express doubts about the Center’s position on the causes of the symptoms popularly attributed to shaken baby. Read these titles! “Exonerating the Guilty: Child Abuse and the Corruption of the False Conviction Movement.” “When Justice Falls Short.” “Setting the Record Straight on Abusive Head Trauma for the Courts, Media and Public.” When you read the explanations of what the sessions will discuss, it is clear that they are aimed at debunking any claim to legitimacy on the side of those who contest the scientific basis for the wholesale acceptance of the shaken baby hypothesis.

    It reminds me very much of Galileo before the tribunal, where, because his knowledge ran directly counter to the beliefs of the prevailing culture, he was forced to kneel down and kiss the ring of some important person and agree not to teach anymore something he absolutely knew to be true, that the sun was the center of the solar system and not the earth.

    I absolutely know that the family with whom I am living did not shake their baby or abuse him in any way. “No, I wasn’t there. I didn’t see it.” But all the evidence I have before me from personal direct knowledge, understanding of science and the evidence clearly stated from the medical record assures me that my position is correct, even in the face of the judge’s judgment notwithstanding.

  2. Unfortunately, Dr. Alice Newton learned from the best. Dr. Eli Newberger, whose testimony for the state at the Louis Woodward trial was later discredited, has offered his cookie-cutter, graphic visual comparison in many cases when he testified for the state. Although he now says that he is concerned with “board-certified child protection specialists wielding enormous and unchecked power in and out of the courtroom,” he should probably take his own advice. Dr. Newberger has long been qualified by the state as a child abuse expert. He wields his curriculum vitae on his stage, the witness stand and most times doesn’t even get challenged – not effectively anyway.

  3. Michael Innis

    Requests sent to me indicate doctors in the UK, USA and Australia continue to falsely accuse innocent parents and carers of Shaking an infant to death because the child shows evidence of “unexplained” bruising, subdural and retinal haemorrhages with ischaemic encephalopathy.
    What these doctors don’t seem to be able to understand is these are the features of TISSUE SCURVY which I have fully explained in a peer reviewed paper summarized here:
    To cite this article
    Michael D. Innis, Tissue Scurvy Misdiagnosed as Shaken Baby Syndrome Homicide, Clinical Medicine Research. Vol. 3, No. 1, 2014, pp. 6-8. doi: 10.11648/j.cmr.20140301.12
    Abstract
    “Tissue Scurvy” is an autoimmune disorder in which there is an abundance of Vitamin C in the body (unlike the Seafarer Scurvy of yesteryear) but it is inhibited from entering the tissue cells to perform its functions of maintaining the integrity of the blood vessels and skeletal tissue and partaking in several enzymatic reactions because of the lack of insulin which is essential for the transfer of Vitamin C into the cell. The result is the development of fractures, hemorrhages and other lesions of Scurvy. Here it is shown a child alleged to have been murdered by being shaken to death was found to have hyperglycemia, implying insulin deficiency and concomitant Tissue Scurvy. It is concluded that the diagnosis Shaken Baby Syndrome, and all examples of unexplained fractures, bruises, retinal and subdural hemorrhages with encephalopathy – the so-called “TRIAD” – are in fact an autoimmune disorder following antigenic stimulation in a genetically susceptible child. Vaccines administered within 4 weeks of the onset of symptoms are the most common cause. The Shaken Baby Syndrome is a fabricated diagnosis and has no place in medical jurisprudence.
    I am sure most intelligent lay people can understand the concept of Tissue Scurvy and it is incomprehensible why doctors are still making false accusations of Shaken Baby Syndrome.
    Today I received this message –
    “John was found guilty of 1st degree murder an child abuse sentenced to life without parole. Doctors say our daughter was shook.”
    The Laboratory result in this case show:
    Haemoglobin 7.0 g/dL Normal Range 9.5 – 13g/dL
    WBC 10.1K/ul 5.6 – 18.0 K/uL
    Platelets 247K/uL 180 – 400 K/uL
    Fibrinogen <50 150 – 450 mg/dLplo
    Prothrombin Time 18.6 secs 9.0 – 11.5 secs
    aPTT 53.1 secs 25.0 – 35.0 secs
    Glucose 200 mg/dL 60 – 115 mg/dL
    Death occurred shortly after admission 24 days after she had been vaccinated.
    I am sure any 3rd year Medical student can see abnormal Fibrinogen, Prothrombin Time and aPTT mean the child has a coagulation disorder and the elevated level of Glucose is a feature of Tissue Scurvy.

  4. John Fryer

    Firstly

    The need to measure head sizes of babies BEFORE and after vaccines is a necessitiy to help differentiate child abuse from vaccine adverse effects.

    In the absence of such careful measurements, the chance of a false accusation followed by a false conviction is too high for any kind of justice other than a lynching.

    The normal adverse reaction to repeat vaccines was laid down by the research of Charles Richet more than a hundred years ago. Never denied, never overcome only handled by dangerous medical interventions such as aspirin (Reyes Syndrome) and today acetaminophen (possible liver damage up to sudden deaths?)

    Secondly

    Today and for 60 years or more we (USA et al for example) have been giving Vitamin K hugely massive overdoses in an effort to stop possibly the negative effects of neurotoxic chemicals such as glyphosate which act on the bodies (human microbiota) ability to produce Vitamin K.

    Lack of vitamin K leads to bleeding notably in the brain which is identical to that seen in child abuse cases.

    A case of damned if you do (inject overdoses of chemicals) and damned if you dont (bleeding risks).

    At present a reasonable percentage of people do not get vitamin K injections rightly or wrongly because they believe a many thousand times overdose must come with adverse effects, especially when babies very rapidly develop their own vitamin K in the absence of chemical neurotoxic insults in their GMO foods.

    Breast feeding and neurotoxic free foods are the best for a healthy baby.

  5. John Fryer

    For the case of Justina, a 15 year old with weak muscles, it is reminiscent of polio, coincident with over use of DDT, a dangerous organochlorine toxic compound. See for example Rachel Carsons emotive Silent Spring much decried,denied and disputed by Big pHARMa et al.

    Today, the exposure to DDT is theoretically zero but other toxic chemicals such as glyphosate and other organophosphorus compounds (OPs) do affect humans despite the protestations of little or no harm from Monsanto and their scientific experts who would lose their job and career to tell the truth for a change.

    Glyphosate is one of many suspected causes of autism, as it preferentially harms the neurons of the brain rather than the muscles of all of us.

    This said, there will be those genetically more sensitive to toxic chemicals than others. Damage or death to the same could easily explain the weakness of muscles and tests can establish the individuals toxic load.

    In the interest of justice this should be done to remove confounding diagnoses that would make child abuse the sham it clearly is in this case. Useful tests which can show the genetic susceptibility of a person to an OP chemical toxin are invariably never done, as it would immediately spell the end to the whole toxic industry that insists a pesticide/herbicide et al can kill just bad insects/plants with 100 per cent efficiency while leaving good insects/plants and the rest of us unscathed.

    The truth is tending to the exact opposite with pest resistant mosquitoes:weeds while the 5 fold increase of dangerous chemicals is putting most of us at risk from pre-clinical signs of illness such as the 49 per cent now at huge risk for diabetes.

    And even the best scientific brains of USA now admit as fact:

    USA Poorer Health, Shorter Lives is today fact, especially for the very young.

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