Steps Forward, Steps Backward, Part II

The second half of a posting started on March 7

In another small step forward, a father in Michigan has been found not guilty of murder or abuse in the death of his 11-week-old son, after spending 16 months in jail waiting for trial.

Mark Hontz had reported falling down the basement stairs with the boy in his arms, landing on the infant when they reached the floor. Doctors at the University of Michigan, however, rejected that explanation for the child’s injuries. At the preliminary hearing, forensic pathologist Dr. Jeffrey Jentzen pointed to anterior rib fractures and neck damage, which he said were “more consistent” with the compression and whiplash that occur during squeezing and shaking than with a fall down stairs.

Dr. Jentzen’s testimony reflected an opinion I’ve heard before about pediatric stairway falls:

In the journal Pediatrics in 1988, Drs. Mark Joffe and Stephen Ludwig at the University of Pennsylvania proposed that model in their paper “Stairway Injuries in Children,” illustrating their point with the figure to the right. That paper had concluded that “nonaccidental injury should be suspected” when children receive serious injuries in an alleged stairway fall.

The photos at the top of this page show the stairs to Mark Hontz’s basement, with the figure at the starting and landing spots he reported. A biomechanical engineer brought in by the defense pointed out that an adult falling forward down stairs does not fall one step at a time, as the feet are no longer under the center of mass. Instead, the body falls forward, propelled by the force of gravity, until the motion “is arrested by contact with the ground or steps.” The engineer calculated that the infant experienced a vertical fall of 9 feet, landing with an approximate speed of 16 miles per hour.

Investigators conducted a series of interviews with Mark Hontz, finally confronting him with the medical opinion that his son did not die from a fall down the stairs. “Hontz offered no other explanation,” the police report says, which is another way of saying that, even under intense pressure during repeated interrogations, the father never changed his story.

Illustrating the value of a thorough defense, attorney Sharon Clark Woodside also called in a forensic pathologist, a child abuse pediatrician, and a pediatric radiologist to rebut the prosecution theory.

Witnessed Shakings

Two witnessed shakings in separate hemispheres this winter seem to have produced no injuries, nor any questioning of shaking theory.

Dismayed diners at an Australian cafe called authorities about a man shouting and shaking his 5-month-old daughter, according to a news story by reporter Allison Harding. After paramedics checked the child and cleared the father to take her home, Harding wrote, other patrons attempted unsuccessfully to block his car. The father later pled guilty to unlawful assault and has sought treatment for “long-term mental health issues.” His wife reportedly stood by him in court, calling him a responsible and loving father.

Concerned bystanders in Cottonwood, Arizona, called police and recorded video of a 19-year-old mother shaking and slapping her 10-month-old daughter at a street corner, according to coverage in the Verde Independent. Responding officers arrested the mother, a transient already known to local police and described as “combative.” Authorities later discovered that the child was missing from foster care in another state, kidnapped by her parents during a family visit. The Independent’s coverage quoted Cottonwood Police Sergeant Tod Moore, who said, “I have seen too often in shaken baby cases where permanent brain damage or death occurs. We appear to be very fortunate this time.” I note that Sgt. Moore has probably seen serious injury in cases where the doctors diagnosed shaking. In the one witnessed case he’s probably handled, doctors at the local hospital found no injuries.

More Fathers in the News

Convictions of and accusations against fathers continue to pass through the headlines.

One case in Pennsylvania has it all: no external signs of assault, the presumption of immediate symptoms, and a retreat from the term “shaken baby syndrome”—but with a computer animation shown at trial illustrating the presumed effects of a violent shaking. From an article before the verdict by reporter Laurie Mason Schroeder of The Morning Call:

Prosecution expert Dr. Debra D. Esernio-Jenssen, medical director of the Child Advocacy Center at Lehigh Valley Hospital, testified that Quinn suffered from symptoms of abusive head trauma, formerly called “shaken baby syndrome.”

Using a computerized animation, Esernio-Jenssen demonstrated how, she said, a baby’s brain would hemorrhage from being snapped back and forth in the hands of an angry adult.

On the subject of timing, Leigh Valley Live reporter Sarah Cassi wrote in an article reporting the conviction:

[Dr. Esernio-Jenssen] testified the baby would have shown immediate symptoms following the “severe, lethal episode of head trauma” she suffered, meaning the injuries occurred while [the father] was alone with the child.

Depressingly, the father’s defense attorney seems to have focused on blaming the child’s mother, arguing only that the injury had been inflicted before the girl was left in his client’s care.

A father in Tennessee has been sentenced to 15 years for aggravated child abuse, convicted after a 4-day trial, according to coverage in the Johnson City Press. The child’s mother still insists her husband is innocent—in a moving clip from the trial posted by WCYB, she said, regarding her son, “We wanted a real answer because we knew he wasn’t abused.”

The story of a young father accused in Wisconsin, meanwhile, received mixed coverage in a single treatment, with a headline about possible doubts but six opening paragraphs focused on the prosecution theory of shaken baby syndrome—the unfolding article then cites the Audrey Edmunds case and reveals that the defense attorney is fighting hard against the diagnosis.

Foster Mom Charged

And in Florida, investigators have reached the improbable conclusion that a 43-year-old mother and foster parent—active in the local child protection community—became enraged enough to batter a 17-month-old to death in the 7-minute gap between the time a social worker left her home and the time she dialed 911 for help with an unconscious toddler. Coverage in the Tampa Bay Times describes a boy with a complex medical history, including developmental delays and physical signs of early neglect. The child used a feeding tube, and he had been discharged from the hospital just a few hours before his collapse, after three days of treatment following a choking incident. Faith in the diagnosis of abusive head trauma, with a guarantee of immediate symptoms, apparently overrides the logical assessment of established medical facts.

This story reminds me of Quentin Stone in California, a father acquitted in 2014 by jurors in Yolo County who accepted that the child’s fatal collapse had resulted from an evolving head injury suffered in an accidental fall. Stone had taken his son to the hospital several months before his medical crisis, just to make sure he was OK, he said, after the boy had rolled off a bed. Doctors found no injuries and released him, but over the following weeks, the Stones had sought medical advice repeatedly for their son’s ongoing vomiting and apparent “breath holding.” Despite that well documented history, the prosecution charged Stone with murder after the boy’s fatal collapse, based on medical opinion that the brain findings proved abuse and the symptoms would have been immediate.

Also in Yolo County,  a public invitation this winter to the annual Rotary Club of Davis fund-raising dinner noted that a team of Rotarians had taken a trip three years ago to Kenya, East Africa, “to educate physicians, medical students and nurses on how to identify abusive head trauma in children.” The article did not say where the Rotarians got their own medical training, but it reported that the team “trained nearly 1,200 professionals throughout Kenya.” According to the shaken baby page on the web site for Rotary District 5160 (northern California), the Davis chapter also provides shaken baby simulator dolls to schools and hospitals.

Fractures in the News

Finally, a television station in Indiana ran a provocative segment on a family trying to regain custody of their two sons, removed because of fractures discovered in their first-born when he was four months old. “I understand them getting involved at that point,” says mother Ally Allen on camera, “The frustration came in that they never tried to find an answer.”

Knowing they had not abused their son, Ally says, she and the child’s father started looking for another doctor who could give them an accurate diagnosis. They found Dr. David Ayoub, a pediatric radiologist in Illinois who determined that the infant suffered from rickets, a lack of mineralization in the bones that predisposes to fractures. Once considered a disease of the past, rickets remains “a significant cause of nutritional disease for infants,” according to the American Academy of Pediatrics.

The family’s second child was removed from them at birth because of the pending charges. While they wait for their case to work its way through dependency court, Ally and her partner can see their sons only for a few hours at a time during scheduled visitations.

If you are not familiar with the debate about shaken baby syndrome/abusive head trauma, please see the home page of this site.

copyright 2017 Sue Luttner