Category Archives: AHT

With Their Own Nightmare Behind Them, Trying to Make a Difference

Edelyn & Peter Yhip

Edelyn Yhip, RN & Peter Yhip, MD

Last summer, Edelyn and Peter Yhip were preparing for the worst:  If they were both convicted, they asked each other, who would take their children, 13-year-old Mikaela and 9-year-old Jonathan? What would happen to their home, and everything in it, if they were both in prison?

But on August 23, after 6-1/2 years of accusations, the Yhips stood in court and heard the judge drop charges against them, because the state had conceded it had insufficient evidence of murder in the 2012 death of Jonathan’s twin brother Benjamin.

“We felt so blessed when the charges were dismissed,” Edelyn said when we got together in September, at a fencing tournament where Mikaela was competing. “Now we can grieve and mourn for Benjamin, and start to heal our family.”

In a video posted by the Northern California Innocence Project (NCIP), which helped with their defense, Edelyn reflected on the reality that set in after the “jubilation” the day the charges were dropped. Although it was “great to leave this behind us,” she said, “my son is gone, and our family is not the same. Our children are still in pain—they were alone and scared when they needed us the most.”

In a television interview in the fall, Mikaela remembered how police officers came to her school one afternoon and took her and Jonathan away from the family friend who’d come to pick them up—leaving them instead in the care of foster parents they’d never met before. “They told me that Benjamin died,” Mikaela recalled. “I was so confused and scared… I really missed my parents, especially at night.” She was 7 years old.

The Yhips were eventually able to transfer the foster placement to a family the children knew, but even then they were allowed only an hour and half a week of visitation, always supervised by social services—”It was like somebody was spying on us all the time,” is how Mikaela put it. Jonathan was not allowed to attend his brother’s funeral.

Edelyn said she now has two goals: restoring her children and changing how infant death investigations are handled. “I can’t just pick up and go back to normal,” she declared, “not after what my children went through, what Peter and I went through. This nightmare should not happen to another family.”

Peter Yhip told me the ordeal destroyed his own faith in the legal system—”You never imagine something like this could happen to a perfectly innocent family,” he said—but he has learned the power of community. When he and Edelyn realized they were accused of murdering their son, he remembered, “We were numb with disbelief. But so many people rallied around us, it gave us hope. I have more faith in humanity now.”

Yhip FamilyEdelyn is a nurse and Peter is a doctor. They paid off their student loans before starting a family, Edelyn explained in the NCIP video. When they found themselves infertile, Edelyn said, they adopted the infant Mikaela from China in 2005, and then their sons in 2010, when the boys were 18 months old. “Returning from Taiwan with the boys,” she beamed, “We felt like our family was complete.”

They quickly realized, though, that Benjamin had serious medical problems, with recurring infections and a diagnosis of failure to thrive that led to an implanted feeding tube. In the spring of 2012, Edelyn found him not breathing in his bedroom and called 911.

Local press coverage quoted the NCIP about what happened next:

“At the hospital, bone scans showed unchanged abnormalities suggesting a genetic condition, and the neurosurgeon opined Ben had suffered a stroke that caused his collapse,” according to the NCIP. “Ben was put on life support and eventually declared brain dead. Arrangements were made for organ donation.”

Despite Benjamin’s long and complex medical history—including a series of hospitalizations in Taiwan, before he was adopted—the state’s pathologist declared the death a homicide, citing the presence of subdural and retinal hemorrhages, which are two elements of the  “triad,” a pattern of bleeding and swelling inside the infant skull that is commonly attributed to “abusive head trauma,” previously known as “shaken baby syndrome.”

While their children remained in foster care, baffled and terrified, Edelyn Yhip was arrested at the family home, and Dr. Yhip was arrested at his clinic, handcuffed and led out the front door past patients in the waiting room.

The Yhips’ friends and family rallied behind them, setting up a web site and raising money to mount a defense. More than one family put their homes on the line, adding their properties to the bond, so Edelyn and Peter could be out of prison while waiting for trial. The family was reunited about a year after the accusations, when the dependency court found “substantial evidence” that Benjamin had died of medical complications, not criminal assault. Still, the county continued to press its criminal case for five more years, while the NCIP submitted a growing body of medical reports supporting the family’s innocence, as well as court decisions from other disputed shaking cases and the 2018 book, The Forensic Unreliability of the Shaken Baby Syndrome.

“We had a host of heroes in this case,” wrote NCIP attorney Paige Kaneb, who stuck with the case through all those years, in an email announcing the decision to drop the charges. “Great day, long overdue. The best part was after court when the Yhips told their 13-year-old daughter that this is finally over.”

The nightmare is over, but the Yhips are not leaving their experience behind. Both Edelyn and Peter say they hope their case might help move the debate about shaking theory forward, and help other families avoid a nightmare like theirs. “The triad has got to go,” Edelyn insists. “It’s not just the financial toll, it’s the emotional toll it takes on your whole family.”

This week, the Yhips are heading to Atlanta for the annual Innocence Network conference, April 12–13, where they are hoping to connect with other accused and exonerated families. You can contact them at fresh20fishing@gmail.com.

copyright 2019, Sue Luttner

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

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Ohio Decisions Seed Hope

Two decisions this fall in Ohio offer hope for the wrongfully accused, while underscoring both the ironies and the complexities of misguided accusations of child physical abuse. One of them even opens the door to possible legal accountability for the casual over-diagnosis of abuse.

First, the Supreme Court of Ohio has reversed the 2016 assault conviction of child care provider Chantal Thoss.

In December of 2014, Ms. Thoss called 911 for help with a baby who she said had fallen from a couch and was “not acting right.” Doctors at the hospital found no bruises, fractures, or other signs of assault, but did find retinal hemorrhages and both new and old bleeding inside the boy’s skull, evidence of both a recent and a preexisting brain injury.

Early in the investigation, Dr. Randall Schlievert at Mercy Health offered his opinion that the baby had been shaken by his last caretaker before the call for help. Detective Brian Weaver never questioned the presumed timing, and the case proceeded against Ms. Thoss.

According to the court’s summary, Dr. Schlievert explained on the stand “that once the brain is injured, symptoms manifest immediately,” with this concession:

“Schlievert remarked that it is debated in the field whether an older injury can make a child more fragile or more likely to suffer a serious injury from a mild fall later. He noted that many doctors believe that they may have seen such a case, but there is not a single published article that proves that that happens.”

After reading the trial testimony and listening to the 911 call and taped interviews with the babysitter, the three-judge panel declared that a guilty verdict was “against the manifest weight of the evidence.” Noting that they had listened to the same recordings the jury had, the judges offered a different interpretation:

“From those recordings, it is evident to us, acting in this instance as the thirteenth juror, that appellant wholeheartedly believed that she caused injury to E.A. not by shaking him, but by placing him on the couch while retrieving his diaper and by her instinctual response of picking him up off the floor after he had fallen. We could hear the raw emotion in appellant’s voice [emphasis added] as she reported the child’s condition to the 911 operator, the self-condemnation over the decision to briefly leave him unattended on the couch, the genuine surprise upon being informed by Weaver that E.A. had signs of previous injury, and her struggle to understand how this incident produced the injuries suffered by E.A.”

Ms. Thoss has been released from prison. The state has not yet announced whether it will refile charges against her.

A civil case

Meanwhile, Senior District Judge James G. Carr in western Ohio has allowed a civil case against Dr. Schlievert to move forward. Although far from any resolution, the decision is a rare crack in what is usually a solid wall of immunity for physicians who diagnose child abuse.

mopBucketIn September of 2014, day care worker Beth Gokor called her supervisor to report that a 3-year-old boy she was watching couldn’t walk or stand on his own after slipping and falling on a wet linoleum floor.

At the hospital, the boy told a physician’s assistant that he “slipped and fell,” and a co-worker later confirmed Gokor’s report that the floor was wet from a recent mopping. According to police notes, the child’s mother said he had told her he slipped while running.

childRunningCartoonWhen Dr. Randall Schlievert reviewed the records, however, he concluded that the spiral fracture to the boy’s leg must have been an inflicted injury, not an accident—and he recommended challenging the day care’s license because “[c]hildren do not appear to be currently safe there.” Schlievert offered his opinion that the day care was making “improbable statements” and asserted, as if refuting the caretaker’s report, “[JJ] would not have been able to stand.”

Ms. Gokor was fired immediately, and she was later charged with endangering children.

Her defense team hired pediatric radiologist Gregory Shoukimas, who, according to the court summary, not only concluded that the injury was accidental but also noted that Dr. Schlievert’s report was “riddled with errors.”

When prosecutors received the alternative medical report, the state dropped charges against Ms. Gokor, who then filed a civil suit against Dr. Schlievert. The decision this fall rejected a motion by Dr. Schlievert to block that suit, which will presumably now move forward.

A similar suit

Criminal defense attorney Lorin Zaner

Criminal defense attorney Lorin Zaner

Intriguingly, the same judge who gave the green light to the Gokor suit this year blocked a similar suit in 2017, also against Dr. Schlievert and also pressed by criminal defense attorney Lorin Zaner, a veteran of wrongful abuse cases.

The plaintiff in the earlier decision was Molly Blythe, the mother of twin daughters born prematurely, as many twins are. The second-born twin, referenced as “KB,” endured first manual repositioning and ultimately vacuum extraction, emerging with “significant bruising” on  her scalp. At early visits with the pediatrician, the mother expressed ongoing concerns over KB’s frequent vomiting and difficult sleep patterns.

At the age of two months, with her head growing unusually fast, KB was found to have bilateral subdural hematomas and large extra-axial fluid collections. Doctors performed surgery to relieve the brain pressure. The first eye examination, conducted after the surgery, revealed retinal hemorrhages,.

“In the absence of any other explanation, the doctors diagnosed KB with Shaken Baby Syndrome,” the judge’s opinion recounts, and the county hired Dr. Schlievert to perform a formal child abuse assessment. “After reviewing KB’s medical file,” the judge wrote, “Dr. Schlievert concurred in the initial child abuse diagnosis.”

zaner@NormansParty

Mr. Zaner speaking at Dr. Norman Guthkelch’s 100th birthday party, 2015

Mr. Zaner hired a full complement of experts—a neuroradiologist, a diagnostic radiologist, a pediatric opthalmologist with a specialty in retinas, a pediatrician with extensive child abuse experience, and a biomechanics professor. After receiving their reports, which enumerated other possible causes for the findings, the state dropped criminal charges. Rather than engage in further court proceedings, the mother consented to a family court order giving custody of the girls to their maternal grandmother. Then she filed suit against Dr. Schlievert and the county.

In his opinion blocking that suit, Judge Carr emphasized that Dr. Schlievert’s conclusions matched those of the treating physicians:

“The fact that Dr. Schlievert reached nearly identical conclusions supports a determination that his conduct did not ‘shock the conscience’ but rather was a sound medical conclusion based on his review of KB’s medical file.”

In its insistence that Dr. Schlievert was innocent of intentional misdirection, the opinion seems to sanction his apparent decision to finalize his abuse assessment in the case of a 2-month-old preemie without examining the birth records or establishing a clear timeline for the reported findings:

“The complaint does not allege that at the time he provided his February consultative report to CSB [Children’s Services Board], Dr. Schlievert knew about the traumatic birth or that the surgeries had preceded the first, and thus baseline, retinal examination.”

I can understand why the unanimity of opinion among child abuse experts gives the impression that shaking theory is well established—that conclusion, alas, is one of the reasons this fight is so difficult. The problem is that shaking theory was adopted before it was proven scientifically, and the research since that point has been premised on the assumption that convictions and plea bargains prove abuse.

My best hope is that Judge Carr might notice a pattern in the child abuse suits that come through his court. A few popular but unproven tenets of child abuse medicine—that the triad proves shaking, for example, and the symptoms are always immediate, or that spiral fractures mean abuse—continue to derail accurate diagnosis and mar the good work that child abuse physicians otherwise do.

copyright 2018, Sue Luttner

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

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“Why Can’t Uncle Come Home?” – A Book for Families

Author Christiane Joy Allison and illustrator Liz Shine have hit the mark with their engaging and healing children’s book about a relative’s wrongful imprisonment, an offering the author calls “a bittersweet labor of love for both the illustrator and me.”

Why Can’t Uncle Come Home?  addresses the anger, fear, and confusion a child feels when a beloved relative is sent to prison, and it explains how an innocent person might be convicted of a crime. The book succeeds in its own right, but it also fills a need, telling the young relatives of innocent inmates they are not alone.

“I read this book with my 6-year-old grandson. It is a great tool for opening conversation,” posted Vickie Fetterman to a support group for accused families. “He has been so affected by his father’s wrongful conviction.”

Christiane Joy Allison, “CJ” to her friends, knows her subject: Her book chronicles the reactions of her own niece and nephew when her husband, Clayton Allison, was accused and ultimately convicted of murder in the death of his and CJ’s daughter Jocelynn. At the time, while also trying to defend her husband and grieve for her daughter, CJ looked for books to help her young relatives understand what was happening, and found nothing. “I saw a need and I realized I had to fill it,” CJ said in a telephone interview last month. “I didn’t intend to write a children’s book. It just sort of landed on me.”

From the Rasmuson Foundation web site

On-line comments have been effusive. “This beautifully illustrated and accessibly written book fills a hole in the world of literature,” wrote Laura Ojedo in an Amazon review, “A must-read for children, and honestly for people of any age.”

CJ said she was gratified when she read her book recently to school children in her community of Wasilla, Alaska, and found her audience of 5-to-7-year-olds fully engaged. “I felt so blessed when one of the parents pulled me aside afterward and thanked me for tackling the subject, because they just had a friend experience wrongful conviction and felt lost how to explain it.”

When her husband was accused in 2009, CJ and an army of other supporters stepped forward in his defense, and they have stuck with the campaign even after his conviction in 2015.

In the course of the investigation, CJ showed herself both stronger and more ethical than a pair of Alaska state troopers, who thrust grisly autopsy photos in her face, ridiculed her faith in her husband, and misled her during a long and heartless interrogation.

The Allison family’s experience features a number of elements that show up frequently in these cases:

  • a plausible alternative explanation (Clayton reported that the toddler fell down the stairs)
  • a quick diagnosis by physicians unaware of the child’s complex medical history
  • distraught parents subjected to cruel and deceptive interrogation tactics and
  • a tangle of legal rulings that limited what CJ could say at trial

You can follow the family’s struggle through the Free Clayton Allison Facebook page.

The Rasmuson Foundation, which supports artists and non-profits in Alaska, has awarded CJ a grant to publish a follow-up book, Timmy and Kate Go to Visit.

Why Can’t Uncle Come Home? earned honorable mentions for its illustrations and cover design and for its handling of family issues in the 2018 Purple Dragonfly Book Awards from Story Monsters Ink, a magazine about children’s literature for teachers, librarians, and parents.

CJ, a writer by both nature and training, has an MBA in Management & Strategy and a BA in Journalism & Public Communications.

As CJ predicted, Why Can’t Uncle Come Home? is the only children’s book I could find that addresses wrongful conviction. Several books deal with parents in prison, including these titles that have received generally good customer reviews: The Night Dad Went to Jail; Far Apart, Close in Heart; and My Daddy’s in Jail. Customer reviews also give a thumbs-up to Maybe Days, a book written for children entering foster care. The State of New Hampshire publishes this list featuring more titles for children with parents in prison.

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Falsely Accused: Organized Parents in France Earn Credible Coverage

A coalition of wrongly accused parents in France has caught the attention of Le Monde, which Wikipedia calls “one of the most important and widely respected newspapers in the world.”

Association Adikia put up their web site just last month, although some of the members have had a Facebook presence for some time. Last week Le Monde published a letter from key organizers explaining who they are, what the problem is, and what they plan to do.

Here is a Google translation of the published letter:

We are wrongly accused of abusing our children as a result of misdiagnosis”In a tribune in “Le Monde”, a hundred parents testify to their fight, accused of violence on their children while they are suffering from a rare disease. They created the Adikia association to advance their cause to justice.

We are more than a hundred parents wrongly accused of abusing our own children as a result of misdiagnosis. Two and a half years ago, one of us created a Facebook group to tell her story. This is where we found ourselves over the months after experiencing the same dramatic situation.

While we consult pediatric emergencies for our babies who are uncomfortable, doctors detect signs a priori suggestive of abuse. These are mainly fractures, bruises, or bleeding inside the skull and eyes (subdural hematomas and retinal hemorrhages). These last two signs are typical of the “shaken baby syndrome”.

In our case, however, our children have various rare diseases. For example, the son of Virginie (creator of the group) is suffering from hypofibrinogenemia, a rare genetic abnormality of blood coagulation. As indicated by the report of the High Authority of Health on the subject, disorders of coagulation form an important class of differential diagnoses of shaken baby syndrome.

Unjustified accusations

The son of Vanessa (president of the association) is one of the many babies in our association with external hydrocephalus. Clinical studies suggest that this pathology may favor the occurrence of subdural haematomas. Marielle’s daughter has osteogenesis imperfecta, or glass bone disease, which can cause fractures. Emi has hypophosphatasia and her son has bone fragility associated with vitamin D deficiency.

In an emergency, however, doctors must diagnose quickly and act if they feel the child is at risk in their family. They make a report, which leads to the almost automatic placement of our children. They are withdrawn while we are taken into custody and questioned by the police.

As if dealing with the suffering of our babies was not enough, we must also suffer unjustified accusations of abuse. Worse, we must live with the idea that our babies will have to spend the next months or years away from us, when they are sick and need all our love. Their first steps, their first laughs are stolen forever. Strong emotional ties with parents are essential for the neuropsychological development of babies, as pediatrician Catherine Gueguen has shown. We have all had suicidal thoughts, but we must absolutely stand firm for our children.

The placements end when the juvenile judges finally feel that we are not dangerous. In a way that is difficult to understand, we are criminally prosecuted when the judicial expertises are carried out. Specialized maltreatment doctors seem to validate the violence systematically, even in the presence of rare and unknown diseases. We have a hard time getting specialists in rare diseases to do their own expertise, even more when the medical records of our children are seized by the courts!

The example of the little Luqman is characteristic. At 16 months, he spent 13 away from his parents. More than a year ago, he had hemorrhaging leading to a diagnosis of shaken baby syndrome. An extremely severe vitamin K deficiency (necessary for blood clotting) was quickly detected. It appeared later that Luqman had abetalipoproteinemia, a rare genetic disease that could cause such a deficit. According to several doctors, this disease could explain the symptoms.

Shaken baby syndrome

Today, Luqman is still placed, and his parents are indicted. For the legal experts who have access to the whole file, the signs presented are characteristic of shaken baby syndrome and the diagnosis of abuse is therefore certain. Can we really be certain that this disease, which affects less than one in a million babies, can not cause subdural haematomas and retinal hemorrhages?

We have trouble making it clear to the various speakers that the words of doctors and experts never have absolute truth. We must all show the greatest humility before the complexity of the human body. We do not know everything about medicine, far from it.

We have created our association – Adikia – to support and inform those unfairly accused, to make our testimonies known to the public, and to gain more weight in court. We would like doctors to take every precaution, as far as possible, and for the judges to consider all the elements of the files. Decisions as serious as long-term placements or prison sentences must not be made solely on the basis of medical evidence, however clear and categorical.

We would also like to be involved in improving the reporting and diagnosis criteria for suspicion of abuse. Our goal is to avoid unfounded accusations and unjustified placements as much as possible while respecting the sound and indispensable principle of child protection.

Virginie Skibinski and Vanessa Keryhuel, for the Adikia association.

Association Adikia had already reached out to other parents’ organizations, including Protecting Innocent Families in the U.S., which now shares the logo created for them all by Italian artist Chiara Zini. For more of Zini’s work, see the beautiful and touching site una Mamma, un Papá.

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

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Shaking Accusations Gone Wrong

The interrogation

A series of legal developments in the past few weeks highlights the devastating effects of misguided abuse diagnoses on innocent families.

In Sacramento, California, father Jesus Flores was found innocent in June of shaking his son Mason, but despite the verdict, Mason is being adopted by another family. Flores lost parental rights during the years he spent in jail awaiting trial.

The child’s mother, Sara Guzman, also lost custody, ironically because she refused to believe that Flores had injured their son. Reporter Lois Henry quoted Guzman in the Bakersfield Californian:

“They told me the only thing messing me up from getting Mason back was that I stood by Jessie (Jesus),” Guzman said. “They said I needed to go against him. But that wasn’t right. I knew he wasn’t the kind of man who would ever hurt his baby.”

After watching video of the police interview, reporter Henry disputed statements from both the diagnosing doctor and the detective that Flores had confessed to shaking his son. Henry wrote:

Flores uses a doll to show detectives how he rocked Mason earlier in the day to try and comfort him.

In the video, Flores cradles the doll, supporting its head and rocks him back and forth.

He tearfully asks if that could have been what hurt his son?

“Could that have caused it?” he asks over and over. “If it did, then I’m the worst father…”

One of the detectives would later testify that Flores demonstrated shaking the doll, causing its head to violently snap back and forth.

Not even close. (See video at bakersfield.com)

The reporter is right: Not even close. Check the video. The detective hands the doll to Flores at 12:03:38 am on March 22, 2015, and 15 seconds later Flores demonstrates the motion he will repeat through the rest of the interview—which I would call more up-and-down than back-and-forth, but certainly not violent.

The jurors who found Flores innocent heard about Mason’s complex medical history, and the new brain bleeds that appeared while the boy was in the hospital and then again in foster care. On the interrogation tape, however, long before anyone had looked at past medical records, the detectives never waver from confidence in the father’s guilt. Ignoring Flores’s obvious pain and confusion, they reject his story again and again, prodding him to quit lying and “accept responsibility.” Even when he breaks down and accepts their accusations, Flores says only that he “might have” rocked the boy harder than he realized, he doesn’t remember.

Another disturbing video was released last week in Detroit, showing a father’s pain at learning that his daughter had died—information he heard in open court when he was charged with her rape and murder. (On the page with the print coverage, scroll down to the second large graphic for the video.) James Lee Saltmarshall, 22, has now been released, after an autopsy disproved the medical findings that had triggered the charges against him. The video treatment includes a from-the-heart statement from Saltmarshall’s attorney:

“You have somebody charged with the most salacious thing you can charge him with, the worst thing, raping and killing his infant daughter. And now it’s a big ‘Oops’?…

“How do you fix it? I don’t know.”

In South Carolina, meanwhile, Wayne County dropped charges against an accused father who’d been in jail for two years—and indicted the babysitter instead. As summarized by reporter Angie Jackson in The Post and Courier:

Eugene Anthony Wright, 49, was initially charged with homicide by child abuse. At the time of his daughter’s death, he was accused of slamming her to the floor in his Dorchester Gardens apartment in North Charleston.

The Attorney General’s Office said after further investigation, it was determined that Wright could not have committed the crime and the charge has been dismissed.

The indictment of the babysitter, Jackson wrote, “does not detail the evidence against her.” I speculate that the key point is whether the effects of a serious pediatric head injury are or are not immediately obvious, a question still under debate in the journals and in the courtroom, along with the potential for serious injury in short household falls. Earlier coverage of the case seemed to put the father at the scene, but it’s hard to know the story from what’s available.

In a long-lingering case in California, foster mother Jovannee Reynolds has been sentenced to four years of probation, after a plea bargain in which she “took responsibility” for the death seven years ago of a days-old baby named Mikayla who quit breathing in her care.

Reporter Pablo Lopez wrote in the Fresno Bee:

On Friday, [defense attorney Curtis] Sok told the judge that the case took seven years because it turned into a battle of medical experts – one who said Mikayla died of shaken-baby syndrome and two who suggested she suffered her fatal injury in her mother’s womb.

Reynolds had told police she had “patted the baby on the back” when the little girl seemed to be having trouble breathing. Reynolds was originally charged with murder, but the plea agreement reduced that to manslaughter. According to the Bee coverage, prosecutor Christopher Gularte gave this explanation:

Because of the conflicting medical opinions, Gularte told [the judge] that the prosecution could not prove the murder charge. Instead, Gularte said both sides settled on the manslaughter charge because of Reynolds’ admission to police about patting the baby on her back. In essence, her use of force in patting the child was more than a reasonable person would do.

While I am pleased that Ms. Reynolds will face no jail time, I am sobered that the county insisted on pressing charges against her, and that the act of patting a baby on the back when it’s struggling to breathe has been declared manslaughter. Ms. Reynolds and her husband had started caring for Mikayla about a week before the child’s collapse, when she was only five or six days old, after her mother, a known drug user, had tested positive for methamphetamine. I’m guessing there were no actual signs of trauma, just the brain findings, or the news reports would mention them.

Updates

The Medill Justice Project has published a poignant look at the effects of his mother’s incarceration on the son of child care provider Jennifer Del Prete, released in 2014, after a successful appeal of her 2005 conviction.

A Florida court has agreed to hear an appeal by the Innocence Project of Florida on behalf of child care provider Stephanie Spurgeon, in prison on a manslaughter conviction in a shaking case. She the Tampa Bay Times coverage.

copyright 2017, Sue Luttner

If you are not familiar with the debate about shaken baby theory, please see the home page of this blog.

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Shaken Baby Theory: Poking the Hornet’s Nest

The July issue of Acta Paediatrica offers a collection of free, live links to a volley of rebuttals published over the past four months to an article in March submitted by medical ethicist Dr. Niels Lynøe and most of the other experts who informed the 2016 Swedish report critical of shaking theory, commissioned by a government agency whose name is abbreviated SBU.

In an email exchange last week, Dr. Lynøe wrote that his team knew the topic was controversial, but they were “rather surprised” at the vehemence of the criticisms. “I also think that there was something positive with the critical comments,” he added, “because we got the opportunity to explain and explore some aspects more.”

Dr. Niels Lynøe

The March paper reported on the same research as the SBU study, an exhaustive evaluation of the shaken baby literature that ultimately declared the scientific evidence behind shaking theory “weak.” The analysis noted fundamental problems with the bulk of the published research—in a typical study design, the report noted, researchers had applied the criteria they were attempting to prove when identifying and sorting their subjects, so the results necessarily supported their theory.

Weeks after the Lynøe et al. paper appeared, Acta Paediatrica published an editorial  by epidemiology professor Jonas F. Ludvigsson criticizing  the SBU’s methods and warning of an “imminent risk” that the paper will discourage the reporting of child abuse and leave abused children undiagnosed. Dr. Ludvigsson conceded quality problems with past SBS research, but rejected the SBU’s conclusions and endorsed reliance on the triad:

“[The study’s] publication in Acta Paediatrica does not spell the end of the discussion. Instead, it is a clear signal that more research is needed. But for now, paediatricians should continue to alert social services when they observe a child with the triad, once other explanations for subdural haematomas, retinal haemorrhages and brain ischaemia and oedema have been ruled out.”

The next critique of Lynøe et al., in mid April, added irony to the collection by denying the triad itself. An editorial by violence and abuse specialist Dr. Steven Lucas and others charged that the SBU’s methods had become “untethered from the agency’s published methodology” and argued that the study was fundamentally flawed, because it had examined the question of whether the presence of the triad proves infant shaking. Lucas et al. wrote:

“The construct of the ‘triad’ represents a rhetorical fallacy known as a straw man, which gives the impression of refuting an opponent’s argument – the ‘triad’ is pathognomonic for AHT – when, in fact, that argument was never advanced by that opponent. We maintain that the term ‘triad’ carries no value for clinicians experienced in evaluating suspected AHT.”

In refutation of the straw man argument, I point out that both Joshua Burns and Michelle Heale were convicted based only on the opinion of child abuse experts that the triad proves abusive head trauma—these cases are not unique, only easy to reference here. I myself have researched dozens of convictions based on the triad, sometimes on only one or two elements of the triad.

Lynøe et al. addressed the straw man argument in a response to a different criticism (the response to Narang et al.), by quoting these physician guidelines, which clearly endorse the triad:

“If there is no history of traffic accident or fall from a considerable height, the combination of subdural hematoma and encephalopathy with edema or hemorrhage strongly suggest that the infant has been abused. If there are also retinal hemorrhages then from the medical point of view the diagnosis of abuse is quite clear.”

Also in April, Acta Paediatrica published an editorial by pediatric ophthalmologist Dr. Alex Levin, who declared, “There is a plethora of scientific evidence that retinal hemorrhages are a cardinal feature of abusive head trauma.” Among other objections to the study, he criticized the SBU’s failure to consider the various possible sizes and locations of retinal hemorrhages. “To ignore these descriptors,” he wrote, “is like saying that a rose is no different than any other ‘flower.'”

Dr. Levin also objected that the SBU team had ignored the “wealth of clinical experience” available from the community of child abuse experts.  He argued that certain retinal findings, even in the absence of any other evidence, should shift the assumption to one of abuse:

“A diagnosis of abuse should not be made solely based on retinal haemorrhages, but certain retinal findings make that likelihood dramatically high, so high that one must actively seek (or rule out) supportive evidence that the child has been abused and is in need of protection.”

Another commentary in the April issue, by eye and vision specialist Dr. Kerstin Hellgren and others, called the SBU report “misleading.” In an apparent endorsement of both the triad and the literature that supports it, the authors wrote:

“The SBU report concludes that there is only limited evidence that shaking of an infant can cause the triad signs, in contrast with the numerous reports describing such lesions in victims of verified shaking. It is unfortunate that the SBU panel neither included a paediatrician nor a paediatric ophthalmologist with experience of child abuse to facilitate a correct interpretation of the cited papers.”

In a response to both Levin and Hellgren et al., the Lynøe authors reiterated their commitment to objectivity:

“If physicians involved in child protection teams embraced the research question as if it was a generally accepted scientific fact when classifying cases and controls, this would have resulted in circular reasoning when estimating the diagnostic accuracy of the triad. For that reason, and in order to avoid conflicts of interest and circular reasoning, the expert panel did not include any experts associated with child protection teams. The panel comprised two paediatricians and one expert each from the fields of forensic medicine, radiology, epidemiology and medical ethics. All the included had long experience of assessing scientific work and were scrutinised for potential conflicts of interest and cleared by the Agency. The expert panel followed the guidance in handbooks for assessing health technology and any other panel reproducing the study would have probably arrived at the same conclusions.”

In May, Dr. Sandeep Narang and Dr. Christopher Greeley, both renowned child abuse specialists, published a column in the Acta Paeditrica series “A Different View” that lambasted the methodology, objectivity, and transparency of the SBU study. Like Lucas et al., Narang and Greeley declared the triad a “strawman,” with the statement:

“Physicians experienced in the clinical evaluation of paediatric traumatic brain injury and AHT do not diagnose SBS by a ‘triad’.”

Narang and Greeley also found it “troubling” that the SBU panel “was offered and refused external peer review by no fewer than seven international professional medical societies” before the publication of their report, and charged that the panel was biased in two ways:

  • One of the SBU panelists had testified before the highest court in Sweden, prior to the study, that “the diagnostic model of the ‘triad’ for diagnosing SBS ‘has been criticised’, and that ‘there is currently no clarity about the extent to which the components of the triad are specific to violent shaking’.”
  • A former chair of the SBU had also testified in the same case, and “has openly expressed scepticism of the diagnosis of AHT because of his personal experiences with a family member being criminally charged in a suspected shaken baby case.”

Another “Different View” column published in May, by Dr. Robert A.C. Bilo and others, focused specifically on the papers used to support the study’s conclusion that the triad had many “alternative explanations.” Bilo et al. rejected the cases and papers cited in support of these explanations, with three main arguments:

  • many of the cases would never have been diagnosed as abuse, because the children clearly suffered other medical conditions
  • some of the cases did not fully conform to the triad
  • some of the cases were in fact abuse misrepresented as organic causes

Like other critics, including Lucas et al., the Bilo authors accused the SBU of applying a double standard, because the reviewers accepted individual case reports as evidence for other causes, while they rejected studies with fewer than 10 cases from their main literature review.

Lynøe et al. clarified in their response that the papers cited as evidence for other causes had simply emerged during their literature review, and had been rejected from the main study for the same reasons as many others. They explained:

“From an epidemiological point of view, and due to random fluctuations, studies with less than 10 study cases are of very limited value. But when looking for differential diagnoses, one single case is sufficient to question the general assumption that when the triad is present the infant must have been violently shaken.”

The original study had addressed the question:

With what certainty can it be claimed that the triad, subdural hematoma, retinal hemorrhages and encephalopathy, is attributable to isolated traumatic shaking (i.e. when no external signs of trauma are present)?

The Acta Paediatrica treatment articulated the answer in two, subtly different conclusions. First:

“[T]here is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).”

That is, the literature supporting the opinion that the presence of the triad proves a child was shaken is “insufficient,” because none of the papers supporting that opinion ranked above “very low-quality.” Second:

“[T]here is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking (low-quality evidence).”

That is, the researchers found some low-quality papers supporting the opinion that traumatic shaking causes the triad—two French papers based on confessions—but no medium- or high-quality papers. Before reaching their conclusions, the authors had read and evaluated 1,000 academic papers, only 30 of which met their inclusion criteria. They ranked 28 of those 30 papers as having a “high risk of bias,” 2 of them as having a “moderate risk,” and none of them as having a “low risk” of bias (a flow chart illustrating the literature search).

In an over-reaching answer to their many critics, the Lynøe team called for a more scientific approach to research in the arena:

“We acknowledge the concerns expressed by all of the authors who responded with regard to child welfare and the possibility that the diagnoses may be delayed in individual cases of child abuse. However, we are very troubled by the disregard displayed by those authors to the significant methodological problems inherent in published research on shaken baby syndrome. With the exception of Ludvigsson, none of these authors expressed concern about the problems of circular reasoning, lack of comparison groups or the other methodological problems we identified in the systematic review. Where has all the critical thinking in research gone?…

“The purpose of a systematic review is to examine the quality of published research. With that in mind, please accept the substantial difficulties and limitations of previous research carried out by the ‘shaken baby syndrome’ and ‘abusive head trauma’ and help to add true knowledge by performing better research that overcomes the methodological problems.”

copyright 2017, Sue Luttner

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

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Filed under AHT, shaken baby syndrome, Uncategorized

Steps Forward, Steps Backward, Part II

The second half of a posting started on March 7

Re-creation of the reported fall

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:

“Well actually, going down stairs is not a single fall down, for example, ten feet. It is ten individual falls down a single foot, so there’s not the long distance fall that you would expect.”

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.

cottonwoodaz

Cottonwood, Arizona

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.

Sam Stone

Sam Stone

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

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Filed under abusive head trauma, AHT, parents accused