November 15, 2012 · 5:49 pm

Old Theories Die Hard

The Wrongful Convictions blog has pointed out a careful and well-researched article by Michael Barajas at the San Antonio Current, featuring four women found guilty in 1997 and 1998 of aggravated sexual assault on two sisters, 7 and 9 years old at the time. During a week-long visit with their aunt, prosecutors said, in between trips to the pool and to Walmart, the girls had been held down by the women and raped repeatedly with small objects: syringes, vials of white powder, a gun.

Two years ago the Innocence Project of Texas took up the cases of the “San Antonio Four,” a group of friends who have maintained their innocence throughout long prison terms. One of the presumed victims, now an adult, has recanted her tale, which she says was coerced by her father after the visit.

Dr. Nancy Kellogg, head of the child-abuse unit at the Univeristy of Texas Health Science Center, testified during the trials that the thickness of the sisters’ hymens was a sign of trauma, and that reddening of the younger girl’s hymen was evidence of assault and a white line on the older girl’s was a scar. While child-abuse experts once taught that such findings resulted from sexual encounters, by the late 1990s methodical clinical examinations had revealed that normal hymens come in all shapes and sizes, with features that include streaks, fringes, bumps, and even perforations. The findings listed in Kellogg’s reports  are now considered “normal,” as they were by most experts at the time of the trial.

Outside the jury’s hearing, Dr. Kellogg had also testified that the unusual situation of multiple female perpetrators made her think it was a case of Satanic ritual abuse. Like Dr. Kellogg’s opinions on pre-adolescent genitalia, belief in child sexual abuse by Satanic cults had also been discredited by 1997:  In 1991, FBI special agent Kenneth Lanning published a landmark statement in the journal Child Abuse and Neglect, in which he reflected on eight years of looking unsuccessfully for evidence of the bloody rituals commonly reported in cult-abuse cases. Lanning’s objection was that child sexual abuse is a real problem, and blaming it on elusive cults wastes resources and impedes the credibility of the child-protection movement.  For my own research into this arena, see chapter 3 of my upcoming book.

Dr. Kellog was and is an active and respected member of the child-protection community, as chronicled on her UT faculty web profile. She was the lead author on the 2007 clinical report from the American Academy of Pediatrics Committee on Child Abuse and Neglect, “Evaluation of Suspected Child Physical Abuse,” published in the journal Pediatrics and quoted regularly. I’m thinking it’s a safe bet that she had read Lanning’s work at the time of her 1997 testimony, and I conclude she had not yet abandoned her faith in the reality of Satanic ritual abuse.

Looking for the silver lining in all this, I propose that the same reluctance to change one’s mind is at work in the shaken baby syndrome debacle. In the 1980s, a wave of pre-school teachers and other caretakers went to jail based on bizarre and lurid tales of cult abuse, and uncounted pre-schools simply closed as the witch hunts spread. Now the Innocence Project of Texas is revisiting one of the last convictions based on medical and social beliefs that were accepted at the time but have since been abandoned. I fear that the misconceptions about shaken baby syndrome will be harder to overcome, both because the concept is more plausible than human sacrifices in secret underground tunnels and because the convictions have been going on for so long that the theory seems to its adherents to have been proven.

The good news since the 1980s is two-fold:  First, there is an Innocence Project of Texas willing to re-open these cases in San Antonio, which, like shaken baby prosecutions, hinged on sincere but unproven medical opinion. Second, the community of child-protection experts has changed course in the past, even after sending people to prison on the basis of accepted but flawed common knowledge.

It won’t be easy, but I’m hoping they can do it again.

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

-Sue Luttner

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November 6, 2012 · 4:49 pm

Witnessed Shaking: Reports and Reflections

Police in Concord, New Hampshire, reported last week that a woman had brought them a 3-month-old baby whom she had seen being shaken. According to  WMUR, Channel 9, police took the child to the hospital, where doctors found bruising on the child’s ribs but apparently no brain injuries. The Union Leader coverage adds that the witness is not the child’s mother.

This case prompted a colleague of mine to pull out her notes from a talk given in 1996 at the First National Conference on Shaken Baby Syndrome, in Salt Lake City, Utah, by a team from from the Children’s Hospitals and Clinics of Minnesota.

With pediatrician Dr. Carolyn Levitt, case director Julie Pape had collected 12 cases in which children under the age of two were brought to the child-protection team for evaluation after witnesses reported seeing them shaken. These children were examined not because of physical signs or symptoms, Pape emphasized, but because of the witnessed assault. “Those people who were observing the events felt as though that episode of shaking had to be significant enough or violent enough to cause injury in the child.”

All of the children had complete skeletal x-rays, and six of them had both CT scans and retinal exams:  No subdural hematomas, brain swelling, or retinal hemorrhages were found in any of the children, although bruises and fractures were found in some.

The cases:

  • A 19-year-old uncle left alone with a 7-week-old told the child’s mother that he had shaken the baby. He reported shaking the infant four or five times, after which “he became scared, because he thought that he may have injured the baby.” The only physical finding was a bruise on the child’s ankle, which the uncle acknowledged he may have caused when he picked up the baby.
  • A suicidal teen-aged mother reported shaking her 5-month-old son. Examination revealed old soft-tissue injuries, some bruising, and a burn.
  • An employee at a juvenile residential home reported seeing a young mother shake her 6-week-old daughter. A bone scan revealed three leg fractures but the CT scan and retinal exam were negative.
  • A bank teller reported seeing a mother shake her 12-month-old daughter in a stroller. Doctors found no broken bones or soft-tissue damage.
  • A mother brought her 17-month-old daughter to the clinic with a report that she had seen the biological father shake and spank the girl. The skeletal survey was negative, and old bruises were inconclusive for abuse.
  • A single mother called her own father and told him she had shaken her 8-month-old daugher, in her walker. The grandfather called the child’s pediatrician, who reported the case to CPS. A skeletal exam, a CT scan, and a retinal exam produced no physical findings.
  • A mother reported she had seen the father of her 4-month-old son shake the infant. The father’s hands were around the child’s rib cage, she said, and the boy’s head was “bobbing back and forth.” The skeletal, CT, and retinal exams were all negative.
  • During a hospital visit for a burn injury, the mother of an 11-month-old patient reported that she had seen the boy’s father shake him 10 months earlier, when the infant was one month old. The skeletal survey, CT scan, and retinal exam were negative, but the boy had some soft tissue injury.
  • A mother brought in her 17-month-old daughter after a visitation with the girl’s father, because of bruises. The grandparents reported that they had seen the father shaking the girl on previous occasions. A skeletal survey revealed healing  arm and leg fractures.
  • The paternal grandparents of a 17-month-old boy and a 5-month-old girl called CPS to say they’d seen the children’s mother shaking them and throwing them onto the couch while the three were visiting. The children were removed from the mother at the AMTRAK station. Skeletal surveys showed no fractures, and doctors found no bruising.
  • A mother reported seeing the father of her 9-month-old daughter shake the little girl during an argument that also involved a gun to the mother’s head. The child protection team did a skeletal survey, head CT, and retinal exam, “and as is consistent with many of the other kids in this study, we did not find any physical findings,” Pape reported.

None of the 12 children was admitted to the hospital, although one returned for a follow-up bone scan.

Noting that “children who have a history of being shaken do not always sustain physical injury,” Pape advocated a “consistent medical approach” to these cases, as further examination did uncover evidence of past abuse in some cases.

“We also need to listen to these histories and not ignore them,” Pape said. “If a parent is saying, or if anyone is saying, that they have witnessed an act that is violent enough that they think this child could be injured, we need to pay attention to that. And that’s not necessarily because we think these might be shaken babies, because obviously we are learning that this is not how children who are diagnosed with SBS present. However, these children might be children who are battered and at risk.”

Also, if these really are shaken babies, Pape clarified, “We don’t want these children to go on and then have physical findings because someone may have shaken this child and then decided that if I shook the child this hard and it didn’t have physical findings then it should be OK.”

This study doesn’t seem to have been published, and I haven’t seen anything like it in the literature. As far as I know, there have been no witnessed shakings that were followed by findings of brain swelling and brain bleeding. If anyone knows of one, please leave a comment.

I’ve seen nanny-cam footage of violent treatment that seems to include shaking (this YouTube video, for example [now deleted], and this footage from India [also deleted], and news reports of the resulting prosecutions (like this one).  Has any of these cases ever resulted in the triad?

Curiouser and curiouser.

Spring 2014 update:   Although I’m not comfortable with how the nurse is handling the baby in this murky report from Tomo News, it doesn’t look as violent to me as the narrator and commenters describe.

Fall 2015 update: An Alabama television station reports that a day care worker was fired after a parent saw her shaking a toddler via an on-line video feed. Doctors found no injuries.

Winter 2016-17:  Two more reported cases of witnessed shaking with no injury:

Winter 2018-19: Alas, I’ve had to delete quite a few links to surprising and unsettling videos no longer on line—all resulting in no injuries. But we have two new entries:

copyright 2012, Sue Luttner

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

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November 6, 2012 · 11:05 am

A Word From the Hangbin and Ying Li Rescue Committee

The second-degree murder trial of Hangbin Li, the immigrant father in the news last month for turning down a generous plea bargain,  has been postponed due to the storms in New York, but is now scheduled for later this week.

Mid-November update: The trial is now scheduled for January, 2013.

Hangbin Li and his common-law wife Ying Li were accused of shaking their daughter Annie to death in 2008. While the couple has spent years in jail, denying the charges and waiting for trial, their community has rallied around them. Now their friend Michael Chu has released a statement of support, which he hopes to distribute widely before trial, on behalf of the Hangbin and Ying Li Rescue Committee:

Shaken Baby Syndrome Accusations:
A Modern Day Witch Hunt?

Abuse of children is a real problem. People who commit the crime deserve the full fury of law. However, it is very important that evidence based science instead of the old SBS dogma be used in distinguishing cases where abuse actually occurs as opposed to trauma occurring for other reasons. In the Li’s case, 5 months after the passing away of their beloved daughter Annie, and still in deep bereavement over the loss of their beloved child, Hangbin and Ying were incarcerated, not knowing why.

Last month (October), which is almost 5 years after their initial incarceration, Hangbin was offered a plea bargain which was really tempting. This poor young man was offered the choice of immediate freedom at the price of his innocence. The mental torture he suffered was inhumane. “To be or not to be, that is the question.” He called family members, supporters and friends for advice. He asked me and my wife, “If I were your son, what would you tell me?” We cried. Oh God, what this man has suffered I would not wish my worst enemy to go through.

Finally, Hang Bin made a decision. While he almost ended up accepting the offer, a sudden idea struck him. As a victim of false SBS allegations, he felt that no one else should suffer as he did. From various literatures, he had learned that the number of people who have been wrongly accused of SBS is far more than he imagined. He started to ask himself these questions: Does this (false allegation/conviction) have to go on and on? Why do I have to admit to something I did not do? Do innocent people have to be accused and convicted of something they have not done and do nothing about it? On top of that, he has already lost Annie; he can’t afford to lose Ying and his second daughter Angela (he will be deported when the court releases him if he admits to any charge against him). They are the love of his life.

Baby Annie was born with mutated gene and had spent her first few days in the NICU. In a DNA test done on Annie’s tissue a couple of months back, defective gene relating to OI (Osteogenesis Imperfecta) had been detected. “ It would be important to understand other inherited conditions in Annie’s family that might have created a situation that looked like shaken baby syndrome but was in fact, attributed to something else,” said Dr. Sessions Cole, director of newborn medicine at St. Louis Children’s Hospital.

If one would just spend some time researching the SBS literature and talk to the wrongly accused in depth, he/she will be taken aback at the absurdity of the triad based SBS assumptions which the prosecutors resorted to in the conviction of many parents/caregivers. You can’t help but ask one question again and again: Given the wide array of solid scientific research that questions the validity of SBS theory, why does the judicial system still choose to turn a deaf ear to evidence based science? Even former supporters of the SBS theory such as the renowned Dr. Norman Guthkelch and Dr. Patrick Barnes, are now advising caution before choosing a SBS diagnosis. Dr. Guthkelch is credited with founding the syndrome in 1971.

How can the criminal justice system and law enforcement officers, hold high the banner of justice on one hand, but on the other, refuse to look at truth? How many ears must one law officer have before he can hear innocent people cry? How many wrongful imprisonments will it take till he knows that too many people have been falsely convicted? This is a very serious question that every concerned citizen should think about. The protection of children is a measure of society’s progress. There are people who abuse children. They should be given the gravest penalty that the law allows. But do we have the right to punish the innocent just because we know that there are heinous child abusers out there so that scarifying the innocent can be justified in the name of protecting children? A humanistic society should not allow that.

We need a rigid diagnostic protocol to be applied to SBS cases to prevent medical professionals from jumping to conclusions as soon as they see the 3 symptoms of shaken baby syndrome. Dr. Guthkelch says it’s time to get all interested parties together to get them to agree on what can be said with scientific certainty about shaken baby syndrome. How much longer do we have to wait until this is accomplished? The sword of Damocles could fall on anyone as long as the triad based diagnosis is allowed to reign supreme.

Hangbin & Ying Li Rescue Committee/Michael Chu

For more information on this case, see the New York Times coverage from last winter, at http://www.nytimes.com/2012/01/15/nyregion/what-happened-to-baby-annie.html?pagewanted=1&_r=2&sq=li%20hangbin&st=cse&scp=1

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October 29, 2012 · 3:24 pm

Case Dismissed Against Drayton Witt

Drayton Witt and his wife, after his release in the spring

The Arizona Superior Court dismissed charges today against Drayton Witt, convicted in 2002 of second-degree murder in the death of his son Steven, the Arizona Justice Project has announced.

As reported in the Arizona Republic in September, Steven Witt suffered a short lifetime of health challenges, starting with breathing problems at birth and including unexplained seizures that had him hospitalized for a week when he was four months old. At five months, he suffered another seizure while in the care of his father and collapsed.

Despite Steven’s health history, doctors at the Phoenix Children’s Hospital insisted that bleeding and swelling found in the boy’s brain meant he’d been abused, and Drayton Witt was convicted of second-degree murder. The Arizona Justice Project took up his case in 2008, under the leadership of attorney Carrie Sperling.

In the spring of 2012, Witt’s legal team petitioned successfully to vacate his conviction. The state did not oppose that decision, but began moving to retry the case. Then last week the district attorney’s office filed a motion to dismiss the charges without prejudice. This morning the court approved that motion, but specified that the dismissal was “with prejudice,” meaning that the state is barred from pressing this case again.

I wrote a bit more about this case earlier in the year, in this post.

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October 25, 2012 · 12:41 pm

Accused Father Rejects Plea, Insists He’s Innocent

An immigrant father from Queens has made news by turning down a plea offer that would have allowed his immediate release from jail, after more than four years on Riker’s Island waiting for trial. Li Hangbin says his daughter Annie, 70 days old when she died in 2008, seemed to choke on a bottle and quit breathing in his arms. The proseuction says he shook and slammed the little girl to death.

The plea agreement would have required Li Hangbin to plead guilty to reckless endangerment. Rejecting the plea means he will be tried for second-degree murder instead.

Remarkably, the agreement would also have meant that second-degree manslaughter charges would be dropped against Annie’s mother, Li Ying.

According to the report in yesterday’s New York Times, Annie’s mother supports his decision. The good news in yesterday’s report is that Li Ying is now out on bail, as reported in March. The couple’s other daughter, born after her mother was imprisoned in 2008, remains in the custody of the couple’s friend and former landlady.

As described in last January’s New York Time coverage of the case, the Lis have enjoyed the support of their community throughout their ordeal; supporters report that genetic tests have actually exonerated the family.

You can follow the unfolding story at this web site:  http://ny121asil.wordpress.com/2012/01/15/please-help-this-couple-genetic-conditions-vs-shaken-baby-syndrome/

2013 Update:  Hang Bin Li was found guilty of manslaughter and sentenced to 5 to 15 years.

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October 18, 2012 · 2:13 pm

Separating the Sheep From the Wolves

Gray fox at a wildlife rescue center in Lafayette, CA

I have returned sobered from the Twelfth International Conference on Shaken Baby Syndrome/Abusive Head Trauma, Sept 29–Oct 1 in Boston.

Dr. Robert Block, President of the American Academy of Pediatrics (AAP), opened the conference with an address titled “While We Argue, Children Die:  The Consequences of Misinformation,” arguing that the press has been getting it wrong by reporting that shaken baby syndrome is now in doubt.

If the number of shaking diagnoses is not decreasing, Block said, then “the assertion that there has been a significant shift in medical opinion and medical thinking is false and it is not supported in basis of fact.”

Block protested that an upcoming law-journal article misrepresents the intent of the 2009 AAP position statement recommending that doctors drop the term “Shaken Baby Syndrome” in favor of “Abusive Head Trauma.” The goal of the new name, Block said, was “not to detract from shaking as a mechanism of abusive head trauma as much as to broaden the terminology to account for the multitude of primary and secondary injuries that result from abusive head trauma.”

The article Block cited—“Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence:  Getting It Right”—was written by law professors Keith Findley and David Moran, with pediatric radiologist Patrick Barnes and pediatric neuropathologist Waney Squier, in response to an earlier article in the same journal —“A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome“—by pediatrician, attorney, and pediatrics professor Sandeep Narang. Dr. Narang had proposed in that piece, as he did again at the Boston conference, that the diagnosis of child abuse is best left to the experts who have devoted their careers to studying it.*

Like Dr. Narang, Block emphasized the importance of clinical experience. The experts have seen “thousands and thousands of children, of all ages, in all stages of health, from perfectly healthy to perfectly dead,” Block said, “Without that experience one cannot understand, get involved in, begin or end that science that we so desperately need.”

Arguing that child-protection doctors are forced to spend their time fighting baseless attacks, Block asked, “Can the media, and the folks who feed the media, be held responsible for injuries to, and deaths of, children?”

Block encouraged the building of multi-disciplinary bridges, where physicians from different specialties can share experiences and learn from each other. Conversation is difficult “with people who are emotionally invested,” he said, and he would welcome the entry of the Institute of Medicine and the National Academy of Sciences into the arena.

Monday morning’s keynote address—”A Wolf in Sheep’s Clothing:  Denialism in Child Abuse Pediatrics” by Dr. Christopher Greeley, professor of pediatrics at the University of Texas Health Science Center—reaffirmed that there is no disagreement within the medical community about abusive head trauma.

“I believe this not to be a medical debate,” Dr. Greeley opened, but “a legal debate with a white coat on.”

Greeley proposed that critics of the known science behind shaken baby syndrome have fallen for the allure of their own personal narratives. “They think, ‘This is Galileo trying to prove his case to the people,'” he explained. “They think, ‘I have this knowledge and it’s being squashed by misguided authority.'”

Alluring at it is, that narrative is false, he said. “Are we the overbearing establishment? Is Dr. Block our pope?”

Dr. Greeley characterized those who question SBS theory as denialists, and he outlined their tactics:

  • Manufacture of doubt—emphasizing small areas of disagreement to give the impression of fundamental flaws
  • Identification of conspiracies
  • Creation of impossible expectations—demanding that the child abuse literature  provide the same kind of evidence produced by drug trials, for example
  • Use of fake experts
  • Misrepresentation and logical fallacies—the “straw man,” for example
  • Selectivity of citation

Dr. Greeley’s slide show of media denialism included offerings from major news outlets (the 2008 Discover magazine piece by Mark Anderson, Prof. Deborah Tuerkheimer’s 2010 New York Times op ed, Emily Bazelon’s New York Times Magazine cover story, and the Frontline/ProPublica/NPR critique of child death investigations) as well as small internet voices (the Medill Innocence Project, MedicalMisdiagnosisResesarch, Medical Veritas [which seems to be an anti-vaccine organization], this blog, and the EBMSI conferences), plus a radio commentary by Phyllis Schlafly.

In the professional arena, Dr. Greeley lambasted the 2003  literature review by Dr. Mark Donohoe, “Evidence-Based Medicine and Shaken Baby Syndrome,” which had concluded that “the commonly held opinion that the finding of subdural hematoma and retinal hemorrhage in an infant was strong evidence of SBS was unsustainable, at least from the medical literature.”

Donohoe had searched the Biomednet Medline database using only the phrase “Shaken Baby Syndrome,” Greeley pointed out, four years before the phrase was officially adopted into the Medical Subject Headings maintained by the National Library of Medicine. Donohoe did not search for terms like “abusive head trauma,” “child abuse,” “subdural hematoma,” or any of the other phrases that might have captured additional relevant articles, Greeley charged, and then he didn’t even read all of the articles he found. Although Donohoe’s search was conducted in 1998, the article wasn’t published until 2003. Greeley said that his own search using Donohoe’s described strategy, even limiting the time range to 1966-1998, produced far more citations than the 54 Donohoe reported. (Greeley did not, however, offer any examples of papers that would have provided stronger scientific support for shaking theory than those Donohoe evaluated).

“Donohoe is a horrible paper and you should never cite it,” Greeley summarized. Noting that Supreme Court Justice Ruth Bader Ginsburg had in fact referenced Donohoe in her minority opinion in the Shirley Ree Smith decision, he speculated, “Surely Justice Ginsburg didn’t read this paper…  or she wouldn’t have cited it.”

He also criticized medical-journal articles by Drs. Pat Barnes, Waney Squier, Jennian Geddes, and Steven Gabaeff and the “Getting It Right” law-journal article by Findley et al.

In other sessions I heard speakers explain that Vitamin D levels in a newborn are unrelated to bone fragility, hypoxia does not cause subdural hematoma, and physicians always do a complete work-up for other conditions that might cause the symptoms before diagnosing abuse. While I’m still puzzling over the medical possibilities, I know from personal experience that the third point is an unattained ideal.

I had hoped the conversation was opening up, but it’s hard to feel encouraged after being dismissed as a denialist. More to come.

* Dr. Narang’s article posits that there is no real medical debate about AHT and concludes:

“It is understandable that lawyers will look for opportunities to create doubt in the minds of jurors. However, the only way to appropriately improve the chances for justice in the courts with respect to AHT is to assure that an unbiased, financially-unmotivated, medical expert testifies to the current state of medical evidence.”

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September 28, 2012 · 9:55 am

When Pie in the Sky Turns Out to Be Dawning Knowledge

With the Twelfth International Conference on Shaken Baby Syndrome/Abusive Head Trauma coming up this weekend, I’ve been reviewing the literature and sorting my thoughts. What I see is an odd mix of new thinking and old stances.

In the June 2012 issue of Pediatric Radiology, for example, Dr. Thomas Slovis and his colleagues open their editorial, “The creation of a non-disease: an assault on the diagnosis of child abuse,” with a triad I’m not familiar with, but it’s got a classic ring to it:

The triad of subdural hematoma, retinal hemorrhage and multiple fractures in a child has been extensively documented to strongly suggest non-accidental trauma. Based on confessional evidence, a medical workup excluding diseases that can present with some of these abnormalities, and almost 50 years of scientific medical supportive literature, the diagnosis of abuse is being made with increasing medical certainty [1–7].*

With that diagnostic guideline in place, the authors object to “a small group of individuals” who have “created controversy where there should be none” and “perverted cases by using incomplete statements of the facts and unproven hypotheses to obscure the straightforward historical and physical findings utilized to make the diagnosis of child abuse.”

The paper describes a recent training that included these presentations:

  • Pediatrician and geneticist Dr. Ingrid Holm explaining that vitamin D levels have not been scientifically connected with fractures in the fetus or neonate, presumably a counter to the rickets work of Drs. Pat Barnes, Kathy Keller, David Ayoub and others; and
  • Pediatric radiologist Dr. Gary Hedlund noting that  “intracranial venous thrombosis alone” is not known to be associated with subdural hematoma, possibly a response to many of Dr. John Plunkett’s diagnoses, with the additional observation “that one of the commonest causes of intracranial venous thrombosis is trauma, and that trauma does cause subdural hemorrhage.”

The key point about the non-disease commentary, though, is near the introduction, in an off-hand reference to new understandings in the field:

[The seminar]  presented the scientifically accepted methodology for the diagnosis of nonaccidental trauma with emphasis on the pathophysiology of various injuries, and covered areas where new data have changed our understanding (e.g., subdural hematoma can occur from bleeding dural veins and not only bridging veins) [20–22].

20. Mack J, Squier W, Eastman JT (2009) “Anatomy and development of the meninges: implications for subdural collections and CSF circulation.” Pediatr Radiol 39:200–210

21. Nelson MD Jr (2009) “Unraveling the puzzle.” Pediatr Radiol 39:199

22. Slovis TL, Chapman S (2009) “The pathophysiology does not denote the mechanism.” Pediatr Radiol 39:197–19

What we have here is an editorial criticizing and dismissing the defense experts in the shaken baby syndrome debate, but with the concession that Drs. Mack, Squier and Eastman were correct in their 2009 proposition, which they also published in a different paper, “The neuropathology of infant subdural hemorrhage,” Forensic Sci Int 2009, soi:10.1016 j.forscicnt.2009.02.005.

At the time it was published, that paper received a scathing review by Dr. Lucy Rorke-Adams in The Quarterly Update, a guide to the child-abuse literature published four times a year by Dr. Robert Reece at Tufts University School of Medicine. Dr. Rorke-Adams’s review (Winter 2010, Vol. XVII, No. 1, p. 14) objected that the authors had rejected “the mountains of evidence that tears of bridging veins consequent to trauma are the primary cause of SDH,” adding in the Reviewer’s Notes:

This concept, initially proposing a non-traumatic pathogenesis of SDH in infants, namely hypoxia, advanced by Geddes et al. in a severely flawed paper with no credibility whatsoever and later repudiated by her, is not being allowed to rest in the dustbin of junk science [10-11].  The disciples of Geddes cannot allow this to happen, else they will be unable to introduce “reasonable doubt” when tetifying on behalf of perpetrators of abusive head injury to infants. Hence, they are flooding the literature with pie-in-the-sky claims that totally lack any evidence base.

10.  Geddes JF, Tasker Rc, Hackshaw AK et al. “Dural haemorrhage in non-tramatic infant deaths:  Does it explain bleeding in ‘shaken baby syndrome’?” Neuropathol Appl Neurobiol 2009;29:14-22

11. Jenny C. The timtimidation of British pediatricians. Pediatrics 2007;119:797-799

This transition, from “pie-in-the-sky” to “new data have changed our understanding,” strikes me as a change in the recognized model of abusive head trauma. It reminds me of comments made by a number of presenters at the 2010 NCSBS conference, when the take-home message was that the “triad” (the AHT triad, that is:  subdural hematoma, retinal hemorrhages and brain swelling) was a straw man invented by defense experts to discredit shaken baby syndrome theory.

2016 Update:  Denial of the triad has been formalized in a commentary by Dr. Christopher S. Greeley, “‘Shaken Baby Syndrome’ and Forensic Pathology” (Forensic Sci Med Pathol 16 Feb 2014 DOI 10.1007/s12024-014-9540-0), where he wrote:

“The complex features of AHT are often disparagingly distilled simply to ‘‘The Triad’’; a term devoid of any real clinical meaning and not used at all in practice.”

But I also have notebooks from prior conferences, when the triad was, indeed, considered enough.  I will close this posting with a quote from a letter published in Pediatrics in 1998, signed by 70 child-abuse physicians, including a few of those 2010 presenters, objecting to the defense testimony in the Louise Woodward trial:

The shaken baby syndrome (with or without evidence of impact) is now a well characterized clinical and pathological entity with diagnostic features in severe cases virtually unique to this type of injury – swelling of the brain (cerebral edema) secondary to severe brain injury, bleeding within the head (subdural hemorrhage), and bleeding in the interior linings of the eyes (retinal hemorrhages). Let those who would challenge the specificity of these diagnostic features first do so in the peer-reviewed literature, before speculating on other causes in court.

My point is that the model is evolving in the face of new evidence.  What I don’t understand is the reluctance of the child-abuse community to look back at possible mistakes in the past.

I’m off to the conference now and not likely to be blogging on the road, but you never know.

* Citations from the opening quote of the Slovis et al. article:

  1. Caffey J (1946) “Multiple fractures in the long bones of infants suffering from chronic subdural hematoma.” AJR 56:163–173
  2. Silverman FN (1953) “The roentgen manifestations of unrecognized skeletal trauma in infants.” AJR 69:413–427
  3. Woolley PV Jr, Evans WA Jr (1955) “Significance of skeletal lesions in infants resembling those of traumatic origin.” JAMA 158:539–543
  4. Kempe CH, Silverman FN, Steele BF et al (1962) “The battered-child syndrome.” JAMA 181:105–112
  5. Silverman FN (1972) “Unrecognized trauma in infants, the battered child syndrome, and the syndrome of Ambroise Tardieu.” Rigler lecture. Radiology 104:337–353
  6. Faure C, Kalifa G, Sellier N (1994) “Les responses de l’imagerie medicale chez l’enfant battu. Syndrome de Silverman-Ambroise Tardieu.” J Radiol 75:619–627
  7. Kleinman PK (ed) (1998) “Diagnostic imaging of child abuse,” 2nd edn. Mosby, St. Louis

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Filed under abusive head trauma, AHT, SBS, shaken baby syndrome

September 22, 2012 · 8:54 pm

Boxed in, Even Before Prison

As the rolls of exonerated prisoners grow, plea bargaining by innocent defendants has found its way into the news.

Accepting a plea bargain can be especially tempting in the child-abuse arena, where an innocent parent is offered not only the chance to avoid an expensive trial and the risk of a long sentence but also the added hope that “taking responsibility” for a child’s injuries will keep the children out of foster care and the other parent out of prison.

After her husband accepted a plea bargain in the 2007 death of their daughter, Tonya Marrhoubi Sadowsky gathered data about case resolutions at her local courthouse, first in 2010 and again in 2012. As she reported on her blog this summer, the vast majority of criminal cases in her jurisdiction are being settled with pleas, almost none with trials. As it turns out, Tonya had observed a national trend, described in fascinating detail in The Unexonerated: Factually Innocent Defendants Who Plead Guilty by law professor John Blume of Cornell and Rebecca K. Helm. (That link is to the downloadable article, well worth reading; thanks to the Wrongful Convictions Blog for this literature tip.)

The Cases

The May exoneration of football player Brian Banks kicked off this season’s coverage of innocent defendants who plea bargain.  In the early 2000s, faced with decades or life in prison if convicted of the rape and kidnapping of a childhood friend, Banks entered a plea agreement. He had served his time in prison but was still on parole when the alleged victim recanted. The California Innocence Project took up his case, and this fall Banks is back on the field, as reported last week on CBS in Los Angeles. ABC News posted this moving coverage of the exoneration proceedings in the spring.

The West Memphis Three in 1993

Then the “West Memphis Three” made another run through the headlines this summer with the release of a book by Damien Echols, one of three young men in Arkansas convicted of a grisly triple murder in 1993. After 18 years of protesting their innocence from prison, the three were exonerated by DNA tests in 2011. Instead of simply releasing the men, the state negotiated an Alford plea, which freed them immediately but only if they all pled guilty to a lesser charge. The New York Times coverage in August explores their legal conundrum and rocky first year out. A dispatch from the book tour on CAPITAL focuses on Echols, who spent his prison time isolated in a small cell on death row because prosecutors had perceived him as the ringleader in the supposed “cult” killings.

Myself, I’ve been frustrated because plea bargaining by innocent defendants has shut off access to the evidence in a number of cases, and left prosecutors with the impression that the defendants were in fact guilty. I echo the sentiment of defense attorney Zack Bravos, who says he can’t fault anyone who makes the rational decision to take a plea, but it adds to the perceived evidence in favor of classic shaken baby syndrome theory. If you haven’t yet read about my rubber-band case, for example, please see this story.

Drayton Witt and his wife
Courtesy Arizona Justice Project

Now the news coverage around the Drayton Witt reversal in Arizona has brought to light another plea bargain by an innocent parent, Armando Castillo, who met Witt in prison. In two insightful articles in the Arizona Republic, reporter Richard Ruelas first explores Witt’s conviction for the presumed shaking death of his son and then follows up with Castillo’s story (Listening to the medical testimony, Castillo told Ruelas, “I would have found myself guilty.”)

Back to Tonya, who alerted me earlier this summer to the prevalence of plea bargaining:  In a 2008 hearing she was not allowed to attend, her husband pled guilty to murder, felonious assault, and endangering a child. Although his reasons don’t appear in the court record, Tonya once told me that part of his inducement was the prosecution’s promise to “not go after Tonya” if he accepted the deal. Indeed, she wasn’t charged, but even through her relief she thought he’d made a mistake.

On the day of their daughter’s injury, Tonya’s husband called her at work to say he had dropped the baby and she should meet him at the hospital; he had already called 911. Her boss gave her a ride to the hospital, but her husband never made it:  He was taken to the police station instead. She hasn’t seen him out of custody since.

At the plea hearing, the judge was careful to make sure that Tonya’s husband Elwood Sadowsky was entering the plea without coercion. The opinion denying his appeal summarizes:

Upon questioning by the trial judge, Sadowsky confirmed that he had no questions about the plea. Sadowsky further stated that although he was taking several medications, he was able to think clearly and was of “sound mind and reason.”

Sadowsky told the judge, “I’m not high. I’m not drunk, sir. I’m just very grieved.”

This arena is tragic.

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September 11, 2012 · 11:38 pm

Communication, and Miscommunication, in the Courtroom

A courthouse in New Mexico.

Three legal developments this week illustrate that the steady push against unfounded diagnoses of shaken baby syndrome is having its effect.

A Grand Jury Listens in New Mexico

A grand jury in Taos has declined to charge a young father with the shaking death of his son, after hearings that included testimony by emergency physician Dr. Steven Gabaeff, an outspoken critic of shaken baby syndrome theory.

Reporter Chandra Johnson’s first-rate article in The Taos News implies that this was a triad-only case with complicating factors. The child was only three weeks old, and the parents had taken him to the doctor not long before his melt-down because he was congested and was having trouble breathing. On the day of the incident, the father reported, he was again having breathing trouble, with “not much of an appetite.”

Ms. Johnson quotes defense attorney John Day in the fourth paragraph:

“In recent years, the whole shaken baby theory has come under fire as misguided and wrong,” Day said in a phone interview Tuesday (Sept. 4). “There are a combination of relatively normal illnesses that could have caused brain swelling that put pressure on the retinal tissue.”

Montana Innocence Project Steps Up

In Montana, meanwhile, the Innocence Project has filed an appeal on behalf of Robert J. Wilkes, convicted of killing his 3 1/2-month-old son in 2008. The case against Wilkes rested on two presumptions:

  • his son’s brain injury was the result of abuse, and
  • the abuse must have happend in the few minutes between Wilkes’ feeeding the boy a bottle while visiting with the babysitter, who was also a neighbor, and the child’s meltdown soon after the father and son arrived home.

According to Gwen Florio’s refreshingly thoughtful article in the Missoulian, the appeal argues both that Wilkes received ineffective assistance of counsel and that new evidence shows his son suffered from a rare and deadly liver disorder. The coverage quotes the Innocence Project’s appeal:

“Over the past decade, opposition to SBS (shaken baby syndrome) has grown from a trickle to a virtual avalanche.”

Readers of this blog are likely to endorse the author’s final paragraph, about her talk with Montana Innocence Project executive director Jessie McQuillan, who “said she’d like to see Wilkes’ case added to the national conversation on the issue.”

Canadian Judge Blasts Reid Technique

Provincial Court Judge Michael Dinkel in Alberta has issued an opinion that both dismissed aggravated assault charges against day-care operator Christa Lynn Chapel and blasted the Reid Technique, an interrogation protocol used routinely by police investigators.

Denkel’s decision discarded Chapel’s confession to inflicting head injury on a child, which was delivered after eight hours of interrogation by officers the judge described as “a desperate investigative team that was bent on extracting a confession at any cost.”

Reporter Douglas Quan’s well-researched piece in The Calgary Herald quotes the judge’s opinion at length, including this statement:

“I denounce the use of this technique in the strongest terms possible and find that its use can lead to overwhelmingly oppressive situations that can render false confessions and cause innocent people to be wrongfully imprisoned.”

If you missed the post last winter about the interrogation that led to a dubious confession by teenager Nga Truang, you can see it here.

Not Everybody Listens Carefully

The Columbia Missourian ran a poignant story last week about a young father taking a plea bargain. He originally reported that his daughter had fallen out of her crib, and that he had shaken her to see if he could rouse her.  The doctors insisted the shaking had been violent, and the police heard a confession.

While accepting the father’s guilty plea on an assault charge, the judge asked the young man if he knew what he had done wrong, and the father said something very much like, “I guess that would be the shaking part.”

Side note: The National Institutes of Health infant CPR advice sheet begins its list of first aid steps with, “1.  Check for alertness. Shake or tap the infant gently.”

This story was but is no longer on line at http://www.columbiamissourian.com/stories/2012/09/05/man-pleads-guilty-assault-shaking-baby/

Finally, a tragic young mother in Virginia pled to charges of child neglect, again after changing her initial story under further questioning. Astonishingly, she confessed to interrogators that she had shaken her son, but the autopsy showed no signs of shaken baby syndrome.

Reporter Amber Lester Kennedy, understandably, I admit, treated the abuse as a given in her article in the Williamburg Yorktown Daily.

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Filed under Damian Stow, Innocence Network, Innocence Project, parents accused, Reid Technique, Robert J. Wilkes, Sabrina A. Battad, Sabrina Battad

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September 10, 2012 · 2:00 pm

Medill Justice Project Starts Posting

2020 Update:  The Medill Justice Project has reorganized and refocused. The links on this page that no longer work have been deactivated.

Journalism students at the Medill Innocence Project have started adding content to a blog devoted to their shaken baby syndrome project.

The first stories went up in late August, print-only updates about their efforts to re-examine the case of Jennifer Del Prete, an Illinois child-care provider convicted of shaking an infant in 2002.

Dr. A. Norman Guthkelch, May 2012

The Audio Podcast

On Friday an excellent podcast appeared, “Setting the Record Straight,” based on an interview with Dr. A. Norman Guthkelch. The pioneering pediatric neurosurgeon who first proposed that shaking an infant can trigger subdural hematoma is now speaking out about the over-diagnosis of infant shaking.

The audio treatment includes a riveting exchange between Dr. Guthkelch and Carrie Sperling, the Innocence Project attorney who contacted him about the troubling case of Drayton Witt. Dr. Guthkelch says that the Witt case opened his eyes to how shaken baby syndrome theory is being used in the courtroom. The piece is even stronger for the inclusion of an interview with Dr. Robert Block, president of the American Academy of Pediatrics and a staunch defender of the classic model.

The Human-Interest Video

Earlier last week a video went up, “Tia’s Story,” a moving visit with Jennifer Del Prete’s 23-year-old daughter. The treatment does not consider the legal issues, but showcases another way in which a hasty diagnosis of infant shaking destroys families.

The Database Update

The site also features an announcement about the database project, started at the beginning of this summer, with some background on the issues.

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Filed under abusive head trauma, AHT, SBS, shaken baby syndrome