Tag Archives: abusive head trauma

Innocent Family Petition Hits a Nerve

Geers twins

Geers twins

When child protective services separated Melissa and Anthony Geers from their five sons last spring, Melissa says, the pain was staggering. The worst part was watching the effects on their children: the 9-year-old’s full-blown panic attack, the 8-year-old’s holding his mom “so tight I couldn’t breathe,” the sudden interruption of breast-feeding for the 4-month-old twins (Melissa pumped throughout their foster placement).

The state filed to terminate the Geers’ parental rights just weeks after x-rays revealed rib fractures in both twins—but withdrew the suit 10 weeks later, after the Geers submitted opinions from eight outside experts who attributed the fractures to fragile bones, citing two underlying causes: First, the boys had a metabolic disorder that impedes bone formation. Second, like most twins, the youngest Geers had arrived early, 7 weeks early in their case. Because the rate of bone mineralization ramps up during the final trimester of gestation, premature infants in general are prone to weak bones.

photo by Doug Smith, Washtenaw Watchdogs

Anthony & Melissa Geers. Photo by Doug Smith, Washtenaw Watchdogs

But those explanations entered the record only because the Geers did their own research and called in their own experts. The state tore her sons’ lives apart, Melissa says, based on the opinion of one child abuse doctor “who never met me, my husband, or our kids.”

“We have two sons, now 10 and 8, who were traumatized by this experience,” she points out. “They don’t do the things they used to do. They are afraid. The child abuse experts need to understand what they are doing to children.”

Since their story hit the news, Melissa says, they have been contacted by an astonishing number of families with their own stories of ill-considered abuse diagnoses—most of them with far less happy outcomes. “How are the child abuse doctors not aware of all these other things?” Melissa asks. “That’s the part that bothers me the most. Why are they not doing their due diligence?”

GeersQuoteThe Geers say they understand how valuable it was to have a supportive community during their ordeal, as documented by Click on Detroit and later by Melissa herself in an essay on Medical Kidnap. Melissa says she and her husband now feel compelled to do what they can to shed light on a broken system. Earlier this fall, the Geers joined demonstrators at the University of Wisconsin Board of Regents meeting, where supporters of Joshua and Brenda Burns protested the Burns family’s treatment by the university’s Mott Children’s Hospital. As reported on this blog in the spring, the Burnses’ daughter Naomi was diagnosed as a shaken baby at Mott in 2014. While Naomi seems to have recovered fully, Joshua is serving a one-year sentence in the county jail. As he approaches his December release date, Joshua had been granted weekly visits with his family, through a glass window and a telephone handset, after a year and a half of no contact at all with Naomi—but those visits were cancelled after the first one. (For an insider’s view of the regents meeting, including video statements by Melissa Geers and Brenda Burns, please see the Washtenaw Watchdogs coverage.)

Accused father Andrew Sprint

Accused father Andrew Sprint

The Burns family and the Geers family found each other, and they also found the Protecting Innocent Families (PIF) petition, which calls for an objective, scientific review of the evidence base underlying today’s guidelines for diagnosing child abuse. The petition form includes an optional field where signers can identify the name of a defendant or family they are supporting. Of about 2,700 people who have signed the petition so far, slightly more than 1,000 have filled in the support field. The signers have named 338 individuals and families. The most frequently named case, with 270 signatures, is the Burns family, the subject of the Torn Family web site, which includes a link to the petition. The Geers family is the second most-often named, with 96 signers, presumably from their Facebook site.

Other defendants named in significant numbers were a mix of past cases that helped inspire the petition—like the stories of Kristian Aspelin, Brian Peixoto, Tiffany Cole-Calise, Amanda Brumfield, and Leo Ackley—and unfolding cases like those of Rebecca and Anthony Wanosik and Cynthia and Brandon Ross, reunited with their children this summer; Cindy Rosenwinkel, convicted in 2015; and single father Andrew Sprint, who declared his innocence outside the Children’s Justice Conference this past spring in Seattle.

GeersQiuoteWhen PIF launched the petition in March of 2015, the immediate goal was to collect the names of 1,000 people who had seen a medical misdiagnosis of child abuse tear apart an innocent family. Three weeks after the petition went live, 1,000 people had signed and signatures were still coming in. The rate has slowed since then, but new names continue to arrive, and PIF has decided to launch another publicity campaign before implementing its labor-intensive plan for taking the petition to Congress. Signers who indicated they would be willing to contact Congress personally should expect to be hearing from PIF volunteers.

In addition to calling for a review of the scientific literature, the petition objects to the suppressive tactics used by the state and by professional organizations. Both families and professionals feel extraordinary pressure, the petition argues:

Even when charges are dismissed, caretakers acquitted, or verdicts overturned, families are emotionally and financially devastated, with many unwilling to speak out because they are still traumatized or they fear stigma or retaliation. Doctors and other experts who question or criticize these diagnoses also suffer retaliation, including threats against their jobs and licenses.

Dr. Waney Squier

Right now in England, for example, neuropathologist Dr. Waney Squier is facing hearings by the General Medical Council, where she is accused of testifying “outside her field of expertise,” giving biased opinions, and not paying “due regard to the views of other experts.” Last fall, The Telegraph reported that the original complaints against Dr. Squier came from the Metropolitan Police, who were tired of losing shaken baby cases because of her testimony on behalf of accused parents.

Dr. Squier has long been the target of direct and indirect harassment from her opponents. As reported in 2012 on this blog, a fictional character with a curriculum vitae remarkably like Dr. Squier’s confessed on the BBC program Silent Witness to having conducted her research using illegally harvested infant brain tissue. In fact, the real Dr. Squier had been readily cleared when the same accusations were levied against her—and some observers suspect those accusations were merely a ploy to keep her out of the courtroom during the resulting investigation.

Dr. John Plunkett

Dr. John Plunkett

In the U.S. in the early 2000s, forensic pathologist Dr. John Plunkett was forced to defend himself against charges that he lied under oath after he testified on behalf of an Oregon defendant in a child head injury case. In “The Battle of the Expert,” ABA Journal reporter Mark Hansen traced the byzantine course of the case against Dr. Plunkett, which ended with an acquittal in 2005.

 

Drs. Squier and Plunkett have also brought their criticisms of shaking theory into the medical journals. When Dr. Squier and her colleagues proposed an alternative to torn bridging veins as the source for thin-film subdural hematomas in 2009, their ideas were dismissed, but their model is now finding acceptance by doctors on both sides of the debate. Still, instead of considering the reasoned objections of their critics, some proponents of shaken baby theory demonize defense experts at conferences and in the press. After charges were dropped against Irish nanny Aisling Brady McCarthy earlier this fall, for example, Kevin Cullen at The Boston Globe quotes Dr. Eli Newberger calling shaken baby critics “defense whores”:

Newberger is dismissive of the revisionist views that defense attorneys are increasingly tapping.

“On the clinical testifying roster are a whole lot of people who will cut their consciences for money,” Newberger said. “They’re hired out as defense whores. I just find this vile.”

The Protecting Innocent Families petition is an effort to bring together the many people who are affected by misguided diagnoses of child abuse, including the accused families, their extended communities, and the medical and legal professionals who defend them.

If you agree that we need an objective, scientific review of the evidence base for today’s guidelines for diagnosing child abuse, please sign the petition, at http://bit.ly/InnocentFamilyPetition. If you have a web site or Facebook page, please post the  url. If you are a medical or legal professional, please consider sharing the url with your colleagues and clients (that’s http://bit.ly/InnocentFamilyPetition).

A number of individuals and families not mentioned above have also received quite a few votes of support, including Angela and Danny Frasure, Cor and James Thompson, Andrew Valdez, Megan Griffin, Marsha Mills, Rachel and Gourab Sahoo, Kacie and Raymond Hernandez, and a handful of people who would rather not be named publicly.

copyright 2015, 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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Filed under abusive head trauma, AHT, parents accused, SBS, shaken baby syndrome

Retro Report Nails the Nanny Story

Louise Woodward, 1997

Louise Woodward, 1997

Retro Report producer Miriam Weintraub, in her recent documentary looking back at the story of “Boston nanny” Louise Woodward, has identified the key fact about news coverage of the case in the 1990s: In its fixation on working parents and teenage nannies, the press missed the real story, the actual medical debate about shaken baby theory.

“But today the shaken baby diagnosis is under increasing scrutiny,” the narrator informs us, cutting to a quote from Dr. Patrick Barnes:

“There is no doubt that errors have been made and injustices have resulted.”

Dr. Barnes, a pediatric neuroradiologist, testified for the prosecution at the Woodward trial but later began doubting what he’d learned from his mentors and peers about infant head injury, as he explains on camera:

“Particularly when I started going to the literature outside of the box I was in, in the child abuse literature box, and looking at the science of traumatic head injury written by true specialists and experts in those fields. Then I began to be concerned that for the prior 15-20 years I may be wrong.”

Prosecutor Martha Coakley, however, stands by the conviction and the diagnosis:

We knew that the injuries this child had suffered, given that he was fine that morning and by the time he was in the emergency room he was on death’s door, those had been inflicted injuries. They were severe, they were acute and they were not accidental.

And Dr. Robert Block, past president of the American Academy of Pediatrics (AAP), says there has been no change in thinking among child abuse experts:

There are a few people who have generated opposing points of view for whatever reason. But, if you talk to child abuse pediatricians who work with these clinical cases all the time you will find that opinion about the presence of shaken baby syndrome or abusive head trauma has not shifted one iota.

At the time of the Woodward trial, the official name of the diagnosis was still Shaken Baby Syndrome (SBS), as described in both the 1993 AAP position statement and the 2001 AAP technical report. By the time Dr. Block was interviewed by Retro Report in 2015, the AAP had issued its 2009 update, changing the name to Abusive Head Trauma (AHT) with this explanation:

“The term ‘shaken baby syndrome’ has become synonymous in public discourse with AHT in all its forms.17 The term is sometimes used inaccurately to describe infants with impact injury alone or with multiple mechanisms of head and brain injury and focuses on a specific mechanism of injury rather than the abusive event that was perpetrated against a helpless victim. Legal challenges to the term ‘shaken baby syndrome’ can distract from the more important questions of accountability of the perpetrator and/or the safety of the victim.”

I recommend following the link from this quote to the abstract for footnote 17, Lazoritz and Baldwin (1997), “The whiplash shaken infant syndrome: Has Caffey’s syndrome changed, or have we changed his syndrome?,” which documents how far the diagnosis had strayed in 1997 from Caffey’s first definitions. Following some of the further links on that page, to the abstracts for Bandak 2005 (“Shaken baby syndrome, a biomechanics analysis of injury mechanisms”), for example, and Talbert 2009  (“The nature of shaken baby syndrome injuries and the significance of the ‘lucid interval’), illustrates some of the unresolved questions about the condition.

The Retro Report narration identifies the traditional triad as the defining features of shaken baby syndrome at the time of the Woodward trial:

“For decades, when doctors saw a child with a particular set of symptoms known as the triad—bleeding behind the eyes, bleeding on the brain, and brain swelling—they would conclude there was only one possible cause: shaking.”

But Dr. Block says doctors do not rely on the triad:

“Nobody looks at a baby with those three things and says, ah ha, shaken baby syndrome… We go through a very intensive history taking, which involves looking at the last 24 to 48 hours of this baby’s life. And then we do what’s called a differential diagnosis after doing a bunch of laboratory tests. Our job is to make sure that we’ve looked at every other possibility.”

As this blog has reported before, however, in 1998 several dozen child abuse experts signed a letter about the Woodward case that took this position:

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.

Dr. Block’s parting quote explains his priority in the shaken baby debate:

I think it’s reasonable to worry and be as careful as we can to make sure that people who are convicted are appropriately convicted. But to talk about their conviction negates the fact that we really need to be talking about the children. It’s the children who are affected in each and every case. It’s the children who are devastated or killed.

Quentin Stone

Quentin Stone

The Retro Report documentary also features the case of Quentin Stone in Yolo County, California, who was found innocent by a jury in May of 2014 but is still fighting in family court for reunification with his wife and two surviving sons. “I don’t think there’s really a way to explain what it feels like to lose your entire family,” Stone tells the interviewer.

The Retro Report posting was published in conjunction with a New York Times article by Clyde Haberman that includes two additional short videos, a “mini-doc” featuring professor Adele Bernhard from the Pace Law School Post-Conviction Project talking about the René Bailey case, and an interview with pioneering pediatric neurosurgeon Dr. A. Norman Guthkelch, the first person to propose in print that shaking an infant could cause subdural hematoma.

Melissa Calusinski

Melissa Calusinski

In other shaken baby news, the lawyer for convicted day care worker Melissa Calusinski in Illinois has made a small step toward a possible appeal. According to the Chicago Tribune, a judge is considering attorney Kathleen Zellner’s motion for a hearing on what she says is new x-ray evidence in the case. Earlier this week, the judge gave the state 90 days to respond to Zellner’s request. Calusinski’s case moved to the national stage this past winter, when a 48 Hours report, “Blaming Melissa,” raised questions about the evidence and the interrogation that led to a confession she later recanted. Tribune reporter Lisa Black published this article in June about the current motion and the possible new evidence.

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

Aisling Brady McCarthy Released, a Decision That Will Matter

Aisling Brady McCarthy, from The Boston Globe coverage

Aisling Brady McCarthy, from The Boston Globe coverage

Last week’s decision in Boston to drop charges against Irish babysitter Aisling Brady McCarthy, now free after two and a half years in jail awaiting trial in the death of 1-year-old Rehma Sabir, seems to have produced only a few ripples in the news, but I think the case will stand as a touch point in the ongoing debate about shaken baby.

The Middlesex County District Attorney dropped the charges against McCarthy after the medical examiner reviewed the evidence and amended the child’s autopsy report, changing the cause of death from “homicide” to “undetermined.” The move validated years of dogged filings by McCarthy’s defense attorneys, Melinda Thompson and David Meier, who had argued from the beginning that the shaking diagnosis was made without considering Rehma’s complex medical history, including a likely bleeding disorder.

A press release from the district attorney’s office quotes the medical examiner:

In particular the overall state of Rehma’s health and her past medical issues raise the possibility that she had some type of disorder that was not able to be completely diagnosed prior to her death.

Even the in-depth coverage of the story focused on the problems with this particular case, not the larger debate about the diagnosis, while most news reports stopped at McCarthy’s personal story and her joyful welcome in Ireland, and some treatments seemed intent on shoring up historical opinion. Boston’s public radio station WBUR, for example, broadcast an interview with Dr. Robert Sege, a member of the American Academy of Pediatrics committee on child abuse and neglect, who was asked about the implications of this story and a recent rash of successful appeals:

To me, it doesn’t raise the question at all. If you think about it, there are people who are falsely accused of murder, robberies, all kinds of things and the justice system is not perfect. So in a situation where we have hundreds and perhaps a thousand infants a year who experience shaken baby syndrome, the fact that 16 convictions over a multi-year period were overturned lets me know that the justice system worked, and that people get a fair shot at getting their story told.

WBUR also ran an interview with Dr. Shannon Carpenter, a bleeding disorder expert who seemed to think that McCarthy really is guilty. The reporter paraphrased Dr. Carpenter as saying:

[S]adly, no, there’s no kinder explanation here: Abusive head trauma — a better term than “shaken baby syndrome” because abuse can involve more than shaking — is far more common than serious bleeding disorders.

and offered this direct quote:

“While anything is possible, you have to look at what’s probable and what other patients have experienced. And patients with bleeding disorders are not immune to trauma, whether it’s inflicted or non-inflicted.”

So much for innocent until proven guilty.

middlesexCountyCourthouse

Middlesex County Courthouse

Still, both Boston television station WCVB and letter writer Phillip L. Radoff in The Boston Globe noted that McCarthy’s case is the second Middlesex County shaken baby prosecution to be dismissed in the past year—charges were dropped in September of 2014 against local father Geoffrey Wilson. Both diagnoses were made by child abuse pediatrician Dr. Alice Newton, who presented at the National Center on Shaken Baby Syndrome conference in Denver last fall, on the topic, “Towards Better Collaboration Between District Attorneys and Child Abuse Pediatricians.” Her abstract for that talk includes this reflection:

With an increasing focus in our society on whether Abusive Head Trauma exists, close collaboration between medical professionals and law enforcement has become increasingly important for a successful investigation and prosecution.

What I find refreshing about Dr. Newton’s abstract is the full transparency: She seems to believe that the debate really is about whether or not Abusive Head Trauma exists, and she recommends that child abuse pediatricians view themselves as part of the prosecution team.

Meanwhile, Katherine Judson and Keith Findley at the Wisconsin Innocence Project wrote a letter to the editor of The Boston Globe praising the Middlesex medical examiner’s office for its willingness to re-think the McCarthy case and offering this bold—and accurate—indictment of the community of child abuse experts:

Even after nearly 20 reversals of convictions and hundreds of dismissals and acquittals, some proponents of the shaken baby syndrome and abusive head trauma hypothesis refuse either to acknowledge that there may be flaws in the diagnostic process or to engage in an honest conversation about the science. Instead, they engage in personal attacks upon those who challenge their dogma or claim that there is no debate.

What I think Judson and Findley are asking for is not more talk about whether or not abusive head trauma exists. Shaking a baby, like hitting or slamming a baby, is unacceptable and likely to cause serious injuries. The question is whether the findings that now lead to a diagnosis of shaken baby syndrome really do prove abuse.

Because of the Boston angle, I suppose, with its echoes of Louise Woodward, and the continuing interest of the Irish press, the McCarthy case has given shaken baby syndrome another run in the national and international headlines, and it has given the world a look at how these diagnoses are handled. The case against McCarthy started unraveling more than a year and a half ago, when doctors realized that the stress fractures in the child’s spine seemed to date from a time when she was out of the country with her family and not in McCarthy’s care. Still, the prosecution stood by its case, and McCarthy remained in jail.

Through years of pro bono perseverance, McCarthy’s attorneys finally convinced the county to drop the charges against their client, who must now figure out how to put her life back together. And unlikely as it is to say about someone who’s spent two and a half years incarcerated for a crime that never occurred, McCarthy is one of the lucky ones. Despite their own best efforts and the efforts of their attorneys, Michelle Heale in New Jersey and Joshua Burns in Michigan were both convicted earlier this year—also in cases where the infants had complex medical histories—and Cindy Rosenwinkel was convicted in a short fall case.

I can’t put it any better than Judson and Findley, who wrote:

The flawed analysis of child abuse cases has led to the conviction of innocent people and the destruction of many more lives. It must be reevaluated. Children and families deserve real science and sound research; they deserve better than the repetition of unsubstantiated dogma.

Sept. 14 Update:  Kevin Cullen at The Boston Globe has published a first-rate analysis of the decision to drop charges, predicting that the case will have ongoing impact:  “Nanny’s case could have broad effects on child abuse prosecutions.”

Oct. 13 Update: Yvonne Abraham at The Boston Globe has reported that the medical examiner felt “bullied” by the prosecutor’s office in the Geoffrey Wilson case, in “Autopsy notes in baby’s death raise questions about DA’s role.”

If you are unfamiliar with the debate surrounding shaken baby syndrome, please see the home page of this blog.

copyright 2015, Sue Luttner

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Breathtaking Strength Under Heartless Interrogation

AllisonInterrogationCloser

The interrogation of Christiane Allison

The support group for convicted father Clayton Allison in Alaska has posted a disturbing video that not only reveals the heartless tactics employed by police investigators but also showcases the extraordinary strength of Clayton’s wife Christiane, who seems to have been the only honest person in the room during her interrogation.

From the beginning, Christiane Allison says, she believed her husband’s report that he had accidentally left the baby gate open, allowing their 15-month-old daughter Jocelynn to fall down the stairs. Based on medical opinion, Clayton was convicted of second degree murder this past February, and sentenced last week to 30 years in prison.

The interrogation was conducted in January of 2009, four months after the incident, when the police called the child’s mother to the station to tell her that the medical examiner had declared Jocelynn’s death a homicide. In the video, two state troopers are trying to convince Christiane, 22 years old at the time, to call her husband immediately, on a secretly taped line, and ask him what really happened that day.

“Either you’re on the side of Jocelynn or you’re on the side of Clayton,” one officer explains, insisting that Christiene look at the autopsy photos and mocking her statements that she loves her daughter.

Since Jocelynn's death, her mother has been diagnosed with Ehlers-Danlos Syndrome.

Since Jocelynn’s death, her mother has been diagnosed with Ehlers-Danlos Syndrome.

Christiane steadfastly refuses to cooperate with a secret taping. “If I can tell him it’s being taped, I’ll make that call,” she says, but “I will not be deceitful.”

“Clayton has been lying to you every day since September,” the interrogator sneers. “The fact that Clayton makes love to you knowing he did this to your daughter, that’s deception,” and she thrusts in Christiane’s face a color glossy from the autopsy that shows the skin of the girl’s face peeled back and bunched up under her chin.

Early in the interrogation, Christiane had said, “Could you please not show me that one?” and, when the officer persisted, “Or at least don’t show her face all mutilated like that.” Four hours later, her protests are louder and more forceful. “Don’t accuse me of not loving my daughter because I won’t look at that picture,” she seethes, “I’m not looking at that picture because I don’t want to look at that picture every time I go to sleep… Regardless of what happened to her, I don’t want that picture in my head.”

While showing her frustration at the cruel and irrational interrogation, Christiane is not confused by the tactics. Accused of being too calm for a mother who has just learned her child was murdered, she explains she is showing her “cold face” because “words are too important” to let her emotions control the moment. “When I walk out of that door I’ll probably fall apart,” she predicts, “but right now I’m being a politician.” Reiterating that she will make no decisions as long as she’s in the interrogation room with them, she offers—sagely, I thought—”Life is too short for rash decisions.”

AllisonGroupChristiane even acknowledges that the troopers are only doing their jobs, looking for the truth, but she declines to cooperate with their deceptive strategy, and she refuses to accept on the spot that her husband murdered their daughter. “I’m taking every word you’re saying with a grain of salt,” she says. “I don’t believe anything until I’ve thought about it, I’ve prayed about it, and I’ve come to my decision.” Unaware that she is free to leave, Christiane interrupts the histrionics at one point,  “I don’t know how else to do this with you,” she says, clearly exasperated. “We could go around and around forever.” The interrogator stays in character, though, responding that she is personally disturbed by Christiane’s “reluctance to have an open mind about what happened.”

The video ends with Christiane alone on the moral high ground, when her parents arrive with news that her husband was arrested earlier, and she realizes her interrogators had kept pressuring her to call him at home long after they knew he was no longer there. “You’ve been in my face this entire time that Clayton is deceiving me,” she simmers, “but it’s OK for you to do that, when I’ve been completely honest with you?”

The video is just short of 34 minutes long and well worth watching, available on the Free Clayton Allison web site and on YouTube. What I find chilling is the troopers’ willingness to treat a grieving mother with such callous contempt. Christiane Allison was not home the day of the incident. She was never a suspect. But the police were sure her husband had been lying to her—because that’s what the doctors told them—and because she believed her husband, the troopers were willing to accuse, berate, and taunt her for four hours, while she didn’t change her story by an inch. Do the doctors know how the police conduct these interrogations? Do they care?

Of course watching the video reminds me of Scenes of a Crime, the award-winning film that eventually led to the release of Adrian Thomas in New York.

AllisonSupporters2The outpouring of support for the Allison family echoes other movements that have been springing up in child head-injury cases—on behalf of Joshua and Brenda Burns in Michigan, for example, and Melissa Calusinski in Illinois. I’m discouraged because the convictions continue, but I’m encouraged because defense groups continue to seek relief for those in prison—as in the cases of Albert Omenged Debelbot and Ashley Deone Debelbot in Georgia, Leo Ackley in Michigan, Jeffrey Havard in Mississippi, and many others, including but not limited to Brian Peixoto and Amanda Brumfield.

I hope the families and communities affected by these misguided accusations will keep speaking up, and that they’ll start connecting with others in the same position. I encourage anyone who has personal experience with the misdiagnoses of physical child abuse to look into the Protecting Innocent Families petition at http://bit.ly/InnocentFamilyPetition and its companion web site.

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

Copyright 2015, Sue Luttner

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

The Word Is Out

WashPostTitleAfter 30 years of occasional, isolated coverage, both the national and the local media are starting to take a serious look at the debate about shaken baby theory—even as the accusations and convictions continue.

This past weekend Debbie Cenziper at The Washington Post published what I think qualifies as an exposé of shaking theory, the result of a full year of research that brought together the work of other Post staffers as well as students and teachers at half a dozen universities, including the Medill Justice Project at Northwestern University.

Dr. A. Norman Guthkelch

Dr. A. Norman Guthkelch

Shaken Science: A Disputed Diagnosis Imprisons Parents” offers a thorough but engaging analysis of the issues, including  helpful diagrams and the most accessible press treatment I’ve seen yet of the biomechanics. Cenziper opens, of course, with the story of one accused caregiver and interweaves more cases along the way, so that the piece is not only informative but also readable. She also reports the thoughts of several physicians, including Dr. A. Norman Guthkelch, the first person to propose in print, in the British Medical Journal in 1971, that shaking an infant could cause subdural bleeding.

The National Center on Shaken Baby Syndrome (NCSBS) has released a response to the Post piece, listing the professional organizations that have endorsed shaken baby theory and protesting:

 The Washington Post article portrays a “dispute” in the medical community as to the existence of SBS/AHT. There is a very small minority of proponents for the position that shaking cannot harm an infant, but this position is not supported by the science.

Like the letters protesting the film The Syndrome, the NCSBS response to the Post says that critics of shaking theory think that shaking a baby is not dangerous, although I don’t see anyone in the article making that statement. I think the question is whether the presence of the brain injury proves that a child was violently assaulted.

Cenziper’s article has been picked up in a number of regional newspapers, including the Hamilton Spectator in Ontario, the Daily Herald in Illinois, and the Dallas Morning News in TexaPBSNewsHours.

Then on Monday of this week, PBS NewsHour ran a segment on the shaking debate, a report titled “A disputed diagnosis that sends parents to prison for abuse.” The piece includes a look at the case of Drayton Witt in Arizona, whose appeal drew Dr. Guthkelch back into the arena, as well as interviews with child abuse pediatrician Dr. Lori Frasier—the author of a book on abusive head trauma written “for clinicians, investigators, prosecutors, and social workers”—and Katherine Judson from the Innocence Network.

Josh Burns with his daughter Naomi

Josh Burns with his daughter

Even before these national treatments emerged, regional news outlets had started giving sympathetic coverage to local cases. Last week in Michigan, Heather Catallo of ABC affiliate WXYZ  led off her video report about convicted father Joshua Burns with images of Burns’s supporters proclaiming their faith in his innocence at his sentencing hearing. The prosecutor argued for a harsh sentence, calling Burns a “danger” and objecting, “He’s not admitting that he did it. He’s still maintaining full innocence.” But the judge handed down the minimum sentence, a year in jail. Yesterday, WXYZ reported that prosecutors say they are not moving to terminate Joshua’s parental rights.

Also in early March, the Bennington Banner in Vermont ran a feature story by Keith Whitcomb Jr. about accused father Russell Van Vleck, found innocent by a jury in 2011 after a two-year nightmare for his entire family. Van Vleck’s son Colin, 5 weeks old the evening he quit breathing while lying on the couch next to his father, had been born with a skull malformation that had complicated his delivery.

TheSyndromeAnd the film exposé The Syndrome, which premiered in the fall of 2014, is being accepted at film festivals across the country (coming up: the (In)justice for All Film Festival in Chicago, April 13, and the Arizona International Film Festival in Tucson, April 18), staying in the news and triggering more coverage of the topic.

Outside of the mainstream press, web sites targeted to attorneys are also addressing shaken baby syndrome. On Wednesday of this week, the American Bar Association published an article in its Children’s Rights Litigation section by Katherine Judson at the Innocence Network, titled “What Child Welfare Attorneys Need to Know About Shaken Baby Litigation.” In February, the site LLRX.com, which describes itself as a web journal offering resources for legal professionals, published a valuable review of the debate, “Shaken Baby Syndrome: A Differential Diagnosis of Justice,” featuring live links to court decisions, journal articles, and other resources, by attorney, librarian, and writer Ken Struton, and the National Association of Public Defenders published an essay by public defender Jill Paperno, “Another Step Away From Bad Science – a Review of the  History and Science of Shaken Baby Syndrome in People v. Rene Bailey (December 16, 2014, Monroe County, NY).”

Still, the community of child abuse experts and the justice system remain committed to shaken baby theory. Yesterday in South Carolina, an 18-year police veteran was in court, accused of shaking his 3-month-old son into permanent brain damage. According to the local news report, the prosecutor told the judge that the boy’s injuries “could only have been caused by a violent shaking or by a fall of 20 feet or more.”

oklahomaChildrensIn Oklahoma last week, a step-father was charged with abuse after reporting that the baby fell from a bed. According to the News 9 coverage:

Detectives said they knew [the stepfather] was not being honest about what happened after doctors said the baby’s injuries weren’t consistent with his story. “The baby had to be violently shaken for him to have these injuries,” [Det. David] Thompkins said.

And this week in New York, detectives revisiting an old case charged a mother’s ex-boyfriend with manslaughter for the 2010 death of a 13-month-old boy who suffered injuries “consistent with shaken baby syndrome.” According to the report in The Buffalo News, detectives had acquired a more definitive medical opinion and carried out an additional interview with the suspect:

“In questioning Gonzalez, detectives were able to confirm a few things, though he didn’t confess, but it helped our case,” [Homicide Capt. Joseph] Gramaglia said. “We also obtained a medical opinion that bolstered the case.”

I don’t know what it will take to stop the ongoing tragedy of shaken baby theory in the courtroom. I have taken one small step, though. I’ve signed the Protecting Innocent Families petition, which asks for an objective, scientific review of the evidence behind today’s guidelines for diagnosing child abuse.

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

copyright 2015, Sue Luttner

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Shaking: “A False and Flawed Premise”

Kristian Aspelin and his son Johan

Kristian and Johan Aspelin

February opened with a pair of important and complementary postings, a bold academic statement signed by 34 physicians, attorneys, and child-protection professionals with “deep concerns” about shaken baby theory in the courtroom, and a beautifully written examination of the Johan Aspelin case that illustrates why the experts are so concerned.

Published in the British journal Argument & Critique, the Open Letter on Shaken Baby in the Courts: A False and Flawed Premise argues that a diagnosis of shaking “risks blurring the line between diagnosis and verdict,” and that “SBS has never been proved as anything more than an hypothesis.” Citing the dearth of scientific research underlying the theory, the authors write:

Noticeably, the requirement for scientifically based evidence is far more rigorous in medical negligence cases than in the family or criminal courts where believing something to be true appears to have achieved sufficient evidential value to sway the determinations of the court.

The letter also notes that the justice system has tended to suppress arguments about shaken baby syndrome:

One of the consequences has been the vilification of experts prepared to advance competing theories and the suppression of sensible debate.

Dr. Waney Squier

Dr. Waney Squier

One example of such vilification is unfolding now in England, where pediatric neuropathologist Dr. Waney Squier is facing a challenge to her license triggered by complaints to the General Medical Council (GMC), reportedly from the Metropolitan Police, that her courtroom testimony exceeds her area of expertise and ignores the opinions of her peers. Dr. Squier has been testifying on behalf of accused parents for about the past decade, since her own research, clinical experience, and reading of the literature convinced her that the prevailing model of shaken baby syndrome is flawed.

My favorite report about Dr. Squier’s GMC hearings, which opened in the fall and continue intermittently, is a legal-training company’s blog posting that features praise from readers for her intellectual honesty in the face of peer pressure. A general practitioner offered this striking parallel with an historical report to the GMC:

Surely the Met investigating a Dr who happens not to agree with the consensus — and holds an expert view — is a little like the tobacco companies (circa 1960s) reporting Sir Richard Doll to GMC for his novel theory that tobacco caused lung cancer.

WhatRealllyHappenedJohan copyIn the U.S., meanwhile, an in-depth treatment of the Johan Aspelin case published last week on Medium by reporter Elizabeth Weil also reveals striking new facts, like the botching of Johan’s initial intubation at San Francisco General, which caused the complete collapse of one lung and serious damage to the other. And that Johan received several times the recommended dosages of two different sedatives, which, Weil writes, “left him essentially paralyzed and unable to communicate distress as air was pumped into his compromised lungs.” The article notes:

Nowhere in the police investigation transcripts does it suggest that doctors considered Johan had a brain injury and retinal hemorrhaging due to low blood-oxygen levels and high carbon dioxide pressure, problems that may result from faulty intubation.

Johan’s mother Jennie Aspelin learned about the error and resulting crisis only because she’d contacted the organ-donation agency to find out why there had been no recipient reported for Johan’s lungs, as there had been for his other organs. Even then she received only the oblique message that it was “a matter of function,” enough to send her on a focused search for the full medical records.

Johan

Johan Aspelin

In November of 2010, Johan’s father Kristian Aspelin told emergency responders that he had fallen in the kitchen while holding 3-month-old Johan, but child-abuse expert Dr. Chris Stewart rejected that explanation and told police that the boy had been violently shaken to death.

In December of 2012, the county dropped murder charges against Kristian, after defense attorney Stuart Hanlon turned over a collection of exonerating reports from outside experts as well as a carefully assembled medical time line that included the hospital’s mistakes. By that time, the family had lived apart for two years, when they’d  lost their baby and needed each other more than ever. They’d sold their house and taken on a staggering debt to cover legal bills, and they’re not slated for any compensation from the state.

Dr. Mark Feingold

Dr. Mark Feingold

But the people who train child abuse physicians continue to teach that children seldom if ever suffer serious injury in short falls, and that only abuse causes severe retinal hemorrhages. In a January, 2015 lecture titled “Is There a ‘Shaken Baby Syndrome’?,” for example, which earns the medical viewer one continuing education credit, child abuse pediatrician Dr. Mark Feingold reported that hypoxia does not cause “macroscopic subdurals” and that children do not suffer serious injury in short falls:

A lot of our opponents say, “Well, the child died. That’s too bad. But it was a short fall, just like Mom said. He fell from Mom’s arms.” The evidence shows that children who fall more than 20 feet can die, but children who fall less than 3 feet almost never die, and when they do, it’s a different kind of accident. It’s a playground accident. It’s an older child. They die of a large subdural that causes lots of pressure. And the RH if present are not the kind we see in abuse cases (emphasis added). But nonetheless, different versions of “I was carrying the baby and I tripped and fell” are often offered.

Slipping and falling with the baby is the explanation Kristian Aspelin offered, like countless parents and caretakers before him and countless more to come, while pediatricians are being trained to reject that story, and to dismiss the hypoxia that frequently accompanies head injury as a source of compounding symptoms.

The retinal hemorrhages in Johan’s eyes were widespread and multi-layered, the kind that child abuse pediatricians insist do not result from short falls or lack of oxygen to the brain. So were the hemorrhages in the eyes of the toddler in the care of René Bailey, who said the little girl had fallen off a chair—Bailey’s murder conviction was vacated in December. Doctors also pointed to extensive retinal hemorrhages when diagnosing shaking injuries in the cases of exonerated babysitters Jennifer Del Prete and Audrey Edmunds and exonerated father Drayton Witt, and in an exasperating case local to me in which paramedics pulled a rubber band from the child’s throat during resuscitation and the only physical evidence of abuse was the triad. It seems to me that the world now offers quite a few examples of extensive retinal hemorrhages from plausible, non-abusive accidents and medical conditions.

RHKelloggWhen I started researching shaken baby theory more than 15 years ago, I routinely read in trial transcripts that doctors considered the presence of retinal hemorrhages a sure sign of child abuse, but since then the situation has grown more complicated. When researchers started looking systematically, they rediscovered that retinal hemorrhages have a long list of non-traumatic causes, including diabetes, anemia, bleeding disorders, increased intracranial pressure, increased intrathoracic pressure, and certain types of infections. A startling one quarter of neonates born spontaneously arrive with retinal hemorrhages, more in deliveries that involve instruments. In light of this new understanding, child abuse experts now recognize other causes of retinal hemorrhages but insist that most of them result in only a few small hemorrhages near the optic nerve, not in widespread, multi-layer hemorrhages, which they continue to interpret as evidence of whiplash shaking.

I don’t know how we will move forward, but I welcome the growing chorus of voices in the journals, in the press, and in the courtroom, who demonstrate through their work and their testimony that the Open Letter on Shaken Baby is representing the situation correctly in its message to the courts:

In short, we would inform members of the judiciary and legal profession in those countries which utilise the SBS construct, that it does not have the undivided support of the relevant professional community, an essential consideration in the assessment of expert testimony.

The letter was edited by Argument & Critique’s managing editor Dr. Lynne Wrennall, whose doctorate is for work in child welfare, from a draft prepared by solicitor Bill Bache and veteran child social worker Charles Pragnell. The signers include 16 physicians, a handful of scientists, and a variety of social work professionals, from both academia and the field.

For the observations of Phil Locke at the Wrongful Convictions Blog, see his posting about the Open Letter.

The film company Mighty Myt is making a film about Johan Aspelin’s case, In a Moment: The Johan Aspelin Story.

copyright 2015, Sue Luttner

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

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New Cases Keep Coming, And So Do the Appeals

brianPeixotoThe action in the shaken baby arena seems to be ramping up, maybe because a few successful appeals have breathed new hope into old cases. This site is receiving not only the usual traffic from newly accused families looking for answers but also messages from supporters on the outside renewing their commitment to prisoners convicted years ago—like Brian Peixoto, who has been such an exemplary inmate during 18 years of incarceration that he was chosen to train service dogs at one facility, although he’s since been transferred.

Brian’s most recent appeal was turned down this past fallbut his case has been taken on by both the innocence arm of his state’s public defense committee and the New England Innocence Project, and his supporters have just this winter put up an ambitious web site.

Closer to the public eye, judges have granted new hearings in two old cases, reopening the convictions of child care providers Jennifer Del Prete in Illinois, whose case I looked at in a posting last month, and René Bailey in New York, featured briefly in a posting last summer. In Bailey’s case, the appeal brief offered a new report from a child care provider who said she had seen a 2-year-old boy who was at Bailey’s home on the crucial day re-enacting with stuffed animals a sequence that matched Bailey’s description of an accidental injury to a little girl. Both that boy and another child had confirmed Bailey’s report at the time, but were deemed too young to be reliable witnesses.

ReneeBaileyThe decision in Bailey’s case, issued by Monroe County Court Judge James J. Piampiano, limits the new hearing to the question of whether the defense has really produced “new evidence” with its proffered testimony from experts about a change in medical thinking regarding shaken baby syndrome and from the boy’s care provider about her observations.  Reporter Steve Orr wrote in the Democrat Chronicle:

At the time of her conviction, nearly all physicians and other experts believed that symptoms such as those displayed by [the toddler] could be caused by violent shaking, and conversely that nothing other than shaking or throwing a child could cause them.

But some experts now argue that those conclusions were based on shaky science. They say new research shows falls or illnesses can cause some of the symptoms traditionally ascribed to shaking.

The Criminal Justice Center Blog at Pace Law School posted this commentary on the case.

jhavardIn Mississippi, meanwhile, where Jeffrey Havard waits on death row, his supporters have created a thorough new web site that includes the text of his most recent appeal, filed in November of 2013. The appeal is based on both a new set of expert opinions and the 2009 recanting by the state’s star witness, Dr. Steven Hayne, of the sexual abuse diagnosis that made Havard eligible for the death penalty. Arguing that testimony about shaken baby syndrome at Havard’s 2002 trial has also not withstood the test of time, attorney Graham P. Carner quotes, among others, the affidavit of biomechanical engineer Chris Van Ee, PhD:

It would be biomechanically incorrect to dismiss the history of fall as a causal factor resulting in the findings described at autopsy. Shaking is a less likely explanation for these findings…
The rotational forces attained in manual shaking cannot be equated to those occurring as a result of a multistory fall or a high speed motor vehicle accident. To suggest otherwise is without scientific foundation.

amandaRallyFeb2014And in Florida, friends and family are regrouping in support of Amanda Brumfield, convicted in the 2008 death of her best friend’s one-year-old daughter. Brumfield reported that the baby had fallen and hit her head while climbing out of a portable playpen. Supporters are launching their new campaign with a rally next Friday at the church Amanda attended before her incarceration.

Supporters of child care provider Marsha Mills in Ohio have had their site up since 2007, within months of Mills’ conviction in another toddler-fall case. The site shows fundraisers for her defense as recently as November of 2013. They are now awaiting the results of the most recent appeal.

Finally, in Canada, Onatario Court of Appeal Judge Marc Rosenberg has authorized appeals by two shaken baby defendants who have already served their time but want to clear their records. The decision cites the lessons of the Goudge hearings in 2012.

All of this appeal activity would feel like progress, except that the other kind of story keeps coming as well. Just in the past two days I’ve seen news reports of shaking allegations against a father in Wisconsin, a young mother in Pennsylvania, and the boyfriend of the child’s mother in Ohio.

Note:  A number of support sites have remained in place for years but are not mentioned in this posting because they are holding steady, not surging. Still, it feels incomplete not to mention here the The Amanda Truth Project, which contains many family vignettes. For a  list of individual support sites, petitions, and Facebook pages, please see the lower portion of the Cases page on this blog.

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

copyright 2014, Sue Luttner

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New Research Questions Classic Model of Shaken Baby Syndrome

Kieran wired up and ready to jump

When Kieran Lloyd was seven months old, his favorite way to pass the time, right after eating and sleeping, was bouncing in his Fisher-Price Jumparoo.

He would bounce eagerly, smiling and laughing, several times a day if he was given the chance, apparently delighted with the upright posture and the kinetic results of his own kicks.

Then his father, head-injury researcher John Lloyd, PhD, realized that before him danced a chance to measure and record an important new data point in the accumulated knowledge about infant head-injury: A magnitude of repetitive angular acceleration that’s known to be safe.

He fitted his son with an accelerometer, like those used on crash-test dummies in the lab, and collected data while the boy played. By the time Lloyd was done, he had not only replicated the original 1987 research that first cast scientific doubt on infant shaking as a source of subdural hematoma but also refuted the hypothesis that repetition can make a benign acceleration injurious.

Kieran with the CRABI-12 biofidelic mannequin

In a paper published this winter in the Journal of Forensic Biomechanics, Lloyd and his colleagues reported that “angular acceleration of the head during aggressive shaking of the CRABI biofidelic mannequin is statistically indistinguishable from angular head kinematics experienced by a 7-month-old fervently playing in his Jumparoo.”

Lloyd’s paper joins a series of biomechanical studies that have all reached the same conclusion:  Shaking is unlikely to be the source of subdural hematoma in children with no signs of impact or neck injury, despite decades of courtroom testimony to the contrary.

Although the theory of shaken baby syndrome has enjoyed thirty years of general acceptance within the community of child-abuse experts, the diagnosis has been controversial from the beginning. Testing it of course was impossible.

In the mid-1980s, Dr. Ann-Christine Duhaime and her colleagues set out to investigate whether shaking without impact could cause the intracranial bleeding and swelling that defines the syndrome. They examined medical records and revisited autopsy slides, and they conducted laboratory experiments in which adult volunteers shook infant models wired with accelerometers.  They found that shaking without impact did not reach the presumed thresholds for the intracranial bleeding or neuronal damage that’s presumed to result from shaking.

Then the researchers asked their volunteers to throw the dummy down after shaking it, and learned that accelerations upon impact reached injury levels, as illustrated in Figure 2 from their paper (“The Shaken Baby Syndrome:  A clinical, pathological, and biomechanical study,” Journal of Neurosurgery 66:409-415, 1987). The shaking data are the cluster of points at the lower-left corner; the triangles are impact trials. DAI stands for diffuse axonal injury; SDH stands for subdural hematoma.

Duhaime and her team concluded, “Although shaking may, in fact, be part of the process, it is more likely that such infants suffer blunt impact. The most common scenario may be a child who is shaken, then thrown into or against a crib or other surface.”

Lloyd did not conduct impact trials, but his shaking data were in the same range as not only Duhaime’s data but also those of Prange et al., who replicated the original work in 2003  (“Anthromomorphic simulations of falls, shakes, and inflicted impacts in infants,” J Neurosurgery 99:143–150, 2003).

The NCSB demonstration doll and the CRABI-12 biofidelic mannequin

To help establish a base line for the forces commonly experienced by an infant, Lloyd also recorded acceleration data during what are called “activities of everyday living,” or ADLs. Adult volunteers rocked and burped the wired crash-test dummy, walked and ran on a treadmill with it, and took it for stroller rides over various surfaces.

Lloyd also had volunteers shake the demonstration doll sold by the National Center on Shaken Baby Syndrome. The doll is commonly used in trainings, and occasionally it’s allowed in court. The doll weighs only two pounds and volunteers were able to shake it longer and harder than the CRABI-12, producing higher angular accelerations—but still not high enough to reach projected injury thresholds.

Figure 7, below, from Lloyd’s paper summarizes the accelerations recorded during various scenarios. The entire article is available on line at this address.

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Can We Help Win a Pardon for Shirley Ree Smith?

christmas cactus blossom

April 6 update:  Governor Jerry Brown has commuted Shirley Smith’s sentence.  Shirley thanks everyone who wrote on her behalf, and I add congratulations to that.

I was expecting to hear by now from California Governor Jerry Brown about a possible pardon for Shirley Ree Smith (case summary), but there’s been no word yet.

Over the weekend, Shirley’s daughter Tomeka Smith told me they’re hoping to hear soon, because in a few weeks her mother will be taken back into custody—-but there’s still time for individuals to contact the governor’s office encouraging the pardon, as detailed below.

The Smith case continues to pop up in the press.  On the bright side:

Distressingly, a bereaved grandmother in Fresno, California, has launched a campaign against the pardon, on the theory that Ms. Smith is guilty. You can read the press coverage here.

Meanwhile, the governor’s office makes it easy for individuals to voice their opinions on these questions.  One click takes you to the contact page, at http://gov.ca.gov/m_contact.php

To make sure your comment is received in time, use the electronic form, which first asks for four pieces of information:  Your first and last name, your email address, and the subject of your comment.  Open the drop-down subject menu and select the “Pardon” item.  The user interface is odd, because you then have to click the “Submit” button before you’re given a text box for comments, but if you soldier on, you can get there.

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Pardon Possible in Smith Case

It’s too early to celebrate, but the Sacramento Bee reports that Governor Jerry Brown is expected to pardon Shirley Ree Smith, the grandmother whose conviction in a shaking case was recently reaffirmed by the Supreme Court:

http://www.sacbee.com/2011/12/29/4150363/calif-gov-brown-weighs-clemency.html

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