Tag Archives: Waney Squier

June 29, 2023 · 12:58 pm

A Must-Read Book From a Potent Team

A bold new book from Cambridge University Press assembles, in one passionate collection, the fundamental arguments for reconsidering 50 years of shaken baby convictions, Shaken Baby Syndrome: Investigating the Abusive Head Trauma Controversy.

The authors, 32 experts with impeccable credentials from a range of medical, mathematical, scientific, and legal specialties, bring both years of experience and a fresh, international perspective to the debate.

One chapter, for example, opens with a personal anecdote from retired Norwegian neurosurgeon Knut Wester, who has a scientific interest in external hydrocephalus. Asked his opinion in a shaking case, he writes, he was surprised to receive images that looked like a familiar presentation of Benign External Hydrocephalus (BEH) complicated by bleeding. His report convinced the court to drop the charges. Then he was asked his opinion in a second case, and again the images looked like BEH with bleeding. Swedish neuroradiologist Johan Wikström, Wester’s co-author on this chapter, shares his own parallel experience, all as a preface to their examination of the medical and statistical facts suggesting that BEH can be and often is misdiagnosed as SBS/AHT.

In a companion chapter, the two collaborate with pediatric neurologist Joseph Scheller in the US on a groundbreaking survey of neuro-imaging in the child-abuse literature. Their findings appear in this book for the first time anywhere. The implications, as the authors write, are “frightening.”

The book also brings a level of rigorous mathematical analysis to the SBS/AHT research I’ve never seen before.

A chapter by mathematician Leila Schneps at the French National Center for Scientific Research (Centre national de la recherche scientifique), for example, explores the logical and numerical errors in a seminal 1991 article [1] from the Children’s Hospital in San Diego, in which researchers advised that parents who report “short indoor falls” to explain serious injuries are lying.

Schneps has already published a broader look at the short-fall literature [2], where she found one study [3] that not only reported a few deaths following short falls but noted that some of the children could have been saved with prompt medical attention. In this book, Schneps takes a deeper dive into the San Diego analysis, concluding, “These articles claiming that short falls cannot cause serious harm are not only dangerous, but they are wrong.”

Similarly, British mathematician Norman Fenton and Australian health-information technologist Scott McLachlan devote their chapter to a “causal Bayesian network model,” to examine the methodology of the “Cardiff study” [4], a meta-analysis that combined data from six individual studies to build a tool for confirming a shaking diagnosis based on medical findings.

In its conclusion, the Cardiff paper offered itself as a rebuttal to Deborah Tuerkheimer’s 2009 law review article positing that the scientific underpinnings of shaking theory had crumbled. Rather, the Cardiff authors wrote in 2011, their analysis “confirms the association of AHT with specific combinations of clinical features.” Fenton and McLachlan’s modeling, however, reports “strong biases and errors” built into that work.

Meanwhile, medical ethicist Niels Lynøe and forensic medicine specialist Anders Erikssøn contributed a chapter on their own examination of the SBS controversy, inspired by the “massive and surprisingly critical international reaction” to a literature review they worked on in 2014-2016 for the independent Health Technology Assessment authority in Sweden (SBU in English).

Lynøe and Erikssøn had served on a team of SBU research experts who looked only at the study designs in the SBS literature, focusing on the question: ”With what certainty can it be claimed that the triad, subdural hematoma, retinal hemorrhages and encephalopathy, is attributable to isolated traumatic shaking (i.e. when no external signs of trauma are present)?”

Citing the prevalence of circular reasoning in the studies, the team concluded that there was “insufficient evidence on which to assess the diagnostic accuracy of the triad,” triggering a flood of denunciations from the community of child abuse experts. After studying the content of the literature, and the criticisms of their work, Lynøe and Erikssøn now report that proponents of SBS theory disagree with skeptics not only about whether and how shaking leads to the triad but about “whether there is a controversy over SBS/AHT at all.” Having experienced the controversy first hand, they suggest that this denial may be “a symptom of a crisis within the prevailing AHT research field.”

Key to pulling together this international team was French neuroscience researcher and software engineer Cyrille Rossant, whose son was diagnosed as a shaken baby seven years ago—see his blog posting about his experience. (If you or a family member has been interrogated in one of these cases, please see my earlier posting about Rossant’s request for letters.)

The book also includes veteran voices in the arena—like Innocence Project founder Barry Scheck, who defended “Boston nanny” Louise Woodward in the case that brought shaken baby into the headlines in 1997. Scheck’s foreword offers a readable summary of the evidence and testimony that presumably informed the judge’s decision, after Woodward’s second-degree murder conviction, to reduce the charge to manslaughter and set the sentence to time served.

Law professor Keith Findley, a key player since he won a pivotal appeal in 2008 on behalf of child care provider Audrey Edmunds, is surely the most qualified attorney in the arena to have written the chapter on appealing SBS cases, and he brings an insider’s view to his analyses of the confession research as proof of SBS theory and the challenges of cognitive bias.

And of course neuropathologist Waney Squier (winner of the Innocence Project Champion of Justice Award in 2016 for her work in the arena), in collaboration with forensic pathologist Tommie Olofsson at Uppsala University Hospital, provides a readable overview of the neuropathology of SBS/AHT, addressing some of the misconceptions propagated in the child-abuse literature.

A chapter Squier co-authored with radiologist Julie Mack examines the imaging of the most common brain findings in SBS/AHT cases, with commentary on what isn’t yet understood and the limitations of what imaging can reveal.

The chapter on scientific evidence in the courtroom, by public defense attorney Kathleen Pakes, caught me by surprise, flatly rejecting courtroom testimony from a physician about mechanism of injury.

In conversation Pakes says, “If these were civil cases, if we were Monsanto or Dow Chemical and we had the money to question the science, this stuff would never be allowed.”

Pakes is more restrained in print, where she addresses the difference between a doctor’s ability to identify and treat a medical condition and that same doctor’s ability to divine what caused the condition—a distinction that’s been pivotal in employee-injury and product-liability litigation. Pakes also reviews the circular reasoning in the literature, the questions raised by biomechanics research, and the subjective nature of the diagnosis, concluding, “a consistent application of governing legal principles would exclude opinion evidence purporting to ‘diagnose’ SBS/AHT.”

And there’s lots more–the international statistics, for example, and the histories of SBS in the Swedish and Japanese courts; Marta Cohen on misdiagnosis of SIDS. This book deserves more coverage than I have room to give it in one posting. If you are an attorney working in this vital, complex, divisive arena, or anyone trying to figure out what’s going on, you need to read Shaken Baby Syndrome: Investigating the Abusive Head Trauma Controversy.

The ebook is now available for download. The hard copy seems to be shipping in the U.K., but I haven’t seen the copy I pre-ordered some weeks ago on the US site. Click the button below for a downloadable coupon for 20% off if you order directly from the Cambridge University Press.

20% off coupon

Cambridge University Press, UK edition order page

(1) Chadwick DL, Chin S, Salerno C, Landsverk J, Kitchen L. Deaths from falls in children: How far is fatal? Journal of Trauma. 1991;31(10):1353–5 (Abstract)

(2) Schneps L, Rossant C. Chutes de faible hauteur et syndrome du bébé secoué, erreurs numériques et logiques. In Hématomes sous-duraux et collections péri- cérébrales du petit nourrisson. B. Échenne, A. Couture, G. Sébire, eds. Sauramps, 2020, pp. 299–328 (English translation)

(3) Hall JR, Reyes HM, Horvat M, Meller J, Stein R. The mortality of childhood falls. Journal of Trauma. 1989;29(9):1273–5

(4) Maguire S, Kemp A, Lumb R, et al. Estimating the probability of abusive head trauma: A pooled analysis. Paediatrics. 2011;128(3):e550–e564 (Abstract)

copyright 2023 Sue Luttner

If you are unfamiliar with the controversy surrounding SBS/AHT, please see the home page of this blog.

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March 18, 2018 · 11:07 am

From the heart, from the brain: A top-notch TEDx talk on shaken baby

Pediatric neuropathologist Dr. Waney Squier has hit one out of the park in her TEDx talk, “I believed in Shaken Baby Syndrome until science showed I was wrong,” published Friday on Progress Video TV.

While telling her own story with calm, compelling intensity, she also describes the pain inflicted on innocent families by misguided accusations of abuse and documents the refusal of the legal and medical communities to accept the unwelcome truth about their flawed theory.

“By ignoring the science and adopting an unproven hypothesis, doctors have done great harm,” she concludes, “and have led the courts astray.”

The talk opens with the story of Linda, a mother convicted of shaking her third child to death based on the presence of the triad: bleeding in the retinas, bleeding beneath the lining of the brain, and brain swelling. “At her trial, Linda was described as a woman of good character, a caring and careful mother,” Dr. Squier recounts, “But doctors—medical experts—said that those three findings meant that [the boy] must have been violently shaken” when alone with his mother.

Three years later, Linda’s conviction was overturned on appeal. “Her name was cleared, but her life was ruined,” Squier says. Her parents had died and her husband had left her. Her fourth child, a little girl born in prison, had been taken from her at birth and placed for adoption, and even after her exoneration, Linda was prohibited from attempting contact.

When Linda was first accused, the police had called in Dr. Squier, an expert on infant brain pathology. After examining the brain, she had endorsed the opinion of the other doctors, that it was a case of shaken baby syndrome. “They believed in it, and I believed in it,” she grimaces, “and so my report was part of the evidence that cost Linda so much.”

Dr. Squier says her own doubts about shaking theory started when another neuropathologist, Dr. Jennian Geddes, published research suggesting that the damage in presumed shaking cases resulted from lack of oxygen, not from direct violence. Dr. Squier recalls:

“Back in 2001, the Geddes research stopped me in my tracks. It wasn’t what I had expected. So I read everything I could about shaken baby syndrome, and as a scientist, I’m embarrassed to admit to you I hadn’t done so before. I’d been making this diagnosis on the basis of my uncritical acceptance of what was in the textbooks and what I’d been taught. I was startled to learn that there was no scientific foundation for the hypothesis.”

No one has ever witnessed a shaking assault that resulted in the triad, she reports. Laboratory research and biomechanical calculations have only cast doubt on the theory, and past experience with front-facing car seats tells us that whiplash forces cause fractures and dislocations in the neck, not intracranial bleeding and swelling.

After her realization that the theory was not only unproven but likely wrong, Dr. Squier started conducting her own research, and she started testifying for the defense. But her willingness to speak out against the common knowledge resulted in criticism from colleagues, scoldings from judges, and complaints to the authorities. In the spring of 2016, after hearings triggered by a police complaint to the General Medical Council, she temporarily lost the right to practice medicine, until a higher court reinstated her, declaring most of the first findings “unsustainable.” She is still prohibited from testifying in British courts for another year and a half.

The actions against her have successfully stifled the voices of dissent, Dr. Squier argues, leaving innocent families “defenseless” against their accusers. “Back in 2005, Linda had seven medical experts to support her. Today she would be likely to have none.”

Some other key points from Dr. Squier’s talk:

“So today, as I stand here, I am sure that shaking can harm babies, and we certainly shouldn’t shake babies. But nearly 50 years of research has failed to provide us with the justification to make the assumption that a baby who has the triad or any of its components must have been shaken.”

“If we do nothing, then ordinary people, people who have already suffered the tragedy of the death of a baby, will continue to have their families torn apart by incorrect and unscientific opinions…

“If we do nothing, this travesty will continue… this willful refusal of the courts and the doctors advising them to recognize the science that shows they are wrong.”

But you might have other favorite quotes. I suggest you watch the entire talk.

Copyright 2018, Sue Luttner

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

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November 7, 2016 · 11:18 pm

Dr. Waney Squier Reinstated

SquierProfileNoCaption

Dr. Waney Squier

A British High Court judge has reinstated Dr. Waney Squier’s right to practice medicine, in a decision that dismissed as “unsustainable” a number of findings by a tribunal appointed by the General Medical Council (GMC) in 2015 to investigate her testimony in a series of shaken baby cases. A well respected pediatric and perinatal neuropathologist, Dr. Squier has questioned shaken baby theory in the medical journals and has testified to her opinions in court. After the tribunal’s findings were issued last spring, the GMC removed her from the medical registry.

Justice Sir John Edward Mitting explicitly rebutted the tribunal’s conclusions that Dr. Squier had acted dishonestly, noting at one point that “her views were genuinely held.”

Despite his harsh criticism of the tribunal’s report, Justice Mitting upheld their finding that Dr. Squier had practiced outside her field of expertise. He has prohibited her from giving expert testimony in British courtrooms for three years.

The GMC’s actions against Dr. Squier were based on a complaint lodged in 2010 by the National Policing Improvement Agency (NPIA), a government body disbanded in 2013 only a few years after it was created “to support police by providing expertise in such areas as information technology, information sharing, and recruitment.” The agency seems to have acted on a broad interpretation of its charter, supporting the police by attempting to silence one of the few physicians in Great Britain willing to testify against the prosecution model of shaken baby theory.

waneyPlanoProfile

Justice Mittering, who heard a week of testimony on Dr. Squier’s appeal last month, had clearly studied the transcripts from a series of hearings held by the tribunal, because he identified a number of factual errors in their report—such as their finding that Dr. Squier had proposed choking in a case with no evidence to support that conclusion, even though a 7-year-old witness had told an investigator the baby “was trying to vomit and was choking” and the clinical notes included repeated references to “gastro-oesophageal reflux disorder,” a condition consistent with choking.

I was relieved to see that the judge had also read much of the medical literature, and so recognized some of the tribunal’s misunderstandings and mischaracterizations of her citations. The tribunal had found, for example, that Dr. Squier had “completely misinterpreted” the Duhaime 1987 paper and had misrepresented both it and the Cory 2003 follow-up study under oath. Comparing her testimony with the published papers, however, Justice Mitting noted the tribunal’s error:

This was a good example of her giving evidence outside her expertise, but, properly stated, both reports were not inconsistent with, and were to an extent supportive of, her hypothesis that a fall from a low height could cause fatal head injuries in small babies.

The institutional  insistence that Dr. Squier gave evidence outside her expertise continues to strike me as ironic. In a tortured qualification to his endorsement of that finding, Justice Mitting recognized that medical specialists evaluating the triad would necessarily be expressing opinions outside their own disciplines, but he still seemed to agree with the tribunal that Dr. Squier had crossed a line:

The qualification is that, when the triad fell to be considered, any specialist, with the possible exception of a forensic pathologist, who supported or doubted the triad as indicative of NAHI [non-accidental head injury], would be bound to be expressing an opinion outside his specialism. There can be no proper criticism of a neuropathologist, neuroradiologist or ophthalmologist/ophthalmic pathologist for explaining why he supports or doubts the majority view and in doing so, expresses a view about symptoms or pathological findings outside his own discipline. It is neither improper nor professional misconduct for an expert in one specialism to do so. The boundary line between a proper explanation of support or doubt and trespassing impermissibly outside the expertise of the witness is imprecise and difficult to identify in any particular case. It would have been better if the [tribunal] had acknowledged that difficulty; but, with that qualification, there is and can be no justified criticism of its conclusions about the limits of Dr. Squier’s expertise.

I don’t understand how either the tribunal or Justice Mitting can object to Dr. Squier’s expressing her opinions about short falls but still accept the opinions of physicians who diagnose shaking injury, a proposition that implies a level of biomechanical understanding not included in anyone’s medical education.

Stepping through the dozens of charges and sub-charges, Justice Mitting determined that Dr. Squier had correctly cited not only Duhaime and Cory but also Arbogast 2005, Rooks 2008, Oehmichen 2008, and others, noting in one case that the tribunal had relied on the testimony of  neuropathologist Prof. Colin Smith, who himself had misrepresented the paper in question:

Professor Smith stated, in evidence accepted by the [tribunal], that the authors could discriminate between traumatic and ischaemic causes of axonal injury. In fact they only did so in 2 out of 18 cases. Unfortunately, this proposition was not put to Professor Smith in cross-examination. As a non-expert, I set out my understanding of the passage on which he relied with some diffidence, but it does, in the end, seem to me to be reasonably clear. It supports rather than undermines Dr. Squier’s opinion. The [tribunal] was wrong to find this sub-charge proved.

Still, Justice Mitting agreed with the tribunal that Dr. Squier had “cherry-picked” from her sources and had at various points misrepresented Arbogast and others, and he seems to have accepted some common misunderstandings about shaking injuries. The tribunal had found, for example, that Dr. Squier was untruthful and “evasive” in her testimony in front of them, citing four specific instances in which they found her statements unbelievable. In one of their examples, she gave inconsistent answers to the question of when she had suggested a child had experienced a “lucid interval”—in her written report or in her oral testimony at either the civil or the criminal trial. Evaluating that exchange, Justice Mitting wrote:

Her explanation for the difference was that she was confused. Her answers read like an attempt to justify an opinion about lucid intervals which she realised was difficult to support. The [tribunal]’s finding that her explanation of confusion was “incredible” was justified if, by it, they meant that she was struggling to justify an unsustainable opinion. To that extent, her answers were evasive.

Myself, I endorse Dr. Squier’s opinions about the lucid interval, which I think are well supported by the published literature—please see, for example, the letter to the American Journal of Forensic Medicine and Pathology from Dr. Robert W. Huntington III, on the home page of this blog.

After last week’s decision was released, including the restriction on Dr. Squier’s giving court testimony, intensivist and shaken baby critic Dr. Steven Gabaeff observed that even with the reinstatement, proponents of shaken baby theory have achieved their goal of “suppressing defense testimony.” If no one who doubts shaken baby theory is allowed to testify, then accused parents have no chance to argue their innocence at trial.

heather2015

Heather Kirkwood

Detective Inspector  Colin Welsh from New Scotland Yard articulated the suppression strategy in 2010 in Atlanta, Georgia, at the biannual conference sponsored by the National Center on Shaken Baby Syndrome, in a talk with the title “A National Co-ordinated Approach to Cases of Non-Accidental Head Trauma in the UK.” According to attorney Heather Kirkwood, who attended the session, Welsh reported that his team had been facing a “systemic failure” of shaken baby prosecutions and the primary cause was that “juries were being confused by defense witnesses.” He recommended intense scrutiny and criticism of experts for the defense, and he mentioned his partnership with NPIA, the agency that filed the the complaint against Dr. Squier. Kirkwood later made her notes public, along with a deposition that offered this summary of Welsh’s presentation:

“Shortly into the talk, I realized that the ‘national coordinated approach’ referenced in the title of the talk was essentially a description of the joint efforts of New Scotland Yard, prosecution counsel, and prosecution medical experts to prevent Dr. Squier and Dr. [Marta] Cohen from testifying.”

For more about professional harassment of Dr. Squier, please see my blog postings “Back Door Tactics Show Through” and “When Pie in the Sky Turns Out to Be Dawning Knowledge.”

On October 7 of this year, just before the appeal hearings opened, the BMJ published a letter of support for Dr. Squier from more than 250 physicians, attorneys, and others protesting that the GMC’s sanction was depriving patients of her skills and expertise—if you have not yet done so, you can go to the letter site and click the thumbs-up button to add your vote of support for Dr. Squier.

Last week’s decision reinstating Dr. Squier brought her story back into the headlines, including treatments by the BBC, the Daily Mail, and The Justice Gap, an on-line magazine about justice and the law aimed at the public.

The GMC’s decision last spring to remove Dr. Squier from the medical registry triggered immediate outrage from her defenders, followed by continuing coverage within the U.K. justice community, which recognized the chilling effect of the medical council’s actions on any physicians who dare to disagree with mainstream thinking.

Inside Justice, an investigative group that looks into alleged miscarriages of justice, published a series of insideJusticeHeaderdocuments and commentaries about Dr. Squier’s case, including a collection of careful and articulate rebuttals to the tribunal’s report written by Michael Birnbaum, QC; Dr. Michael Powers, QC; U.S. attorney Randy Papetti; and veterinarian Nicholas Binney, who is working on a graduate thesis on diagnostic practices. The rebuttals received coverage in the popular magazine Private Eye as well as in forums like The Justice Gap, where founder Jon Robins wrote in an essay titled “The Silencing of Dr. Waney Squier“:

In a forensic analysis of the judgment, Michael Birnbaum QC, who gave evidence on behalf of the doctor, pulls few punches accusing the tribunal’s reasoning of being ‘largely formulaic and frequently illogical’ as well as being littered with ‘howlers’. ‘In my 43 years of practice at the Bar I have rarely read a judgment of an English Court or Tribunal so deeply flawed and unfair as this,’ he begins.

‘Given this bizarre combination of the apparently one-sided and the obviously inept, I cannot make up my mind whether the tribunal was actually biased in the sense of being actively prejudiced against Dr Squier or whether it was just not up to its task,’ he writes. ‘Whatever view one takes on its impartiality, the tribunal’s presentation of the evidence is so inadequate and its conclusion so poorly reasoned that its determination lacks all credibility.’

I am gratified that Justice Witting also recognized some of the many objective errors in the tribunal’s report, and I am pleased that Dr. Squier is allowed to practice again. I wish that someone at the GMC would also read the report carefully and realize that the organization has imposed professional sanctions based on a series of misinterpretations and fundamentally flawed conclusions.

In fact, I wish someone at the GMC would also read the shaken baby literature carefully, because they would be forced the reach the same conclusions as Dr. Squier and the team of Swedish scientists and physicians who last month published their review of the shaken baby literature, that is, that shaken baby theory has never been proven. For my personal analysis of the medical literature, please see Shaken Baby Syndrome: Medico-Legal Miscommunication.

Like the tribunal’s report, the published literature in support of shaken baby theory does not hold up under careful scrutiny.

copyright 2016, Sue Luttner

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

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March 14, 2016 · 6:54 am

Guilty of Intellectual Honesty

Pediatric Neuropathologist Dr. Waney Squier At the Evidence-Based Medicine Symposium in Denver in 2009In a 96-page decision packed with irony, the Medical Practitioners Tribunal Service (MPTS) in Britain has declared pediatric neuropathologist Waney Squier guilty of practicing outside her area of expertise, ignoring the opinions of her peers, and tarnishing the reputation of the medical profession with her testimony and written opinions in a series of shaken baby cases between 2007 and 2010.

“The tribunal is in no doubt you have been a person of good character and have not acted dishonestly in the past,” the statement offers, but it characterizes her opinions about shaken baby syndrome as “dogmatic, inflexible and unreceptive to any other view” and declares her work in the arena “misleading,” “irresponsible,” and even “dishonest.”

MackSquierHead2009For about the past 15 years, Dr. Squier, a consulting neuropathologist at the Oxford Radcliffe Hospitals, has been challenging the community of child abuse experts to reconsider the unproven model of shaken baby syndrome that’s been winning in court for decades. She has not only testified to her theories but also conducted research and published in the medical journals.

The charges against her were levied by the General Medical Council (GMC) at the instigation of prosecutors concerned that her testimony was impeding convictions in shaking cases, according to Dr. Michael Powers, QC, as quoted in the coverage by Robert Booth at The Guardian. The GMC will determine her penalty later in the month, possibly loss of her status as a practicing physician.

Dr. John Plunkett

Dr. John Plunkett

Dr. John Plunkett, a pathologist who has fought off charges of perjury for his testimony regarding shaken baby theory, pointed out that Dr. Squier is receiving a Champion of Justice award next month at the annual Innocence Network conference in San Antonio, Texas. “How is it that the Innocence Network can give this award to Dr. Squier if the GMC has correctly characterized her behavior as dishonest and worthy of sanction?” he asked.

Dr. Bergina Brickhouse, a psychiatrist whose husband was cleared of shaking accusations based partly on a report from Dr. Squier, wrote in an email, “If not for the strength, fortitude, and technical expertise that Dr. Squier has shown, my family would most assuredly have been ripped apart by well-meaning but ignorant medical staff.”

Developmental Medicine & Child Neurology, 2008

Developmental Medicine & Child Neurology, 2008

I would have expected adjudication of the charges to be conducted by a panel of physicians, but the MPTS set up a team of one retired psychiatrist and two lay persons—a retired Royal Air Force wing commander and a retired police officer—to evaluate the evidence against Dr. Squier. The members seem not to have read the medical literature but based their conclusions primarily on oral testimony given over several months of hearings that started in the fall. The panel’s report describes all of the prosecution’s expert witnesses as “credible” but articulates various objections to the experts called by the defense.

Forensic pathology professor Bo Erik Ingemar Thiblin of Uppsala University, for example, had explained how circular reasoning in the early shaken baby papers allowed the theory to become established without scientific proof, the same argument that convinced the Swedish Supreme Court to revisit the legal status of shaken baby theory last year. Dr. Thiblin is an expert in epidemiology, the study of patterns, causes, and effects in health conditions, a complex field that emphasizes assessment and analysis of the known facts. In a triumph for circularity, the tribunal rejected his testimony with this explanation:

“It was clear that Professor Thiblin did not believe in the concept of shaken baby syndrome, and his view of the literature was coloured by that. He was critical of the methodology of all the research literature in relation to the subject because of its perceived circularity bias. The tribunal considered that his expert opinion on non-accidental head injury lacked credibility; therefore the tribunal attached limited weight to his evidence.”

In an insightful editorial in The Guardian today, human rights attorney Clive Stafford Smith compared the tribunal to the trial of Galileo by the church for his theory that the earth orbits around the sun and not the other way around:

“I am convinced that Squier is correct, but one does not have to agree with me to see the ugly side to the GMC prosecution: the moment that we are denied the right to question a scientific theory that is held by the majority, we are not far away from Galileo’s predicament in 1615, as he appeared before the papal inquisition… It was not until 1982 that Pope John Paul II issued a formal admission that the church had got it wrong.”

Dr. Waney Squier

One of the inexplicable elements of the decision was the tribunal’s finding that Dr. Squier had erred by testifying to biomechanical issues without any expertise in biomechanics—although the prosecution experts who testified in the hearings were, like Dr. Squier, physicians with no apparent specialized training in biomechanics (Dr. Richard Bonshek, ophthalmic pathologist; Prof. Rupert A. Risdon, pediatric forensic pathologist; Dr. Neil Stoodley, neuroradiologist; and Prof. Colin Smith, neuropathologist).

Similarly, the declaration scolds her for citing the 1987 paper by Duhaime et al. to support her observation that shaking without impact has not been shown to create forces sufficient to cause the brain injury. The tribunal said she had “completely misinterpreted what Duhaime had actually said,” even though the paper’s introduction says:

“It was concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome.”

In a moving one-minute interview on the BBC, Dr. Squier said she is “devastated” by the finding, which she said has “enormous implications” not just for doctors but for any experts willing to testify in court. “You can give an honestly held, well-supported opinion and find yourself out of job,” she observed.

The charges against Dr. Squier are consistent with a strategy advocated by Detective Inspector Colin Welsh of New Scotland Yard in 2010 at the 11th International Conference on Shaken Baby Syndrome for improving the conviction rate in these cases by neutralizing experts willing to testify for the defense (see “Back Door Tactics Show Through“).

Proponents of shaking theory also ridicule their critics at conferences and scorn them in print, and in 2014 they attempted to block the premiere showing of the documentary The Syndrome, which they dismissed as “a national platform for the tiny handful of well-known child abuse defense witnesses to publicize their fringe message.”

An editorial this winter in the journal Pediatric Radiology, “Child Abuse: We Have Problems” by Dr. Peter J. Strouse, declares that “child abuse denialists” now pose “a growing threat to the health care of children and the well-being of children and families,” and calls on institutional rejection of doctors who defy the common knowledge about child abuse:

The court system seems ill-equipped to properly censure the denialists in spite of their deceitful and unethical behavior. Ideally, the legal system would practice peer-review by unbiased observers, but this does not occur. Institutions that harbor denialists, whether they be private practices or esteemed academic institutions, should carefully consider their employment.

Even in this environment, Dr. Squier has been willing to say in print and in court what her own research and experience were telling her about shaken baby theory.  I am in awe of both of her intellectual honesty and her courage, and I am horrified at Friday’s decision. The only silver lining I can think of is that maybe, this time, they have gone too far. The ironically named “determination of facts” released on Friday will not hold up to the scrutiny that Dr. Squier’s own work has already survived (see, for example, “When Pie in the Sky Turns Out to Be Dawning Knowledge”).

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

Copyright 2016, Sue Luttner

 

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October 22, 2015 · 1:20 pm

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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February 9, 2015 · 12:38 pm

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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July 24, 2013 · 11:53 am

Shaken Baby Doubts Keep Surfacing

As the improbable accusations, heart-wrenching convictions, and dogged appeals accumulate, the press is running more stories about disputed diagnoses of shaken baby syndrome.

Prof. Adele Bernhard

Law professor Adele Bernhard

In upstate New York, for example, the Democrat and Chronicle has run a two-part series of what it calls “Watchdog Reports,” with independent text and video treatments.

Part I, “Shaken baby science doubt grows,” features a complex and thoughtful text piece about child-care provider René Bailey, whose 2002 conviction is now being appealed by Professor Adele Bernhard and her students at Pace Law School’s Post Conviction Project. The story includes an intriguing tale told by a new witness, the woman who later cared for a 2-year-old boy who was also at Bailey’s house that day. She says that he seemed to be re-enacting the fatal incident during spontaneous play, again and again with stuffed animals, as a leap from a chair.

Michael Tantillo Ontario County District Attorney

District Attorney Michael Tantillo
Ontario County, New York

The video offers statements from both sides: Ontario County District Attorney Michael Tantillo says the “vast majority” of experts are comfortable with the diagnosis once known as SBS, now called abusive head trauma. Defense attorney William Eastman expresses his skepticism without explaining that he was part of the team that represented Barbara Hershey, 67 years old when she was convicted in 2007 for the presumed shaking death of her 4-month-old grandson. Hershey was released in 2011, after her sentence was reduced in a proceeding that did not address the validity of the diagnosis. Like so many women in her position, Hershey has had the support of her family from the beginning.

Part II of the series, “Shaken-baby triad still rules in New York courts,” devotes both the text and video segments to Hershey’s case—the treatments are different, though, and the commercial before the video is only 15 seconds, so I recommend both reading and watching.

Decision Returns Quashed Conviction to the Headlines

ECHRA European human rights court, meanwhile, has declined to order compensation for accused mother Lorraine Allen, whose 2000 conviction for presumably shaking her son to death was reversed in 2005. Ms. Allen says she was not surprised at the decision, but is bitterly disappointed that she still has no visitation rights with her surviving son, born after the charges were brought and adopted out against her will.

Allen’s case is one of the last in which Dr. Waney Squier testified to the mainstream model of shaken baby syndrome, repeating on the stand what she’d learned from her medical mentors and colleagues: that the boy’s combination of subdural hematoma, retinal hemorrhages, and encephalopathy represented a shaking injury.

Dr. Waney Squier, at the 2009 Evidence-Based Medicine Symposium Denver, CO

Dr. Waney Squier,
at the 2009 Evidence-Based Medicine Symposium,
Denver, CO

Dr. Squier realized the model was wrong over the next couple of years, she has said, based on her experiences with cases like Allen’s and the work of Dr. Jennian Geddes. “By then it was far too late for my family,” notes Allen, although Dr. Squier did help overturn her conviction—after Allen had already served her time in prison and lost both her sons and her marriage to the accusations. At the time of his death in 1998, four-month-old Patrick had no bruises, grip marks, neck injury, or other signs of violence, only the pattern of intracranial bleeding and swelling that at the time was considered proof of abusive shaking.

The current coverage focuses on whether the vacation of Allen’s conviction was an actual exoneration, as explained in this report from The Guardian: “Lorraine Allen denied compensation after being wrongfully jailed for killing son.”

The diagnosis in this case was made in the face of this extraordinary history:  On December 4, 1998, 4-month-old Patrick received his third round of immunizations. At 1 am the next morning, Allen called her doctor with a report that the boy was having trouble breathing. Dr. Barber made a house call and found the child a little “snuffly” and with a slightly elevated temperature, but otherwise fine. He left the home at about 1:30. An hour later, Allen called for emergency help with an unresponsive child. Patrick was resuscitated and placed on life support, but he never regained consciousness and died two days later. Prosecutors concluded that Allen had violently shaken her son after the doctor’s visit and before the emergency call.

For a solid account of the case, written last year for The Justice Gap by a consultant to Allen’s defense team, please see “Shaken Baby Syndrome—And the Fight for Justice.”

Articulate Voices Speak Out

Back in the States, the Medill Justice Project has put together its best shaken baby video yet, including a rare interview with law professor Deborah Tuerkheimer, who has caused major waves the past few years with her journal articles and New York Times op ed piece.

Series Examines the Role of Social Services

And moving north again, the Weekend Telegram in Nova Scotia has run a thoughtful three-part series featuring a familiar tale:  An infant with previous health issues removed by social workers who believed the little girl had been shaken—in this case, even though doctors deemed the evidence against the mother too murky for criminal charges.

Part 1 “Guilty until proven innocent”

Part 2 “Justice at a heavy price”

Part 3 “Victims of tunnel vision,” which introduces the case of Audrey Edmunds.

Judge Listens to Parents

A High Court judge in Britain has declined to remove three children from the care of their parents, despite findings of subdural hematoma in each of their offspring. The judge seems to have been swayed by the family’s complex medical history, as explained in the coverage on the web site This Is Cornwall: “Parents win battle to keep their children out of care.”

Misdiagnosis Prompts Bill

Finally, a family in the southern U.S. has enlisted the help of their legislator after social services restricted access to their older children because of an abuse report triggered by retinal hemorrhages in their infant’s eyes. A follow-up evaluation found no evidence of abuse and attributed the infant’s death to a bad reaction to medication, but the family was disrupted for 5-1/2 months while the paperwork caught up to them.

As the child’s mother noted, “We were kind of guilty until proven innocent.”

Television station KATC in Layfayette, Louisiana, offers both video and text coverage on their web site, at “Iota family fighting for new legislation after misdiagnosis forces call to child services.”

Business Goes On as Usual

Despite all of these developments, the accusations continue—and the interrogations and the prosecutions. Just in the last couple of days, for example, young men who initially denied any abuse have become confession statistics:

“Father Accepts Plea Deal in Shaken Baby Investigation”

“Police:  Ogden Man Admitted To Shaking Baby in His Care”

And a couple has been cast by the police and the press in the worst possible light after they sought medical help for their son, who was found to have symptoms “consistent with” shaken baby syndrome:

“Couple arrested after baby found unresponsive”

I suppose some or all of these people might be guilty, but myself, I see lots of room for innocence in all three cases.

-Sue Luttner

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

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July 2, 2012 · 10:02 am

Well Said: Law Reviews Address SBS

Keith Findley, co-director of the Wisconsin Innocence Project, at an SBS meeting in February 2012

With manuscripts from seasoned veterans, young idealists, and players in between, law journals are starting to cover the legal tangle surrounding shaken baby syndrome.

Law professor Keith Findley at the University of Wisconsin Law School, co-director of the Wisconsin Innocence Project, has collaborated with an all-star team to produce a thorough, careful, and readable response to an article that appeared in the April issue of the Houston Journal of Health Law and Policy, from the University of Houston Law Center.

In the original paper (“A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome,” Volume 11, issue 3), attorney and child-abuse pediatrician Dr. Sandeep Narang rejected the mounting criticism of classic SBS theory and argued that, in the absence of a clear alternative diagnosis, the courts should rely on child-abuse experts to tell them whether the presence of the triad represents abuse.

Findley’s response—written with pediatric radiologist Dr. Patrick Barnes, pediatric neuropathologist Dr. Waney Squier, and law professor David Moran from the Michigan Innocence Clinic—is a must-read for anyone facing or defending an SBS accusation. You can download the unpublished draft of “Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right” at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2048374.

Winter 2013 update:  Dr. Narang’s paper is now available at http://www.law.uh.edu/hjhlp/volumes/Vol_11_3/Narang.pdf, and the response from Findley et al. is now available in situ at http://www.law.uh.edu/hjhlp/volumes/Vol_12_2/Findley.pdf

Past Convictions

The University of Wisconsin Journal of Law Reform, meanwhile, has published a careful analysis that calls for a review of all past convictions in shaking cases. Senior law student Rachel Burg opens her article with the story of Julie Baumer, who was featured in Emily Bazelon’s New York Times Piece in 2010. Baumer served four years in prison before a pro bono attorney brought in new experts, who unanimously and independently diagnosed venous sinus thrombosis. Burg writes, accurately, I’d say:

The truly heartbreaking stories, however, are those that are not told—the innocent people currently in prison, convicted of seriously injuring a child that they loved, based on a medical diagnosis that has become scientifically questionable.

You can download a .pdf of Burg’s article from the journal’s web site, http://www.mjlr.org/2012/05/volume-45-issue-3-spring-2012/

SBS as Established Mistake

In 2011 the Brigham Young University Law Review published a reasoned article calling for bone-density testing before fractures are considered pathognomonic for abuse. Author Matthew B. Seeley, a recent law school graduate, cited shaken baby syndrome as an example of past judicial mistakes. He reviewed the history of the syndrome, including recent rethinking about both the specificity and the timing of the symptoms, and wrote:

There are many lessons to be learned from the history of shaken-baby syndrome, not all of them within the scope of this Comment. One lesson, though, is clear: a misappraisal of whether a certain injury or combination of injuries is pathognomonic can lead to the conviction and imprisonment of innocent caretakers.

Although I’d expect that article to be heading to the archives soon, it is currently available through the Current Issue tab on the journal’s web site, at http://lawreview.byu.edu/issue.php

Shaking as First-Degree Murder

Practicing attorney Derick Vollrath in North Carolina has published an intriguing analysis in the Campbell Law Review, arguing that the prevalence of anti-shaking campaigns is inconsistent with his state’s policy of prosecuting shaking deaths as first-degree murder. Vollrath writes:

These campaigns share a common assumption: a significant number of Shaken Baby Syndrome deaths are not the intended result of a caregiver’s premeditated design.

Caregivers just lose it. They snap. They don’t know any better.  At the same time, North Carolina’s criminal law allows the state’s district attorneys to prosecute these caregivers for first-degree murder,  the most serious criminal charge available.

Although I regret that Mr. Vollrath seems to accept the specificity of the triad, I do appreciate his careful analysis and thoughtful position.  The article is in the current issue of the Campbell Law Review, available at  http://law.campbell.edu/lawreview/

Professor Deborah Tuerkheimer, De Paul University College of Law

The Classic

My files contain a handful of older papers, but the first highly publicized law journal article critical of infant shaking convictions was Professor Deborah Tuerkheimer’s 2009 critique in the Washington University Law Review.

She has since published a follow-up article in the Alabama Law Review addressing the lag in courtroom policy despite the evolving science.

Both Professor Tuerkheimer and Audrey Edmunds—the Wisconsin babysitter whose vacated conviction in 2007 marked the beginning of the Innocence Network’s success with shaking cases—will have books on the shelves soon.  The tide is turning.

©2012, Sue Luttner

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June 12, 2012 · 12:42 am

“Back Door” Tactics Show Through

March 16, 2012, BBC One

Tensions have been mounting among the pathologists on the medico-legal drama Silent Witness, and now the doctors are finally speaking frankly. No, the head of the lab assures his young colleague, there is no conspiracy against Dr. Helen Karamides, the prominent pediatric neuropathologist whose maverick views on shaken baby syndrome have made her a lightning rod for criticism. He is double-checking Karamides’s work not because of a political witch hunt, he explains, but because the pathologist has been accused of conducting her research with illegally acquired brain tissues.

Pediatric Neuropathologist Dr. Waney Squier
At the Evidence-Based Medicine Symposium in Denver in 2009

To anyone familiar with the career of pediatric neuropathologist Dr. Waney Squier, the parallels were obvious:  Like the Karamides character, Squier has testified for the defense in infant-shaking cases, in the face of harsh criticism from her peers and even from the bench—as in the courtroom scene in the opening episode of the two-part show, titled “Paradise Lost.”

Unlike Karamides, however, Squier has published her infant-brain research in the peer-reviewed literature, and she was quickly cleared when accused of violating the human-tissue laws.

The irony is that the conclusion of “Paradise Lost” actually adds to the evidence for a conspiracy of sorts against doctors who question the prosecution model of shaken baby syndrome:  By the end of the wrap-up segment, the Karamides character has videotaped her own suicide, confessing that, “as you correctly alleged,” she had conducted her research on illegally harvested baby brains. Autopsy reveals that she was an alcoholic. The packet that I’d hoped would document her research contains only extensive interviews with a serial killer, who seems to have turned himself into a psychopath by head-banging as a lonely, unloved child.

Anyone who questions the classic model of shaken baby syndrome would be discouraged by the fictional outcome, but Waney Squier has filed a complaint, with both the BBC and Ofcom, an entity that describes itself on the web as an “independent regulator and competition authority for the UK communications industries.”

Dr. Squier declines to talk about the situation, saying only that she trusts the BBC will do the right thing. Her complaint was leaked to the magazine Private Eye, however, which claimed to be quoting from her letter to the two agencies:

“While the storyline portrayed my unique professional circumstances in some detail, it deviates from the truth with respect to an accusation of retaining baby brains for research without permission. Such action would be gross professional miconduct and a criminal offence.”

Squier’s complaint allegedly described the character’s suicide as “disturbing to me and my friends” and “extremely painful to my daughters and my close family.”

The coverage in Private Eye, which doesn’t seem to be posted publicly, also included this observation about the BBC’s embarrassment:

One of the many factors that make the Beeb’s position extremely dicey is that none of the dirt previously directed at Squier by her enemies has stuck, thrown as it was by parties with an obvious axe to grind.

Squier was one of the doctors deeply involved in the response to the Alder Hey organ retention scandal in Liverpool 12 years ago which, ironically, led to the Human Tissue Act three years later and the setting up of the HTA to police it. She now believes she has been depicted as in the mould of Professor Dick Van Velzen, the rogue pathologist at the centre of the Alder Hey scandal.

One of the other factors that “make the beeb’s position extremely dicey” is that Squier had received a call from Silent Witness about a year before the “Paradise Lost” show aired, in which she learned they were doing a program on shaken baby syndrome.

The London Evening Standard published this piece on the complaint, seemingly picked up from Private Eye. 

Heather Kirkwood in 2015

Heather Kirkwood in 2015

What fascinates me about this story is that the BBC faux pas illustrates the kind of “back door” campaign that attorney Heather Kirkwood alerted me to two years ago, between sessions at the Eleventh International Conference on Shaken Baby Syndrome/Abusive Head Trauma, in Atlanta, Georgia.

I happened to catch Kirkwood not long after she’d attended a talk, by Detective Inspector Colin Welsh from New Scotland Yard, with the title “A National Co-ordinated Approach to Cases of Non-Accidental Head Trauma in the UK.” Kirkwood knew complaints had been filed with the General Medical Council (GMC) against Dr. Squier and a colleague of hers, histopathologist Dr. Marta Cohen, based on their courtroom testimony in shaken baby cases. She had just learned why.

“I don’t believe this,” she said, her incredulity tinged with indignation. “Their entire coordinated plan was to keep Dr. Squier and Dr. Cohen off the stand.”

According to Kirkwood’s transcribed notes, D.I. Welsh’s talk had detailed a strategy for improving the conviction rate in shaking cases by neutralizing the “handful of experts” who testify  for the defense and whose role, according to Welsh, is to confuse the jury with the complexity of the science and provide possible alternative causes without explaining why the child died.

In a witnessed statement drafted after the conference, Kirkwood wrote that she had gone to the session expecting to hear about coordination among different arms of law enforcement but realized several minutes into the presentation that “the ‘national coordinated approach’ referenced in the title of the talk was essentially a description of the joint efforts of New Scotland Yard, prosecution counsel, and prosecution medical experts to prevent Dr. Squier and Dr. Cohen from testifying for the defense on their findings in specific cases as well as on their published and peer-reviewed research.”

Welsh’s talk also addressed the problem of “judicial inexperience,” Kirkwood’s notes report. His advice for influencing judges who’ve been listening to SBS critics was not to address the debate in argument, but to work through the “back door,” reaching judges informally outside of court and explaining the prosecution point of view without the opposition present.

Kirkwood’s notes also quote Welsh as advising police to “seek maximum publicity for convictions” and to relay to the press that “shaking undoubtedly causes injuries and in some cases death.” Welsh reported that his team had scheduled SBS training courses for police officers and first responders, and that his agency makes itself available to “offer advice to senior investigating officers.”

Squier and Cohen have so far weathered the complaints lodged against them, but the campaign is having its effect. Last year Squier told the Canadian Broadcasting Company that attacks motivated by her position on shaken baby syndrome threaten her ability to work, and she hesitates to continue testifying.

Presumably the editors at “Silent Witness” consulted one or more child-abuse experts to advise them on their story about shaken baby syndrome. I hope they take a second look at the sources who not only approved such a dismissive treatment of a real problem—the overdagnosis of infant shaking—but also planted a personal attack on one of the rare, courageous physicians willing to rely on scientific evidence instead of popular opinion.

-Sue Luttner

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