Saturday, 16 October 2010

SBS: Response to Tuerkheimer

In last week’s New York Times Op-Ed page, Professor Deborah Tuerkheimer claims that mainstream medicine doubts the existence of Abusive Head Trauma/Shaken Baby Syndrome (AHT/SBS).  As prosecutors of these cases, which are the leading cause of all child abuse deaths in the United States, we are appalled.
What confounds the vast majority of medical and legal experts in the field of AHT/SBS is that Professor Tuerkheimer, a Yale law graduate and former Assistant District Attorney in Manhattan, has been informed about the credible science in the field of AHT/SBS and the investigative methodology of resulting prosecutions, and yet, still chooses to ignore the overwhelming medical evidence that shaking an infant can and does severely injure and kill babies hundreds of times each year. The American Academy of Pediatrics (AAP) defines the types of forces associated with this devastating form of child assault/homicide: “The act of shaking leading to shaken baby syndrome is so violent that individuals observing it would recognize it as dangerous and likely to kill the child.”  Here in New York City, the Office of Chief Medical Examiner published a study in 2009 that examined 49 child homicides involving AHT and concluded that shaking alone kills babies.
There is widespread consensus that shaking babies is dangerous and often lethal:  mainstream scientists and medical organizations, such as the American Academy of Pediatrics; the National Association of Medical Examiners and the American Academy of Ophthalmology have published positions statements recognizing SBS and each describe their discipline’s role in its diagnosis and response. This year, the Centers for Disease Control and Prevention (CDC) published a SBS prevention guide for health departments and community organizations and recognize SBS as a “public health issue.” The Department of Defense authorized an SBS prevention initiative in 2007 and continues to provide this prevention education throughout the world.  Several states, including New York, Texas and Ohio, have passed legislation that require SBS training for child care providers and/or distribution of SBS prevention materials to parents of new babies.  This year the United States Senate again passed a resolution declaring the third week of April 2010 as “National Shaken Baby Syndrome Awareness Week.”
“The triad of symptoms alone cannot prove beyond a reasonable doubt that an infant has been fatally shaken,” says Professor Deborah Tuerkheimer of Depaul University in the NY Times Op-Ed piece.  And she is right.  A simple triad of medical findings is never the sole basis for a prosecution in an AHT/SBS case.  To be sure, if certain unexplained medical findings in an infant are detected, including but not limited to subdural hematoma, retinal hemorrhages, brain injury and brain swelling, AHT/SBS will be a part of the initial differential diagnosis and further medical and legal investigation will be initiated.  But the medical diagnosis and subsequent prosecution depend on a combination of the infant’s medical history, the infant’s medical findings and the ability of the doctors to rule out by scientific means other potential causes for the infant’s findings such as leukemia, bleeding disorders or accidental injury. Situations involving these easily identifiable and legitimate disorders are not diagnosed as child abuse and never make it to court…and they don’t need to be addressed by Professor Tuerkheimer or the Innocence Project.
Also surprising is Professor’s Tuerkheimer’s claim that the AAP “recommended that the diagnosis of shaken baby syndrome be discarded and replaced with abusive head trauma.” Dr. Robert Block, slated to become President-Elect of the AAP in October, said, “Nothing could be farther from the truth. Sadly, people injure and kill their babies through a variety of mechanisms including shaking and blunt force trauma.  When severe forces are associated with these mechanisms, babies suffer brain injury and can die.” He also notes that a recent paper published by the AAP’s Committee on Child Abuse and Neglect “in no way discards the diagnosis. It simply recognizes that there are multiple ways for an adult to inflict severe injury on a child’s brain.”
“Child abuse diagnoses are taken very seriously and are made after careful consideration of every medical fact and circumstance…these are not rushes to judgment,” said Dr. Carole Jenny, Professor at Brown University Medical School and Chief of the Child Abuse Consultation Team at Hasbro Children’s Hospital in Rhode Island. “The overwhelming combination of medical literature and clinical experience tells us that shaking can and does kill.  Those outspoken few on the fringe in medicine who claim this diagnosis does not exist may have other motivations worth considering.”
Not to mention the number of perpetrator confessions, which often include demonstrations of what was done to the baby.  “In addition to numerous published studies in the medical literature from around the country and from around the world that describe perpetrator admissions, we see confessions to shaking an infant many times each year in Queens County alone.  Perpetrators describe how they held the baby, usually underneath the baby’s arms, and then how the baby’s head flew back and forth repeatedly during the violent shaking. Perpetrators also describe how the baby immediately becomes “sleepy” or unresponsive. Unfortunately, all too often these confessions describe exactly how children are killed, and the medical findings bear it out: violent shaking kills, leaving retinal and subdural hemorrhages to tell the story of the baby’s death.  It is inconceivable to us that Professor Tuerkheimer fails to credit hundreds of cases where descriptions of shaking are given by the perpetrators, and the babies die with exactly the findings she condemns and dismisses.  These descriptions are consistent with what medical research and clinical experience tells us about traumatic brain injury in infants,” said Marjory Fisher, the Bureau Chief of the Special Victims Bureau at the Queens County District Attorney’s Office in New York City.
These are the words of people who have actually shaken their babies to death.
Last year, a perpetrator in Queens confessed to prosecutors on video: “I knew it was wrong to shake my baby. I watched the shaken baby video in the hospital and I’ve seen the ads on TV.  Assholes shake their babies and today I was that asshole.”
Another perpetrator confessed on video saying, “My baby wouldn’t stop crying…I got frustrated…I held him in front of me and I shook him.  I don’t know how many times, but when I shook him it was hard.  He was limp and wasn’t breathing.”
Yet another perpetrator said, while demonstrating how he had inflicted he fatal injuries on his baby, “My mother-in-law, my mother, my wife and all my immediate family have told me its not good to shake [my baby] because it can give him brain damage…if he’s crying for no reason, I say to him, ‘You have no reason to cry.  Shut the fuck up.  I fed you and I burped you.’  And then I’ll just shake him.”
And then, of course, there are the guilty verdicts.  Decisions that are unanimously reached by jurors, often after months of evidence presentation at trial and hours of thoughtful deliberation. “We have presented our cases to juries time and again.  The investigations have been thoroughly and competently challenged in court and juries just don’t buy the alternative courtroom diagnoses presented by defendants.  Medical findings are not presented in a vacuum. Juries base their decisions on all of the facts and circumstances of each case and consistently reject defense claims that a short fall, a vaccine, meningitis, West Nile virus or CPR caused the injuries,” said Leigh Bishop, Senior Trial Attorney in the Special Victims Bureau in Queens.
Professor Tuerkheimer, in conjunction with the Innocence Project, an organization known for bringing claims concerning DNA evidence after rape convictions, recently published a law review article in which she attempts to discredit shaken baby syndrome as a medical diagnosis and as a basis for criminal prosecution.  In her paper, she presents alternative theories to Shaken Baby Syndrome/Abusive Head Trauma to support her position that there are rampant miscarriages of justice in this field.
However, her assertions are just that: they are not supported by credible medical research and ultimately result in a feeble attempt to elevate and equate fringe supposition contrived strictly for use in the courtroom to the level of widely-accepted medical science and research that has been supported by hundreds of studies and millions of hours of clinical experience around the world.
“Education is the key to stopping this deadly form of child abuse,” says Marilyn Barr, the Executive Director of the National Center for Shaken Baby Syndrome.  We think it is time for Professor Tuerkheimer to go back to school.
Marjory Fisher, Bureau Chief
Special Victims Bureau, Queens District Attorney’s Office
Queens, New York
Leigh Bishop
Senior Trial Attorney
Special Victims Bureau, Queens District Attorney’s Office
Queens, New York

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