SIDS: infant deaths statistics in Milwaukee

Crocker Stephenson of the Journal Sentinel: Jan. 24, 2011

Milwaukee Health Commissioner Bevan K. Baker vowed Monday to place infant mortality at the top of the city's health agenda, and Mayor Tom Barrett called for a communitywide effort to reduce the rate at which Milwaukee children die before their first birthday.

The news conference at the Southside Health Center announcing the efforts was a short drive from where a 5-month-old baby died Sunday while sleeping beside her mother in an adult bed.
Near the podium from which Barrett and Baker spoke was a poster used by the city in its Safe Sleep campaign.
It was a life-size photo of an adult bed with a gravestone for a headboard.
Engraved in the stone: "For too many babies last year, this was their final resting place."
"We will have to change," Barrett said. "But real change requires real commitment. If we are serious about turning this around, then it is going to take each and every one of us."
The purpose of the news conference was to release the city's 2010 Fetal Infant Mortality Report, which examines the 499 infant deaths that occurred in Milwaukee from 2005 to 2008.
A story in Sunday's Journal Sentinel, titled "Empty Cradles," used the report and other sources to place Milwaukee's infant mortality crisis in context.
The story found:
• Babies in Milwaukee die at rate greater than in all but six of the nation's 53 largest cities.
• Black infants die in Milwaukee at about 2.5 times the white rate.
• In some parts of Milwaukee, the infant mortality rate is higher than in the Gaza Strip.
Barrett noted from the report that complications from prematurity account for more than half of all infant deaths.
Sudden infant death syndrome, including unsafe sleep and accidental suffocation, accounted for nearly one in five deaths.
Barrett said the city would play host to a summit on premature births in May.
Baker called the city's infant mortality rate a crisis, but one that can be addressed.
"This is something we can do," he said. "This is something we must do.
"The Health Department will make this our major health issue in the years ahead," he said.
The baby who died Sunday is the second Milwaukee infant this year to die while sleeping with an adult.
The child's mother, a nursing student, told investigators that it is her custom to sleep with her daughter to facilitate breast feeding. She had recently begun feeding the girl formula and was beginning to place the child in her own crib, according to a medical examiner's report.
The mother told investigators that she was playing with her daughter late Saturday and the child fell asleep in the mother's bed, according to the medical examiner's report.
The mother covered the baby with three comforters, which she pulled up to the girl's chest, according to the report.
The mother told investigators that she does not smoke, drink heavily or use drugs.
The medical examiner's report said the mother's apartment was clean and well equipped with baby supplies. There were no signs of smoking or alcohol use.
The city Health Department recommends that children sleep alone, in a crib, on their back, without blankets and toys and with a tight fitting sheet.
http://www.jsonline.com/news/milwaukee/114527764.html

SBS: British Columbia: Judge clears Avtar Basi, accused of violently shaking baby

 CINDY E. HARNETT, January 28, 2011

 

   Photograph by: Debra Brash,

 

A man accused of violently shaking an 11-week old baby girl in frustration, causing permanent brain damage, was found not guilty in Victoria provincial court Friday.

Avtar Basi, 33, was charged with the aggravated assault of Baby E.B. in the Central Saanich foster home run by his girlfriend, Micheline Slader.
After the verdict, Basi left the courthouse fighting back tears of relief.
Basi was also clutching the hand of Slader, with whom he said he planned to adopt Baby E.B., now two. The baby is so profoundly handicapped that she will require a feeding tube and 24-hour care for the rest of her life.
Basi is the only person who will ever know what happened in the five minutes and eight seconds between the end of an unremarkable phone conversation with Slader about baby formula at 9:04 a.m., on Nov. 26, 2008, and 9:09, when he called to say Baby E.B. had stopped breathing.
"No one else was there. He is the only person who does know what happened," defence lawyer John Green said Friday. "The judge accepted his evidence."
Judge Adrian Brooks ruled the Crown had not proven beyond a reasonable doubt that the force Basi used on Baby E.B. was not done for the purpose of caring for the infant and that excessive force was used.
"While Mr. Basi obviously bears a heavy moral responsibility for what he has done to the life of this child, E.B., it is not established that his is a criminal responsibility under our law and I find him not guilty," Brooks said as he read his 37-page verdict.
Slader and Basi met in Nov. 2007. By September 2008, they lived together.
Slader is the biological mother of three school-age children, and at the time was a caregiver for a children aged three, one and five months — placed with her by the Ministry of Children and Family Development.
In October 2008, Baby E.B. arrived. She was the seventh child in the home. Basi and Slader considered her the "perfect baby" and talked of adopting her.
In court, Basi testified that, on the morning of the incident everything unfolded normally — until Baby E.B. began crying loudly and arching her back. She fell limp and unconscious. In a panicked reaction, he shook her three times. She was not breathing. He called Slader, then 911.
The judge heard expert medical testimony about the child's injuries and about a condition known as "breath holding," in which children cry forcefully only to get stuck at the point of exhalation and stop breathing, faint or pass out.
In determining whether excessive force was used, the judge took into account both the physical vulnerability of an infant and the life-and-death circumstances Basi said he was facing.
"I have concluded that although the severity of the injuries is an important factor, it is only one factor," Brooks said.
"I have found that E.B. behaved suddenly and uncharacteristically. She stopped breathing. The force applied by Mr. Basi was three motions of back and forth shaking.
"The purpose of that shaking motion was an attempt to relieve that life-threatening situation.
"When the shaking did not resuscitate E.B., Mr. Basi immediately sought assistance," Brooks said. "I am not persuaded beyond a reasonable doubt that the force used was excessive."
The judge rejected focusing on a snippet of conversation during an undercover police sting when, on June 12, 2008, Basi says "Yeah" to questions such as "This kid was pissing you off, right?"
Rather, Brooks looked at the day's conversations, including Basi saying "No, no, no, no" when asked if he was angry at the time of the shaking and explained it as "strictly panic."
The entirety of Basi's comments on June 12 were consistent with his testimony, Brooks said.
Basi, with a Grade 11 education and no first-aid training, was a man of few words but direct in his testimony, Brooks said.
"There was no air of deception in his manner," Brooks said. "His demeanour was of a witness doing his best to tell the truth.
Although Basi originally lied to his girlfriend and authorities about what had happened to the baby, Brooks said: "Basi's lying about having shaken E.B. does not cause me to reject his evidence given on the stand."
Basi sat pensively in the front row of courtroom 203 as he listened to the verdict being read aloud for about an hour. Slader sat a few rows back, tightly clenching the hand of a friend. When the judge concluded, Basi eyes welled with tears.
Defence lawyer John Green described his client's emotional reaction to the verdict as "relief," and said the case had been extremely "difficult" for all concerned.
ceharnett@timescolonist.com

http://www.timescolonist.com/Judge+clears+accused+violently+shaking+baby/4188415/story.html#ixzz1CR6CPgNx

SIDS: Idaho: Wyatt Greenough declared "Not Guilty"

Kristin Rodine - krodine@idahostatesman.com :  01/26/11


A jury of nine men and three women unanimously found Wyatt Greenough not guilty of involuntary manslaughter Wednesday after about 90 minutes of deliberation.
Greenough told the jury he is devastated by the 3-month-old's death but does not believe he did anything to cause it.
He declined comment as he left the courtroom with crying, smiling friends and family.
Prosecutors said Greenough was criminally reckless when he drank at least seven or eight beers within a couple of hours, then went to bed with little Meadow snuggled against on his shoulder. A few hours later, the baby's mother came home to find the infant under a thick comforter and her father's arm, not breathing.
The defense argued there is no way, within a reasonable doubt, to eliminate the possibility that the little girl died of Sudden Infant Death Syndrome rather than suffocation.
The jury apparently agreed with the defense.

 http://www.idahostatesman.com/2011/01/26/1503581/nampa-man-denies-responsibility.html#ixzz1CQwoDfXh

SIDS: Idaho: Wyatt Greenough charged with infant's death by manslaughter

 KRISTIN RODINE - krodine@idahostatesman.com 01/25/11

Meadow Nickel turned 3 months old the night her mother went out for the first time since the baby was born.
But when Betsy Nickel came home — about 8 a.m. last Feb.6 — the infant was not in her basket, but in bed with Wyatt Greenough, Meadow’s father.
When Nickel could not find the child among the covers on the bed, she said, she panicked and started screaming. But even that did not immediately rouse Greenough, Nickel testified in court Monday.
“I was patting everywhere, digging in the blankets. I finally flopped his arm over and I saw … I saw … I found her,” Nickel said, sobbing.
The baby was covered by a thick white comforter, with Greenough’s arm on top of her and her faced pressed up against and under him.
“She was still pink, so I thought she was alive, but when I looked in her eyes they were just blue and glossy,” Nickel said. “She was just gone.”
Greenough, 26, sat solemnly in a blue suit, blinking often as testimony began in his involuntary manslaughter trial.
Deputy Canyon County Prosecutor Ty Ketlinski said Greenough acted recklessly when he drank heavily and then took the child into the bed with him — after telling Nickel he would not drink while caring for their daughter.
The little girl’s autopsy report tells a different story, defense attorney Lary Sisson said during his opening argument. He told the jury the doctor who examined the child will testify that Meadow’s death was caused either by sudden infant death syndrome or by “positional asphyxia” — a condition caused when an infant sleeps in an unsafe position, cutting off breathing.
“Was it a tragic event or an unfortunate accident?” Sisson said. “It was not involuntary manslaughter.”
Greenough’s mother, Carrie Robertson, talked to the Statesman during a break in the prosecution’s case, saying the baby’s death was a tragedy for all involved and that it is unfair to place the blame on Greenough.
“It was an accident,” she said. “They were both so in love with that baby. It was a horrible accident.”
Robertson had watched the baby earlier in the night, until Greenough got home from his late shift at work. He was not drunk, she said.
But Ketlinski, the prosecutor, said Greenough had stopped and had two or three beers with a friend after work, then picked up an 18-pack of Coors Light on the way home.
“When police came the next morning, all but seven of those beers had been consumed,” he said.
Nickel said Greenough had gotten drunk and rolled onto the baby in November, when Meadow was a newborn. After that, Nickel had demanded that he not drink when he was taking care of the child. She pressed that point with Greenough, she said, before she left to go out with a friend and stay overnight with her sister in Boise.
Ketlinski told the jury that Greenough is not a monster, and he is remorseful.
“But he was reckless, and that recklessness is a crime,” Ketlinski said. “That crime is involuntary manslaughter.”

WHAT DO EXPERTS SAY ABOUT BRINGING AN INFANT INTO BED WITH YOU?

Co-sleeping, in which a baby sleeps in same bed as his or her parents, has been the subject of much debate in the United States.
The American Academy of Pediatrics and the U.S. Consumer Product Safety Commission have said that infants should not co-sleep with their parents because it is not safe.
Still, many parents do it because they say it helps with nursing and allows baby and mom to get better sleep.
If you have decided to co-sleep with your infant, here are do’s and don’ts from the March of Dimes:
DO’S:
• Always place your baby on his or her back to sleep. Babies who sleep on their backs have less risk of SIDS than babies who sleep on their tummies or sides.
• Always leave your child’s head uncovered while sleeping.
• Be sure there are no openings in the bed’s headboard or footboard where your baby’s head could get trapped.
• Remove cords and drapes from nearby windows.
• Remove strings or ties from pajamas — yours and the baby’s.
• Remove soft bedding.
• Place a tight-fitting fitted sheet on the mattress.
• Make sure that there are no spaces between the bed and the wall or furniture.
• Make sure your mattress fits snugly in the bed frame.
• Make sure there is nothing near the bed that could suffocate or strangle the baby.
Don’ts
• Never put a baby to sleep in an adult bed alone.
• Never place your baby on a waterbed, sofa, soft mattress or other very soft surface.
• Never place pillows, comforters, quilts or other soft/plush items on top of or under your baby.
• Never sleep with your baby if you smoke, have been drinking, or have used medicines or drugs that make it hard for you to wake up.
• Never overdress your baby for sleep or overheat the room.
Sources: kidshealth.org and marchofdimes.com

Kristin Rodine: 377-6447
 http://www.idahostatesman.com/2011/01/25/1501019/manslaughter-sids-or-tragic-accident.html#ixzz1CQuFp67S

SIDS: What Parents and Caregivers Need to Know about Sudden Infant Death Syndrome

January 22, 2011

By Renee Fox, M.D.Mary McCaffrey, MSN, RNC-OB, CNS-BC, CNS
UMMC Women’s Services
Last year, there were 128 deaths of Baltimore City children under one year of age. Of those deaths, 26 were sleep related, and likely preventable. This is a tragedy not only for the families affected, but for entire neighborhoods and for the city as a whole. These children could have been our future teachers, firefighters, doctors, nurses or community leaders.
Sudden Infant Death Syndrome (SIDS) is the sudden, unexplained death of a baby under one year of age. African American babies are two times more likely to die from SIDS, and Native American babies are three times more likely to die from SIDS than white babies. Most of these deaths occur between two to four months of age. SIDS has also been called “crib death” as many of the babies are found in their crib, but cribs do not cause SIDS.
What You Need to Know
All young babies are at risk of dying while they sleep, but there are things you can do to reduce your baby’s risk. Most of these deaths are preventable.
What You Can Do
Put your baby to sleep safely EVERY TIME he or she goes to bed at night or for a nap. There are three things to remember:

• Alone: Most sleep-related deaths occur when babies sleep with an adult or another child, or in an adult bed or on a sofa. Share your room with your baby, but not your bed.
• Back: Babies are more likely to die of SIDS if they are placed to sleep on their stomach or side. The safest position for a baby to sleep is on his or her back. Experts know that babies are not as likely to choke while lying on their backs. In fact, when a baby is on its stomach, anything spit up can block the air pipe and cause choking or breathing problems.
• Crib: Your baby’s sleeping place should be clean and clear. No blankets, pillows, fluffy toys or stuffed animals. Just put a tight-fitting sheet on a firm mattress. Your baby can wear a sleeper if it is cold.

Keeping your home smoke-free can also reduce your baby’s risk. Don’t let anyone smoke around your baby. That includes you!
You can also use a pacifier to calm your baby and help him or her go to sleep. Research suggests that pacifiers help reduce risk too.
For more information, please visit http://www.healthybabiesbaltimore.com/home.
http://medcenterblog.org/2011/01/what-parents-and-caregivers-need-to-know-about-sudden-infant-death-syndrome/

SIDS: North Dakota: Ray Leon Huether convicted

January 21, 2011 - By DAVE CALDWELL,

A former Minot man convicted Wednesday in federal court on child pornography charges was not only convicted in state court last year of gross sexual imposition for performing sex acts with a child, but also served a 10-year prison term in another state after being linked to the deaths of two of his own infant children.
Ray Leon Huether, 42, of Fargo, was convicted of the Class AA felony imposition charge after Minot police received a report of a 6-year-old child who had been sexually assaulted. The child told police she had been involved in sexual acts with Huether, who at the time was in a relationship with her mother while living in Minot. Huether later moved to Fargo to pursue employment there.
Huether had previously been convicted in Billings, Mont., of negligent homicide following the death of his 2 1/2-month-old daughter in March 1995 while Huether was living in that city. The girl was in the sole care of Huether at the time of her death, which occurred only seven months after Huether's 7-month-old son also died while in his sole care. While the boy's death was determined to be related to sudden infant death syndrome, prosecutors alleged that the baby girl had been suffocated when Huether placed a pillow over her bassinette. After a judge ruled that he would allow testimony related to the boy's death, Huether entered a no contest plea and was convicted.
Investigation into the sexual assault also brought authorities into contact with a large amount of pornography, including child pornography. The pornography charges were severed from the GSI charge, with federal prosecutors assuming jurisdiction over the pornography cases.
Huether was subsequently convicted by a Minot jury of gross sexual imposition and sentenced to serve 30 years in the state penitentiary.
Huether appealed both the Montana conviction and the GSI conviction, but both were upheld in the states' respective supreme courts.
Meanwhile, the federal case against Huether moved forward, ending Wednesday with his jury conviction on receipt of materials involving the sexual exploitation of minors and possession of materials involving the sexual exploitation of minors. The receipt charge carries a minimum penalty of 15 years in prison and a maximum of 40 years, while the possession charge mandates five years up to a maximum of 20 years.
Huether's sentencing in federal court has been scheduled for April 18 in Bismarck.
http://www.minotdailynews.com/page/content.detail/id/551097/Former-Minot-man-convicted-of-child-porn.html?nav=5010

SIDS: Tan Yik Kiat: Baby died while lying on tummy

Jan 20, 2011 : By Elena Chong and Tham Yuen-C

WHEN babysitter Wong Poh Chun left her four-month-old charge after putting him to bed, he was lying on his stomach and sound asleep.
Four hours later, when she went to wake him up, he was not moving and his palms had turned purple.
At an inquest on Thursday, State Coroner Victor Yeo said he was unable to ascertain the manner or the cause of the death.
The pathologist who examined Tan Yik Kiat's body said his death on July 27 was most likely due to natural causes linked to Sudden Infant Death Syndrome, or the result of an accidental death by suffocation.
Yik Kiat had been sleeping on a mattress with his tummy facing down, arms over his head and face tilted to the side.
The babysitter said this was how she would normally put her charges to bed, as they would sleep better and not be shocked by any sudden loud noises.
http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_626459.html

SIDS: Point of view of pathologist and detective

Samantha Yale Scroggin / Staff Writer / sscroggin@santamariatimes.com Santa Maria Times : 
January 24, 2011

Dr. Robert Anthony, right, the sole forensic pathologist for Santa Barbara County and Det. Todd Henslin examine brain tissue under a dual-view microscope at the county coroner’s office.//Eric Isaacs/Contributor

 

Dr. Robert Anthony has learned to finesse his response at cocktail parties to the question of what his job is within the medical field.
Anthony said that if he truthfully answers — “I take people apart as my job” —  people “look at you like you just sprouted a second head.”
Instead, he simply tells people he’s a pathologist, “and you hope they drop it.”
Those who push Anthony for more information end up taking a step away from him when they get their answers, he said, but are usually ultimately intrigued by what they hear.
“I’m the specter of death, and a lot of people don’t like that,” he added.
Anthony, who is the sole forensic pathologist for Santa Barbara County and handles all the county’s autopsies, and the four detectives within the county’s coroner’s bureau deal with a topic on a daily basis that most people would like to keep as distant as possible — death.
An interest in solving the puzzles that sometimes surrounds death can be a motivator for these people to enter this line of work, but Anthony and the detectives are not immune to being affected by the smell of decay or the agony of breaking the news to a family of a loved one’s death.
At the end of each workday, they return home to their own families, and must find balance between the intense and sometimes gruesome nature of their jobs and their home lives.
The work
Nearly every death in Santa Barbara County that doesn’t happen in a hospital is reviewed by the coroner’s office, according to Detective Rick Miller with the coroner’s bureau.
If the death is the result of natural causes and the deceased person was being treated by a doctor for ailments prior to death, sometimes the person’s attending physician will list a cause of death.
If a doctor is unable to provide a cause of death, Miller said, the coroner’s bureau will do an exam on the body and conduct an in-depth review of the person’s medical history.
The coroner’s office detectives can be called out at anytime of the day or night to investigate suspicious deaths, which typically happens a few times a month.
“We’re trained on how to look for the specific indicators,” he said.
Anthony will do an autopsy on the body unless the cause of death is obvious to the eye.
Anthony said he performs about 150 autopsies each year. The process involves the inspection and dissection of a body after death to determine the cause of death.
“The case load here is crazy,” he said. “We just work together.”
Half of the death certificates in the county are signed by physicians, Anthony said.
Doctors, unlike Anthony, must determine a cause of death in order to sign the death certificate, he added.
“They have to have a reason. They can’t put down ‘I don’t know’.”
Anthony said the coroner’s office is usually able to determine a cause of death, with the exception of 2 percent to 5 percent of cases.
“It can be frustrating because we like to answer those questions,” he said. “But you can only do what you can do.”
“Death, as in life, sometimes leaves unanswered questions for us all,” Anthony added.
The most common cause of death in the county is heart disease, he said.
The number of cases that funnel through the coroner’s bureau keeps those who work there extremely busy.
“It’s bad and you don’t have a choice,” Anthony said of the workload. “You’ve got to do what you’ve got to do.”
“Literally, I’m involved with everything that comes through the office,” he added.
The investigators are important, Anthony said, because they make suggestions to him and provide him with useful information about the deceased person, such as if the person was an alcoholic.
The challenges
The tough aspects of investigating death are numerous.
In addition to the constant cases coming in that must be dealt with, there is the emotionally troubling element of the job, the grieving families who often are unsatisfied by the answers to their questions. Then there sometimes is the stomach-churning smell of decaying bodies.
Sgt. Sandra Brown, who oversees the coroner’s bureau, said that families of the deceased often have questions the investigators are not able to answer.
Even after autopsies are conducted, the investigators do not always have the answers the families want to hear, Brown said. In cases of suicide, families are sometimes in denial, she added.
“Sometimes we’re talking to family members half a dozen times before the family starts wrapping their minds around that,” Brown said of suicide.
Serving as a counselor of sorts comes with the territory.
“We’re compassionate but a lot of times we have to be blunt,” Brown said.
She said those in the bureau go through the grieving process along with the families.
“I really have to keep in touch with my investigators and make sure they’re doing OK,” Brown added.
Cases can become especially unsettling for an investigator with close ties to a case, she said, such as if the detective has a child the same age as a victim.
“This job can get very dark and sad,” Brown said.
Those in the office try to have fun together and enjoy each other’s company, she said, “but emotionally, it’s very draining.”
Miller, who spent 10 years with the Air Force before joining the Sheriff’s Department full time in 1995, came to the coroner’s bureau in 2008.
He recalled that he was upset as a patrol deputy when he discovered a man who had hanged himself next to his dog, who was also hanging. However, working in the face of death became easier for Miller.
“You start getting more used to dealing with it,” he said.
Miller’s job sometimes includes informing families about the death of a loved one, a “horrendous” task that he said he does “very carefully, because you never know how people are going to react.”  Sheriff’s deputies outside of the coroner’s bureau also make death notifications.
Miller said he’s had people faint at the news or come after him, while others remain calm.
“ A lot of times they have no idea it’s coming,” Miller said.
Sometimes, the investigators bring a chaplain with them.
“Sometimes that helps, sometimes it doesn’t,” he said.
“You don’t look forward to it,” Miller said of making death notifications. “But it’s part of the job.”
Miller, who has a grown son, said he especially dislikes working cases of Sudden Infant Death Syndrome (SIDS), as do the other detectives.
Anthony said that when dealing with the death of a child, there are somber faces all around, “and everybody’s on edge.”
“The violent death of a child particularly is probably one of the most distressing things we have to deal with,” he said.
If the coroner’s office doesn’t do its job, though, prosecutors, the court and the jury can’t do theirs, Anthony said.
Anthony compared a job in the coroner’s bureau to working in a mobile army surgical hospital.
“You need humor to keep your sanity,” he said.
If the investigators internalized their work, they could have nightmares and alcohol and drug abuse problems, Anthony said.
However, by maintaining their sense of humor, “we survive, we keep going,” he said.
Anthony said that when he first started in the field, he was mildly to moderately repulsed.
“It was always the smells that got to me,” he said. “But I kept having the question. I kept having to go back.”
“After awhile, it’s just part of the business,” Anthony added.
The reasons to stay in the bureau
Todd Henslin, a detective with the coroner’s office, had experience dealing with death while working as an emergency medical technician, a volunteer firefighter and a patrol deputy for 13 years before spending the last four months in his current role.
He said working as a detective in the coroner’s bureau is challenging and interesting. Each case presents a mystery for the detectives to try to solve.
“It is intriguing in a sense to kind of see how things work in the body,” Henslin added.
Fellow detective Miller also said the job is interesting, noting that he’d rather investigate death than reviewing someone’s bank records, for example.
“Right now I have no plans on going anywhere,” he said. “I’ve learned  a lot.”
Anthony, the county’s forensic pathologist, said his interest was piqued by the field of toxicology while doing blood analysis in the military.
He met a forensic toxicologist who invited him to work with him, and he started down his career path.
“For me, it’s the puzzle. It’s the question. It’s coming up with the answer,” Anthony said. “And every case is unique.”
“It’s not a boring job,” Anthony said later.
Working in the field of death also provides a unique perspective on life.
Brown, who is in charge of the bureau, said her job makes her realize how short and precious life is.
“I enjoy everyday, and I’m very blessed for knowing that,” she said. “I enjoy, I think, smaller things than I used to.”
Henslin said his work encourages him to act with a little more caution and to look out for health risk factors among his loved ones.
“You kind of look at your own mortality,” he said.
Finding balance
Humor and a close bond among those in the office help them keep a healthy mindset.
And perhaps the occasional video game session or glass of wine.
Henslin said he tries not to dwell on his cases or take the work home with him emotionally.
“Luckily, I got a long drive home,” he added.
Exercise and being around people can be good outlets for stress, Henslin said.
Henslin said his job is one he chose to do.
“You take pride in your work, and you take pride in giving people as much answers as you can.”
Miller said he likes to play Xbox to unwind from work.
After hours, “I’m really good at separating myself from work,” he noted.
He is thankful for his understanding wife, who puts up with his unpredictable hours.
Anthony said he avoids conducting autopsies on those he knows beyond much more than a one-time meeting.
In those situations, a forensic pathologist would be called in from another county, he said.
Anthony said his work has always been a large part of his life, and he even took his children to the office when they were young.
When his son was 7 or 8, he showed him a plane crash victim.
“He thought it was great and he’s gone into law enforcement,” Anthony said.
In his off time, Anthony said, he relishes local wines, including visiting area vineyards.
“I’m a big wine collector and I enjoy the wines of Santa Barbara County,” he said.
His dark sense of humor coming through, Anthony added, “the wines smell a whole lot better than my job does.”
http://www.santamariatimes.com/news/local/article_9ea78e16-2789-11e0-8207-001cc4c03286.html

SIDS: North Carolina statistics

Sharon McBrayer Published: January 26, 2011

The leading cause of death for children in Catawba County is something going wrong before they are born.
That’s according to a 2009-10 annual report from the Catawba County Community Child Protection/Child Fatality Team. The team, made up of representatives from agencies and groups around the county, review each child death that occurs in the county.
The county had 23 child deaths last fiscal year. Ten children died from prenatal issues in Catawba, while five died from illness, four from motorcycle accidents, one from Sudden Infant Death Syndrome and one from homicide.
Two others died from reasons not disclosed, according to the report. Any time a death is ruled undetermined, that decision is made by the medical examiner, said Jennifer McCracken, who serves on the team and is manager of Catawba County Public Health Services.
Of the cases of child death in the county, six had active child protective services involvement, according to information from the team.
The information says child protective services received 2,570 reports. Of the 1,604 cases accepted that met state criteria (3,660 children), 9 percent were reports of abuse and 91 percent were reports of neglect. Information from the report says 92 percent of the families served didn’t have a recurrence of child maltreatment within a 12-month period.
The most recurring issues found were prenatal care, SIDS, unsafe sleeping patterns, motor vehicle accidents, substance abuse and domestic violence issues, according to information supplied by John Eller, director of Catawba County Social Services. The report was presented recently to county commissioners.
Because of what the group learned through reviewing the deaths, it will focus on preventing distracted driving, co-sleeping and prenatal care, McCracken said.
Eller, who serves on the team, said the group also will focus on prevention of abuse and neglect.
“The importance of this team is to focus on child protection and also assess all childhood fatalities regardless of whether social services was involved,” Eller said. “This allows us to focus on this issue from a systemic and community perspective. That is the key.”
McCracken said the state sends the team birth and death records and then it pulls needed records from various agencies, including hospitals. The team, which has more than 20 members, then reviews the death to see what recommendations it can make to prevent the same kind of death from happening in the future, she said.
For instance, because the highest number of child deaths occurred because of prenatal issues, the team will work to get the word out that women need to immediately start care within the first trimester of pregnancy, McCracken said. The team also will focus on distracted driving, she said. 
Eller said, “No one agency, whether it be law enforcement, public health, the court system or social services can ensure the protection of children alone. It takes all of us, public agencies and citizens in the community alike. While North Carolina has made great strides in the protection of children, our resolve should be to strive for prevention through education, advocacy and proper intervention.”
The state just released its 2011 annual report to the Governor and the state General Assembly. Birth defects and other birth-related conditions were the top causes of child fatalities in 2009, with 755 deaths combined, according to the report. The state had a total of 1,486 child deaths in 2009, which was down from 1,573 in 2008, the report says.

http://www2.hickoryrecord.com/news/2011/jan/26/panel-inadequate-prenatal-care-cause-most-child-de-ar-729188/

SIDS: Lancashire, England: Hyndburn mum in terrible reality of cot death

26th January 2011

• 
• By Anna Mansell » Features writer

Cot death has been at the forefront after EastEnders focused on the issue in its most controversial storyline ever. An East Lancashire mum talks about the heartbreak when her five-week-old son died suddenly.

IT’S every new mum’s nightmare: Checking on her newborn to find that they’re motionless and have stopped breathing.
But it’s a harrowing moment Lisa Boyle, who lives in Huncoat with her partner Michael, is all too familiar with.
“I was breastfeeding Harrison and he just passed away in my arms,” said the 40-year-old hairdresser.
“He was asleep one moment and then I could see something was wrong.
“It happened in the space of an hour. I moved him and he was floppy and not ‘normal’.
“I shouted to Mick and he tried to resuscitate Harrison as I called an ambulance. "The paramedics couldn’t do anything,” she recalled.
Baby Harrison died at just five weeks old in July 2005.
Tests carried out gave no indication as to a cause of death and it was put down to sudden infant death syndrome (SIDS) — commonly known as cot death.
Doctors explained the death to Lisa, and partner Mick, 41, saying that cot death babies are often ‘just too little to cope’ despite Harrison being born healthy at 37 weeks, weighing 6lbs7oz.
Lisa added: “A lot of people associate cot death with finding your baby passed away in the cot. But that’s not always the case.
“Looking back, in a way it was quite nice for us — Harrison was warm and in my arms. "For me, it would have been worse to wake up and find him cold and blue.
A little more than 12 months after Harrison’s death, the couple — who already had a daughter Natalya, now eight — completed their family when son Jakson, four, was born.
The pregnancy had been monitored with support from The Foundation for the Study of Infant Deaths (FSID), as Lisa had also given birth to a stillborn boy, at 39 weeks, before her daughter was conceived.
“Having Jakson was one way of dealing with what had happened,” she said.
“Not replacing one with another, but choosing not to have your options taken away from you. I wanted a baby and a brother for Natalya.
"I was worried all through the pregnancy, and for the first 12 to 18 months, and I’m very protective of the children now.”
TV viewers have been shocked by the recent cot death plot in EastEnders, which saw grieving mother Ronnie Branning, played by Samantha Womack, leave her dead son’s body in the crib of Kat Moon’s healthy son, and take the infant for her own.
The storyline prompted nearly 6,000 complaints and writers have cut some of the plot with a ‘happy ending’ scheduled in coming weeks.
Lisa, said it was a shame the cot death element of the storyline had been over taken by the baby swap debate.
And she backed the new Pendle Baby Safe Project, run by Pendle Council and NHS East Lancashire.
Lisa said she copes with her grief by talking about her experiences. Running her own salon, Hairways in Clayton-le-Moors, she talks regularly to her customers about her family.
She said: “You have to say to yourself that you’ve done everything you can, and you have to think it would have happened whatever you’d done.”
http://www.lancashiretelegraph.co.uk/news/hyndburn/8813714.Hyndburn_mum_in_terrible_reality_of_cot_death/

SIDS: Pennsylvania Experts Back placement is key to preventing SIDS

January 24, 2011

Randy Griffith http://tribune-democrat.com/ The Tribune-Democrat  Jan 24, 2011,

— It is considered the leading cause of death for babies, but the truth is, doctors don’t know the cause.

Sudden infant death syndrome, also called SIDS or crib death, is defined as a death that “cannot be explained after a thorough investigation.”
Instead of a cause, SIDS is a “diagnosis by exclusion.”
Even after a thorough autopsy and review of the scene, no cause can be pinpointed, the National SIDS/Infant Death Resource Center reports.
The unexpected, random nature of SIDS deaths is devastating for parents because it happens despite every precaution, said Dr. Andrew Garbarino of Pediatric Care Specialists, 1322 Eisenhower Blvd., Richland Township.
“Everything would have been normal when they put the baby in its crib,” Garbarino said. “There is no time for the family to prepare.”
There are, however, a few ways to reduce the risk, and a new state law was designed to make sure new parents know the simple steps.
The most important rule is to place babies on their backs.
“Everything we’ve tried to do with monitoring and other measures hasn’t done anything,” Garbarino said. “The only one thing that has been proven to decrease the incidence of SIDS is the positioning of the baby on the back.”
Thirty years ago, the SIDS death rate was between 1.5 and 2 for every 1,000 babies. Since Back to Sleep began in 1994 to promote infant back sleeping and other risk-reduction strategies, that rate has reduced by half, Garbarino said.
Like most hospitals across the nation, all those in the region have provided new parents with SIDS prevention instruction for several years. It is also part of many prenatal classes.
Now Pennsylvania’s Sudden Infant Death Syndrome Education and Prevention Program Act requires all hospitals and home-birth practitioners to give approved instruction. New parents must sign a form showing they understand the information.
“We’ve been educating all along,” Le Ann Kaltenbaugh, education coordinator, said from Windber Medical Center.
“The education is nothing new.”
What is new at Windber is a program to provide each newborn’s parents with a wearable blanket, trademarked the SleepSack, which wraps the baby snugly.
“There are no loose blankets in bed that the baby can be tangled with,” Kaltenbaugh said. “It is very simple. They keep the baby nice and tight. They can’t wiggle out of it.”
Doctors theorize that exhaled carbon dioxide can “pool” under blankets and on the mattress surface, where it is inhaled again by the baby. Doctors believe this can cause death, diagnosed as sudden infant death syndrome, Garbarino said.
It’s important to keep the crib free of stuffed toys or other items that can promote the collection of exhaled gasses, he added.
“No pillows or bumpers – anything that can come against a baby’s face and create pooling – we want to get all that stuff out of the crib now,” Garbarino said.
Despite widespread publicity in recent years, convincing new parents of the importance of back placement can be an uphill battle, Pam Harris, nursery coordinator, said at Memorial Medical Center in Johnstown.
“When we are teaching them, we will get the grandmother in the room saying, ‘I put all my babies on their bellies and they are fine.’ ”
It can be worse for new mothers if the grandparents don’t hear the hospital training, Kaltenbaugh said. It happens the first time Grandma sees her grandchild put to bed face-up.
“It’s a whole new process,” Kaltenbaugh said. “They are going to get from their parents, ‘You can’t do that.’”
In the past, placing babies on their belly or side was thought to reduce the chance of aspirating and choking on vomit, but Kaltenbaugh said research has shown babies naturally turn their heads if they throw up.
Another difficult lesson for new parents to grasp is the danger of letting a newborn sleep in bed with adults. Besides the additional risk of pooling gasses, it is possible for an adult to roll over on a baby without waking up.
“That’s very unwise and there have been bad outcomes,” Tiffany Pugh, nurse manager for obstetrics, said at Memorial.
“The safest for babies is to be in their own crib, rather than in bed with Mom and Dad,” Harris said.
Use of tobacco during pregnancy or around a newborn increases the risk of sudden infant death syndrome, while breast feeding, use of a pacifier and a firm crib mattress can reduce the risk.
But the best way to reduce the risk is putting newborns to sleep on their backs, Garbarino emphasizes, noting it isn’t just while sleeping at home.
One thing parents should do is check their day care centers,” Garbarino said. “A survey of day cares showed very few day care centers were positioning babies on their backs.”
There is one complication from back positioning that parents should watch, Garbarino said. They should alternate which end of the crib where the baby’s head is placed.
“Babies in the crib on the back look out toward the open room,” Garbarino said. If the baby is always put to bed in the same position, it can lead to uneven flattening of the skull and tight neck muscles.
“I tell people to make sure they change the position of the baby in the bed by 180 degrees,” Garbarino said.
Following all the expert advice reduces the risk of crib death, but it does not eliminate all deaths, Kaltenbaugh said.
“It is not something you ever, ever want to happen,” Kaltenbaugh said. “But if it does, you must know you are not responsible. There is nothing you could have done to prevent it.”
http://tribune-democrat.com/local/x530799426/Experts-Back-placement-is-key-to-preventing-SIDS

SIDS: Wisconsin: For Milwaukee's children, an early grave

Jan. 22, 2011

Martin Kaiser, editor: Rick Wood:

Ben Poston of the Journal Sentinel staff contributed to this report.

Lakisha Stinson and her daughter, Rashyia, who was born last month and is healthy, live in a Milwaukee neighborhood where the rate at which African-American babies die is worse than Botswana.

By Crocker Stephenson of the Journal Sentinel

Lakisha Stinson holds her newborn daughter, Rashyia, in their Milwaukee home. Stinson’s first daughter, Kelviana, died of sudden infant death syndrome in 2004. Infant mortality is a problem that plagues the Milwaukee area.

About This Series

The Journal Sentinel today takes on an issue we have too long ignored - the death of children before their first birthday. Infant mortality is a crisis not just of public health, but of ethics and morality. The rate at which infants die in our city is unacceptable. In 2011 we will examine the problem and point to solutions. -  

 

On a bitter January afternoon, a 22-year-old mother sits on the edge of her bed and feeds her infant daughter.

The child, Rashyia, born in December, is healthy. She coos, eyes closed. She touches her mother's cheek with her perfect hand.
Rashyia and her mother, Lakisha Stinson, live in a small attic apartment on Milwaukee's near north side.
Three modest rooms. The kitchen has just three chairs and a table that is missing its glass top. The living room has no furniture. The bedroom has a bed and a Pack 'n Play crib, a gift from Wheaton Franciscan-St. Joseph's Hospital, whose staff, nurses and doctors brought Rashyia through a high-risk pregnancy and into the world.
Rashyia and her mother live in a neighborhood where the rate at which African-American babies, such as Rashyia, die during their first year of life is worse than Botswana.
Public health experts have long considered the infant mortality rate to be an essential indicator of a community's well-being.
"It's like the canary in the mineshaft," said Geoffrey Swain, who is medical director of the Milwaukee Health Department and a scientist at the Center for Urban Population Health.
"The factors that drive the leading causes of infant mortality also drive the leading causes of death, illness and disability for all of us."
In Milwaukee, babies die during their first year of life at a rate greater than all but six of the nation's 53 largest cities.
In Milwaukee, babies die at rates associated with the Third World.
In Milwaukee, the infant mortality rate for all children, regardless of race, exceeds that of Uruguay, Bosnia or Kuwait.

Worldly comparisons

In 1900, the infant mortality rate in the United States was about 100 deaths for every 1,000 live births, or 1 in 10.
By 1960, it had been knocked down to 26 deaths per 1,000 births.
By 2008, it was 6.6.
Sounds good. But compare the U.S. infant mortality rate with the rest of the world.
With the caveat that some countries count and report infant deaths in different ways, the U.S., for all its wealth and medical sophistication, does poorly.
In recent years, the U.S. infant mortality rate has been twice that of nations as diverse as Japan, Sweden, Portugal and the Czech Republic.
One federal ranking, based on 2010 estimates, puts the U.S. rank at 46th among 222 nations. That puts it behind Cuba, Hungary and South Korea.
Wisconsin's 2008 rate - 6.9 deaths per 1,000 births - falls in the middle of the other states.
Still, the number of infant deaths was staggering: 501 babies died in Wisconsin in 2008 - more than three times the number of homicides, more than twice the number of drunken-driving deaths.
The story of infant mortality in Wisconsin is the tale of two worlds divided, at least on the surface, by race.
In 2008, the infant mortality rate for whites was 5.9 per 1,000 births.
It was 13.8 for blacks.
That means that in Wisconsin, black infants die during their first year of life at more than twice the rate of white infants. It is worse than Romania.
It is among the worst in the nation.
It wasn't always this way.
From 1979 to 1981, Wisconsin's black infant mortality rate averaged third best in the nation. By 2003 to 2005, the three-year average dropped to the second worst.
In this discouraging trend, Swain finds reason for optimism.
"That's not ancient history," he said. "It's not some unchangeable situation. It changed recently. It can change again."
The Northern Manhattan Perinatal Partnership often is cited by public health experts as an example of what communities can do.
In 1990, when the partnership began, the infant mortality rate for New York City's central Harlem neighborhood was 27.7 per 1,000 births. In 2008, it was 6.1.
Using the New York approach as one of its models, the Wisconsin Partnership Program and the University of Wisconsin School of Medicine and Public Health are launching a $10 million program to improve birth outcomes in four of Wisconsin's most troubled cities: Beloit, Kenosha, Racine and Milwaukee.
The Milwaukee Lifecourse Initiative for Healthy Families is expected to complete its planning stage by July.

'Public health crisis'

How bad is the situation in Milwaukee?
The city Health Department on Monday is to release the 2010 Fetal Infant Mortality Review Report, based on an examination of all 499 infant deaths that occurred in Milwaukee from 2005 to 2008.
In that time frame, for every 1,000 babies born, 11 died.
"We have a public health crisis," said Bevan K. Baker, Milwaukee's commissioner of health.
"We have moved beyond the tipping point."
The disparity between black and white infant deaths is even more disturbing.
The city's 2005-'08 white infant mortality rate was 6.4. The Hispanic rate was close: 7.4.
The city's black infant mortality rate during that period was 15.7, about 2.5 times the white rate.
These deaths are concentrated in a handful of ZIP codes, where poverty, joblessness and crime also are high.
The ZIP code with the highest rate was 53210 - which includes central city areas as well as parts of the Sherman Park and Enderis Park neighborhoods - with 19.5 deaths per 1,000.
That rate is worse than Colombia, Bulgaria and the Gaza Strip.
Health does not depend on health care alone.
Nor is it fully explained by genes or good habits.
Health care matters. So do the attributes we are born with. So do the decisions we make. Smoke or don't smoke. Eat this, not that.
But our health is also a product of the families that raise us, the communities that shape us, the times that we live in.
It is telling that two of the area's top hospitals for infant care are in the two ZIP codes with the highest infant mortality rates: St. Joseph's on the northern boundary of 53210 and Aurora Sinai Medical Center on the northern boundary of 53233.
"Infant mortality is a problem that is more than access to care," said Tina Mason, program director of Aurora Sinai's obstetrics and gynecology department and a former associate commissioner for New York City's Department of Public Health.
"It's a societal problem."
Jackie Tillett, director of the Midwifery & Wellness Center, which is located at Sinai, said many of the women she sees are young, poor and uneducated.
"We follow people who are socially high-risk," she said. "You can't just take a pill for it."
The Center for Urban Population Health published a 2010 study focusing on health disparities among Milwaukee's socioeconomic groups.
The study ranked the socioeconomic status - measured by income and educational attainment - of people in Milwaukee's 29 ZIP codes, then sorted those ZIP codes into three groups: low, medium and high.

Problem areas

The bottom third - the group of ZIP codes with the most poverty and lowest college graduation rates - had the highest infant mortality rate.
It also had the highest premature death rate, chlamydia rate, HIV rate and teen birthrate.
It had the greatest percentage of low birth weights; preterm births; uninsured adults; people who hadn't seen a dentist in a year; births to mothers who received no prenatal care during their first trimester; smokers; pregnant smokers; obesity; violent assaults within the past year; single-parent households; and children who tested positive for lead poisoning.
The report emphasized that the sheer number of people living in the city's lowest tier and the depth of the health issues affecting them compromised the well-being of all Wisconsinites.
"Milwaukee's large population, poor health outcomes and large health disparities," the report says, "have a significant impact on the overall health of the state as well as on the economic vibrancy of the city and state."
Income and education fail to account for the racial disparity in Milwaukee's infant mortality rates.
Blacks across the socioeconomic spectrum have higher infant mortality rates than whites.
The infant mortality rate for a child born to a black woman in the highest tier is about the same as the rate for a child born to a white woman in the lowest tier.
The infant mortality rate for babies born to a black woman in the middle tier is three times the rate for babies born to white women in the same tier.
It is not clear why.
"I've been working on this for 20 years," Mason said, "and just when you think you've figured it out - whoosh! - it's gone."
A growing field of research suggests that the chronic stress of living in poverty or with barriers associated with low educational attainment increases the risk of the leading cause of infant mortality: preterm birth and low birth weight.
Research also shows that the experience of racial or ethnic discrimination deepens stress and further increases the risk of preterm or low birth weight.
A novel study published in 2006 vividly illustrates this theory.
Diane S. Lauderdale, a professor of epidemiology at the University of Chicago, wanted to know whether poor birth outcomes increased for women of Arab-origin after the terrorist attacks of Sept. 11, 2001.
Lauderdale looked at all California birth certificates for 2001, 2002 and 2003. She identified more than 15,000 mothers with Arabic last names.
Prior to 9-11, she discovered, women with Arabic last names had the same low birth weight rate as non-Hispanic white women.
But in the six months after 9-11, the chances of having a low birth weight child increased 34%.
The risk of bearing low birth weight babies, she found, did not increase for any other ethnic group.

There's a cost

Complications of prematurity, including low birth weight, accounted for more than half of all infant deaths in Milwaukee, according to the 2010 infant mortality report.
A preterm baby is a child born before 37 weeks' gestation. A low birth weight baby is a child who is born weighing less than 5.5 pounds.
Preterm and low birth weight babies, even when they survive, are subject to a host of medical complications, such as breathing problems, infections, neurological problems and unstable heart rhythms.
The report attempts to calculate the cost of preterm births.
Citing March of Dimes data, it estimates cost of a normal full-term delivery to be about $3,325, including prenatal care, hospitalization and drug costs.
Citing an Institute of Medicine report, it estimates the cost of a preterm birth to be $51,600.
It multiplies that figure by 4,851, the number of preterm babies born in Milwaukee from 2005 to 2008.
The cost: More than $250 million - about what the Milwaukee Public Schools system pays to run all its elementary and all its kindergarten through eighth-grade schools.
Lakisha Stinson would count the cost differently.
She would measure the bottomless anguish that followed the death of her first born, Kelviana. She would measure the years that followed that were lost to drinking, drugs, violence and jail.
There is a photo of Kelviana above the window in the bedroom where, on this cold January day, Stinson feeds Rashyia.
Stinson was 14 when she gave birth to Kelviana on July 28, 2003.
Kelviana was 14 weeks premature. She weighed less than 2 pounds.
She spent most of her life at St. Joseph's. The complications stemming from her preterm birth were legion: She suffered damage to her eyes and central nervous system, she bled into her brain, she was jaundiced, she had to be intubated and required a chest tube.
But she survived. By her 6-month checkup, her condition had stabilized and she seemed fine.

A young life lost

On April 15, 2004, while visiting her father's home, Kelviana spent the night in her grandparents' bed.
According to a medical examiner's report, the grandfather created a pile of pillows, blankets and dolls so she would not roll off the bed. The infant's grandmother, after taking a sleeping pill, joined her. Later, so did her grandfather, who had been drinking, according to the report.
The grandfather found Kelviana in the morning with her head over the side of the mattress, resting on the pile of blankets. He picked her up and put her to his shoulder. She vomited blood and sputum.
Kelviana was pronounced dead two minutes after arriving at St. Joseph's. The medical examiner ruled sudden infant death syndrome as her cause of death, with co-sleeping and prematurity as contributing causes.
Stinson, a child, buried her child in a toy-sized casket.
Less than 11 hours into this new year, Milwaukee recorded its first infant death. Malachi, 1 month and 9 days old, died sleeping beside his mother in an adult bed.
More babies will die in the year to come.
They will die of prematurity, sudden infant death syndrome, infection, homicide.
Too many of these deaths will have been preventable.
http://www.jsonline.com/news/milwaukee/114430774.html

SIDS: Solano County infant mortality rates studied

Published by The Reporter

Posted: 01/25/2011

A recent analysis of deaths of Solano County babies in the first year of life reveals that the two leading preventable causes of infant deaths are babies being born too small and too soon, and deaths related to unsafe sleeping, including babies who die of Sudden Infant Death Syndrome.
While the causes of prematurity are not completely understood, several known risk factors include mothers who entered prenatal care late or had no prenatal care at all, and mothers who smoked or had secondhand smoke exposure, officials said.

"Smoking nearly doubles a woman's risk of having a low birthweight baby," said Nancy Calvo, Maternal, Child and Adolescent Health administrator. "We also need to address chronic health problems during pregnancy." Women who were obese, diabetic, had high blood pressure or other health problems during pregnancy were more likely to have a baby die, she noted.

Infants who died of Sudden Infant Death Syndrome had risk factors which included sleeping face down versus the recommended placement on their back and/or sharing a bed space with adults or children.

The report, known as the Fetal Infant Mortality Review, examined data from death certificates, medical charts and interviews with mothers. The study showed local infant mortality rates have not changed much since 2002, and are still too high when compared to national benchmarks. For example, the national Healthy People 2010 objectives set a goal of 4.5 infant deaths per 1,000 live births, but
for the years 2006 through 2008 the Solano County average was 6.0 deaths per 1,000 live births. Compared to Caucasian infants, African American babies were nearly twice as likely to die in their first year.
"In just three years in our county, from 2006 to 2008, we had over 100 babies die before their first birthday, and many of these tragedies can be prevented," said Calvo, adding that women can give their babies the best start by planning their pregnancies and taking good care of their health before and during pregnancy.
 

For the full report, visit http://www.solanocounty.com/.
<http://www.thereporter.com/news/ci_17191812>

AHT: Pennsylvania: Ryan Michael Plouse charged

WARREN HOWELER:, January 25, 2011

A Sayre man who is facing charges that he allegedly injured a two-and-a-half month old infant recently waived his formal arraignment in Bradford County Court of Common Pleas, effectively pleading “not guilty” to the charges filed against him.
Ryan Michael Plouse, 21, is facing charges of aggravated assault, simple assault, endangering the welfare of children, recklessly endangering another person and harassment.
Plouse, who is currently out on $50,000 unsecured bail, is being represented by Athens attorney Robert McGuinness.
On Jan. 11, McGuinness filed a “waiver of appearance at arraignment” on behalf of his client. Plouse was slated to appear before Bradford County Judge Maureen T. Beirne for a formal arraignment on Feb. 3.
Plouse’s next court appearance has not yet been scheduled.
Pennsylvania State Police explained that Plouse was charged after he allegedly caused a severe head injury to the female girl “in an abusive injury consisting with shaken baby syndrome.”
The victim also suffered bruising to her face and a broken rib over an approximately two-month period from Nov. 1 to Dec. 23 at a home in Terry Township, police said.
The victim was treated and released at Geisinger Medical Center in Danville, police said.
http://www.morning-times.com/articles/2011/01/25/local_news/doc4d3edbf41aaf0434761092.txt

SBS: Louisiana: James Brewer pleads guilty to attempted second degree

James Brewer, 24, of Doyline, pleaded guilty to attempted second-degree murder in a plea arrangement reached with the district attorney's office. A Webster grand jury indicted him in March 2009 on one count of first-degree murder.
District Judge Mike Craig ordered a presentence investigation. Brewer faces up to 50 years. He should be sentenced in April.
Brewer's daughter, Kaydance Davis, died of blunt force trauma, or shaken baby syndrome. An autopsy indicated she suffered injuries to the back of the head.
Brewer initially told sheriff's investigators his daughter fell off a bed. He later said he shook her to comfort her after she became fussy.
Although other adults lived in the home, Brewer was the only one there when Kaydance became unresponsive, authorities said
http://www.shreveporttimes.com/article/20110122/NEWS01/101220313/Doyline-father-pleads-guilty-to-daughter-s-death

SBS: Montana: Christopher R. Lewis charged

Christopher R. Lewis entered his plea Wednesday before District Judge Jeffrey Langton. A felony charge of assault on a minor was dropped. Langton scheduled sentencing for March 9.
Prosecutors say the mother of the 9-week-old took her son to a Corvallis clinic on Jan. 13 because the infant was vomiting. The baby was taken to a Missoula hospital where a scan found bleeding in the infant’s brain. A doctor documented bleeding in the eyes consistent with shaken baby syndrome.

At the time, physicians said the infant might be developmentally delayed because of the injuries and that his eyes could be permanent damaged
http://www.greatfallstribune.com/article/20110120/NEWS01/110120002/Man+pleads+no+contest+in+baby+shaking+case

SBS: Connecticutt: Debbie DeCarvalho, and Mario Leone; foster parents charged with assault

January 20, 2011
Westport police said today they have arrested two foster parents following a call last July involving a 6-month-old baby suspected of suffering from “shaken baby syndrome.”
Three other foster children were immediately removed from the residence by officials from the Connecticut Department of Children and Families (DCF), police said.
The couple, identified as Debbie DeCarvalho, 42, and Mario Leone, 38, turned themselves into police on Wednesday after learning of warrants for their arrest, a police news release said.
Both were charged with assault and risk of injury to a minor and bond set at $50,000 each for a court appearance on Jan. 28, police said.
Police said officers responded to a medical call and the infant was transported to Norwalk Hospital “where doctors suspected shaken baby syndrome.” The infant was immediately transferred to Westchester Medical Center due to the severity of its injuries, police said.
Investigators from DCF, the State Attorney’s Office, and the Westport Police Department conducted a joint investigation into the manner in which the infant was injured, police said, and the warrants were issued.
 http://www.westportnow.com/index.php?/v2/comments/31755/

Shaken Baby Syndrome’ – a response by Dr Waney Squier

Shaken Baby Syndrome’ – a response by Dr Waney Squier

Dr Waney Squier responds to a recent article in Family Law Week.

On 25 February 2010, Family Law Week published an article by John Tughan which referred to the judgment in Re S [2009] EWHC 2115. We have received a letter from Dr Waney Squier, who is mentioned in the article and judgment.

Dr Squier has offered to write an article on this subject. The editors of Family Law Week do not consider that it is an appropriate forum in which to debate matters of complex medical disagreement. Instead we publish the following letter by Dr Squier. Family Law Week itself does not hold a view on matters of medical expertise, and so the views expressed are those of Dr Squier.

Department of Neuropathology
Level One West Wing
John Radcliffe Hospital
Oxford OX2 6QY

April 9th 2010

Dear Sir,
In February 2010 Family Law Week published a review by Mr Tughan of the judgment of Mrs Justice King in Re S [2009] EWHC 2115, (Family Law Week: February 2010). I appreciate the opportunity to respond.
The remarks of Dr Al-Sarraj cited in the article are both inaccurate and unrepresentative.
I do not believe that hypoxia alone causes subdural bleeding as I have pointed out on many occasions, both in reports for the Court and in my academic publications; it's a bit more complicated than that. This was put to me in the course of the trial; my response was that I have never stated this and do not believe this.
These issues are far too serious to be matters of faith; medical opinion must be based not on belief, but on empirical observation and peer-reviewed, objective, scientific evidence. 
It is a matter of objective evidence that the blood vessels of the infant dura are immature and far more extensive than in later life.
It is a matter of objective evidence that bleeding into the young infant dura is common.
It is a matter of objective evidence that sick, hypoxic ventilated infants may develop impaired blood clotting. This predisposes to, or exacerbates, bleeding. 
Only by considering the entirety of the evidence and the highly complex physiopathology specific to the young infant brain and its blood supply can a valid opinion be reached. 
Central to so many of these cases, and so frequently trivialised, is a prolonged period of hypoxia with subsequent resuscitation and brain swelling. It is these features which set babies with the "triad" (of retinal and subdural bleeding and encephalopathy) apart from cot deaths. A study presented last month to the American Academy of Forensic Science indicates that these are the critical factors associated with retinal haemorrhage (1). The same study has not been undertaken with respect to subdural bleeding, although multicentre studies, comparing in-hospital with out-of-hospital cardiac arrest, have confirmed the devastating effects on the brain of prolonged collapse followed by resuscitation (2).
I also challenge the statement that I am the only one of 40-44 neuropathologists in this country who holds this belief. Not only, as noted above, do I not hold this belief, but the statistic is misleading. To my knowledge, there are only 5 neuropathologists who regularly become involved with the study of infant brains in the forensic setting; this is reflected in their attendance at a meeting at the College of Pathologists in December 2009 (3). Among these 5 only two of us devote a significant part of our daily diagnostic practice to the study of brains of infants dying from the whole spectrum of natural diseases. This has been my majority practice for 30 years. The others have no such daily experience. It was clear from the meeting at the College that there is considerable divergence of opinion and that I am by no means alone in my views. The other 35 or so neuropathologists have not to my knowledge been canvassed, nor would they have sufficient experience of paediatric brain injury and the rapidly evolving literature to form an objective opinion.
I am accused of clinging to a hypothesis; on the contrary my views, shared by hundreds around the world, continue to evolve. They are based on the incontrovertible evidence provided by the tissue I see daily on the microscope slides and informed by research and critical examination of the scientific literature. What is staggering is that "mainstream medical opinion" has remained just that, opinion; supported not by evidence but by forty years of repetition.
Shaking as a cause of subdural bleeding has not been supported by biomechanical research; as long ago as 1988 Duhaime wrote ""shaken baby syndrome" is a misnomer, implying a mechanism of injury which does not account mechanically for the radiographic or pathological findings"(4). It is inconsistent with the anatomy of the infant head and, despite an estimated 70,000 cases diagnosed in the UK and USA, has never been independently witnessed to cause the collapse of a previously well baby. The mainstay of the hypothesis is confession evidence (5). 
If not shaking, then impact must be considered. If there is no evidence of impact or violence (autopsy means seeing for oneself), then this consideration must be ranked, pragmatically, with all the other potential causes of collapse and according to the facts of the specific case.
Any attempt by the courts to simplify these issues will lead to misunderstanding.  The difficulties of presenting scientific evidence in the courts have been discussed by Tuerckheimer (6), who stresses "the tensions which thrive where science and criminal justice meet" and specifically that ""Because it is fully constructed by and dependent on medical expertise, Shaken Baby Syndrome (SBS) raises in stark form the problems that arise when science outpaces law..."
Progress has been made over the past decade.  Today, as Mr. Tughan correctly observes, the "triad" is no longer accepted as diagnostic of non-accidental injury but is instead viewed "as a mere hypothesis."  Mrs. Justice King is equally correct in recognising that we do not yet know the full range of natural and accidental causes for the triad.
Meanwhile, I will continue to strive to "[t]hrow light into corners that were . . . dark." 
If lawyers are unwilling to question opinion that is validated only by repetition, or to delve beneath the legal issues and explore the science, there will be miscarriages of justice. And slings and arrows will continue to be directed at the messengers.
Yours faithfully
Dr Waney Squier
Consultant Neuropathologist

Reference List

(1)  Matshes E. Retinal and Optic Nerve Sheath Hemorrhages are not Pathognomonic of Abusive Head Injury. 10 A.D. Feb 24; 2010.
(2)  Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ, et al. In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med 2009 Jul;37(7):2259-67.
(3)  Royal College of Pathologists. Report of a Meeting on the Pathology of Traumatic Head Injury in Children.  2009.
(4)  Duhaime AC, ennarelli TA, Sutton LE, Schutt L. The "Shaken Baby Syndrome" : a misnomer? J Paediatric Neurosciences 1988;4(2):77-86.
(5)  Christian CW, Block R. Abusive head trauma in infants and children. Pediatrics 2009 May;123(5):1409-11.
(6)  Tuerckheimer D. Criminal Justice at a Crossroads: Science-Dependent Prosecution and the Problem of Epistemic Contingency. Alabama Law Review 62. 2010. 1-8-2010.

Ref Type: Journal (Full)

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SBS: Dr Squier and Dr Cohen expert opinions

The case of Re S [2009] EWHC 2115 involved the examination of the death of a child. Mrs Justice King’s judgment has recently been published and is of considerable importance in cases involving issues of death, non-accidental head injury and shaken baby syndrome.

 John Tughan, 4 Paper Buildings

Historically, the classic features of non-accidental head injury were said to be encephalopathy, subdural haemorrhage and retinal haemorrhage.  Encephalopathy is disorder or dysfunction of the brain.  The subdural space within the brain lies above the arachnoid membrane and below the dura.  Bleeding into that area, which is not really a space at all in normal life, is the haemorrhage.  Establishing the presence of the triad involves medical experts from a number of different disciplines interpreting signs within the brain and surrounding tissue.  Those signs can range from the radiological imaging of the brain to the post mortem findings of the pathologist down to the microscopic findings from the tissues of the brain and spinal cord undertaken by a neuropathologist.  Often this process of putting the various strands of evidence together in order to achieve a conclusion is likened to the pieces of a jigsaw puzzle slotting into place.  The clinical history of the people involved with the care of the allegedly injured child is also a part of that puzzle and, for a court attempting to draw conclusions from the medical information, a vitally important part of it.

For some years conventional medical opinion was that the presence of the triad of injuries was diagnostic of non-accidental head injury.

However, practitioners in this area will remember that the controversy included the publication by Dr Geddes of her three papers on the subject leading up to her unified hypothesis or “Geddes III”.  The unified hypothesis of Geddes III challenged the importance of the triad of injuries as a diagnostic tool for evaluating the cause of injuries to a child.  At the core of the unifying hypothesis was the proposition that the triad of injuries could be caused by severe hypoxia (lack of oxygen in the tissues) which in turn led to brain swelling.  In turn, the swelling of the brain combined with raised intracranial pressure and could produce both subdural and retinal haemorrhages.  Accordingly, it was asserted that any incidents of apnoea (cessation of breathing) could set in motion a cascade of events leading to the triad of injuries.  The fundamental importance of this will readily be seen to be not only the questioning of the validity of the triad as a diagnostic tool but also the fact that apnoea has many different causes, trauma or abuse being only one of them.

The Court of Appeal considered these issues in R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980.  The decision of the Court of Appeal was that:

(1) It was not possible to find that the triad had been proved as a fact, rather than as a mere hypothesis.  While the triad of injuries was a strong pointer to non-accidental injury on its own, it was not possible to find that it must automatically and necessarily lead to a diagnosis of non-accidental injury.  All the circumstances, including the clinical picture, must be taken into account.  It was for the judge, or jury, to resolve the disputes as to issues of fact on all the available evidence in the case.

(2)  It was not possible to make any finding on the issue of the degree of force needed to cause serious injuries, other than to refer to some general propositions.  Common sense suggested that the more severe the injury the more probable it was that it would have been caused by greater force than mere ‘rough handling’.  Evidence showed that there were cases in which a small degree of force or a minor fall had caused very severe injuries, but if something less than rough handling commonly caused such injuries, the hospitals would be full of such cases; cases of serious injuries caused by very minor force such as might occur in normal handling or rough handling were likely to be rare or even extremely rare.  Although the younger the child, the more vulnerable the child was likely to be, it was not possible to conclude that age was necessarily a factor in deciding whether injuries were caused by a strong force or a minimal degree of force or impact. The balance of the evidence was that, although an infant’s skull was more pliable than that of an older child, the internal organs and vessels were as robust as those of an older child.  The vulnerability of an infant arose from the fact that its head was generally larger in proportion to its body than that of an older child and its neck muscles were weaker and not as well developed.

(3)    The type and extent of retinal haemorrhage and its place in the constellations of symptoms would be a matter for the court to evaluate in each individual case, but there was force in the evidence that caution should be exercised before a diagnosis of non-accidental injury was made in the absence of retinal haemorrhage, whereas in cases of injuries alleged to be caused by an impact or impacts, the evidence suggested that retinal haemorrhages were not a prerequisite.

(4)    Developments in scientific thinking should not be kept from the court simply because they remained at the status of hypothesis, but, obviously, it was of the first importance that the true status of the expert’s evidence was frankly indicated to the court.

(5)    In cases involving allegations of child abuse the judge should be prepared to give directions in respect of expert evidence, taking into account the guidance on the obligations of an expert witness given by Cresswell J in ‘The Ikarian Reefer’ [1993] 2 Lloyd’s Rep 68 and the guidance given by Wall J in Re AB (Child Abuse: Expert Witnesses) [1995] 1 FLR 181. If this guidance were borne in mind and the directions made were clear and adhered to, it ought to be possible to narrow the areas of dispute before trial and limit the volume of expert evidence under consideration.

The Court of Appeal heard evidence and that included the evidence of Dr Geddes.  One of the points made against Geddes III by clinicians in this area was that, if Geddes III was correct, the hospitals would be full of children who presented with the triad of injuries and that this was simply not the case.  Dr Geddes herself accepted that the unified hypothesis did not seek to show that the triad was inconsistent with non-accidental head injury only that it was not diagnostic.  When asked about the hypothesis, Dr Geddes volunteered that she might not have the theory quite right and that it was never advanced with a view to being proved in court but rather as a means to stimulate debate.

For a time it seemed as though R v Harris might have resolved these controversial issues.

Re S [2009] EWHC 2115 was a case involving the death of a child following collapse.  The central issue in the case was what caused that collapse.  The local authority asserted that there was a single primary event which fitted with a traumatic shake or shake/impact which led to the classic triad of injuries.  The mother put forward a number of possible alternatives.

Mrs Justice King heard the evidence of a large number of experts, many of whom were involved in the Harris case.  In particular the court had to deal with the evidence of Dr Waney Squier, consultant neuropathologist, and Dr Marta Cohen, consultant paediatric histopathologist.  Both of these experts continue to subscribe to Geddes III and consider themselves to be building on the work of that hypothesis.  The court recorded that both Dr Squier and Dr Cohen were against the mainstream of current thinking and the analysis in R v Harris.  In this, the court was echoing the view of Hedley J in F & L v A Local Authority [2009] EWCA 140 insofar as Dr Squier was concerned.  To illustrate the point of the mainstream of medical thinking Mrs Justice King read into her judgment the comment of Dr Al-Sarraj, consultant neuropathologist, that

“…there are 40-44 neuropathologists in the country of whom a maximum of 10 or 12 are forensic neuropathologists.  To his knowledge, the only neuropathologist in the UK believing that hypoxia can cause subdural haemorrhages is Dr Waney Squier.  In addition, he said there are two or three other people who share her opinion who are working in different, but related, specialities, of whom Dr Cohen and Dr Scheimberg (Dr Cohen’s co-author) are presumably two.  Dr Al-Sarraj said:

“They come in all the defence cases, so you do not realise that they are in such a minority.”

The court was asked to make findings about the approach of Dr Squier and Dr Cohen in three particular areas, those being the use of research material, their willingness to defer to experts in another field and the confining of their opinion to their own expertise and the importance of factual accuracy.

The court was critical of both experts in each of those three areas.  The criticisms included the conclusion that both, for different reasons, had been “disingenuous” in their citing of research material, “significantly out of their respective areas of expertise” and misleading in the factual errors made.  The court concluded 

“…In considering the evidence of Dr Cohen and Dr Squier, I remind myself that four years have passed since Dr Geddes accepted that her unified hypothesis could no longer credibly be put forward.  Dr Cohen and Dr Squier regard themselves as having built on her work.  I remind myself also that the next generation of experts and scientific research may, as Butler-Sloss P. said:

“Throw light into corners that were then dark and that the hypothesis of Dr Geddes may yet be proven to be in all, or in part, correct.” 

…Dr Squier and Dr Cohen, I find with regret, have each fallen into that category of expert identified by Butler-Sloss P. in Re U [2004] EWCA Civ 567, namely the expert who has developed a scientific prejudice.  As a consequence, I accept the submission of the Local Authority that Dr Squier has permitted her convictions to lead her analysis.”

John Tughan
4 Paper Buildings
Temple
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