SBS: Florida: A foster mother goes on trial, and so does shaken baby syndrome

By Curtis Krueger,
August 27, 2010Over three days this week, prosecutors have systematically built a murder case against a former foster mother accused of shaking and killing a baby in her care.
Today a defense attorney will try to build a case against shaken baby syndrome itself.
A nationally known critic of shaken baby diagnoses, neurosurgeon Ronald Uscinski of George Washington University Medical Center, is scheduled to testify today for the defense in the case against Tenesia Brown, 42.
And more experts are coming.
"There are … cases all over the country that are being granted new trials because they found out that the science of shaken baby syndrome is flawed," Ron Kurpiers, the defense attorney, said Thursday during a break in the trial.
The case against Brown in Pinellas-Pasco Circuit Court is one of a growing number of trials nationwide in which expert witnesses are casting doubt on the science surrounding shaken baby cases.
A Connecticut woman was acquitted earlier this year of killing a 7-month-old child after her defense attacked the existence of shaken baby syndrome. A Kentucky judge in 2006 barred trial testimony about shaken baby syndrome on the grounds that it hadn't been scientifically proved. Doubts over shaken baby cases have led to government-ordered reviews of hundreds of cases in Canada and Great Britain.
But it's not a one-sided debate. The diagnosis retains strong support from the Centers for Disease Control and other bedrock medical institutions. Dr. Sally Smith, medical director for Pinellas County's child protection team, testified Thursday that the diagnosis is still widely accepted, though "abusive head trauma" is now the preferred term.
The way the jury interprets these differing medical views could determine whether Brown, who is charged with first-degree felony murder, spends the rest of her life in prison.
Brown's friends and family members attending the trial declined to talk to the media this week, but it's clear they are wasting no expense to clear her. Uscinski, the neurosurgeon scheduled to testify today, charges "up to $750 per hour as a consultant and up to $10,000 per day on the witness stand for out-of-town cases," according to a 2008 Discover magazine article. Mark Herbst, a St. Petersburg radiologist who testified for the defense on Thursday, said his fee is $3,000 for an afternoon.
This case, in a sense, began with the birth of Lazon Gulley. He was born with cocaine in his system. So foster care workers intervened and placed him in foster care while his mother received drug treatment.
Prosecutors said Brown never had been a mother before becoming a foster parent with her husband. In less than six months time, foster care caseworkers sent them four children.
On March 3, 2006, Brown picked up 14-month-old Lazon early from day care because he was suffering from diarrhea and vomiting. About 45 minutes later, she called 911 and reported he was virtually lifeless.
At All Children's Hospital, doctors discovered severe brain damage. Smith, the doctor who testified for the prosecution on Thursday, said Lazon suffered from hemorrhaging in his retinas, and beneath the layer around his brain called the dura. He died in 2008.
The symptoms Lazon suffered are ones that have traditionally been considered hallmarks of shaken baby syndrome, and they are believed to occur right after a child is shaken. Brown was with Lazon just before his injuries were observed in the hospital, which is a big part of the reason she was charged with murder. No one saw her shake Lazon, and she never confessed to doing so. Kurpiers said she may take the witness stand today and deny doing so.
Nationwide, some of the debate centers on the symptoms that are traditionally linked to shaken baby syndrome — especially the retinal and subdural hemorrhaging. When these symptoms are present, they're often cited as evidence that someone must have shaken a baby.
Critics say there's new evidence showing other causes for these symptoms, such as congenital defects. Also, critics say laboratory studies of monkeys and baby-dummies question whether someone shaking a baby would produce enough force to cause the severe brain injuries in cases like Lazon's.
The critics aren't denying that shaking would hurt babies. They're saying babies with these injuries might have gotten them some other way. And that can raise reasonable doubt about whether accused caregivers such as Brown are responsible for the injuries.
So far the defense has not presented a theory on how Lazon was hurt. They are not legally required to.
"We're not blaming anybody else," Kurpiers said. "We're saying it was not shaken baby and that the trauma did not occur from the actions of Mrs. Brown."
http://www.tampabay.com/news/courts/criminal/a-foster-mother-goes-on-trial-and-so-does-shaken-baby-syndrome/1117768

SBS: UC Berkeley expert on head impacts sets out to change way society deals with possible shaken baby syndrome

27 November 2001
By Robert Sanders,
Mechanical engineer Werner Goldsmith of the University of California, Berkeley, is on a mission to reform the way doctors and prosecutors view the thousands of suspected cases of shaken baby syndrome each year.
An often fatal set of symptoms caused by violent shaking of an infant or young child, shaken baby syndrome can be difficult to diagnose because frequently there are no external signs of abuse. Most of the damage is in the brain.
Backed by decades of research on the effects of head impacts, and as author of the only book on the subject of impacts, Goldsmith nevertheless sees a rush by pediatricians, social workers and prosecutors to brand many parents and caregivers as child abusers when the injuries were more likely caused by a fall.
"Anyone who abuses a child deserves the full fury of the law," said Goldsmith, a professor of the graduate school at UC Berkeley. "But people should know the truth. The brain injuries that lead many prosecutors to file charges of child abuse can also be caused by falls or even result from chronic bleeding in the brain."
To get his message out, Goldsmith is traveling around the country educating the medical community as well as lawyers and child welfare caseworkers about the complexities of establishing a cause of child brain damage. He also counsels numerous lawyers and testifies as an expert on head impacts at trials, where he sees first-hand the rush to judgement.
"A child in someone's care dies by natural causes or accident and the district attorney files charges claiming shaken baby syndrome," he said. "Suddenly, the caregiver is faced with life in prison."
His message to doctors and lawyers is not to assume that a child with bleeding in the brain and the eye is automatically the victim of child abuse. Doctors typically look for these symptoms, called subdural hematoma and retinal hemorrhage, respectively, plus brain swelling or edema.
Such symptoms could result from an accident or, under certain circumstances, from a chronic condition. Doctors and medical examines need to look for other signs of abuse, in particular, neck damage, he argues.
"I am absolutely convinced that in order to do serious or fatal damage to an infant by shaking you have to have soft tissue neck damage," Goldsmith said. "Yet, in 95 percent of cases, medical examiners do not look at the neck in autopsy. They look at the stomach, the abdomen, the head, but the neck is neglected."
The main problem is that very little research has been done on the effects of head impacts in infants and small children. Goldsmith, whose 1960 book, "Impact: The theory and physical behaviour of colliding solids," will be reissued next month by Dover Publishers, has written more than 50 papers on the biomechanics of head and neck injury. Yet, though he pioneered the application of biomechanics to head injury, he has conducted no studies of infants. Only one such study has been done, in 1987, and that employed a doll whose head was stuffed with wet rags.
To remedy this lack of basic data, within a few months he plans to embark on a preliminary study with UCSF neurosurgeon Geoffrey Manley, MD, PhD, using professional crash test dummies instrumented with devices to measure the types of forces an infant would sustain during shaking and other types of abuse.
"I have a very strong feeling that, given how little we really know about the mechanical issues involved in head injury, there may be people who are convicted of crimes they are not guilty of," said Manley, chief of neurotrauma at UCSF.
For now, Goldsmith hopes to make an impact on the overly aggressive approach of many pediatricians to suspected shaken baby syndrome.
Though most doctors look for brain edema, subdural hematoma and retinal hemorrhaging, many other types of trauma produce similar symptoms, he said. In fact, bleeding in the brain normally increases pressure, leading to swelling and retinal bleeding. So anything that causes intracranial bleeding, in particular falls, can display this trio of symptoms.
A fall backwards from three feet onto a hard surface, like concrete, can produce nearly 180 Gs of acceleration - 180 times the force of Earth's gravity - enough to cause a subdural hematoma, Goldsmith calculated. Shaking a child once a second through a range of one foot produces only 11 Gs, at the most.
"There is an order of magnitude difference between shaking and falling," Goldsmith said. "From the point of view of the brain, shaking is a much, much milder form of braking than a fall."
One dogma often espoused by doctors is that short distance falls do not cause serious harm. However, videotapes demonstrate that falls from as little as 32 inches can cause fatal brain damage in infants and toddlers.
To complicate matters, between 5 and 10 percent of children are born with undiagnosed subdural hematomas, and 30 percent are born with retinal bleeding, Goldsmith said.
"If you get a rebleed, you may get something that looks like shaken baby syndrome," he said.
Because of such uncertainties, Goldsmith urges physicians and prosecutors to look for more certain evidence of shaking, specifically damage to the neck.
"You should be able to show neck damage to prove shaken baby syndrome," he said.
Goldsmith also urges doctors to talk to biomechanical engineers to get an understanding of the forces involved in accidental falls versus child abuse.
The ultimate goal of Goldsmith and Manley is to build a sufficiently lifelike baby dummy containing a skull, dura (a tough membrane that lines the skull and envelops the brain) and brain whose properties are very similar to the real thing. The dummy studies planned for January will provide some of the data they need, and help them apply for a grant from the National Institutes of Health for further studies.
"The infant neck, particularly before the age of one, is dramatically different from the neck of, say, you or me," Manley said. "The same is true of the head, which in infants is soft and compliant - they haven't formed sutures yet.
"We don't believe that these crash test dummies are sufficient to represent the actual biology of the infant head and neck, so we are going to use the preliminary data to write a grant to develop a much more realistic model."
In addition, Goldsmith and graduate student Ken Monson are working with Manley to obtain fresh cerebral arteries and veins from surgery patients for measurement of their mechanical properties. Despite the fact that arteries and veins are embedded in the brain like a net, no one has considered them in models of how the brain responds to impact.
In the late 1960s, Goldsmith was chair of a committee at NIH, the Head Injury Model Construction Committee, that for four years oversaw research to construct a model of the adult head and brain. Unfortunately, funding dried up in the 1970s, and the research project was dropped.
"Well over 50,000 people die from head injuries each year. Finding out the causes and procedures is very difficult, but essential," he said.
http://berkeley.edu/news/media/releases/2001/11/27_baby.html