SBS: Wisconsin: Andrew Goldston trial conflicting evidence

The jury chosen to decide the fate of Andrew Goldston got a crash course in medical analysis Wednesday as doctors brought in by the prosecution and defense offered greatly contrasting explanations for the fatal injuries suffered by his 1-month-old son.
Dr. Lynn Sheets, medical director of the child abuse program at Children’s Hospital of Wisconsin in Wauwatosa, said she can say with “no hesitation” that Leander died of “abusive head trauma.” She examined the boy during the nine days he remained hospitalized before dying of his injuries.

“Absolute abuse – no hesitation,” Sheets told the jury. “You have severe rotational injuries, and that’s very different from straight-line or falling injuries.”

The jury also saw a picture of Leander for the first time, as Sheets displayed a picture of the boy in head restraints at Children’s Hospital. She said Leander had slight facial twitching immediately after he arrived but soon stopped responding and breathing on his own.

Sheets said the injuries, which included bleeding throughout the brain and severe retinal bleeding, could “absolutely not” be caused by falling 18 to 30 inches to the ground. That was the claim Goldston made in describing to police that the child fell from his arms as he reached for a remote control.

But Dr. John Plunkett, a forensic pathologist who specializes in infant head trauma, testified with equal vehemence that Leander’s injuries could have occurred in the fall Goldston described.

“They’re going to be rare, but (deaths) can occur,” he said.

Plunkett said the injuries Sheets cited as too extensive for a simple fall could have occurred as a cascading effect, with one causing the other in the aftermath of the fall.

Goldston also told a 911 dispatcher the child fell onto a bouncy seat, and he told a fellow jail inmate that he needed God’s forgiveness for squeezing, shaking and dropping the boy, witnesses testified earlier in the trial.

Goldston, 24, of Sheboygan, is charged with first-degree reckless homicide for allegedly causing the injuries on March 9, 2010. The trial began Monday and is scheduled to wrap up by the end of the week.
 http://www.sheboyganpress.com/article/20110608/SHE0101/110608065/Doctors-debate-cause-fatal-injuries-infant?odyssey=tab%7Ctopnews%7Cimg%7CFRONTPAGE

SBS: Missouri: Caringer: Timetable of infant's death disputed during trial

Kathryn Wall November 11, 2010

Doctor says baby's injuries within hours of death; defense disagrees.
While prosecutors worked to prove an infant died of an abusive head injury in a single day, the defense questioned a pattern of injuries that they say were the real cause of the 9-month-old's death.

Lucas Theede-Bennett died Jan. 6, 2009. His baby-sitter, Brenda Caringer, is charged with his murder.
Throughout the trial, prosecutors have argued that Caringer was the only person who could be responsible for the traumatic head injuries that ultimately lead to Lucas' death.
The defense claims Caringer was preparing a bottle for Lucas when she heard a thump and came into the living room to see the infant falling back from her coffee table. He stopped breathing a short time later, the defense has said.
They contend that a series of falls Lucas experienced in the eight days prior to the Jan. 6 incident were a slow lead-up that triggered his death.
The prosecution presented Dr. Martin Jones, the trauma doctor who directed Lucas' care after he was flown to Cox South hospital.
"His injury was severe. His presentation was just as dramatic ... I have not seen a minor fall like that ever cause that type of injury," Jones said.
Jones noticed shortly after Lucas' death that he had retinal hemorrhages -- bleeding in the arteries of the eyes most commonly connected with Shaken Baby Syndrome.
CT scans performed on Lucas after his death revealed a skull fracture and bleeding and swelling of his brain. Jones declared Lucas' cause of death "abusive head trauma."
Caringer's defense attorneys cited the mention of an older area of bleeding on the brain in Jones' report that they say points to previous, older injuries that slowly contributed to Lucas' death.
Jones acknowledged that the CT scans showed an area that could have been another, smaller area of bleeding that was older than other areas in the brain, but he said those areas were considered "questionable" in the scans and could have easily been an overlap or another error in the image. He said if the area was bleeding, it was unrelated to the skull fracture and the massive bleeding that caused Lucas' death.
"It's not significant enough to cause the profound injury we found on the child," he said of the possible past injury.
Jones also said the extent of Lucas' injuries would have been immediately apparent. He said the skull fracture and subsequent bleeding had to have occurred within hours of Lucas' death.
The prosecution presented five other witnesses Wednesday -- including police personnel who responded to the scene, paramedics who treated Lucas and another woman whose daughter was being watched by Caringer at the time.
Police and paramedics who responded to Caringer's home said many of the same things heard Tuesday -- Lucas was cold to the touch when they arrived, Caringer was frantic and wasn't answering questions and that Caringer's story seemed to change as the time went on.

SIDS: Kansas statistics of child mortality

 October 25, 2010

TOPEKA, Kan. -- In its annual report, the Kansas State Child Death Review Board released statistics of child deaths from 2008, and the board made a number of recommendations to try to reduce some of the preventable deaths in the report.

The board broke the deaths out into six catergories: natural-except sudden infant death syndrome (SIDS) - 316 deaths; Natural-SIDS - 49 deaths; Unintentional injury (motor vehicle crash, drowning, strangulation, etc.) - 79 deaths; Homicide (including gang-related and child-abuse) - 26 deaths; Suicide - 9 deaths; and Undetermined - 23 deaths.

The recommendations the review board included: comprehensive and thorough investigations and autopsies, working partnerships with various for public education purposes, improving women's/maternal health to lower infant mortality, comprehensive laws regarding ATVs, prohibiting unattended children in vehicles, and adjustments to laws allowing children to drive on a farm permit.

In the natural deaths category, the report notes that 64 percent of the deaths were from infants less than 29 days old, 40 percent were due to prematurity and 22 percent were from congenital malformation.

In 2008, the report said 85 percent of the SIDS deaths in Kansas occurred in the first four months of life. In 82 percent of the SIDS cases, the report said mechanical asphyxia or suffocation caused by overlay could not be ruled out because the infants were placed to sleep in an unsafe environment, like in a bed, on a couch or recliner or on their abdomen. Of the infants who died from SIDS, 24 percent of those who died were placed in a crib to sleep and 37 percent were placed on their back.

The report noted that the violence-related deaths were the most alarming of the deaths. The statistics showed 50 percent of homicides came from abuse cases and most of those deaths came from children under the age of 4 and died from abusive head trauma. The report also noted 61 percent were killed by someone other than their biological parent, including 38 percent being killed by the mother's boyfriend who was left to care for the child.

The majority of the suicide deaths, the report said, were from teens ages 16 and 17, who died from asphyxia and that 33 percent had previously attempted suicide or had suicidal tendencies before their death, the report said. The board noted 44 percent of the suicides came after a recent breakup or argument with a significant other and 77 percent had some type of family discord.

Most of the unintentional deaths were from motor vehicle crashes, the report said, and accounted for 65 percent of the total unintentional injury deaths. In breaking down the unintentional death numbers, 48 percent of the deaths involved inattentive or inexperienced teen drivers. Four of the five children killed in ATV wrecks in ATVs were under the age of 13

http://www.kctv5.com/news/25503225/detail.html

SBS: AHT and more, Woods and Burd, Virginia

Date published: 10/22/2010

BY KEITH EPPS

When 15-month-old Ryan Schutt was brought to Stafford Hospital last month, he had an astonishing number of injuries.
He had a skull fracture, bleeding in the brain, two black eyes, and numerous bruises and scratches all over his body. He had recently suffered a broken arm.
"This is a child who was tortured, and tortured over time," prosecutor Eric Olsen said in a preliminary hearing yesterday in Stafford Juvenile and Domestic Relations Court.
Ryan's mother, Carrie Woods, 23, and her live-in boyfriend, 35-year-old William Burd III, are both charged with felony child abuse and felony child neglect.
Judge Julian Johnson sent the charges to a Stafford grand jury at the end of yesterday's hearing.
According to the evidence, the Sheriff's Office got a 911 call late Sept. 19 about a baby in distress.
Rescue workers met Woods near her home in Aquia Harbour and took the child for medical care.
Doctors determined that Ryan was possibly the victim of shaken baby syndrome, and it was initially thought that the child might die.
But according to Olsen, the baby has made good progress in his recovery and is now in foster care.
Pat Smidt, a child protective services worker in Stafford, testified that Woods gave several possible reasons for the numerous marks on the baby's body.
She said the family had an aggressive puppy that may have scratched the child, and she has a 3-year-old son who was mean to the baby.
In addition, Smidt said, Woods said the baby fell out of his crib that night while he was being watched by his grandmother.
Medical professionals told police that the child's injuries were too severe to have been caused by a small child or a fall from a crib.
Smidt said Woods also admitted that she knew Burd was a registered sex offender before she and her four children moved in with him.
The key witness against Burd yesterday was an inmate at the Rappahannock Regional Jail who shared a cell with him for a few days.
Olsen asked that the inmate's name not be used because he could face repercussions from fellow inmates.
The inmate, who has pending drug charges in King George, testified that Burd told him that he and Woods were using multiple drugs that night, including methamphetamines, Oxycontin and Vicodin.
According to the story, the baby wouldn't stop crying that night so Burd went to tend to him. Burd dropped the baby, whose head hit on a table, the inmate said.
After putting the baby back in his crib, Burd resumed the drug party.
Defense attorneys Jim Ilijevich and John Mayoras attacked the inmate's credibility, suggesting that the five-time felon came forward in hopes of getting leniency in his pending case.
"When there's no evidence, someone comes from the side door," Ilijevich said, referring to the door from which inmates enter the courtroom.
The inmate said he contacted the Stafford prosecutor's office because "it was the right thing to do."
http://www.blogger.com/post-create.g?blogID=7660800713990843286

SBS: Torrey

A Candia woman who allegedly caused a severe brain injury to an 8-month-old boy she was babysitting in June is facing a new charge and possibly a longer prison term if she is convicted, according to indictments.

Elizabeth Torrey, 26, is now facing a charge of first-degree assault and a new charge of second-degree assault in Rockingham County Superior Court, after being indicted by a grand jury for allegedly causing injuries to the baby boy.
Torrey could be sentenced to 10 to 30 years in state prison on each of the charges if she is convicted.
Police first learned of the baby's injuries after Torrey's neighbor called 911 June 9.
The neighbor was outside mowing his lawn when Torrey came running out of her home, calling for help, according to prosecutors.
Investigators and doctors believe the baby likely sustained the injury from "violent shaking", according to a doctor's findings detailed in a police affidavit.
Candia police responded to a 911 call about an unresponsive child, and found the baby boy "unconscious and barely breathing," the police affidavit says.
Torrey was baby-sitting the child at her home at 101 Douglas Drive. She was hired by a local couple to care for the child, police said.
The baby showed no symptoms of injuries when the mother of the baby left her son in Torrey's care on June 9, according to the affidavit by Police Chief Michael McGillen.
Police and rescue crews were called to the home shortly after 4 p.m.
"Torrey's statement to police is that [the baby] was in her sole care and custody for the hour preceding the onset of symptoms," McGillen wrote.
A team of Boston doctors who examined the baby led to police deciding Torrey had to be the one who inflicted the injuries.
Dr. Alice Newton, leader of the child protective team at Boston Children's Hospital, issued a report on June 17, concluding that the injuries came from severe, abusive head trauma, the affidavit said.
The findings by Children's Hospital came after extensive evaluation and testing, McGillen wrote.
Torrey told police that she only left the baby alone after he vomited some formula on her and the couch. She told police that she left the baby on the floor to clean up, according to the affidavit.
Torrey remains free on bail.
http://www.necn.com/06/22/10/Candia-NH-baby-sitter-facing-assault-cha/landing_newengland.html?blockID=258677&feedID=4206

SBS: Nicholas McKee charged: Pediatrician says baby suffered abusive head trauma; Neurosurgeon says she might have suffered cardiac arrest

DON AINES
October 7, 2010
dona@herald-mail.com

Expert witnesses presented opposing views Thursday of how a 5-week-old girl incurred the injuries that led to her death, during the second-degree murder trial of the girl’s father in Washington County Circuit Court.

Nicholas Ray McKee, 23, of Warfordsburg, Pa., also is charged with first-degree child abuse resulting in death, first-degree assault, manslaughter, second-degree child abuse, second-degree assault and reckless endangerment in the Jan. 9, 2010, death of Bella Appel-McKee, who suffered brain damage Jan. 3 while in his care at the Hancock home he shared with the baby’s mother, Jordan Appel.

McKee waived his right to a jury trial. The case is being heard by Circuit Judge Daniel P. Dwyer.

“I concluded Bella had suffered abusive head trauma,” Dr. Tanya Hinds, a pediatrician at Children’s National Medical Center in Washington, D.C., testified during the second day of McKee’s trial. Hinds testified that the girl sustained brain hemorrhaging and swelling, and injuries to the muscles and spinal cord in her neck.

Dr. Ronald H. Uscinski, a neurosurgeon, testified for the defense that the girl might have suffered cardiac arrest that deprived her brain of oxygen and that the bleeding on her brain could have been caused by spikes in intracranial pressure brought on by attempts to resuscitate her. The cardiac arrest could have been triggered by the baby vomiting and cutting off her airway, he testified.

Appel left her daughter in the care of McKee on the night of Jan. 3 to have dinner nearby at her grandmother’s home, she testified Wednesday. She left the girl behind because the child appeared to have a cold and it was cold outside, she testified.

About 30 minutes later, a relative called to tell her that there were firetrucks near her house, Appel testified. The girl was taken to War Memorial Hospital in Berkeley Springs, W.Va., then to Children’s National Medical Center, where she died six days later, according to trial testimony.

Hinds and Uscinski had opposing interpretations of MRIs, CT scans, photos and other medical records, from prenatal exams and pediatric exams before the injuries to examinations of the injuries and the autopsy report.

Hinds testified that the bleeding in the girl’s brain could have occurred within two days to two weeks of an MRI taken Jan. 5 and that the injuries were indicative of “acute, recent, high-energy events” similar to the trauma that might be sustained in a vehicle crash.

“They are also caused by vigorous repetitive shaking,” Hinds testified. “It would not be a birth injury.”

The injuries also could have been caused by grasping and twisting an infant’s head, or by holding the baby by the head, she testified. The girl had no outside bruising that would indicate an impact injury, but Hinds testified she could not rule that out.

The retinal hemorrhages in the girl’s eyes were “too numerous to count” and injuries of that extent could not be caused by efforts to revive her, Hinds testified.

“I don’t believe in the Shaken Baby Syndrome,” testified Uscinski, who said he had treated suspected cases and found there usually was another explanation for the injuries other than shaking.

Uscinski testified that the girl’s brain images showed evidence of both fresh and old blood, and that a high percentage of infants have some bleeding on the brain resulting from the trauma of birth. The subdural bleeding the girl suffered could have been “rebleeding” from that birth trauma, he testified.

Uscinski testified he could detect no evidence of neck injuries in the images that might be caused by shaking. The retinal hemorrhaging could be attributed CPR and other efforts to resuscitate the girl, Uscinski testified.

As for several fractures to the occipital bone of the girl’s skull, Uscinski testified those could have occurred at birth or after the girl’s death. The head of an infant deforms as it passes through the birth canal, which can result in injury, he testified.

http://www.herald-mail.com/?cmd=displaystory&story_id=254358&edition_id=1625&format=html

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