Ed Meyer
F or years, there was little controversy about what caused the severe head trauma linked to many child fatalities.
Prevailing medical opinion held that with no other outward signs of broken bones or abuse, there was one conclusion: ''shaken-baby syndrome'' — and a very rapid, if not instantaneous, incapacitation of the child.
Some recent scientific studies and research projects in this field, however, are leading forensic pathologists to other conclusions.
The debate will take place again, beginning Monday morning, in the murder trial of Tiffani D. Calise, 20, of Green.
Summit County Common Pleas Judge Alison McCarty, who is hearing Calise's case, set up the impending courtroom drama six months ago with the declaration that testimony by both sides' forensic experts ''is going to be rather crucial.''
Prosecutors, backed by their Summit County medical experts, have accused Calise of causing fatal head injuries to 23-month-old Aaliyah Ali while baby-sitting Aug. 9.
Aaliyah died three days later at Akron Children's Hospital.
Deputy county Medical Examiner Dorothy E. Dean, who performed the autopsy, ruled the death a homicide from ''complications of blunt impact(s) to the head.''
Dean concluded that Aaliyah suffered severe brain injuries during an assault.
Her testimony will be supported by the Children's Hospital pediatric experts who treated Aaliyah and by Dr. R. Daryl Steiner, longtime director of the hospital's child abuse center.
Steiner has testified in many of the county's shaken-baby cases over the past two decades.
Laurie Cramer, spokeswoman for the prosecutor's office, declined to comment on a defense challenge to the state's position that shaken-baby injuries unmistakably caused Aaliyah's death.
''We are bound by ethical rules not to speak, even in general terms, about our evidence,'' Cramer said.
Calise's defense team, Bill Whitaker and Donald R. Hicks, also said it would be inappropriate to comment before the case goes to trial.
But their general position was established with the Aug. 9 emergency call, beginning at 11:44 a.m. and lasting nine minutes, that Calise made from her Mayfair Road apartment.
''Oh, please, help me. Oh, my God, I need a paramedic!'' Calise told the 911 dispatcher. She said Aaliyah had fallen in the bathtub and had bumped her head.
Calise said she didn't see the fall — she said she only heard a thud — because she had stepped away from the nearly empty tub to get a towel.
''I came back in there and she's all limp,'' a sobbing Calise told the dispatcher.
In support of Calise's story that she did not inflict the injuries, the defense has hired neurosurgeon Ronald H. Uscinski, who serves on the faculties of Georgetown University Hospital and George Washington University Medical Center in Maryland. He has 40 years of experience in the field.
Uscinski has filed his own forensic analysis of Aaliyah's injuries, concluding the child did not die from the effects of blunt-impact injuries to the brain.
Uscinski wrote that results of the hospital CT scans were consistent with brain-cell death from oxygen deprivation caused by a bread-like substance removed from Aaliyah's airway as doctors tried to insert a breathing tube in the emergency room.
After about only four minutes of complete oxygen deprivation, brain cells begin to die, Uscinski said.
Experts say such a theory cannot be easily dismissed as simply coming from the defense's ''hired gun.''
'Short-fall' injuries
Forensic pathologist John J. Plunkett of Minnesota, an outspoken critic of shaken-baby syndrome, wrote a 2001 report showing that those findings can be wrong.
Toddlers can and do die from the effects of what is known in forensic science as ''short-fall'' head injuries — similar to Calise's description of how Aaliyah was hurt — according to the report.
Plunkett's case study involved a 23-month-old girl, the same age as Aaliyah, who was playing on a plastic gym set in the garage at her home.
The child lost her balance on the top rail and fell, head first, onto a three-quarter-inch-thick plush carpet remnant spread out on the garage's concrete floor.
She was removed from life support 36 hours later.
Plunkett said hospital personnel, ''who were convinced without any question that this was shaken baby,'' reported the death to law enforcement.
Officers were preparing to arrest the child's father, Plunkett said, when the 23-month-old's grandmother intervened, saying she had videotaped the girl playing on the gym set.
''So the cops went over to the home and found the video camera, which she had dropped when the little girl hit the floor, and they played the videotape and went: 'Oh, my goodness!' '' Plunkett said.
The grandmother's tape showed that the child hit her head on the floor in an accidental fall from a height of 28 inches.
''Prior to publication of my [study] in 2001,'' Plunkett said, ''the pediatric community said, uniformly, that short-distance falls can't cause injuries or death. They didn't say it's rare. They said it doesn't occur. Period. And most forensic pathologists, not all, but most, said the same thing.''
The belief system that once was so firmly in place in the medical community was based on the so-called ''triad'' of sure-fire indicators that a child had been violently shaken to death.
Patrick E. Lantz, professor of forensic pathology at Wake Forest Baptist Medical Center, who said he has conducted more than 1,100 autopsies in his career, said those three signs are swelling of the brain, bleeding over the surface of the brain and hemorrhaging of the retinas.
''It has been assumed for the last 20 to 30 years that [this] combination was fairly diagnostic in little children of shaking or shaking impact, and a lot of [experts] would say it would only occur in shaking or shaking impact or abusive head trauma,'' he said.
But some forensic studies and research, such as that by Plunkett and Lantz, have shown that this triad of signs, particularly retinal hemorrhaging, does not always mean shaken baby syndrome.
An analytical paper from Lantz, scheduled to be published this fall in the Journal of Forensic Science, shows how retinal hemorrhaging can occur from a short fall.
The baby in Lantz's case had fallen down a section of six to seven carpeted steps, suffering bleeding on the surface of the brain and severe retinal hemorrhaging.
''It would have looked just like shaken-baby syndrome or abusive head trauma, except there were three people who were at the home and all three gave the same account of what actually happened,'' Lantz said.
Legitimate challenges to the conclusion of shaken baby syndrome are becoming more common.
''More and more people are realizing that other things can actually cause this triad [of injuries], and if people are basing it on just the triad and nothing else, it's unsafe without more evidence,'' Lantz said.
Calise is charged with murder, involuntary manslaughter and two counts of felony child endangering. She has been held at the county jail in lieu of a $500,000 10 percent cash bond since her Aug. 11 arrest.
Ed Meyer can be reached at 330-996-3784 or emeyer@thebeaconjournal.com. http://www.ohio.com/news/123178573.html
Prevailing medical opinion held that with no other outward signs of broken bones or abuse, there was one conclusion: ''shaken-baby syndrome'' — and a very rapid, if not instantaneous, incapacitation of the child.
Some recent scientific studies and research projects in this field, however, are leading forensic pathologists to other conclusions.
The debate will take place again, beginning Monday morning, in the murder trial of Tiffani D. Calise, 20, of Green.
Summit County Common Pleas Judge Alison McCarty, who is hearing Calise's case, set up the impending courtroom drama six months ago with the declaration that testimony by both sides' forensic experts ''is going to be rather crucial.''
Prosecutors, backed by their Summit County medical experts, have accused Calise of causing fatal head injuries to 23-month-old Aaliyah Ali while baby-sitting Aug. 9.
Aaliyah died three days later at Akron Children's Hospital.
Deputy county Medical Examiner Dorothy E. Dean, who performed the autopsy, ruled the death a homicide from ''complications of blunt impact(s) to the head.''
Dean concluded that Aaliyah suffered severe brain injuries during an assault.
Her testimony will be supported by the Children's Hospital pediatric experts who treated Aaliyah and by Dr. R. Daryl Steiner, longtime director of the hospital's child abuse center.
Steiner has testified in many of the county's shaken-baby cases over the past two decades.
Laurie Cramer, spokeswoman for the prosecutor's office, declined to comment on a defense challenge to the state's position that shaken-baby injuries unmistakably caused Aaliyah's death.
''We are bound by ethical rules not to speak, even in general terms, about our evidence,'' Cramer said.
Calise's defense team, Bill Whitaker and Donald R. Hicks, also said it would be inappropriate to comment before the case goes to trial.
But their general position was established with the Aug. 9 emergency call, beginning at 11:44 a.m. and lasting nine minutes, that Calise made from her Mayfair Road apartment.
''Oh, please, help me. Oh, my God, I need a paramedic!'' Calise told the 911 dispatcher. She said Aaliyah had fallen in the bathtub and had bumped her head.
Calise said she didn't see the fall — she said she only heard a thud — because she had stepped away from the nearly empty tub to get a towel.
''I came back in there and she's all limp,'' a sobbing Calise told the dispatcher.
In support of Calise's story that she did not inflict the injuries, the defense has hired neurosurgeon Ronald H. Uscinski, who serves on the faculties of Georgetown University Hospital and George Washington University Medical Center in Maryland. He has 40 years of experience in the field.
Uscinski has filed his own forensic analysis of Aaliyah's injuries, concluding the child did not die from the effects of blunt-impact injuries to the brain.
Uscinski wrote that results of the hospital CT scans were consistent with brain-cell death from oxygen deprivation caused by a bread-like substance removed from Aaliyah's airway as doctors tried to insert a breathing tube in the emergency room.
After about only four minutes of complete oxygen deprivation, brain cells begin to die, Uscinski said.
Experts say such a theory cannot be easily dismissed as simply coming from the defense's ''hired gun.''
'Short-fall' injuries
Forensic pathologist John J. Plunkett of Minnesota, an outspoken critic of shaken-baby syndrome, wrote a 2001 report showing that those findings can be wrong.
Toddlers can and do die from the effects of what is known in forensic science as ''short-fall'' head injuries — similar to Calise's description of how Aaliyah was hurt — according to the report.
Plunkett's case study involved a 23-month-old girl, the same age as Aaliyah, who was playing on a plastic gym set in the garage at her home.
The child lost her balance on the top rail and fell, head first, onto a three-quarter-inch-thick plush carpet remnant spread out on the garage's concrete floor.
She was removed from life support 36 hours later.
Plunkett said hospital personnel, ''who were convinced without any question that this was shaken baby,'' reported the death to law enforcement.
Officers were preparing to arrest the child's father, Plunkett said, when the 23-month-old's grandmother intervened, saying she had videotaped the girl playing on the gym set.
''So the cops went over to the home and found the video camera, which she had dropped when the little girl hit the floor, and they played the videotape and went: 'Oh, my goodness!' '' Plunkett said.
The grandmother's tape showed that the child hit her head on the floor in an accidental fall from a height of 28 inches.
''Prior to publication of my [study] in 2001,'' Plunkett said, ''the pediatric community said, uniformly, that short-distance falls can't cause injuries or death. They didn't say it's rare. They said it doesn't occur. Period. And most forensic pathologists, not all, but most, said the same thing.''
The belief system that once was so firmly in place in the medical community was based on the so-called ''triad'' of sure-fire indicators that a child had been violently shaken to death.
Patrick E. Lantz, professor of forensic pathology at Wake Forest Baptist Medical Center, who said he has conducted more than 1,100 autopsies in his career, said those three signs are swelling of the brain, bleeding over the surface of the brain and hemorrhaging of the retinas.
''It has been assumed for the last 20 to 30 years that [this] combination was fairly diagnostic in little children of shaking or shaking impact, and a lot of [experts] would say it would only occur in shaking or shaking impact or abusive head trauma,'' he said.
But some forensic studies and research, such as that by Plunkett and Lantz, have shown that this triad of signs, particularly retinal hemorrhaging, does not always mean shaken baby syndrome.
An analytical paper from Lantz, scheduled to be published this fall in the Journal of Forensic Science, shows how retinal hemorrhaging can occur from a short fall.
The baby in Lantz's case had fallen down a section of six to seven carpeted steps, suffering bleeding on the surface of the brain and severe retinal hemorrhaging.
''It would have looked just like shaken-baby syndrome or abusive head trauma, except there were three people who were at the home and all three gave the same account of what actually happened,'' Lantz said.
Legitimate challenges to the conclusion of shaken baby syndrome are becoming more common.
''More and more people are realizing that other things can actually cause this triad [of injuries], and if people are basing it on just the triad and nothing else, it's unsafe without more evidence,'' Lantz said.
Calise is charged with murder, involuntary manslaughter and two counts of felony child endangering. She has been held at the county jail in lieu of a $500,000 10 percent cash bond since her Aug. 11 arrest.
Ed Meyer can be reached at 330-996-3784 or emeyer@thebeaconjournal.com. http://www.ohio.com/news/123178573.html
Aaliyah Ali, age 23 mos.