SBS: "The Child Cases"

 Meredith Blake June 28, 2011

  Isis Vas, Ernie Lopez

 

When a child dies under suspicious circumstances, the understandable impulse is to look for someone—anyone—to blame.  But what if our desire to see “justice” carried out actually has had the opposite effect, and our desire for swift punishment has actually put innocent people behind bars? That’s the alarming possibility raised by tonight’s episode of Frontline, “The Child Cases,” a startling look at the faulty and biased forensic science used to investigate child deaths.

First, we learn the facts in what would appear to be an open-and-shut-case of infanticide. On October 8, 2000, Ernie Lopez made a frantic call to 911. Isis Vas, the 6-month-old infant he and his wife had been babysitting, had suddenly stopped breathing. The baby was rushed to the hospital, where suspicion quickly turned to Lopez, a mechanic and father of three with no prior criminal record. Isis’s body was covered in bruises, and CT scans showed swelling in her brain—classic symptoms of so-called “Shaken Baby Syndrome.” Even more alarming, Isis was bleeding vaginally. Less than 24 hours later, she was dead. A medical examiner swiftly ruled that Isis had died of multiple blunt force wounds and that Isis had been raped. Lopez was arrested for sexual assault and murder; in 2003, he was convicted and sentenced to 60 years in a Texas prison.
From there, reporter A.C. Thompson puts the Lopez case in context. “The Child Cases” is the latest in a series, produced jointly by NPR, Frontline, and ProPublica, investigating medical examiners and forensic pathology in America. Previous stories have looked at the influence of shows like CSI on juries and how severely reduced state budgets have forced medical examiners’ offices across the country to cut corners—with potentially devastating ramifications. A consistent and unsettling theme throughout the series (which is worth checking out in its entirety here) is the lack of national standards when it comes to the accreditation of forensic scientists, and it emerges yet again in “The Child Cases.”
Investigations into infant deaths are complicated by a number of factors, both emotional and medical. Understandably, perhaps, it’s all the more difficult to maintain scientific neutrality when it appears that a child has been killed; at the same time, their smaller bodies and sensitive systems demand specialized medical knowledge. Yet, as Thompson points out, there are few, if any, regulations specific to the investigation of child death cases. Medical examiners in child death cases are not required to be board-certified pathologists, nor are they required to consult with pediatric specialists or submit their findings to peer review.
As one expert puts it, with child deaths, there is an assumption of “homicide until proven otherwise.” Examiners don’t consider—or are not even aware of—the many medical conditions that can manifest themselves in the same ways as physical abuse. At the same time, the medical establishment is also increasingly skeptical about the very existence of Shaken Baby Syndrome. Thompson interviews Dr. Patrick Barnes, a pediatric radiologist who testified in 1997 against Louise Woodward, the British nanny convicted of shaking an 8-month-old infant to death. Barnes is now a vocal skeptic. “You cannot accuse, indict or convict based on the medical evidence that we have,” he declares. Another expert, Dr. Michael Laposata, asserts that there are at least a dozen major blood disorders that mimic the symptoms of physical abuse, like spontaneous bruising and profuse bleeding. Interwoven throughout these interviews are the stories of two other caretakers accused of murdering infants who were later proved innocent. In both instances, the medical examiner had either dubious qualifications, a clear bias against the defendant, or both.
Thompson then returns to examine Lopez’s case in greater detail. The narrative structure is highly effective: Establish what appears to be an airtight case, explain the flawed science, then systematically dismantle the evidence against Lopez (it’s the same structure David Grann used in his brilliant and devastating New Yorker piece on Cameron Todd Willingham, which in my opinion should be required reading for all humans). In particular, we learn about the bizarre set of circumstances leading up to Isis’ death. The baby’s mother, an alcoholic, often left her daughter with the Lopez family for days at a time; an ob/gyn, she has since had her medical license revoked. In the days before her death, Isis exhibited a number of worrying symptoms. Ernie Lopez expressed his concerns about Isis’ health to her mother, but she brushed him off: “She’ll be fine.”
To anyone with even a passing interest in criminal justice reform, Lopez’s case is dispiritingly familiar: A Latino defendant in Texas gets a lousy defense attorney and is sent to jail to life for a murder that he most likely didn’t commit. But, even in a place like Texas, his conviction seems especially cruel. Unlike CSI, almost nothing about “The Child Cases” is sexy—there’s lots of talk about tarry stools and platelet counts—but that’s all the more reason to watch it.
http://www.avclub.com/articles/the-child-cases,58120/

SBS: Australia: doubts reviewed

Sunday Herald Sun : June 11, 2011

 

 

Maeve Sheppard died from injuries consistent with shaken-baby syndrome, but her carer denies harming her. Picture: PA Source: Supplied

WE abhor adults who hurt and kill babies - consider them the lowest of the low - and view shaken-baby syndrome as the act of gutless monsters.

It is abhorrent; shaking a baby so violently that its tiny brain swells.
For decades the triad of encephalopathy (brain swelling), retinal haemorrhages and subdural haemorrhage (shallow collections of blood over the surface of the brain) have been used as the telltale signs of shaken-baby syndrome (SBS).
And this constellation of symptoms has put people behind bars - as it should if they are guilty of such violence.
Some experts say SBS is triggered by parents or child minders taking out their frustrations on a defenceless infant whose only "crime" is to cry too much or soil a nappy.
Others question whether SBS should be accepted as fact when it really is just a theory.
Either way, every year hundreds of babies are shaken until their body starts to break from the inside out. The injuries are so catastrophic that one in four dies.
In Australia we do not know how many babies are shaken because SBS is not a legitimate disease classification diagnostic code, so no figures are collected.
Dr Anne Smith, medical director of the Victorian Forensic Paediatric Medical Service, told me that when infants arrived in hospitals with injuries that might have been caused by trauma but there was no history of trauma, care-givers were rightly viewed with suspicion.
"Even when a story about trauma is offered by care-givers, it is important for doctors and nurses to question whether the story accounts for the observed findings and whether other causes might explain, or better explain, the child's condition," she said.
She said the consequences of a misdiagnosis of shaking were as serious as a missed diagnosis.
"On the one hand an innocent person might be jailed and on the other, an infant might be returned to an abusive home, possibly with fatal consequences," she said.
Several cases in the US and UK have put this debate on the radar this month and make us question whether there could be other explanations - perhaps a bump or an infection - for some of these injuries.
The Victorian Forensic Paediatric Medical Service is unique.
It provides evaluations of infants when shaking is suspected and gives expert opinion for child protection and the courts.
Importantly, it is staffed by a team of people who hold qualifications in both paediatric and forensic medicine - a model that could become standard practice worldwide.
Dr Smith said this unique mix enabled the team to consider a broad range of medical conditions that might be confused with shaking, as well as the forces and patterns of injury caused by shaking, impact and other causes of head injury - deliberate and accidental.
Last month, British mother Keran Henderson - who spent 18 months behind bars for the manslaughter of Maeve Sheppard - spoke for the first time as she considers another appeal over her conviction.
And in the US, a woman with an impeccable record in child care is serving 10 1/2 years after she was charged with shaking a baby boy in her care.
Keran Henderson spoke to investigative journalists Peter and Leni Gillman and her story was published in the UK's Sunday Times last month. In the article, there is no suggestion the syndrome does not happen - far from it - but it claims that in a minority of cases there must be room for doubt.
Mrs Henderson has always maintained she did not harm Maeve, but a pathologist gave evidence at her trial saying the injuries - the retinal haemorrhages, bleeding in the brain and bruising or swelling of the brain - indicated "a great deal of force".
There are 250 shaken-baby cases in Britain a year. Most are the result of abuse, but some experts suggest the syndrome is a theory that the legal and medical fraternities have accepted as fact.
The Gillmans wrote: "A second, equally determined group contends shaken-baby syndrome is a deficient theory that results in innocent carers and parents being jailed because of flawed science."
MRS Henderson told the Gillmans that for the two months she cared for Maeve in 2005 she was sickly, often grizzly and reluctant to eat.
Twice, she claimed, Maeve needed urgent medical attention - once seemingly for a seizure. Could that have indicated a previous injury or an illness such as meningitis?
Mrs Henderson was the last person to handle Maeve before the child arched her back and went floppy while her nappy was being changed.
And, as the last person to handle the baby, Mrs Henderson was blamed for her death.
British paediatric radiologist Dr Patrick Barnes testified against British nanny Louise Woodward in 1997 when she was accused of shaking baby Matthew Eappen before he died while in her care.
In the New York Times this year, writer Emily Bazelon said a lasting legacy of the Woodward case was the eventual conversion of Patrick Barnes from an upholder of the medical orthodoxy surrounding shaken-baby cases to one of its strongest critics.
In the US Trudy Rueda was accused of shaking Noah Whitmer when he was four months old.
Noah survived his injuries, though at two years he is still not talking and has vision problems.
Rueda, his carer, was sentenced to 10 1/2 years after six doctors testified that Noah's brain scans showed he had been abused. Another doctor offered it was possibly a rebleed, the result of trauma from birth.
Who do you believe?
And if shaken-baby syndrome confuses the medical and legal professions, how can a jury hope to decide guilt or innocence?
It will take some brave decision-makers and forensic investigators to thoroughly explore this truly terrifying problem so there is justice for all.
http://www.heraldsun.com.au/opinion/shaken-babies-room-for-doubts/story-e6frfhqf-1226073640796

SBS: Doubt over 'shaken baby' theory

Lucy Cockcroft 15 Feb 2009

Two British pathologists have found that a combination of injuries used to diagnose abuse, known as the "triad", can happen naturally.

Dr Irene Scheimberg, from London's Bart's Hospital, and Dr Marta Cohen, from Sheffield Children's Hospital, warn that bleeding on the brain and retinas, swelling of the brain and oxygen deficiency do not only occur through vigorous shaking.

Their discoveries could have a dramatic effect on future child abuse trials and child protection hearings.

Dr Scheimberg said: "When there is no evidence of physical abuse, apart from the haemorrhaging, we may be sending to jail parents who lost their children through no fault of their own.

"As scientists it is our duty to be cautious when we see the triad and to take each case on its merits. We owe it to children and their families."

The study, published in the journal of Paediatric Developmental Pathology, found that the symptoms of shaken baby syndrome can happen in babies before they are taken home from hospital.

The authors looked at 25 babies who had died shortly before delivery and 30 newborns who had haemorrhages and found similar damage to the brains of all the babies.
The study concluded that the symptoms are common in young babies and could be caused by a traumatic birth or other conditions.
Dr Scheimberg and Dr Cohen believe that what they have found means police and lawyers will need more evidence than bleeding in the brain to prove that a baby has suffered child abuse.
Dr Scheimberg said: "We now know that mothers who have babies through normal vaginal delivery can have a child with a subdural haemorrhage and also retinal bleeding.
"We also know that many of these bleeds resolve themselves – with no outward sign of damage in the first few weeks of life and these children grow up to live a normal life.
"The other group are those children who present with signs of shaken baby syndrome whose bleeding has continued and got worse. These are the children who the courts suspect have been harmed by their parents."
The evidence could now be used in a string of appeals, including the case of childminder Keran Henderson, who is serving three years for the manslaughter of 11-month-old Maeve Sheppard.
Medical experts argued that Maeve's injuries indicated that she had been violently shaken.
But Henderson, of Iver Heath, Buckinghamshire, said the baby had a fit while she was changing her nappy.
Her lawyer, leading child abuse expert Bill Bache, said he was "absolutely sure" the research will be used in appeal cases.
"It is very likely we will use it in Keran Henderson's appeal," he added.
Mr Bache said the evidence may also be used in at least four further cases.
The "triad" of symptoms first came to public attention in 1998 in the US trial of British au pair Louise Woodward, who was found guilty of the second-degree murder of eight-month-old Matthew Eappen in October 1997. She was sentenced to a minimum of 15 years to life in prison.
Her conviction was then reduced to involuntary manslaughter. Her sentence was also reduced to time served on remand, 279 days, and she was freed.
Around 200 cases of shaken baby syndrome are diagnosed in Britain every year and many accused of abuse strenuously deny any wrongdoing.

http://www.telegraph.co.uk/health/healthnews/4632198/Doubt-over-shaken-baby-theory-that-has-sent-dozens-of-parents-to-prison.html