SBS: Ohio: John Wilbert Jones' expert medical witness

Ed Meyer :  May 06, 2011
The lead detective in the Summit County murder trial of 18-year-old John Wilbert Jones unequivocally told the jury Friday that the defense theory on the case was wrong.
Gary Shadie, the Akron police detective who investigated the fatal head injuries to the defendant's 6-month-old daughter, Jada Ruiz Jones, based his testimony on the case timeline.
Both sides have agreed that Jada's mother, Deja Ruiz, the 19-year-old former girlfriend of Jones, left her Springdale Drive apartment and caught a bus for school at 8:05 on the morning of March 19, 2010.
A recorded 911 call, in which Jones told police he saw Ruiz off then awoke to find Jada was not breathing, began at 9:44 a.m.
At that time, Jones alone was caring for Jada, her twin sister and their 2-year-old brother in the Akron Metropolitan Housing Authority apartment.
Based on the Akron police investigative reports, as well as input from all of the doctors who treated Jada's head injuries that day at Akron Children's Hospital, Shadie told the jury that the effects of those injuries would have rendered her unconscious within ''a very narrow window.''
That period of time, Shadie testified, would have been ''immediately to within 30 minutes.''
''There was no possible way that Deja could have caused the injuries prior to her leaving at the agreed upon time, which they both said was 8 o'clock in the morning,'' Shadie testified.
He said that based on input from the doctors, Jada was a victim of shaken baby syndrome.
Lead defense counsel Joseph F. Gorman told the 30-member jury pool Tuesday morning — hours before the final panel was chosen — that the defense's position was that Deja Ruiz inflicted the injuries before leaving for school.
Common Pleas Judge Patricia Cosgrove is hearing the case. Jury instructions and closing arguments are scheduled for Monday morning.
Jones, who was 17 at the time of Jada's injuries, had his case bound over to adult court months after the incident. He was indicted Nov. 2 on two counts of murder, two counts of felonious assault and three felony counts of child endangering.
The murder charges were filed after Jada was removed from life support and pronounced dead July 16.
Children's Hospital doctors who treated Jada testified previously that, in addition to her head injuries, she had retinal detachments, fractures of the right and left upper arm, right thigh and lower right leg, left thigh and lower left leg and a spinal injury.
After the state rested Friday, the defense challenged the analysis of the head injuries by local authorities with lengthy testimony by Dr. Jonathan L. Arden, a veteran forensic pathologist from McLean, Va.
Arden received his medical degree from the University of Michigan in 1980. He did his residency at New York University Medical Center, later served as an assistant medical examiner for the state of Delaware and worked in the New York City medical examiner's office for nine years, eventually rising to a position there of second in command.
He was on the witness stand for more than three hours.
Arden testified that Jada had two types of head trauma — both collections of blood on the brain known in medical terms as hematomas.
He told the jury one was an ''acute,'' or fresh hematoma, which could have occurred up to one week before Jada's brain scans at Children's Hospital.
The other was a ''sub-acute,'' or older hematoma, which was in the middle stages of healing and could have occurred from one to three weeks before the hospital brain scans, Arden said.
Arden said he strongly disagreed with the opinions of the local medical authorities that the effects of Jada's head injuries would have left her unconscious immediately.
He told the jury he had the experience of 2,300 to 2,400 forensic autopsies during his long career and at least 400 pediatric autopsies.
If Jones is convicted of either of the murder charges, he could be sentenced to life in prison.
http://www.ohio.com/news/121418709.html

SBS: Nebraska: Day care provider Kendra Fritsche charged with child abuse

April 14, 2011  BETSY FRIEDRICH
HOLDREGE — A Holdrege day-care provider has been charged with child abuse of an infant girl.

Kendra Fritsche, 38, was arraigned Tuesday on a Class II felony in Phelps County Court.

 Judge Robert Ide issued a warrant for Fritsche’s arrest Feb. 17 and set her bond at 10 percent of $50,000, or $5,000. The bond ordered that Fritsche have no contact with children other than her own, and she can have no children in her care.

Fritsche was arrested Feb. 18 and now is free on bond.
Court records outline the case against Fritsche:
On Oct. 16, the Nebraska State Patrol was asked by the Nebraska Department of Health and Human Services to investigate a possible child abuse case involving a 3-month-old girl who had been in her care from Sept. 7 to Oct. 15.
On Oct. 15, Fritsche contacted the girl’s mother saying she was “not acting right and need to go to the Phelps Memorial Health Center Emergency Room.”
The mother then took the girl to her doctor in Kearney, then to Good Samaritan Hospital, where the girl underwent additional tests and a CAT scan the following morning.
The CAT scan revealed the girl had suffered a skull fracture, which medical staff said was most likely not the result of a short fall but probably occurred from a significant blow to the head. A GSH ophthalmologist also examined the girl and said she had multiple retinal hemorrhaging in both eyes, which he concluded was consistent with shaken baby syndrome.
On Oct. 18, the girl was transported via medical helicopter to Omaha Children’s Hospital. That same day, a State Patrol investigator interviewed Fritsche, who said the girl’s injuries may have been caused when she put the girl down into a car seat too hard, and she may have knocked the wind out of the girl.
On Oct. 20, a Children’s Hospital doctor said the girl had suffered two separate trauma events, as determined by an MRI scan. One indicated a three-week-old bleed in the girl’s brain, and the other more current and acute bleed dated to the previous weekend when the girl suffered a left parietal skull fracture.
The doctor told police it was possible to cause the injuries by forcefully putting the child into a car seat. The doctor also said the girl’s injuries could result in learning difficulties later in life as well as temperamental mood changes over her lifetime.
Fritsche’s preliminary hearing was scheduled for 1 p.m. May 23. A Class II felony is punishable by one to 50 years in prison.
http://www.kearneyhub.com/news/local/article_539e79c8-66bf-11e0-a0ee-001cc4c03286.html

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

SBS: Georgia: Parents share story to help others

Anne Hart  December 20 2010
The Chatham County parents of a 10-month-old baby boy fully understand that shaken baby syndrome is a real and dangerous public health problem.
They in no way want to downplay the fact that shaking an infant can cause severe and irreparable damage to a child.
What they do want people to realize is that sometimes a baby showing some signs of shaken baby syndrome may be suffering from a different, unrelated medical condition, one that does not involve abuse.
They believe this because that's what happened to them.
The parents are sharing their story as a cautionary tale. They say there's a need for closer scrutiny when making such a harsh diagnosis as shaken baby syndrome.
Their names are being withheld to protect the privacy of their son.
The parents say that earlier this year, their only child - the child they call their "miracle baby" because they had tried for a year and half to conceive - was misdiagnosed with shaken baby syndrome.
This commenced a nightmare that included temporarily losing custody of their then 5-month-old son for 56 days and spending roughly $60,000 in the legal battle to regain custody.
The case was eventually dismissed, and the baby was returned to his parents.
"There is abuse of children out there," said the baby's father. "But we are not that family."
Their son turned out to be suffering from chronic subdural hematomas, which they say is a possible complication of being born one-month premature. The baby weighed 3 pounds, 4 ounces at birth and spent a month in the neonatal intensive care unit.
Today, the baby is doing well. His parents take him regularly to Atlanta to be treated for the hematomas.
The parents are also dealing with the emotional and financial fallout caused by the case and worry about other children being misdiagnosed with shaken baby syndrome.

Protecting babies
About 1,500 babies younger than age 2 in the United States are diagnosed with shaken baby syndrome each year, according to MedicineNet.com.
Since the early 1990s, many hundreds of people have been imprisoned on suspicion of murder by shaking.
But according to media reports, there is some question regarding the science behind diagnosing SBS.
According to a Sept. 20 New York Times Op-Ed: "For the past 30 years, doctors have diagnosed the syndrome on the basis of three key symptoms known as the "triad:" retinal hemorrhages, bleeding around the brain and brain swelling. The presence of these three signs (and sometimes just one or two of them) has long been assumed to establish beyond a reasonable doubt that the person who was last taking care of the baby shook him so forcefully as to fatally injure his brain. But closer scrutiny of the body of research that is said to support the diagnosis of shaken baby syndrome has revealed methodological shortcomings. Scientists are now willing to accept that the symptoms once equated with shaking can be caused in other ways."
Pediatric neurosurgeon Dr. David M. Wrubel of Children's Healthcare of Atlanta sees about 50 babies a month, if not more, who show the signs of shaken baby syndrome. He said it's rare that the cases turn out to be something else.
"Unfortunately, with the majority of cases, it's shaken baby syndrome or some other type of abuse,'' Wrubel said. "There are always the unusual cases, such as chronic subdurals. That does happen, but not frequently."
Wrubel is now treating the Chatham County child for the hematomas. Neither Wrubel or Children's Healthcare of Atlanta were involved in the initial treatment.
Wrubel said the system is set up to make sure the child is protected. He said it's a tough situation because the parents or caregivers are considered guilty until proven innocent to protect the safety of the child.
"There's not an epidemic (of misdiagnosed shaken baby syndrome cases),'' Wrubel said. "But unfortunately, sometimes innocent people get swept up in the process to protect the safety of the child."

Contact Anne Hart at anne@southernmamas.com.
http://savannahnow.com/accent/2010-12-19/hart-heart-shaken-baby-parents-share-story-help-others

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: California appeals court

Two-month-old J.M. came to the attention of the Los Angeles County Department of Children and Family Services (Department) because she was found to have a medical condition of chronic subdural hematomas. Her parents L.Z. and O.M. had no explanation as to how the injuries occurred. An expert concluded that birth trauma was a possible explanation for the injuries. Others said it was unlikely. At the time of her injuries, she was under the exclusive care of the parents. J.M's 14-month-old sister, L.C., whose father is J.C., had no evidence of injury.
http://www.leagle.com/unsecure/page.htm?shortname=incaco20100920016

SBS: Missouri: Charged with felony child abuse

By Jeff Haldiman
August 24, 2010
A Mid-Missouri woman has been charged in connection with what authorities believe to be a case of shaken baby syndrome.According to Cole County court documents, Shelley Richter, 40, of 6018 Helias Drive at Taos, is charged with felony abuse of a child. She was released from custody after posting a $5,000 bond.The charging document in this case shows Richter struck the victim's head and shook it causing retinal hemorrhages and subdural hematoma.A Cole County Sheriff's Department probable cause statement shows the incident occurred last Thursday afternoon.Investigators talked with the parents of the 7-month-old boy who said their son was in the care of Richter and had been dropped on a linoleum-covered concrete floor.They said Richter had been the boy's baby sitter since he was around 10 weeks old.Richter told investigators that while picking up the boy from a walker where she stated he was being "good," Richter said she took a step backward, tripped over a toddler that she had not seen behind her.Richter went on to say that she started to fall backward toward the ground and as she was falling, she must have let go of the boy, causing him to fall to the ground. Richter also said she picked the boy up almost immediately and the boy went limp. She then put him down on the floor and called 911.On Friday, doctors at University of Missouri Hospital in Columbia, where the boy was taken for treatment, diagnosed the boy with having an old subdural hematoma and a new one, along with severe retinal hemorrhages. The doctors also said it appeared the boy was suffering from shaken baby syndrome.
http://newstribune.com/articles/2010/08/24/news_local/nt129local04shaken10.txt