Does Shaken Baby Syndrome really exist?

Un-Doctored

Un-edited statements from the health sector and beyond

Friday 20 May 2011, 10:52am

Dr. Waney Squier

Dr. Rorke-Adams

A single firm shake has long been thought to be able to cause serious damage to a baby’s brain. But an article published in the Journal of Primary Health Care (JPHC) suggests it might not be so clear cut, and that babies thought to have died because of being shaken may have actually died from other causes.

Both sides of the debate are presented. Dr Lucy B Rorke-Adams, who holds numerous neuropathology posts and is the Clinical Professor of Pathology, Neurology and Pediatrics at the University of Pennsylvania School of Medicine, suggests that shaking is indeed why the babies have died.

She points out that there is a “high frequency of association between the [three features that indicate central nervous system trauma] and shaken impact syndrome” before moving on to demonstrate the flaws in possible alternate explanations.

She backs up her argument with reference to the body of knowledge about shaken baby syndrome that has built up over the years.

“The scientific base for shaken impact syndrome has accumulated over a period of at least 150 years, although sporadic writings of physicians, anatomists and writers commenting about effects of CNS trauma, in particular concussion, appeared long before that time.”

Dr Rorke-Adams finishes her discussion with a warning that “Those who offer untested hypotheses to defend individuals who have harmed infants do considerable disservice to science and to the victims.”

On the other side of the debate is Consultant Paediatric Neuropathologist Dr Waney Squier, from the John Radcliffe Hospital in Oxford, UK.

While stating that “We can all agree that it is never safe to shake a baby”, she also points out three major arguments against the shaken baby hypothesis.

In the first, Dr Squier states that, “In nearly 40 years [since the syndrome was recognised], no one has ever witnessed shaking to cause the collapse of a well baby.”

Dr Squier describes the second argument as appealing to common sense. Violent shaking would cause neck injuries, which are seldom seen.

A third argument is more complex. To paraphrase Dr Squier, shaking a baby would not cause one of the symptoms seen in shaken baby syndrome. The symptom is “thin-film subdural bleeding”; shaking a baby may well cause bleeding, but because of the anatomy of the central nervous system, it would have a very different pattern.

Like Dr Rorke-Adams, Dr Squier also finishes with a warning.

“Failure to look beyond the simplistic and increasingly untenable shaking hypothesis risks incalculable damage by wrongfully removing children from loving parents or incarcerating innocent people.

“Further, by focusing on shaking or inflicted trauma to the exclusion of accidental and natural causes, we are almost certainly missing opportunities to save babies through prevention, early diagnosis and treatment.”

Journal Editor Professor Felicity Goodyear-Smith says, “Both failure to act in cases of genuine child abuse, and unnecessarily separating children from their parents do irrevocable harm, so this is an important debate that needs to be had.”

Both sides of the debate can be found in the June 2011 issue of the JPHC, which is a scientific journal published by the Royal New Zealand College of General Practitioners.

Download the ‘Back to Back’ articles here:

Dr Squier’s point of view
Dr Rorke-Adams point of view

Source:

http://www.thetimes.co.uk/tto/multimedia/archive/00139/85317211_squier_139356c.jpg

A Very Disingenuous Doctor and a Very Large Elephant

By Lisa Blakemore-Brown, Psychologist

16 May 2011

Fourteen years after New Zealand TV researchers travelled to England to interview Dr David Southall, Dr Paul Johnson, myself and various parents, after contentious allegations of Munchausen Syndrome by Proxy (MSBP), he is again featured in a TV documentary in this country. It is the second in 2 years entitled “A Very Dangerous Doctor”, Channel 4, 12 May 2011.  The TV3 20/20 New Zealand documentary “Lies Lies and Diagnoses” never saw the light of day in the UK.
Dr David Southall, avoiding serious questioning

This documentary reveals that the same experiences of many mothers who had been accused of MSBP by Dr Southall as were raised on this new documentary were evident all those years ago. It was sent directly to the then New Labour Government, newly in office, who did nothing.

Dr Southall was clearly heavily protected by New Labour during their 14 years in office, and many colleagues. He has managed to avoid serious questioning about what he was actually doing with many children whose parents he accused of MBSP, and why he was doing it, in just about every context in which he has been scrutinised that I can think of since then.  These contexts include the General Medical Council (GMC); the High Court, the Police station and TV documentaries. This new documentary at least allows us to look at documentation known to many of us who have been concerned about Dr Southall’s ways of working for many, many years and raises the curtain on what he was doing, though not why.

Protocol 85/02 – Where Is The Written Parental Consent?

We saw a letter many of us have seen, in which Dr Southall writes that he didn’t need written consent from parents to undertake trials on their children. When questioned on this, Dr Southall said asking parents was enough.  But of course it would be his word against the parents if anything went wrong and he wanted to deny their child was in the trial. In a way this was proven by what happened next.  Dr Southall was asked about Protocol 85/02 (meaning the protocol for a trial/experiment was written in February 1985) being in Ben Hollisey-Mclean’s file.  He vigorously denied that the presence of this Protocol in Ben’s file meant that he had actually been in the trial and, slightly agitated, he demanded in the tone of a barrister:  “Where’s the evidence?”  that Ben or others were in that study. He then tried to carry on drilling the point home and the Director, Leo Regan, went in search of lawyers to try to “prove” it. Of course this is very convenient for Dr Southall as he knows full well he did not gain written consent from the parents and that had he done so, there would be the evidence he was now demanding – “proof” of who was in the trial.  In Ben’s case this isn’t necessary – they had a photo of him on Dr Southall’s monitors and more evidence alluded to in this documentary.  Of course Dr Southall himself knows full well who has been in his trials and he alone holds the “evidence” he was calling for.
Young Ben Hollisey-Mclean, hooked up to Dr Southall’s machines

Other parents, to my certain knowledge, have found files named s/c files which Dr Southall has kept on their children away from their general hospital notes pertaining to his research on mainly newborns.

My first “MSBP” Dr Southall case starting in 1995 in which I was also an Expert witness, featured in the New Zealand film above, is one who was told by the GMC in 2006 that there was also an s/c file on her twins. So that finally emerged 10 years after she lost all four of her children after Dr Southall went to Court to accuse her of MSBP in 1996, when the twins were almost 11 years old, and almost 21 years after the twins had been born and taken to a London hospital immediately after their very premature birth, many miles away from where they were born, never even held by their mother.

From this information about the file, we now know they were in one of these trials as newborns. Yet not once, in a trial lasting three weeks in a case which cost £3/4 million to the tax payer back in 1996, was this mentioned. Yet it may well explain the Autistic spectrum/ADHD behaviour of those identical twins and why Dr Southall was so keen to pin MSBP on the mother when she threatened to sue the system about her children as they grew older. Perhaps it also explained why he was so adamant that they were “perfectly normal” which is what made me extremely concerned as they were clearly not. Of course the “system” is merely made up of people who speak to each other and I am sure news of her efforts to sue would have soon reached Dr Southall’s ears. Children in medical trials are often “tagged” with other professionals involved with them around the country for many years. That mother was “found” guilty of MSBP and of fabricating the difficulties the then 10 year old twins experienced, in the draconian UK Family Courts.  The twins must have been in the same trial as Ben Hollisey-Mclean.  They left the Westminster Hospital in February 1985, sent back to their mother with no support. Identical twins are gold dust for any research in any field and mothers expecting multiple births were indeed a variable in the list of criteria for research into infants “at risk of cot death” during that period. The mother in that case had no clue she had been targeted ante-natally or that her children had been placed in a trial after they were born.
Professor Roy Meadow, previously struck off the
Medical Register for playing loose with the facts

Over the years since then it has become clear that Dr Southall worked closely with Sir Roy Meadow who are both known for their claims about MSBP and they were both involved in destroying the Sally Clark family. Both had a period of being struck off over the Sally Clark case. Whist Sir Roy Meadow accused Sally of killing her infants, Dr Southall accused her husband Stephen after she had been convicted and jailed, disingenuously saying he was concerned there had been a miscarriage of justice. An Appeal was about to happen and Stephen Clark had spoken in a TV documentary about a nose bleed his first son had in a hotel a week before he died. Dr Southall watched the documentary and immediately contacted the Crown Prosecution Service claiming that Mr Clark must have smothered the child for its nose to bleed – so probably killed him a week later, not Sally.

Vaccines

Stephen Clark, accused by Doctor Southall of murdering
his two children on the basis of a TV interview he saw

Vaccines featured in the run up to the deaths of those tragic infants and both of those medics damned the parents over a number of years. In the end, despite being freed, Sally had been destroyed and died a couple of years later. There are a number of other cases in which possible vaccine damage features, leading to innocent parents going to prison or damned to a life of hell without their children and prevented from keeping or having any others.

Increasingly I was realising what this was all about and in 2006 there was an interesting revelation: Sir Roy Meadow, also described as a child abuse expert, and indeed Knighted by Tony Blair’s Government in 1998 for it, was found through FOI to have been involved in the Adverse Reactions to Vaccination Committee at the Joint Committee for Vaccination and Immunisation at the Department of Health, discussing adverse reactions to vaccines such as the DTP and at the introduction of the MMR during the late eighties.  See Professor Roy Meadow and Professor David Salisbury at the Joint Sub-Committee On Adverse Reactions To Vaccines And Immunisation held on 6 July 1987 at lO.30am in Room 1611/12 Market Towers, as an example. The meeting notes were headed as ‘commercial’ and ‘in confidence’. MMR and DTP adverse reactions were discussed. A leading journalist at the time wrote to me ”If this is true it’s a MASSIVE breakthrough!!!!!!!!!!” . Of course this too has never seen the light of day and the public don’t have a clue.

Many families whose children died of cot death, which is what Dr Southall and Sir Roy Meadow focused on in their early careers, speak about the children having just had a vaccine. Sally Clark’s Harry had the DTP five hours before he died. See HERE.

Others to my certain knowledge tell the same story and were also accused of MSBP or Shaken baby Syndrome (SBS) – by either or both of these men and/or their colleagues.

When a parent has suffered a cot death, cases are referred to the FSID (Foundation for the Study of Infant Deaths) and the next baby is placed on what is called the CONI scheme – Care of the Next Infant.  The scheme funds research and many other initiatives. Apnea monitors are given to parents, and health visitors monitor weight and other progress. Dr David Southall has always had a close involvement with the FSID and those within it. See HERE.

Were vaccine trials woven into the research funded by FSID, especially if the first cot death followed a vaccine?  The biggest breakthrough in cot death research, reducing deaths by 70%, did not come from Dr Southall research. It was a simple piece of advice – place infants on their backs to sleep. One therefore has to wonder about the acclaim attached to Dr Southall’s cot death work. Maybe it’s about him establishing that some mothers have harmed their children, through covert video, but that’s hardly rocket science. Infanticide is not a new phenomenon.

What I cannot accept is that by establishing the guilt of some he so easily extends it to many where there is NO covert video evidence of any abuse, indeed in the many cases I have seen there is no evidence of abuse at all and no cameras at all. In many cases the accusing medics have not even met the mothers and leave out crucial pieces of evidence. Files often are tampered with or go missing. Allegations are pure speculation. Nor can I accept that it is acceptable to entirely omit the possibility that a child can react to a vaccine or medications.

Precisely What Is Dr Southall Doing In Africa?

Dr Southall, as part of a group called PACA (Professionals Against Child Abuse) who regularly rise to his defence in public, also works in Africa with African mothers and babies as part of this organisation.

One medic who strongly defends Dr Southall in his views on child abuse is Dr John Bridson, and he is part of this group who work in Africa. Actually key individuals from PACA have also become part of the GMC Panel looking into Child Protection after Dr Southall was reinstated by the High Court and the GMC decided to look at new guidelines for medics. Are any of them involved in vaccine trials? Does the work in Africa involve the same breathing experiments we heard about on this recent Leo Regan documentary? Are children being harmed/abused by these procedures? Are they being saved too? I am sure the latter will be vigorously claimed and the former strenuously denied. Does anyone care? I doubt it. If families in this country and increasingly across the Western world have fought in vain for up to 20 years to get the truth out and see justice done for their child, such as Mr and Mrs Hollisey-Mclean, then what chance do African women have in the Third world. Most mothers, including those in this film and the New Zealand one, start by believing medics are there to help their children – hence their initial approach to them.

If a vaccine can kill or brain damage a baby – and the Vaccine Injury Compensation scheme proves that they can – then this is a form of iatrogenic child abuse.  Why is it therefore never mentioned when parents are being accused in this narrow world of research into children’s breathing processes? Haven’t we gone too far adding insult to injury?

General Medical Council Child Protection Guidelines

I have just given evidence to a panel at the GMC (General Medical Council) looking at developing new Guidelines for medics in Child Protection, which includes a number of Dr Southall colleagues and members of PACA. I have provided a lot of written evidence and given oral evidence on two days on certain cases and my concerns about methods used in MSBP/SBS and have raised a number of factors which I hope will help them in the forthcoming development of the new guidelines. One factor concerns being overly dogmatic in one’s views, another concerns the use of pure speculation and failure to check files and associated with this is omission of crucial information as part of the differential diagnosis. If we entirely leave out a possible reason for a child dying or being ill/becoming autistic, having seizures etc, unless it’s drawn out under cross examination in the witness box (or maybe never sees the light of day), we are, as ex Attorney General Lord Goldsmith said back in 2004 in the wake of the Clark and Cannings’ rulings, “at risk of being seen as a charlatan”.

I have never left out the possibility in my mind that a parent may have abused a child – so why do so called Child Abuse experts never mention even the vaguest probability that a vaccine or prescribed medications may have caused damage to a child when we all know that they can?

Whilst we go round and round in circles with yet another Dr Southall MSBP Documentary featuring the same denials from both sides, destroyed lives over decades and no sign  of a resolution – by these methods – the elephant in the room is completely hidden from view.

Maybe the next film maker who wants to devote money and a few years of his life to all this could aim to kick off by focusing on the elephant.

Lisa Blakemore Brown, Psychologist
16 May 2011

Judge Relies On Controversial Medical Argument

A judge attacks my ‘one-sided’ child protection stories – but it cuts both ways

The judgment that Mr Justice Bellamy has published makes for illuminating reading, and not just for its attack on me, says Christopher Booker.

In March, the number of applications by social workers to take children into care set a new record: 882 in a single month. Over the past year, my reports on how our highly secretive “child protection” system seems, too often, to collude in seizing children without proper justification have provoked considerable irritation in a number of judges – and last week the judiciary hit back. Mr Justice Bellamy, presiding over a case to which I have referred several times, took the unusual course of publishing a judgment in which he was highly critical of me for my “unbalanced” and “inaccurate” reporting. Then the head of the family courts, Lord Justice Wall, in his ruling on another case, swiftly endorsed Bellamy’s attack on me (despite his own earlier criticisms of the “shocking” determination of some social workers to place children in “an unsatisfactory care system”).

I am not displeased that Bellamy has published his judgment, because the main part of it provides a rare opportunity to see how a judge may rely on a particular medical argument which has become increasingly controversial. But first I must deal with his criticism of my reporting. In the many hundreds of words I have written about this case, on five separate occasions, he singled out only two points as inaccurate. On one of these he was right: I was misinformed that a particular medical witness had appeared in another of Bellamy’s cases.

The next day, however, the judge had to add a supplementary judgment, correcting some of what he had said. It emerged that he had made several factual errors in his references to me. These included misquoting what I had written, through reliance on a website (which he misspelt), and claiming that my articles had appeared in The Daily Telegraph.

Bellamy went on, however, to use my two errors as his text for a general homily on how inexcusable it is to give a tendentious account of family cases based on a one-sided picture given by aggrieved parents. This might sound damning to anyone unfamiliar with the whole secretive system, but it takes no account of the extraordinary obstacles placed in the way of any journalist wishing to report fairly on them.

On more than one occasion when I approached a local authority to check on the facts of what seemed a very disturbing case, the only response was to seek a gagging order prohibiting me from mentioning the case at all. When I accurately reported on one case so embarrassing to the council concerned that it eventually dropped its bid to seize a child, the judge ruled that any future reference to the case outside the court could lead to summary imprisonment.

So the only recourse left to those trying to establish the facts of such cases is rigorously to test what can be learned from the few people willing to speak, and to come to as informed and judicious a view as possible.

Something else came to light in Bellamy’s judgment, however, that is far more important than his criticism of me. The case before him concerned a couple who last year became so concerned that their six-week old baby had developed a “floppy arm” that in the middle of the night they took it to hospital to be examined. X-rays showed the child had suffered a “non-displaced” fracture of the humerus. The police were summoned to arrest the parents, who were led off in handcuffs and held for hours in police cells. Coventry social workers took the child into care and the police charged the father with physically abusing his son.

Now the judge has delivered his fact-finding judgment, on the basis of which he will decide the child’s future in September, we can see, for the first time, that its injuries included not only the fractured arm but also six “metaphyseal fractures” and several marks or bruises. (“Metaphyseal” refers to the metaphysis, the part of a long bone near where it meets a joint, the part that grows in childhood.) All of this sounded like a very grave set of injuries, which might point to serious physical abuse.

The court heard that in every other respect the couple seemed to be devoted, conscientious parents, anxious only to do the right thing by their child. But what clearly weighed most heavily with the judge were those “metaphyseal fractures”. He heard evidence from no fewer than four medical experts that metaphyseal fractures are a virtually certain sign of “non-accidental injury” (a phrase used 20 times in his judgment), implying intentional physical harm.

Finding on this basis that the child had definitely been abused, Bellamy then saw it as his duty to identify the “perpetrator”. Based on the timing of the events that led to the parents rushing their child to hospital, he concluded that the main injury must have been inflicted in a brief interval when the father was out of the room, and the person responsible must have been the mother. The police, he argued, had been wrong to charge the father (a charge still awaiting trial). The judge was thus, in effect, accusing the mother of a crime.

The problem with regarding metaphyseal injuries as an indicator of abuse is that in recent years ever more medical experts have strongly questioned the idea. Their studies show that metaphyseal fractures may occur in babies with soft, still-forming bones, with minimal trauma. They even question whether such injuries can be properly described as fractures at all. The real explanation, they believe, lies in a metabolic bone disease, a contributory factor to which may be a deficiency in Vitamin D (of the type which evidence showed the mother in our present case to have). Only this month a leading American expert, Dr Marvin Miller, published a major new study suggesting that “the cause of multiple unexplained fractures in some infants” might be “metabolic bone disease, not child abuse”.

Also something of an expert on this subject is Dr James Le Fanu of this newspaper, who in 2005 published a paper in the Journal of the Royal Society of Medicine entitled “The wrongful diagnosis of child abuse: a master theory”. In another paper, “The misdiagnosis of metaphyseal fractures: a potent cause of wrongful accusations of child abuse”, he described how the theory of metaphyseal fractures as characteristic of child abuse, first advanced by Dr Paul Kleinman in the US in 1986, was taken up by a small group of radiologists in Britain who became much in demand in our courts as expert witnesses. In 2005, under the headline “Happy, loving parents? They must be child abusers”, Dr Le Fanu explained in these pages how reliance on this diagnosis in the criminal courts was already strongly contested, to the point where it became discredited. But in the family courts, he wrote – citing a case remarkably similar to the one before Mr Justice Bellamy today – the theory was unchallenged.

It is certainly noticeable from Bellamy’s account of the evidence that it was all strictly according to Kleinman’s theory. The four expert witnesses he heard all came across as committed advocates of the Kleinman thesis, in arguing that metaphyseal fractures are an indicator of child abuse. For whatever reason, not one expert was called who was prepared to challenge that view. Bellamy himself said that these injuries are often regarded as “pathognomonic of abuse”, meaning they can have no other cause – seemingly unaware that there is a growing body of scientific opinion to suggest that this may not be their cause at all.

The lawyers for the mother, who has effectively been accused by the learned judge of a criminal act, are said to be considering an appeal against Bellamy’s ruling. If so, one hopes they will take the opportunity to call expert witnesses ready to challenge this still prevailing orthodoxy, on the basis of which scores of children have been removed from loving and conscientious parents – so that the bench on that occasion can at least be given a rather less “one-sided” view.

By:

By Christopher Booker 7:00PM BST 14 May 2011

Source:

http://www.telegraph.co.uk/comment/columnists/christopherbooker/8513956/A-judge-attacks-my-one-sided-child-protection-stories-but-it-cuts-both-ways.html

More doubts over shaken-baby evidence

12 May 2011 by Andy Coghlan

WATER-FILLED cysts in the brain of a dead baby should not be taken as proof that the infant has been shaken to death. New findings show that cysts are also found in babies known to have died of innocent causes.

If the brain is starved of oxygen – because of a breathing problem or a blood clot caused by trauma, for example – it will swell up. A study of swollen brains in 20 babies who died aged 5 months or less showed that the longer they had survived before dying, the more likely they were to develop water-filled cysts between the cerebral cortex and the inner regions of the brain.

“While these cysts may be seen as a consequence of trauma, they do not appear to be due to mechanical tissue disruption, and may occur after brain swelling from any cause,” says Waney Squier at the John Radcliffe Hospital in Oxford, UK (Early Human Development, DOI: 10.1016/j.earlhumdev.2011.03.003). Squier’s team suggests that the cysts arise because the brains of young babies have yet to fully develop the plumbing needed to drain excess fluid.

The paper is the latest to cast doubt on post-mortem evidence that has till now been taken to show that abuse has taken place. Last year, evidence emerged to challenge the use of the “triad” – the combination of brain swelling, and bleeding on the surface of the brain and at the back of the eyes – as evidence in such cases.

In January the Crown Prosecution Service in England and Wales issued new guidelines stating that the triad would no longer be sufficient to show that a dead infant had suffered “shaken baby syndrome”. As well as requiring additional evidence of possible abuse before a prosecution is started, the guidelines also rename “shaken baby syndrome” as “non-accidental head injury”.

“Squier has shown that sub-cortical fluid collections are not [always] the result of primary trauma to the cortex,” says Julie Mack, a pathologist studying infant brain injury at Pennsylvania State Hershey Medical Center.

One prominent radiologist in the UK who preferred not to be named says he agrees that the cysts can have innocent causes. But he questions the validity of the new study, adding that he seldom sees evidence of cysts in MRI scans of living infants with swollen brains.

Source:

http://www.newscientist.com/article/mg21028124.900-new-doubts-over-shakenbaby-evidence.html

Shaken baby syndrome barred

Judge Joseph Neiles barred any reference to the phrase or the concept of “shaken baby syndrome” during the trial for Dustin Two Bulls Sr. The testimony of medical experts convinced him the term didn’t meet the legal criteria for admissible science.

While the dynamics of this case are complicated and the severity of the injuries to this child proved fatal there is an acknowledged controversy between medical experts on the subject of shaken baby syndrome.

Judge Joseph Neiles has also acknowledged this through his ruling and rightly barred the use of shaken baby syndrome from his courtroom.

A question to be asked then is if shaken baby syndrome is not the correct diagnosis then what steps were taken to investigate this case apart from the faulty diagnosis? What evidence of any other mechanism for the injuries were present and investigated? How complete were the medical tests on this child to investigate differential diagnosis or did they simply stop at shaken baby syndrome due to troubled family history and routine diagnosis of a severely injured child.

Source:

http://www.argusleader.com/article/20110508/NEWS/105080304/Justice-silent-after-abuse-leaves-baby-dead

Also see:

http://www.keloland.com/NewsDetail6162.cfm?Id=100250

Fractures believed to be child abuse may be metabolic bone disease

Pediatric Academic Societies’ Annual Meeting 2011

New data suggest that metabolic bone disease, not child abuse, may be the cause of multiple unexplained fractures in some infants.

“Classic metaphyseal lesions, posterior rib fractures and fractures in different stages of healing are thought to be pathognomonic for child abuse,” researchers wrote. “However, we believe these findings can also be seen in metabolic bone disease of infancy.”

To investigate this theory, a radiologist reviewed X-rays of 63 infants with multiple unexplained fractures for features of metabolic bone disease; their fractures were originally considered child abuse. The researchers also searched the patients’ medical charts for the following factors that predispose children to metabolic bone disease: vitamin D deficiency in pregnancy and infancy; decreased fetal bone loading, including intrauterine confinement, malpresentation and maternal use of drugs that cause fetal immobilization; gestational diabetes; and use of drugs that decrease calcium absorption, such as acid-lowering drugs.

Results revealed that, on average, infants presented with fractures at 12.5 weeks of age, with each infant experiencing an average of nine fractures. The researchers identified 171 classical metaphyseal lesions in 42 infants and multiple rib fractures (≥4) in 29 infants. Although the researchers suspected epiphyseal separations in 6% of classical metaphyseal lesions, the majority were clinically silent and healed without callus or periosteal reaction.

X-ray images revealed that features of metabolic bone disease were present in all infants, the researchers said. Seventy-three percent of the pregnancies had evidence of fetal immobilization. Data showed that 52% of the infants tested and 87% of their mothers had abnormally low 25-hydroxyvitamin D levels. Thirteen percent of mothers also had gestational diabetes. The researchers noted that acid-lowering drugs were used by 14% of mothers during pregnancy and in 18% of the infants. Decreased fetal bone loading also occurred during 43% of pregnancies.

These results suggest that physicians should consider metabolic bone disease when encountering infants with multiple fractures, according to the researchers.

“Careful review of the X-rays with attention to the predisposing factors that can impair fetal and infant bone mineralization is critical to avoid an erroneous diagnosis of child abuse,” they wrote. “We do not believe that most [classical metaphyseal lesions] are fractures, but rather are regions of non-mineralized osteoid in healing [metabolic bone disease in infancy].”

For more information:

• Miller ME. Poster 1403.31. Poster session: Endocrinology & diabetes. Presented at: Pediatric Academic Societies 2011; April 30-May 3, 2011; Denver.

Source:

http://www.endocrinetoday.com/view.aspx?rid=83202

Father found not guilty of child abuse

by Mary Jo Denton

COOKEVILLE — A father who was arrested last year for allegedly injuring his 3-month-old daughter went to trial yesterday and was found not guilty.

Joseph Erwin Dowell, 27, of West Jackson Street, was indicted by the Putnam grand jury last August following an investigation by Cookeville Police Detective Sgt. Bobby Anderson. He was charged with aggravated child abuse, a Class A felony.

Police said at the time that Dowell’s baby daughter was in his care at his home on May 26 when she began having breathing problems. Dowell called 911 and the baby was taken to the hospital by ambulance. Doctors found a possible brain injury and notified police.

The baby was transferred to Vanderbilt Hospital in Nashville and was treated for injuries described as “consistent” with shaken baby syndrome.

After further investigation by detectives and Department of Children’s Services workers, Dowell was indicted.

Yesterday, Deputy District Attorney Tony Craighead and Assistant DA Beth Willis took the case to trial before Judge Leon Burns. Dowell was represented by attorney Rebecca Brady.

According to court clerks, three Vanderbilt physicians testified for the state, all saying that the infant had suffered shaken baby syndrome.

The shaking that causes such injuries had taken place sometime within a 48-hour time span before the baby was brought to the hospital, according to their testimony.

Witnesses for the defense included the baby’s mother and grandmother, both of whom said they did not believe that Dowell had hurt the baby.

They pointed to the time span and said Dowell did not have the baby in his care for that whole time, meaning that the injury could have occurred some other way when the baby was with others during that time span.

The two witnesses for the defense also said they still trust Dowell and would have no qualms about leaving the child in his care.

The child has recovered from the injuries, according to testimony.

The jury took the case for deliberation at 4:50 p.m. and returned a not guilty verdict at 6:30 p.m., Circuit Court Clerk Marcia Borys said.

 Source:

http://www.herald-citizen.com/view/full_story/13140744/article-Father-found-not-guilty-of-child-abuse?instance=latest_articles

Caregiver or killer?

New research on shaken baby syndrome could set Pamela Jacobazzi free

By Patrick Yeagle

Something wasn’t right when Cynthia Czapski picked up her 10-month-old son, Matthew, from a Bartlett, Ill., day care on Aug. 11, 1994. The child seemed to be sleeping, but she couldn’t wake him up. Matthew was taken to the emergency room and then to another hospital, where doctors worked to relieve bleeding and swelling in his brain. He never woke up, remaining essentially comatose for 16 months before dying on Dec. 19, 1995.

The assumption from the start was shaken baby syndrome or “SBS,” a condition characterized by a “triad” of symptoms – bleeding and swelling of the brain and retinal bleeding, widely attributed to violent shaking of an infant. The last person to watch Matthew Czapski was Pamela Jacobazzi, then a 39-year-old day care provider in Bartlett, west of Chicago near Elgin, who had just started watching the child eight days earlier. Naturally, Jacobazzi became the main suspect, although no one actually saw her shake Matthew.

During her trial, Jacobazzi denied shaking the baby, but her only real defense was the assertion that Matthew’s injuries could have been caused when he fell forward from a sitting position on the kitchen floor and hit his head on the tile, or from a bump to the head sustained while he was playing with other children at the day care.

Jacobazzi, now 56, was tried and convicted of first degree murder in a DuPage County court in 1999 and sentenced to 32 years in prison, based on the testimony of the prosecution’s nine expert medical witnesses, who told jurors Matthew’s death could only have been caused by violent shaking that must have occurred while the child was in Jacobazzi’s custody. Jacobazzi has spent the past 11 years in Lincoln Correctional Facility, the all-female state prison 30 miles northeast of Springfield.

What seemed to prosecutors and the Czapski family like a straightforward case of child abuse seems like a miscarriage of justice to Jacobazzi’s defense attorney, Anthony Sassan of Crystal Lake, who says he genuinely believes Jacobazzi is innocent. He describes her as “about four feet, eleven inches tall, maybe about 115 pounds soaking wet.

“She is one of the calmest, most polite, pleasant persons that you’d ever want to meet,” he says. “Even when I’ve had to deliver bad news to her, in the times that I’ve met her, I’ve never seen her come close to losing her temper or getting riled up…just a very, very, very nice lady.”

None of the other children in Jacobazzi’s care showed any indications of child abuse, Sassan says, and Matthew Czapski had numerous pre-existing medical conditions that could have caused his death. Sassan is working on Jacobazzi’s third attempt at securing a retrial, and he’s getting some extra help this time.

The Downstate Illinois Innocence Project – based at the University of Illinois Springfield – has taken on Jacobazzi’s case and will work with Sassan to reinvestigate the case and gather new evidence. The project is celebrating its 10th anniversary on May 16, and a large federal grant has allowed them to hire an in-house attorney for the first time.

“I feel this is a case where she is actually innocent,” says Bill Clutter, a Springfield-based private investigator and founding member of the Downstate Illinois Innocence Project. “There’s medical evidence that would have changed the outcome of the jury verdict.”

Jacobazzi’s case is part of a national trend in which people accused of killing infants are challenging in court old assumptions about shaken baby syndrome. While some advocates against child abuse and even the federal Centers for Disease Control and Prevention say SBS (and the more inclusive “abusive head trauma”) account for three to four cases of child brain injury every day in the United States, critics of SBS say the condition is a creation of the legal system, developed without reliable medical research, as a misguided attack on child abuse.

Deborah Tuerkheimer, a professor at DePaul University College of Law in Chicago, estimates that about 200 people in the U.S. are convicted in SBS cases each year, adding that the legal system is slow to catch up to advances in the medical field, so court cases may not incorporate the most up-to-date information on SBS.

“…Dramatic changes [in medicine] have occurred since the 1990s, when the prosecution template emerged,” Tuerkheimer writes in a recent article titled “Science-Dependent Prosecution and the Problem of Epistemic Contingency: A Study of Shaken Baby Syndrome,” published in the Alabama Law Review. She says the science surrounding SBS has “decisively evolved,” and the “large and highly significant areas of consensus surrounding SBS have shifted.”

Though medical experts once commonly agreed on SBS in the 1990s, there are now legitimate challenges to the idea that shaking a baby is the only way the infamous “triad” of injuries can occur, Tuerkheimer notes. Despite that shift, she says the legal community – particularly prosecutors – have largely persisted in outdated views of SBS.

Jacobazzi’s trial occurred before the shift in medical understanding that Tuerkheimer describes, so the testimony from the expert witnesses in her trial may differ from that of current-day expert witnesses.

Jacobazzi’s attempts to get a new trial revolve around evidence known as the Nadelman records, named after Matthew Czapski’s pediatrician. The records show Matthew had sickle cell trait and abnormal hemoglobin, along with chronic bouts of infection, fever, anemia and dehydration. Additionally, the records show Matthew had a disproportionately large head indicative of external hydrocephalus – a condition in which the space around the brain is enlarged and filled with spinal fluid, often leading to increased pressure on the brain. To Sassan and two new expert medical witnesses recruited for the defense, those records suggest that Matthew’s prior medical problems could have caused his death without a violent force – or any force at all.

Jacobazzi claims her lead trial attorney, Anthony Montemurro of Chicago, failed to provide those records to the defense’s lone expert medical witness and didn’t use the records as part of her defense strategy, leaving unchallenged the prosecution’s assertion that Matthew was perfectly healthy when he arrived at Jacobazzi’s day care. If Jacobazzi can convince the circuit court that the absence of that evidence affected the outcome of her trial, she could get a second chance to assert her innocence.

Jacobazzi appealed her conviction to the Second District Appellate Court of Illinois, which sent the case back to the original trial court with instructions to hash out her claim of “ineffective assistance of counsel.” The lower court again ruled against Jacobazzi, saying Montemurro actually did provide the Nadelman records to the expert witness. Jacobazzi appealed again, this time arguing that the circuit court didn’t address whether the absence of the Nadelman records as evidence affected the outcome of her trial – the second requirement of a legal device known as the “Strickland test” that provides the legal precedent for proving ineffective counsel. The appellate court admitted in its most recent ruling on Nov. 17, 2009, that it had given unclear instructions to the lower court and sent the case back with clarifications.

Bill Clutter with the Innocence Project draws parallels between Jacobazzi’s case and a recently-dismissed Wisconsin case that happened around the same time. Audrey Edmunds of Waunakee, Wis., was accused in 1995 of shaking and killing six-month-old Natalie Beard at the day care she ran in her home. As with Jacobazzi’s case, no one saw Edmunds shake the baby, and there was no history of child abuse or outward signs of injury. For both women, the only evidence against them at trial was that of medical experts who concluded they must have been responsible. And like Jacobazzi, Edmunds spent several years in prison before the local chapter of the Innocence Project got involved.

Edmunds’ big break came when one of the expert witnesses against her realized that he might have misjudged the situation. Pathologist Robert Huntington III performed Natalie Beard’s autopsy and testified at Edmunds’ trial that it was “highly probable” the child was injured shortly before Edmunds reported finding her apparently choking on a bottle of baby formula.

Three years later, Huntington handled a similar autopsy, in which a child had been taken to the hospital with a description of being “clingy” and “fussy” but still responsive – the same description given to Natalie Beard by her parents when she was dropped off at Edmunds’ day care.

The child was in the hospital for 15 hours before doctors detected any brain injury in the child, leading Huntington to believe that there could be a delay in the appearance of SBS symptoms. That revelation caused him to doubt his testimony that the last person to have watched a child who dies from SBS symptoms must be responsible.

Huntington later recanted his testimony against Edmunds in an affidavit, which turned out to be crucial in securing her release.

Huntington’s reversal puts him in the company of a growing number of medical researchers who are rethinking suspected SBS cases. Some of those researchers, such as Dr. John Plunkett, a retired pathologist from Minnesota, are questioning the very principles and existence of SBS. Plunkett has testified in numerous SBS cases, and his research may act as a model for Jacobazzi’s defense team if she wins a retrial.

“As far as I’m concerned, every ********* conviction in this country over the past 25 years which is based on testimony regarding shaking has to be overturned,” Plunkett says emphatically. “It [shaken baby syndrome] doesn’t exist. It has never existed.”

Plunkett says any number of other factors, such as a short fall or a pre-existing medical condition, can cause the triad of SBS symptoms – bleeding and swelling of the brain and retinal bleeding. More importantly, he says, his and others’ research into the very mechanics of human injuries shows that brain injury cannot be caused by shaking a baby. He says the force generated by shaking is simply insufficient to cause the symptoms associated with SBS.

“Despite the fact that we have 30 years of medical testimony that it is a valid medical diagnosis, it is clear that you cannot cause brain injury by shaking a child,” he says. “You may very well be able to cause neck damage, but you cannot cause brain damage.”

Plunkett says a “lucid interval” – a period between when an injury occurs and when symptoms manifest – could explain why seemingly healthy babies can suddenly become ill, much like in the case Robert Huntington witnessed after testifying against Audrey Edmunds in Wisconsin.

Plunkett knows his statements may raise some eyebrows. He has taken mountains of criticism from the medical community, he says, including being accused in 2005 of making false statements as an expert medical witness in an Oregon SBS case. Two counts against Plunkett were dismissed before the trial began, and he was acquitted of the remaining two.

“A dozen years ago, I was the lone wolf,” Plunkett says, referring to his early criticism of SBS. “I was treated like the idiot fringe. The worst part of it is as soon as anybody questions the validity of this diagnosis, they are accused of being a defender of child abusers. It is simply not true for any of us. We all understand that child abuse occurs, but we also understand the importance of scientific integrity.”

Is this a question already settled within the medical community? One expert in Springfield is hesitant to choose one side or the other.

Dr. Tracey Lower, an assistant professor of pediatrics at Southern Illinois University School of Medicine and a staff member at St. John’s Children’s Hospital, says the science of medicine is constantly changing.

“There’s an evolution in what we know and what we’re learning about head injuries in children,” she says, adding that shaken baby syndrome first arose as a concept during the 1940s, before MRIs and similar medical procedures were developed to detect internal injuries. The historical record is largely silent on SBS during the 1950s, she says, until reports of child abuse began to emerge and be taken more seriously in the 1960s.

“There were a lot of assumptions, and I think what we’ve learned over the last five to ten years is that most of the time, the extreme injuries we see are a combination of mechanical forces,” she continues. “I certainly believe there can be severe injuries just by shaking, but usually abusive head trauma includes impact and other substantial injuries.”

Lower, who is also involved with Prevent Child Abuse Illinois, a statewide advocacy organization, says a physician’s primary obligation is caring for the children they treat, rather than investigating suspicions of child abuse themselves.

Plunkett takes that idea a step further. He says members of the medical community who don’t understand how force affects the human body should not even be allowed to testify about SBS in court cases.

“The pediatricians, pathologists and ophthalmologists…need to understand the mechanics of injury,” he says. “They need to understand biomechanics, applications of the principles of motion to human injury, before they open their mouths. If you ask these folks to define force for you, ask them to tell you Newton’s three laws, ask them to define acceleration – you will be shocked at the responses. If you don’t understand the mechanics of injury, I don’t think you should be allowed to be giving testimony on these issues.”

Jacobazzi’s first opportunity for parole is set for 2015, and if the pace of the case so far is any indicator of future progress, she could wind up serving the majority of her sentence before she gets another chance to assert her innocence. Her next hearing is scheduled for May 12.

“If you really get to know her, you would realize that this is not a person who loses her temper, loses her head or would do anything like this to any of the kids,” Sassan says. “It’s a shame. It’s horrible that she’s in this circumstance. As a criminal defense attorney, there are few people you represent that you can say, ‘I really think they’re completely innocent of anything.’ This is somebody who I think is really symbolic of the type of person that can get wrapped up in this theory [of SBS] that shouldn’t.”

pyeagle@illinoistimes.com

Source:

http://www.illinoistimes.com/Springfield/article-8622-caregiver-or-killer.html

Crown and defence jointly call for father’s acquittal in 1992 infant death

By Allison Jones, The Canadian Press – 4 days ago

TORONTO — The Crown is conceding that it was a “miscarriage of justice” when a man pleaded guilty in the death of his two-month-old son because of the daunting spectre of testimony from now-disgraced pathologist Charles Smith.

Both the Crown and the defence are calling for the Court of Appeal for Ontario to acquit Richard Brant, in light of fresh evidence. The court is scheduled to hear his case Wednesday.

Brant, now 38, was charged in 1993 with manslaughter in his baby’s death the previous year. He eventually pleaded guilty to aggravated assault.

Brant was taking Dustin for a walk after the boy had been sick for a few days. When he lifted the rain guard on the stroller he was horrified to find Dustin’s lifeless body with thick, red foam around his nose, Brant says in an affidavit.

The infant was taken to hospital and died two days later.

While the pathologist who conducted the autopsy listed pneumonia and respiratory failure as causes of death, Smith examined the case and concluded Dustin likely died from Shaken Baby Syndrome.

He maintained he never did anything to intentionally cause Dustin’s death, but his lawyer Robert Graydon, now an Ontario Court judge, told him Smith was the “God” of his profession.

With his word against Smith’s word, facing a lengthy prison term if convicted, and having just found out his girlfriend was pregnant, Brant pleaded guilty in 1995 to the lesser charge and was sentenced to six months, Brant’s lawyer writes in documents filed with the court.

“If I knew then what I know now, I would not have done so,” Brant says of his guilty plea in an affidavit. “I ask the court to take the burden of having harmed him from my shoulders.”

Once considered an unassailable expert on child forensic pathology, an inquiry found that errors in Smith’s work were responsible, in part, for several people being wrongfully convicted and sent to prison for killing children.

In addition to the inquiry coming down hard on Smith, other reports and reviews have noted his errors and his findings have been lambasted numerous times in court in recent years.

His medical licence was revoked earlier this year.

The Crown and defence had experts examine the evidence, and while none of them can eliminate shaking as a possible cause of death, all independently put forward an alternative cause or causes of death, Brant’s lawyer James Lockyer writes in court documents.

“The evidence establishes that Dustin likely died of natural causes while in the case of (Brant),” he writes.

The Crown agrees with Lockyer’s call for an acquittal, saying in documents filed with the court that with changes in science and forensic pathology, the evidence now can’t support a conclusion beyond a reasonable doubt that Brant harmed Dustin.

“Fresh evidence establishes that the plea should be set aside as a miscarriage of justice,” writes Crown lawyer Alison Wheeler. “The appellant has explained his guilty plea, and there is compelling fresh evidence which now shows that no reasonable jury could convict the appellant of the alleged offence.”

Source:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jvRzi-2bC5LebBgVSaMtUwp2eWMA?docId=6744432

Controversial child doctor could be struck off for a second time

By Jeremy Laurance, Health Editor

Saturday, 30 April 2011

Britain’s most controversial expert in child protection will this week face a disciplinary hearing before the General Medical Council that could see him struck off for a second time.

Professor David Southall, regarded as a pioneer in the detection of child abuse by his supporters but as a dangerous doctor who ripped families apart by his detractors, is also the subject of a Channel 4 film to be broadcast next month that explores one of the longest and most emotionally charged battles in British medical history. Meanwhile, a working group of the GMC is to produce new guidance for doctors involved in child protection – regarded as the toughest job in medicine, where both intervening and not intervening can lead to tragedy. A draft version of the guidance is due to go out for consultation in the summer.

The developments will focus attention on how the abuse of children can be prevented in Britain in the 21st century. Two children die each week, often murdered by their parents, and hundreds of others endure physical and sexual assaults leading to long-term harm.

There are few crimes to equal abusing a child, but one is falsely to accuse a parent of committing such a crime. The dilemma faced by paediatricians working in child protection is how to steer a course between wrongly diagnosing abuse while avoiding missing it altogether. Dr Southall, formerly a consultant paediatrician at the North Staffordshire hospital in Stoke-on-Trent, was struck off the medical register in 2007 after being found guilty of serious misconduct for allegedly accusing a mother of drugging and murdering her 10-year-old son, who died in 1996.

He had denied the mother’s claim that he had accused her of murder, insisting that he had raised it as one possible scenario to explain her son’s death. His account was backed up by a social worker who had been present during the interview, but the GMC panel chose to believe the evidence of the mother. It concluded Dr Southall had an “attitudinal problem” and that this, combined with his “lack of insight into the multiplicity” of his failings, made erasure from the medical register necessary. But, in May last year, the High Court overturned the GMC’s decision, arguing it was based on “flawed” reasoning, and Dr Southall was restored to the register. However, the GMC had also found that Dr Southall had breached patient confidentiality and kept special case files separate from the main hospital records. The High Court instructed the GMC to resolve these issues, and the hearing, which could lead to Dr Southall being struck off again, has been adjourned three times owing to the illness of a panel member and is now due to resume on Wednesday.

The GMC’s original decision to strike Dr Southall off the register alarmed the paediatric community because it appeared to demolish a key part of their defence against false accusations – the presence of an independent professional witness.

The Royal College of Paediatrics said “nothing should deter professionals from acting in the best interests of vulnerable children” and that “cases such as this have caused considerable concern in the paediatric community”.

The GMC responded by announcing an expert group “to review the guidance for paediatricians who practise in this critically-important area of healthcare”, chaired by Lord Justice Thorpe, a family court judge.

Source:

http://www.independent.co.uk/life-style/health-and-families/health-news/controversial-child-doctor-could-be-struck-off-for-a-second-time-2276844.html