Melissa Davey March 16, 2012
AN INTERNATIONAL expert in inflicted brain injury has challenged the use of specific injury patterns to diagnose shaken baby syndrome, calling for doctors to update their training as new evidence emerges.
Colin Smith, a senior lecturer in pathology at the University of Edinburgh, urged doctors to be more open-minded when assessing children with traumatic brain injuries.
His comments come as 145 incidents of a baby being shaken were reported to the NSW Department of Community Services in 2010-11, compared with 133 the year before – though many doctors believe the condition is under-diagnosed.
When three symptoms occurred together – blood between the brain and the skull, retinal rupture and brain swelling – doctors usually concluded the baby had been violently shaken, Dr Smith told the annual conference of the Royal College of Pathologists of Australasia last week.
But there was growing evidence other conditions, such as lack of blood flow to the brain from a seizure or breathing obstruction, could cause similar injury. ”What was considered to be absolute fact and a guarantee of conviction is now much more circumspect,” he said.
”Those injuries and their relationship with head injury have been challenged by scientific, peer-reviewed literature.”
Doctors were trained to diagnose shaken baby syndrome until proven otherwise, he said, and may have difficulty accepting alternative explanations.
”They see the triad of injuries and don’t question it,” he said. ”It is also very hard to differentiate between deliberate and accidental trauma.
Julie Fordham, an associate professor of forensic science at the University of Western Australia and a criminal lawyer, said wrongful convictions happened ”frequently enough to be worried about”.
”Some people do kill their babies,” she said. ”But you can’t unjustly convict someone either, based on science that is in a constant state of flux.”
Dr Terry Donald, a child protection and forensic paediatrician at the Women’s and Children’s Hospital in Adelaide, said that while experienced doctors were sometimes more circumspect about the cause of head injury in young children, it was ”quite legitimate” for less experienced doctors to be concerned by those same injuries.
By Emily Bazelon|
Posted Wednesday, March 14, 2012,
In 1971, pediatrician Norman Guthkelch helped come up with the medical diagnosis of shaken-baby syndrome. Guthkelch and another pediatrician each wrote a paper proposing that unexplained bleeding in the brain of infants could occur because of whiplash—via shaking—without causing a visible neck injury and without direct impact to the head. That diagnosis became the basis for “do not shake” campaigns and, over the years, hundreds of criminal prosecutions for child abuse.
Now Guthkelch is worried that medical examiners and prosecutors have been too quick to turn to the shaken-baby diagnosis—and that innocent people may be in prison as a result. He called me to express that concern after I wrote about some questionable shaken-baby prosecutions for the New York Times Magazine last year. Guthkelch told Joseph Shapiro of NPR about an Arizona case he found particularly troubling after reviewing it for the defense. “I think I used the expression in my report, ‘I wouldn’t hang a cat on the evidence of shaking, as presented,’ ” he said.
Guthkelch, who is 96, was talking about the conviction of Drayton Witt, who was an 18-year-old when he was charged with shaking his 4-month-old son, Steven, to death in 2000. Based on the standard medical theory of the time, the case looked like a classic case of abusive shaking to doctors who treated Steven in the hospital as well as to the medical examiner who conducted the autopsy. Later at trial, these doctors testified against Witt, who was convicted of second-degree murder and sentenced to 20 years.
But now the case doesn’t look so clear-cut. It may, instead, be an example of doctors applying an outdated method of diagnosis—one that ignored Steven’s troubled medical history and thus missed an alternate explanation for his death. It’s not just Guthkelch who is raising the alarm: The medical examiner who testified against Witt, pathologist A.L. Mosley, has recanted his position at trial. Mosley now believes that Steven died of natural causes. Which raises a couple of questions: Is Drayton Witt serving time for a crime he did not commit? Will prosecutors in Arizona continue to argue that his conviction should stand?
Read the full article here:
by Gretchen Gavett
Feb. 21, 2012, 3:16 p.m.
Last year, as part of our ongoing investigation into the troubled state of death investigation in America, PBS “Frontline,” ProPublica and NPR took a closer look at what can be the most troubling and difficult cases — suspicious deaths of young children.
We discovered a growing awareness in the medical community of a variety of diseases that can mimic the symptoms of child abuse, including hereditary blood disorders, leukemia and vitamin K deficiency.
One doctor we spoke to — Dr. Michael Laposata, a pathologist and blood-clotting expert at Vanderbilt University who co-published a 2005 study on diseases that can mimic abuse — is pioneering a new blood testing regimen to rule out these types of disorders.
“If you’re lucky, most places … do the three routine tests: PT, PTT [both blood-clotting tests] and a platelet count, and that’s it,” Dr. Laposata told FRONTLINE in a phone interview. “It turns out most of the kids that have a bleeding problem have something other than that.”
Laposata and his colleagues have devised a system to make blood testing as foolproof as possible for doctors in cases of potential abuse: They created a tiered series of blood tests, known as a “Non-Accidental Injury Coagulation Panel,” which can identify underlying disorders that are more common in children. The panel can be performed with a small amount of blood, which is key when the patient is a baby.
“I think it’s the most comprehensive evaluation for a bleeding disorder that anybody has put forth to date,” Laposata said.
The panel is expected to be introduced soon at Vanderbilt and Dr. Laposata hopes to study its efficacy and to follow cases through the system over the years.
Because blood tests like these can only be performed on living patients whose blood is still flowing, a gap remains in diagnosing underlying conditions from autopsies. Laposata hopes that advances in genome testing could someday help close it, allowing for hereditary disorders to be better identified.
He said he also hopes his coagulation panel “will spur doctors to invent similar panels to evaluate bone injuries and skin changes that are also misdiagnosed as child abuse.”
Laposata was one of a number of doctors and other experts to offer testimony during the appeals process of Ernie Lopez, a Texas man convicted in 2003 of sexually assaulting 6-month-old Isis Vas. Isis, who had bruising and bleeding in the brain and vagina, later died. Lopez was sentenced to 60 years in prison. After reviewing lab tests performed on Isis before her death, Laposata concluded that they contained “clear abnormalities” and suggested that Vas suffered from a bleeding disorder known as disseminated intravascular coagulation (DIC). He gave an affidavit in the case in 2010.
Last month, the Texas Criminal Court of Appeals voided Ernie Lopez’s conviction, saying Lopez received ineffective counsel because his attorneys did not adequately challenge the prosecution’s medical evidence. Potter County District Attorney Randall Sims says he will retry Lopez.
Take a look at Dr. Laposata’s PowerPoint presentation highlighting the difficulty in diagnosing abuse cases. On one side is a photo of a child with bruises from a bleeding disorder; on the other, a photo of a child who was abused.
“I’ve been looking at patients with bleeding problems for years, more than two decades,” he said. “And if you show me the two children with the bruises on their legs, I couldn’t tell you that that one is the bleeding disorder. I’d have to do the blood test to find out.”
Gretchen Gavett is a digital associate producer for Frontline. “The Child Cases,” our film on questionable convictions in child death cases, rebroadcasts tonight on PBS (check your local listings). You can also watch it anytime online.
Scientists are claiming that parents are being wrongly accused of child abuse because of an undiagnosed epidemic of rickets among very young children.
Rickets is caused by a lack of vitamin D. In very young children, the condition can lead to breakage of bones, and can trigger fatal bleeds in the brain. Cases of the illness have soured in the past decade due poor lifestyle and diet.
It has been shockingly claimed that parents are being accused of abusing their young children, when the children are in fact suffering from rickets.
These new claims are originating from scientists from Sheffield Children’s Hospital and London’s Barts hospital. They are suggesting that in many cases parents are mistakenly being accused of hurting or shaking babies whose injuries were actually caused by rickets.
A case of this was seen recently when a couple were originally accused of murdering their son, Jayden Wray, who died at four months from head injuries. Last month the parents were cleared of murder at the Old Bailey when it was discovered that the child actually had the severe vitamin D deficiency that was passed onto him by his mother, causing him the injuries that led to his death.
Dr Irene Scheimberg, of Barts hospital, believes that the rise of rickets is leading to parents being wrongly accused of abuse.
Dr Marta Cohen, of Sheffield Children’s Hospital, said that due to this confusion, it was likely that many children suffering from rickets had wrongly been placed into foster homes because their parents had been suspected of abuse. When speaking to BBC Radio 4 she said:
“If you have bones that fracture easily they will fracture with any normal movement. Like trying to put a babygrow on a baby, you will twist the arm. ‘In a child whose bones are weakened, it’s easier for them to get these very tiny fractures or big fractures. There should be a commission that studies all of these cases, taking into account the age of these children, their gender, the race, the way in which these families live.”
Dr Cohen also believes that rickets could also be responsible for many cases of cot death, or sudden infant death syndrome, because it can cause the heart to stop beating.
The Doctor recently carried out a study involving 24 babies who had died of cot death. She interestingly found that three quarters were found to have moderate or severe vitamin D deficiency.
The Government estimates that as many as 40 per cent of Britons are deficient in vitamin D. The increase in rickets in young children has been blamed on the children spending considerably more time inside, rather than outside in the sun.
By Jason van Rassel,
CALGARY — A former Calgary pathologist whose findings were reviewed by justice officials is being sued by the family of a toddler whose case sparked the probe.
A statement of claim filed in a Calgary court Wednesday alleges Dr. Michael Belenky’s mistaken finding the two-year-old’s accidental death was a homicide cast the family under a pall of suspicion and resulted in child welfare authorities placing the toddler’s stepbrother in foster care.
The lawsuit is seeking nearly $2 million in damages on behalf of the surviving stepbrother and his family, including his father and his paternal grandparents.
“It was a nightmare,” said the child plaintiff’s grandmother, who referred any further questions to the family’s lawyers.
Belenky is one of several defendants named in the suit, which also alleges negligence by the provincial attorney general, the office of the chief medical examiner and child welfare authorities.
The Calgary Herald has been unable to reach Belenky for comment regarding the lawsuit’s claims, which are unproven in court.
Child welfare legislation prevents publishing the name of the plaintiffs or the boy, who died on April 4, 2009.
The boy suffered a fatal head injury while being looked after by his stepfather at their Calgary home three days before his death.
“The Certificate of Medical Examiner completed by Belenky, dated July 20, 2010 stated that the immediate cause of death of the deceased infant was ‘blunt head injuries’ and that the manner of death was ‘homicide,’” reads the statement of claim filed Wednesday in Court of Queen’s Bench.
Suspicions over the toddler’s death prompted child welfare workers to apprehend his stepbrother and place him in foster care.
The stepbrother’s paternal grandparents received temporary guardianship and the boy went to live with them in B.C. in June 2010.
However, child welfare authorities apprehended the boy again a month later and put him back in foster care.
The family’s statement of claim alleges the boy was taken again because they would not agree to demands to cut off contact between him and his father.
The lawsuit claims child welfare authorities and a worker involved in the case were negligent, and “did not have reasonable and probable grounds to believe (the boy) was in need of intervention(s).”
A Calgary homicide detective assigned to the case first raised concerns about the term “non-accidental” used in one of Belenky’s reports.
The investigator, Det. Ron Ho, told the Calgary Herald last year he requested a meeting with Belenky in August 2010 to discuss the terminology.
In January 2011, Ho wanted further clarification about the report, but Belenky had previously left the medical examiner’s office in Calgary for unrelated reasons.
Another medical examiner who looked at the case for police raised questions about the findings, leading Alberta Justice in Jan. 31 to announce a review of all criminal files handled by Belenky.
In March 2011, authorities overturned Belenky’s original finding in the toddler’s death and determined it was accidental, that he likely suffered the fatal head injury falling from a piece of furniture.
After that finding, the surviving stepbrother, now five years old, was returned to his father following nearly two years in foster care.
“The chief medical examiner failed to ensure that Belenky and the CME (chief medical examiner) employees were properly qualified,” reads the statement of claim.
“The chief medical examiner allowed Belenky and the CME employees to conduct the examination when he knew or ought to have known that they lacked the skills, training or other resources necessary to conduct the examination,” it continues.
Belenky, 47, was educated in his native Russia and received further medical training during residencies in the U.S.
Alberta Justice officials confirmed last year Belenky did not have a certification in forensic pathology from the Royal College of Physicians and Surgeons of Canada.
However, board certification was not a requirement when Alberta Justice hired Belenky in 2008.
The lawsuit alleges Belenky subsequently failed in attempts to qualify for the designation.
“(Belenky) failed his certification exams to become qualified to practice as a pathologist and/or medical examiner while in the employ of the chief medical examiner,” the claim alleges.
Since the review of Belenky’s files, Alberta Justice has also launched a probe of cases handled by another former forensic pathologist, Dr. Evan Matshes.
The investigation, launched earlier this month, was prompted by questions from an insurance company about an accidental death finding.
After an internal probe raised further questions in four non-criminal cases, three files were then sent to U.S. pathologists for a peer review.
During 13 months in the Calgary medical examiner’s office, Matshes conducted 426 death investigations, including 13 criminal cases, which are being reviewed first.
Matshes, who is board certified, left the medical examiner’s office in September 2011 for reasons unrelated to the review.
MCMINNVILLE, Ore. – The state accuses two McMinnville parents of abusing their child, but the couple insists they’re innocent.
The state took custody of Linda and Daniel Dossey’s baby boy, Joss, after the couple brought him in with a fever in November and say doctors found what appeared to be fractures in the child’s leg and ribs. But the couple says their son has a medical condition called neonatal rickets.
The couple says they were shocked after a doctor told them Joss had a broken femur.
“We’re like he’s been kicking around fine,” said Linda. “He seemed a little fussy but not in pain.”
Linda said the doctors’ response to the child’s injuries was it “must have been shaking. That this was (a) grabbing motion that must have occurred that caused the shaking.”
The Dosseys say social services interviewed them and took Joss the next day.
“We’re grasping for anything,” Linda said. “We know that our son has something medically wrong here. Figure it out.”
Looking for an explanation, the couple found a specialist in Illinois who reviewed Joss’ medical file and diagnosed him with neonatal rickets, a rare medical condition that can cause weakened bones.
The specialist testified on their behalf at a custody hearing last month but his expert opinion wasn’t enough to get their son back.
“It hurts. That’s all you can say is it just hurts like beyond anything,” Daniel said.
The Dosseys say there is no proof they abused their son but they have to go through mental evaluations with the state next month. Until then, Joss remains in foster care.
“You’re innocent until proven guilty. We know we didn’t do anything, this will be easy, and then know that it’s not really that easy,” Linda said.
DHS won’t comment on the case. According to OHSU, where Joss was treated before going to foster care, it cannot comment on the specific case but it follows state law, which requires reporting any suspected child abuse.