It is axiomatic when a baby is seen at a hospital emergency room. The child has no marks or apparent injury. The child is examined, and when they find the triad of symptoms, it is axiomatic: Child abuse. The triad of symptoms is: subdural hemorrhaging, retinal hemorrhaging, and swelling of the brain. Subdural hemorraging is bleeding in a space between the skull and the brain. Retinal hemorrhaging is bleeding at the back of the eyes.
Law enforcement describes it as “suspicion” of child abuse, but that may sound like this is just a starting position from which an investigation begins and is conducted with an open mind. Not really. Because law enforcement has been indoctrinated that these symptoms are almost necessarily caused by child abuse. Any suspect who says they don’t know what caused the symptoms will be arrested and prosecuted. Unless someone can otherwise explain those symptoms, criminal charges will be filed and any investigation is narrowed to gathering more evidence to convict, nothing else.
Since the 1980s, something called “shaken baby syndrome” came into medical literature ansd soon into criminal prosecution. It arose from some experiments made on rhesus monkeys in the 1960s by a neurosurgeon named Ayub Ommaya. He subjected the monkeys to acceleration experiments but never experimented with shaking them. Obviously, he never experimented on children. Nevertheless, pediatric specialists wrote papers citing that study as evidence that unexplained subdural bleeding in babies could occur without direct impact to the head and without or without visible neck injury.
Prosecutors began to call doctors to testify that shaking a baby could generate the same force as throwing a child from a second story window. This is a very dramatic illustration to generate the jury’s anger. But it was not true. A neurosurgeon named Ann-Christine Duhaime published a paper that discussed her study with biomedical engineers who used infant-sized dummies for acceleration studies. They equipped the dummies with sensors to measure the acceleration. Shaking the dummies as hard as they could never produced the force earlier claimed. This and subsequent experiments raised doubts in the minds of some doctors and biomedical engineers that shaking alone could cause severe brain damage or death. However, the experiments did not rule it out since the dummies are not live children and the effects of acceleration on brain tissue are hard to model.
Some doctors are now called to testify by criminal defense lawyers to testify. Skeptical of the “shaken baby syndrome, ” based on the later research, they believe shaking alone could in theory cause the triad of symptoms, but only if there is an injury to the neck or spinal cord. This is a critical departure point between the prosecution experts and the defense experts.
When Audrey Edmonds was prosecuted in 1996 for the child abuse death of a child, the triad of symptoms was observed but no spinal cord injuries. She denied ever harming the child, but the prosecution witnesses testified she had to have been the person to inflict the injuries on the child because, as she told authorities, she had care of the child and observed the child to go limp. Robert Huntington, a forensic pathologist, was one of the prosecution witnesses testified the child had to have been injured two hours before the child collapsed.
Of course, Edmonds was convicted and sentenced to 18 years in prison. Then, ten years later, Edmonds was granted a hearing to determine whether she should get a new trial. Her defense attorney called as a witness the same Robert Huntington, who had now changed his opinions and now testified he had since observed a child with subdural hemorraging and retinal bleeding yet was lucid for some time between a brain injury and collapse. His earlier testimony had been that the collapse would necessarily be within two hours of injury.
After that observation, Huntington revisited the medical literature in the field and found research that supported the new observation. He now believed that a lucid interval between injury and collapse is a real possibility, and he could therefore no longer precisely time the injury that caused the death of the child for whom Edmonds was convicted. He testified he simply could not say when the injury had occurred.
Some of that newer research includes a 2001 study by British neuropathologist named Jennian Geddes. That study found most babies with the triad of shaken-baby syndrome symptoms suffer from a lack of blood to the brain – not from a rupture of the nerve fibers of the brain. The lack of blood is caused by oxygen deprivation. Rupture of brain nerve fibers is immediate. It causes an instant coma. Oxygen deprivation, on the other hand, can have slower and subtler results. This could explain how a baby with shaken-baby syndrome triad of symptoms could seem fussy or lethargic or stop eating or sleeping well for some time after the injury. Even Cindy Christian, a leading proponent of the triad of symptoms alone as indicating shaken baby, conceded in a 2005 paper that, “although infrequent,” victims of fatal head injury may appear lucid for a period before death.
Audrey Edmonds was granted a new trial by the Wisconsin Court of Appeal in 2008. The court wrote that the disagreement among physicians was a shift in medical opinion, and therefore Edmonds deserved a new trial.
Among the alternative explanations for the triad of shaken-baby syndrome are infant stroke related to an infection, such as meningitis, resulting in thrombosis. Defense experts concede that severe retinal bleeding is far more common in cases of abuse but assert that does not mean it is never found in other circumstances. At last year’s meeting of the American Academy of Forensic Sciences, Evan Matshes, a Canadian forensic pathologist, presented a study of 123 autopsies performed in Miami, Florida, on infants who died from natural or accidental causes or homicides. Of those with retinal hemorrages, 53 per cent died from accidental or natural causes and 47 per cent from homicide. Severe retinal hemorrages were found in some of those who died from accident. Those in the homicide group were more likely to have severe retinal hemorrages, but this could be explained by factors other than abuse. For instance, the children in the homicide group had isolated head injuries and were more likely to be resuscitated, and, thereafter, they were more likely to develop brain swelling and bleeding disorders. Matshes concluded, “It is simply incorrect to state that severe retinal hemorrhaging is diagnostic or abuse or shaking.” He is now investigating whether infants with subdural bleeding and brain swelling might actually have neck injuries that have not been discovered.
Patrick Barnes, a pediatric radiologist who began as a believer in the prosecution theory, even an author of a chapter of a textbook espousing the traditional prosecution theory, but converted, after much reflection and study, to the other side and sees other possible explanations for the triad of symptoms. He testified for Audrey Edmonds in her bid for a new trial. He says most of his colleagues in the field do not simply present the science dispassionately, that they have built their whole careers on this one issue. One of those is Robert Block, an Oklahoma City testifying doctor and this year’s president of the American Academy of Pediatrics, who has made his name by complete commitment to the single-explanation prosecution theory without a shred of doubt. Block was critical of Deborah Tuerkeimer, a law professor and former prosecutor, when she wrote an Op-Ed piece last September in the New York Times that warned of wrongful convictions and sought the involvement of the National Academy of Sciences to referee the dispute between the experts. Block appears not to welcome other scientists to the debate.