How to Prepare If You Are Charged with SBS

If you are charged with Shaken Baby Syndrome (SBS) or Blunt Forced Trauma or whatever the latest phrase is to charge a person with a theory based crime.  Keep in mind that this is based on a theory as ethically, you cannot shake a baby or a child to determine the extent of injuries.  No one really knows what injuries could present themselves if shaken and the cases where a person has admitted shaking, you can most likely bet that it was a plea to hopefully get a lesser sentence.  Just because a person admits to shaking a child, it may not be so.  There have been studies done that you don't hear about dealing with the force necessary to create the types of injuries that are claimed to have been a result of SBS.  Biomechanics experts, who are trained to understand height/velocity, have published their findings that it is impossible to shake a child to product the constellation or in most cases, one or two of the "known injuries" to charge a person with SBS.

Regardless if you believe or don't believe in SBS, it's important to treat the child for what is really happening.  How many of these children might have an underlying disease state and are being treated inappropriately?  How many children if diagnosed correctly, could be saved?  How many siblings might be a ticking bomb due to a genetic medical condition?  The point to this post is to ensure a child was diagnosed correctly.  It serves no purpose to convict someone when the doctors cannot pinpoint the cause of the alleged injuries.  It is the doctor's duty to ensure the child has been diagnosed correctly.  On a second note, vaccination injuries do occur which is why there is a reporting database and why many lawsuits compensating parents have been resolved.  A doctor should not exclude the possibility of a vaccination reaction if the timing is within a certain timepoint of the alleged injury.

Lucid intervals is another point that needs to be considered.  There is literature showing that a child can have a lucid interval on a previous head injury.  There are also brain injuries involved in the birthing process.  There are many factors that need to be considered in treating and diagnosing these children that present themselves with no obvious reason or witness. 

If you are convicted, there are important steps your attorney needs to take to ensure you are being represented appropriately.

• All hospital records have to be retrieved.   This includes all medical records, reports, lab reports, notes, images, CT-Scans, radiology, prenatal records, well baby records, vaccination records, pre-existing conditions, autopsy rough and formal notes, reports and findings. All experts findings/notes that were involved with the child's care or via the autopsy needs to be obtained.   Most likely, your attorney will need to issue a subpoena.
• All slides from the autopsy need to be obtained.  You want to ensure tissue samples and retinopathy findings are included. 
• All this data needs to be reviewed carefully and put into a timeline format.  It will take skilled people to read and review this data to look for inconsistencies, errors or omissions.
• Review all interviews that the police conducted for additional clues into past injuries, pre-existing conditions, medications and so forth.  Also, have your own interviews by a private investigator.  Key information can be obtained such as the child was seen by various doctors in various towns or the child fell down the stairs a week prior.  All events and knowledge are critical to piecing together the puzzle.  The goal should not be to convict anyone if a child is presented with an unexplained injury.  The goal is to determine what happened to treat the child first and foremost.
• Interview all medical experts for the prosecution and tape record the conversation.  There is critical information that can be obtained from talking to these experts.  The attorney needs to understand what the expert is utilizing to form their opinions.  Perhaps they are referring to old journals and have not seen any of the new literature questioning SBS.  Leave no stone unturned.  Look to see if there are any complaints on this expert.  Look at their history on other cases to see if there are any trends.  There is an influx of pathologists being scrutinized for their past performance on these types of cases.  Look at Dr. Charles Smith out of Canada.

More to come ...

Shaken Baby Syndrome Misdiagnosed

I had to reprint this to keep the information flowing on the fallacy surrounding Shaken Baby Syndrome. 

Regardless of your opinions related to SBS, the profound underlying statement that needs to occur is that anyone convicted of a crime needs to be guilty.  To charge someone based on theory and opinion is just as criminal.  Whereas no one likes a person to "get away" with murder or abuse of a child, no one should like a person being convicted falsely.

I think my biggest issue aside from flawed science is the fact that some of these children could have an underlying medical condition lurking behind the scene.  As a parent, if my child had died unexpectedly, I would want all tests ran to ensure there was no genetic issue at play.  What if my other children are a ticking bomb to face the same fate or what if that child passes on that trait to their children?   It's easy to charge "the last person with a child" but it's not easy to be the one accused falsely.

We owe it not only to the person accused but we owe it to the child, offspring and parents.  

Just imagine if a child would have lived had the doctors accurately diagnosed a child and exhausted all underlying possibilities?   This is the biggest question of all.  What if?  What if the child was treated incorrectly?  

It can take weeks or months to run panels of labs and they are expensive to run.  I propose someone start collecting the labs ran on alleged SBS victims and determine if there is a consensus on labs ran, why are they not all ran and did anyone ever collect all the results? 

Most children don't have but a minimal set of labs ran due to ER doctors already assessing guilt at onset.  It's a vicious cycle of injustice for all. 

It's not acceptable to take one or more symptoms and mold them into an SBS or blunt force trauma case.




From Radley Balko:

A Shake to the System

New research into "shaken baby syndrome" could put hundreds of convictions in peril.

 
In January 2008, a Wisconsin appeals court granted a new trial to Audrey Edmunds, a 45-year-old woman who had been sentenced in 1995 to 18 years in prison for murdering Natalie Beard, an infant in her care. The ruling was significant, because medical experts said Beard died as a result of Shaken Baby Syndrome (SBS), a diagnosis that grew increasingly common in the late 1980s and early 1990s. The Wisconsin appellate court was the first in the country to recognize increasing doubts about the reliability of SBS diagnoses.


The phrase shaken baby syndrome entered the pop culture lexicon in 1997, when British au pair Louise Woodward was convicted of involuntary manslaughter in the death of Massachusetts infant Matthew Eappen. At the time, the medical community almost universally agreed on the symptoms of SBS. But starting around 1999, a fringe group of SBS skeptics began growing into a powerful reform movement. The Woodward case brought additional attention to the issue, inviting new research into the legitimacy of SBS. Today, as reflected in the Edmunds case, there are significant doubts about both the diagnosis of SBS and how it's being used in court.

In a compelling article published this month in the Washington University Law Review, DePaul University law professor Deborah Teurkheimer argues that the medical research has now shifted to the point where U.S. courts must conduct a major review of most SBS cases from the last 20 years. The problem, Teurkheimer explains, is that the presence of three symptoms in an infant victim—bleeding at the back of the eye, bleeding in the protective area of the brain, and brain swelling—have led doctors and child protective workers to immediately reach a conclusion of SBS. These symptoms have long been considered pathognomic, or exclusive, to SBS. As this line of thinking goes, if those three symptoms are present in the autopsy, then the child could only have been shaken to death.

Moreover, an SBS medical diagnosis has typically served as a legal diagnosis as well. Medical consensus previously held that these symptoms present immediately in the victim. Therefore, a diagnosis of SBS established cause of death (shaking), the identity of the killer (the person who was with the child when it died), and even the intent of the accused (the vigorous nature of the shaking established mens rea). Medical opinion was so uniform that the accused, like Edmunds, often didn't bother questioning the science. Instead, they'd often try to establish the possibility that someone else shook the child.


But now the consensus has shifted. Where the near-unanimous opinion once held that the SBS triad of symptoms could only result from a shaking with the force equivalent of a fall from a three-story to four-story window, or a car moving at 25 mph to 40 mph (depending on the source), research completed in 2003 using lifelike infant dolls suggested that vigorous human shaking produces bleeding similar to that of only a 2-foot to 3-foot fall. Furthermore, the shaking experiments failed to produce symptoms with the severity of those typically seen in SBS deaths.

The research implies that human beings simply cannot shake a baby to death without an accompanying impact to the head. SBS cases, however, frequently show no external injuries. This suggests that other causes are at work. Additional research has shown babies to be lucid up to 72 hours before classic SBS symptoms set in, casting doubt on the long-held theory that the child's caretaker at the time of death (or loss of consciousness) was the likely killer.

Last year, Discover magazine published a provocative article laying out much of this new research. Notably, the magazine found several specialists who have since changed their minds after testifying for the prosecution in multiple SBS cases. (At a post-conviction hearing for Edmunds, all of her defense experts said that when the case was tried in 1995, they would have testified for the prosecution.) One of those specialists is Ronald Uscinski, a student of Ayub Ommaya, the scientist whose research on monkeys in the late 1960s is thought to be the origin of the SBS diagnosis. When Uscinski went back and reexamined the study, he found no support for the way Ommaya’s research is currently being being used in the courtroom.

"When I put all of this together, I said, my God, this is a sham,” Uscinski told Discover. "Somebody made a mistake right at the very beginning, and look at what’s come out of it."

Teurkheimer estimates that "what's come out of it" is about 200 SBS prosecutions per year in America, mostly for murder. She believes there's legitimate reason to review nearly all of these cases, including even those where a suspect admitted to having shaken the baby. As she points out, suggestive or coercive questioning may have elicited such admissions. Moreover, in some cases, a defendant who admitted to shaking a child in order to revive it after it had already been unconscious was seen as having confessed to killing the child.

Whether someone can actually "free shake" an infant to death remains hotly disputed in the medical community. Where there is consensus, however, is that the triad of symptoms traditionally associated with SBS are not exclusive to it. A number of other things can produce these symptoms, including falls, head impacts, infections, birth defects, reaction to vaccinations, and surgical procedures. That's a significant departure from what prosecutors have been telling juries for the past 20 years.

In other words, there are almost certainly a significant number of innocent people in prison today who were wrongly convicted of shaking a baby to death. The problem is that there are also likely a number of guilty people who, nevertheless, shouldn't have been convicted on the basis of science-based testimony we now know to be false. The task will be convincing both the courts and the public to risk freeing actual child killers in order to free the innocent people convicted with flawed medical testimony.

Furthermore, unlike with DNA testing, which came about through rapid scientific breakthroughs, the issue of SBS is tied to a slow shift in the scientific consensus. We simply won’t have the slam-dunk evidence DNA provides when it points to the real culprit. With SBS, the question is usually whether a crime was even committed, or if a child's symptoms were caused by something other than shaking.

This whole controversy speaks to a fundamental tension between science and law. Science moves along a slow trajectory from inquiry toward certainty. While the courts have been eager to embrace new science—particularly forensic science—at the trial level, they're reluctant to revisit those cases when the science changes. One example is the now-discredited specialty of identifying bite mark evidence. But while science is mostly interested in testing, revising, and improving existing theories, once the jury has delivered its verdict, our criminal justice system puts a premium on finality. It takes a major upheaval in the scientific community (like DNA technology) to get courts to consider reopening old cases.

But at the very least the courts should stop prosecutors from making the same mistakes in the future. But even that isn't happening. Tuerkheimer, for example, found literature in current manuals for prosecutors that relies on discredited research from the 1980s and 1990s, still touting the pathognomic nature of SBS symptoms. And the same week Edmunds was given a new trial, an appeals court in Arkansas denied a new trial to a woman convicted under similar circumstances, based on the presence of the same symptoms.

Britain, Canada, and Australia have all initiated major reviews of shaken baby prosecutions in response to new research. Teurkheimer makes a convincing case that it’s time for the U.S. to do the same.

Radley Balko is a senior editor at Reason magazine



Washington University Law Review, DePaul University law professor Deborah Teurkheimer

Head Trauma outcomes of verifiable falls in newborn babies

Authors:

Caroline Ruddick, Martin Ward Platt, Camille Lazaro

Affiliations:

Ms Caroline Ruddick, Midwifery Manager, Directorate of Women’s ServicesDr Martin Ward Platt, Consultant Paediatrician, Directorate of Women’s ServicesDr Camille Lazaro, Consultant Paediatrician, Department of Child Health

Corresponding author:

Dr Martin Ward PlattWard 35Royal Victoria Infirmary,Newcastle upon Tyne NE1 4LPTele: 0191 282 5197Fax: 0191 282 5038E mail: m.p.ward-platt@ncl.ac.ukJuly 7, 2009 as 10.1136/adc.2008.143131

Head trauma outcomes of verifiable falls in newborn babies

Abstract

Eleven newborn babies of normal weights sustained falls onto a hard surface in hospital. The one baby who fell from over a metre sustained clinical and radiological trauma and encephalopathy, with a skull fracture and cerebral contusion. No other baby demonstrated neurological signs despite the presence of parietal skull fractures in four of six who were X-rayed; only two babies had scalp swelling. The findings suggest that parietal fractures can result from very low level falls and scalp swelling is a poor marker for underlying fracture.

Introduction

The conditions under which very young infants can sustain skull fractures can be contentious, but are clearly important in determining whether an injury might be consistent with the history given.Studies of linear skull fractures and external evidence of skull injury have mostly focused on falls of 3 feet or more1 2, so there is little information on the outcomes of lower level falls. In the context of the accident and emergency department, the prevarication and false histories that are part of thepresentation of child abuse create difficulties for clinicians and researchers alike.

Therefore, we believed it would be useful to present our experience of injuries sustained from falls in newborn babies in the postnatal ward where the fall occurred under verifiable conditions, or was witnessed by someone other than the mother; there was information about the physical environment; immediate medical assessment was available; and many of the falls were from heights as low as 0.5m.

Method

We used our adverse event register, cross checked with the codings for all trauma in newborn babies from the Hospital Episode Statistics, to identify cases where babies fell accidentally to the floor in our maternity unit for the five years January 1999 to December 2003. The records for each child were examined; details of the height to impact, nature of the surface struck, clinical symptoms and the results of any imaging were identified for each child.

Results

The details of the babies are given in the table. 11 babies were identified, seven girls and four boys,all born at term. Birth weights ranged from 2.1 kg to 3.8 kg. Of the 11, seven were totally breast fed, three artificially fed and one mixed fed. Seven of the falls occurred at night, between the hours of 8 p.m. and 8 a.m. Four babies dropped to the floor when their mothers fell asleep following breast feeding.

The estimated distance to impact in most babies was one metre or less. One baby fell about 1.2m. The surface impacted upon in all falls consisted of vinyl tiles laid upon concrete with an intervening solid screed.No clinical findings were identified in eight of the eleven babies. Of the three with clinical findings,one had a bruise over the temporal area, one had a swelling over the parietal area and one had signs of traumatic encephalopathy.

All imaging was at the discretion of the attending physicians. Six of the eleven babies had skull Xrays, one had a CT scan (but no skull X-ray), and two an ultrasound scan. Of the six with X-rays, five had no scalp swelling, but three of these five had a solitary linear parietal skull fracture. Three of the eleven babies had localised scalp swelling, of which two were imaged and each of these had asingle linear parietal fracture. The baby who fell 1.2m had a fronto-parietal contusion beneath the fracture, and had a transiently decreased level of consciousness consistent with a mild traumatic encephalopathy; this baby was born by normal vaginal delivery.

Discussion

Our observations demonstrate that low height falls of under a metre can cause a linear skull fracture, and such skull fractures are not necessarily accompanied by a boggy swelling in the overlying scalp. However not all babies were radiographed so we cannot make any estimate of the rate of fracture among babies who fall.All the fractures, including that caused by the highest fall, were linear and confined to the parietes. Even the baby falling further, and sustaining brain contusion, had a linear fracture, not a more complex one. Although this finding supports the contention that complex, stellate or occipital fractures do not arise from simple domestic falls3 we cannot rule out the possibility that otherkinds of fracture could result from falls such as we have seen.In spite of the fact that hospital floors are particularly hard and unyielding, we found that symptoms suggestive of underlying brain injury (decreased consciousness, feeding problems, irritability,seizures or apnoea) were not found in 10 of 11 babies, even when fractures were found to have occurred. Existing biomechanical evidence suggests that that there is little difference in the effects of falls onto a hard floor or a carpeted domestic floor 4.

We conclude that even very low level falls may produce linear skull fractures, but that such fractures may occur without the scalp swelling traditionally considered suggestive of a fracture.

References

1. Greenes, D. S., Schutzman, S A. Infants with isolated skull fracture: what are their clinicalcharacteristics, and do they require hospitalization? Annals of Emergency Medicine. 1997;30:253-9.

2. Johnson, K., Fischer, T., Chapman, S., Wilson, B. Accidental head injuries in children under 5years of age. Clinical Radiology 2005;60:464-8.

3. Hobbs, C.J. Skull Fracture and the diagnosis of abuse. Archives of Disease in Childhood1984;59:246-52.

4. Coats, B., Margulies, S. S. Potential for head injuries in infants from low-height falls. Journalof Neurosurgery: Pediatrics 2008;2:321-30.

SBS Can Happen to Anyone

My goal in this whole shaken baby syndrome mess is to educate the general public on the short comings of this crime and diagnosis. I don't advocate turning our backs on those that injure children rather I want the truth to be found. I think the doctors and police owe it to the public to investigate all suspicious injuries and deaths to the fullest.

Doctors should not assume that because a child/baby presents itself with injuries inconsistent to a fall or symptoms that appeared out of nowhere that it's consistent with SBS. Doctors are too quick to accuse people based on brain hemorrhages and retinal hemorrhages alone that abuse had to occur. They refuse to consider other ailments or even medical care that could have either caused or increased the damage. There have been studies showing that CPR can produce retinal hemorrhages. It is possible for a panicked parent or care giver to hurt a child by providing CPR if that person has not received training.

When a child arrives at a hospital with seizing activity, they load them with anti-seizure medications. Doses that are adult strength ... doses that have contraindications with other drugs they administer all at once or one on top of the other. There are known drugs that should not be given to certain conditions such as heparin or mannitol.

What is most alarming is doctors routinely do NOT investigate the child's medical history when assessing the situation and this includes the pathologist/coroner. A minority of doctors advocate ruling out all possible underlying ailments prior to assessing blame. While it's noble to protect innocent children and punish the guilty, it's criminal to be the cause behind imprisoning innocent people.

Vaccinations are immediately not considered as plausible causes to deaths or other serious adverse events. In spite of studies, that are not widely publicized, there are numerous events that occur to include deaths. The reporting process is completely voluntarily reported. Even officials admit a short coming is that only a small percentage are actually reported. Although vaccinations may be okay for most children, there are a handful that do not respond well to the deadly concoctions of lethal ingredients. We have no idea what the long term implications are in children as they age. The number of required and recommended vaccinations have tripled over the years and parents are uninformed on the potential risks and no one really publicizes what a multi-billion dollar business this area is.

Another issue is short falls. Biomechnic engineers have refuted the belief that a child cannot suffer a serious injury or death due to a short fall. Others such as Dr. John Plunkett published research findings to counter those claims. Unfortunately, because this small minority of doctors detract from the 1970ish claim by Dr. Caffey, they are considered quacks. The "rules" surrounding SBS change and are modified to encompass many symptoms. No concise research can be done due to the obvious fact you can't shake babies to prove the theory. SBS is only a theory ... period.

To see some of the injustices, search for Ken Marsh, Audrey Edmunds, Alan Yurko.

If we can get it wrong with all the recent releases of wrongfully convicted people due to DNA testing, why is it so unbelievable that we have it wrong when it comes to the SBS THEORY?

Vaccination Link Study in 1994

I was alerted of a blog entry by a pre-med student in Russia and was more interested when I saw one of the postings by a doctor who rudely responded to a mother who claimed her child was injured by vaccinations. It's interesting to see such intolerance by the medical community and such denial of something that seems so obvious.

Just because the vast majority of children do not react to vaccinations immediately, it does not mean that some children are predisposed to suffer a serious adverse reaction post vaccination. There needs to be more guidance on how to vaccinate and when to vaccinate. Doctors really have no understanding of the long term implications of vaccinations either. We are now vaccinating children to prevent non-threatening diseases. The irony of it all is the vaccinations appear to wear off and as adults, we become vulnerable to the disease and in some cases, are in more jeopardy of the effects had we not even been vaccinated.

This study was published in 1994. If you scroll down, the online version is readable:

http://www.nap.edu/catalog.php?record_id=2138#toc

I can agree that some vaccinations are good but I'm offended that the mainstream medical community continues to deny the effects vaccinations can have on children. I am furious that these same doctors deny that these reactions are not investigated further instead of just merely relying on shaken baby syndrome as the catch all for anything they can't explain based on surface diagnosis.

I guess it will take a high profile celebrity like Jenny McCarthy to bring justice to the SBS world of convict anyone and everyone as long as it's the last person with the child and seek out no more ...

Shaken Baby Syndrome Scandel

There are more and more doctors claiming that shaken baby syndrom (SBS) is not proven to be a true diagnosis. If researched, SBS is based on a theory! People will say there are people who have admitted to shaking so therefore, it's true. What the average law abiding person does not understand is police interrogations can be brutal and harsh. People are usually devasted when put in a situation such as being accused of SBS or blunt force trauma or anything else connected to a constellation of injuries associated with SBS. People will eventually conform to what they are being told they did and often times, interviewers will distort facts to manipulate the person thinking they have something on them and if they confess, they will get a lesser punishment. That is the true crime.

If doctors and police would properly investigator and not close the door on underlying medical conditions to include vaccination injuries, the truth might come out and innocent people may not be sent to jail. Doctors, police and social workers have been brain washed to believe if a child presents with a brain injury of any kind and/or retinal hemorrhages, it has to be abuse. They close their minds on looking for more information and maybe some day, people might start investigating the standard of care given to these poor babies and children and realize had the doctors properly diagnosed, the child might be alive today. How many people really understand how the standard of care most likely caused the child to die? These doctors due to poor decisions ordered procedures, medicines or not ordered the proper procedures and medicine may have been the real reason that children are dying. These same doctors testify at court against the accused proclaiming to get no money for their time while berating the one or two experts who challenge the SBS theory. It's not justice .. it's not innocent until proven guilty in these cases.

Please research SBS and the controversy surrounding it. Just because a few doctors are coming forward to counter the majority, it does not make them quacks. It makes them smart for realizing the flaws in current thinking and it makes them brave for taking a stand. After all, doctors are not perfect and doctors DO make mistakes. Look at the poor babies in Indianapolis that died due to the Heparin mistake at Methodist Hospital. One of the same hospitals that are high on the list of the SBS bandwagon. Wonder why Indiana is top of the list for SBS deaths ... go ask the "forensic pediatrician" as she can tell you more.


http://www.ipetitions.com/petition/falselyaccusedofsbs/

Advice to the Falsely Accused

I was going to go one direction with this blog and switched over to a topic near and dear to me, shaken baby syndrome (SBS).

I found a story from a reporter that I feel is very courageous. This reporter showed another side of SBS that contradicts the majority of the medical profession. Fortunately for thousands, doctors are coming forward to debunk the myth behind SBS. SBS is only a theory .. yes, a theory! For all obvious reasons, they cannot test to prove it. They have conducted tests on animals and dolls specifically created to detect shaking injuries and no force could be exerted that would show the same constellation of injuries that the standards are based on. If any doctor debunks the age old myth started by Dr. Caffey, they are considered crazy or out of their minds. What they don't want you to know is Dr. Caffey backtracked on some of his original "findings" which led doubt to the theory.

Most blogs or comments noted on news sites are very intolerant and hateful towards anyone suspected, charged or found guilty. People don't understand that new scientific evidence does in fact cast doubt on SBS. The only way a majority of the people will understand if one of their loved one's become the unfortunate one to be the last one left with the child. Doctors in ERs and pathologists do not investigate all potential underlying causes that a child may present with. They usually do not look at the entire medical history of a child nor do they consider vaccinations as a culprit. Yes, vaccinations for the large part do not cause life threatening or disabling events but for the children that have something underlying in their tiny little bodies, these adult mega doses of combination vaccines (sometimes live) can create the perfect storm to unleash something horrible. There is a reason there is a vaccinate alert database that captures reported injuries. However, studies have shown that most injuries/events are not reported which waters down the real number or effect of the injuries/events associated with vaccines.

David Crowe wrote a news article which can be found here: http://atlanticfreepress.com/content/view/3700/81/

He also adds:

Financial problems with these cases are common, as 200 to 300 hours of medical research are required for each case, or even more. Dr. Mohammed Al-Bayati has set up a non-profit organization, the “International Center for Better Medicine”, so that other people can assist with the payment of his fees. Checks can be sent to this organization at 150 Bloom Drive, Dixon, CA, 95620. While Al-Bayati has acted pro-bono in several cases, he cannot always afford to do so. Every $100 donated ensures that accused parents get one hour of the best medical-legal expertise.