Thank God others are standing up against theories proven to be wrong but continued to be the cause of many innocent people getting locked away.
March 2010
Letters to the Editor
In our August 2009 issue, we published the article “Challenging an Assumption” (p. 29), which was a profile of Dr. John Plunkett, a Minnesota pathologist who questions the validity of the shaken baby syndrome diagnosis. In January, we received and published a letter critical of our article and of Dr. Plunkett’s views (p. 5). That letter was signed by members of the international advisory board of the National Center on Shaken Baby Syndrome. Since then, we have received numerous letters taking issue with their letter and the views of its signers. Clearly, we have touched a nerve in writing about this issue. Our intent for the story about Dr. Plunkett was neither to validate nor to denigrate his work. We merely wanted to highlight the fact that a Minnesota physician is taking part in a highly controversial debate that has ramifications for medicine and the legal system. Below are some of the letters we have received recently on this topic. Others can be viewed online at www.minneotamedicine.com.
—the editors
Growing Body of Contrary Evidence
In your January 2010 issue, nine doctors, a prosecutor, and a police detective—all of whom are associated with the National Center on Shaken Baby Syndrome, an advocacy group devoted to the promotion of “shaken baby” theory—attacked Dr. John Plunkett, who was featured in the August 2009 issue of Minnesota Medicine. Dr. Plunkett has spent his recent career applying basic biomechanical and medical principles to shaken baby syndrome (SBS) and testifying, if needed, when accused parents or caretakers are confronted with unproven or demonstrably incorrect medical claims. Because of his work and research by others, the literature on SBS has changed substantially since 2000, forcing major changes in the SBS position papers of the major medical organizations. In their 2010 letter, the representatives of the National Center on Shaken Baby Syndrome claim that Dr. Plunkett’s findings are based on “belief” rather than “evidence.” In fact, doctors have been diagnosing SBS for nearly 40 years without an adequate scientific basis—and in the face of a growing body of contrary evidence.
In the 1970s, “shaking” was advanced as a theory to explain a triad of findings (subdural hemorrhage, retinal hemorrhage, and/or brain swelling) that is sometimes seen in infants or children who have no signs of trauma. The theory was that shaking caused these findings by rupturing bridging veins and tearing the axons within the brain. In 1987, Dr. Ann-Christine Duhaime, a neurosurgeon working with biomechanical engineers at the University of Pennsylvania, attempted to prove that shaking could cause these injuries. However, her study
showed the opposite: The forces of shaking fell well below established injury thresholds and were 1/50th the force of impact, including impact on soft surfaces.1
Despite these findings, many doctors continued to testify that shaking was the primary or sole cause for the triad of symptoms and that it would take a fall from a multistory building to cause these findings. In 2001, Dr. Plunkett disproved this premise in an article that included a videotaped fall of a toddler from a 28-inch plastic indoor play structure that resulted in subdural hemorrhage, retinal hemorrhage, and death.2 This videotape proved definitively that short falls can cause the triad and are sometimes fatal. Although SBS proponents initially suggested that the videotape had been altered, Dr. Case (one of the signatories to the attack on Dr. Plunkett) has acknowledged the validity of the videotape, which has been shown in courtrooms and at teaching seminars in the United States and England.3 Numerous biomechanical studies have further confirmed that the force from short falls meets the injury thresholds, while shaking does not.4-6
Short falls are not the only cause of medical findings previously attributed to shaking. Studies by Dr. Jennian Geddes published in Brain, England’s leading neurology journal, from 2001 and 2003 found that the brain injuries of allegedly shaken children were generally hypoxic rather than traumatic in origin, and that subdural hemorrhages are also found in natural deaths.7,8 In 2002, Drs. Hymel, Jenny, and Block (two of whom signed the attack on Dr. Plunkett) listed the alternative causes for findings previously attributed to shaking or inflicted head trauma as accidental trauma; medical or surgical interventions; prenatal, perinatal, and pregnancy-related conditions; birth trauma; metabolic, genetic, oncologic, or infectious diseases; congenital malformations; autoimmune disorders; clotting disorders; the effects of drugs, poisons, or toxins; and other miscellaneous conditions.9 A 2006 text on abusive head trauma in infants and children (co-edited by Dr. Alexander, another signatory to the attack on Dr. Plunkett) and a 2007 review article by Patrick Barnes, professor of radiology at Stanford University and chief of pediatric neuroradiology at Lucile Salter Packard Children’s Hospital, are in accord.10 Despite this consensus, hundreds to thousands of parents and caretakers have been imprisoned based on testimony by doctors that subdural hemorrhages, retinal hemorrhages, and/or brain swelling are diagnostic of abuse, with little or no regard to the alternatives, including short falls and natural causes.
At the same time, many doctors and academics have recognized that the real problem lies in the lack of an evidence base for shaken baby theory. In 2003, a review article by Dr. Mark Donohoe found that “[T]he evidence for SBS appears analogous to an inverted pyramid, with a small data base (most of it poor-quality original research, retrospective in nature, and without appropriate control groups) spreading to a broad body of somewhat divergent opinions.” 12 In 2006, the National Association of Medical Examiners withdrew its position paper on shaking, and its annual conference included presentations with titles such as “‘Where’s the Shaking?’: Dragons, Elves, the Shaking Baby Syndrome, and Other Mythical Entities” and “Use of the Triad of Scant Subdural Hemorrhage, Brain Swelling, and Retinal Hemorrhages to Diagnose Non-Accidental Injury is Not Scientifically Valid.” In subsequent publications, Dr. Waney Squier of Oxford University, one of England’s leading neuropathologists, and Dr. Jan Leestma, author of the textbook Forensic Neuropathology, similarly concluded that the evidence base for shaken baby syndrome is lacking.13,14 None of this material is addressed or cited in the attack on Dr. Plunkett.
The problem, in short, is not that Dr. Plunkett was wrong; the problem is that he was right. Over the past decades, hundreds to thousands of caretakers—many of whom are innocent—have been convicted based on theories that lack a scientific basis. These convictions must now be revisited. Of course children are abused. But there are many ways to abuse children, one of which is ripping them from their families and imprisoning their parents and caretakers based on misdiagnoses of abuse. We therefore urge the medical profession to join us in developing a calm, rational and evidence-based approach to pediatric head injury and child death.
Heather Kirkwood, J.D.
Seattle, Washington
Barry S. Scheck, J.D.
Co-director, Innocence Project
Benjamin N. Cardozo School of Law
New York City
Keith Findley, J.D.
President, Innocence Network
Co-director, Wisconsin Innocence Project
University of Wisconsin Law School
Madison, Wisconsin
Bridget McCormack, J.D.
Co-director, Michigan Innocence Clinic
University of Michigan Law School
Ann Arbor, Michigan
Julie Jonas, J.D.
University of Minnesota Innocence Clinic
Managing Attorney, Innocence Project of Minnesota
Minneapolis, Minnesota
Jacqueline McMurtrie, J.D.
Director, Innocence Project Northwest Clinic
University of Washington School of Law Seattle, Washington
References
1. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical,
pathological, and biomechanical study. J Neurosurg 1987;66(3):409-15.
2. Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001;22(1):1-12.
3. Seventh North American Conference on Shaken Baby Syndrome (Abusive Head Trauma), Vancouver, B.C. October
2008.
4. Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J
Neurosurg 2002;16(3):220-42.
5. Prange MT, Coats B, Duhaime AC, Margulies SS. Anthropomorphic simulations of falls, shakes, and inflicted impacts
in infants. J Neurosurg 2003;99(1):143-50.
6. Goldsmith W, Plunkett J. A biomechanical analysis of the causes of traumatic brain injury in infants and children. Am
J Forensic Med Pathology 2004;25(2):89-100.
7. Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children,
I and II. Brain. 2001;124(part 7):1290-8.
8. Geddes J, Tasker RC, Hackshaw AK, et al. Dural haemorrhage in non-traumatic infant deaths: does it explain the
bleeding in ‘shaken baby syndrome’? Neuropathol Appl Neurobiol 2003;29:114-22.
9. Hymel KP, Jenny C, Block RW. Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma:
addressing the forensic controversies. Child Maltreat 2002:7(4):329-48.
10. Frasier L, Rauth-Farley K, Alexander R, Parrish R. Abusive Head Trauma in Infants and Children: A Medical,
Legal, and Forensic Reference. G.W. Medical Publishing, Inc.; St. Louis, MO: 2006.
11. Barnes PD, Krasnokutsky M. Imaging of the central nervous system in suspected or alleged nonaccidental injury,
including the mimics. Top Magn Reson Imaging 2007;18:53-74.
12. Donohoe M. Evidence-based medicine and shaken baby syndrome part I: literature review, 1966-1998. Am J Forensic
Med Pathol 2003;24(3):239-42.
13. Squier W. Shaken baby syndrome: the quest for evidence. Dev Med Child Neurol 2008;50(1):10-4.
14. Leestma J. Forensic Neuropathology, Second ed. CRC Press; Chicago: 2009.
Circular Reasoning
We read with interest Kate Ledger’s article “Challenging an Assumption: A pathologist questions shaken baby syndrome” (Minnesota Medicine, August 2009) and the response of Drs. Alexander, Barr, Block, et al. (January 2010).
Dr. Block and his cosigners complain that Ms. Ledger ignored the enormous body of international peer-reviewed medical literature about shaken baby syndrome. Much of this literature exhibits circular reasoning, selection bias, or misrepresents the data. Of the 14 references they cite, six are unsystematic reviews or consensus statements that mingle opinion with fact and add no original supporting evidence. Two are based on data described by the authors as “explorative.” Those authors suggest that “further surveillance ... and modelling will be required.” Two are invalidated by insufficiently robust criteria to reliably diagnose abuse and one by failure to address the fundamental methods on which the study was based.
Dr. Block and his cosigners suggest that this literature “consistently and repeatedly supports the concept of shaken baby syndrome.” We do not disagree with this but would point out, as Ms. Ledger clearly did, that supporting a concept is far from demonstrating the scientific basis for it.
Just as disturbing as the literature Block and his cosigners cite is the indignation they expressed that someone should challenge their opinions as medical “experts” in a court of law—as if theyare somehow exempt from the human tendency for cognitive errors in medical decision making. What scientist is afraid of debate that is crucial to our understanding of evolving ideas?
Fortunately, medicine has never been static. There is much to learn about the pathophysiology of infant brain trauma. We cannot make up for this lack of knowledge by reiterating opinion and poor data: Ignoring new evidence and failing to question and engage in debate is a dereliction of our duties to our patients and their families.
Waney Squier, FRCP FRCPath
Consultant neuropathologist
John Radcliffe Hospital
Oxford, United Kingdom
Julie Mack, M.D.
Assistant professor of radiology
Penn State Hershey Medical Center
Hershey, Pennsylvania
Patrick E. Lantz, M.D.
Professor of pathology
Wake Forest University
Winston-Salem, North Carolina
Patrick D. Barnes, M.D.
Chief of pediatric neuroradiology
Lucile Packard Children’s Hospital
Stanford University Medical Center
Stanford, California
Irene Scheimberg, M.D.
Paediatric and perinatal pathologist
The Royal London Hospital
London, England
James T. Eastman, M.D.
Clinical professor of pathology and laboratory medicine
University of Wisconsin
Madison, Wisconsin
Marta Cohen, M.D.
Sheffield Children’s Hospital NHS Foundation Trust
Sheffield, United Kingdom
Peter J. Stephens, M.D., FCAP
Forensic pathologist
Burnsville, North Carolina
Darinka Mileusnic-Polchan, M.D., Ph.D.
Medical Examiner for Knox and Anderson Counties
Regional Forensic Center
University of Tennessee Medical Center Knoxville, Tennessee
Persuasive Evidence and a Theory
I serve on occasion as an expert witness for the defense in shaken baby syndrome (SBS) cases. That is a matter I disclose as a potential conflict of interest. I wish the writers of the letter in your January 2010 issue had done the same.
When I cast doubt on the validity of SBS, I cite the original literature. In my judgment, SBS is so lacking in evidence, it is hard to understand how the hypothesis ever gained traction.1,2
I cite a review of seminal SBS literature up to 1998. It concluded the evidence was inadequate.3 I cite Ommaya, et al., who did the original work on whiplash biomechanics that debunks the SBShypothesis.4 I cite experimental work that indicates forces generated by manual shaking are an order of magnitude less than forces of impact, and less than the threshold for injury.5 I cite an article that states the neck should be destroyed if manual shaking were capable of producing brain damage.6 I have seen no case in which neck injury was observed.
Finally, I cite my own hypothesis. It is untested, just as the SBS hypothesis is untested. If the forces of shaking are sufficient to cause brain damage, the thumbs of the shaker and the places where the thumbs are applied on the victim should be conspicuously injured. They are not.
Edward N. Willey, M.D.
St. Petersburg, Florida
References
1. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 1971;2(5759):430-1.
2. Caffey J. On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and
mental retardation. Am J Dis Child 1972;124(2):161-9.
3. Donohoe M. Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966-1998. Am J Forensic
Med Pathol 2003;24(3):239-42.
4. Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J
Neurosurg 2002;16(3): 220-42.
5. Duhaime, AC, Gennarelli TA, Thibault LE, et al. The shaken baby syndrome. A clinical, pathological, and
biomechanical study. J Neurosurg 1987;66(3): 409-15.
6. Bandak FA. Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Sci Int 2005;151(1):71-9.
Showing posts with label shaken baby syndrome. Show all posts
Showing posts with label shaken baby syndrome. Show all posts
Thursday, March 11, 2010
Thursday, December 24, 2009
Long Term Study Shows Flu Shot Increases Hospitalization Risk In Children
As the "experts" continue to tout how safe and effective vaccinations are, something will get leaked. This news story is important as it shows the "experts" do not truly know or understand how vaccinations affect everyone entirely. It's safe for them to state that they are safe because the majority of children tolerate them. However, there are no long terms studies showing what these deadly chemicals and other ingredients are doing to our bodies in the long term.
What these doctors and other so called experts neglect to understand that although vaccinations are served up as a "one size fits all" program, they do not. Babies and children are dying from reactions to the vaccines and when the reason is not obvious, a caregive is being convicted under the guise of shaken baby syndrome or blunt force impact or whatever name the prosecution will utilize to sustain a conviction at all costs.
How about finding the real cause instead of being on a deadly witch hunt to convict someone? How about convicting the doctors or nurses that give these vaccines that cause injury or deaths? Perhaps if the doctors ran every imaginable test possible to rule out an underlying medical condition, a child might live or a person won't be wrongfully convicted. Has it been considered that doctors treating for SBS are the reasons why the child died? You have to treat for the correct diagnosis.
From Health Freedom Alliance:
An eight year study conducted at the Mayo Clinic, published by the American Thoracic Society suggests that there is a correlation between flu shots and risk of complications from influenza. The study evaluated every pediatric patient that was seen at the Mayo Clinic over the course of eight flu seasons to determine how much the flu shot prevented hospitalization from influenza in asthmatic children. ATS 2009, SAN DIEGO— The inactivated flu vaccine does not appear to be effective in preventing influenza-related hospitalizations in children, especially the ones with asthma. In fact, children who get the flu vaccine are more at risk for hospitalization than their peers who do not get the vaccine, according to new research that will be presented on Tuesday, May 19, at the 105th International Conference of the American Thoracic Society in San Diego.
Flu vaccine (trivalent inactivated flu vaccine—TIV) has unknown effects on asthmatics.
“The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine’s effectiveness has not been well-established,” said Avni Joshi, M.D., of the Mayo Clinic in Rochester, MN. “This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization.”
The CDC’s Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for all children aged six months to 18 years.
The National Asthma Education and Prevention Program (3rd revision) also recommends annual flu vaccination of asthmatic children older than six months. In order to determine whether the vaccine was effective in reducing the number of hospitalizations that all children, and especially the ones with asthma, faced over eight consecutive flu seasons, the researchers conducted a cohort study of 263 children who were evaluated at the Mayo Clinic in Minnesota from six months to 18 years of age, each of whom had had laboratory-confirmed influenza between 1996 to 2006. The investigators determined who had and had not received the flu vaccine, their asthma status and who did and did not require hospitalization. Records were reviewed for each subject with influenza-related illness for flu vaccination preceding the illness and hospitalization during that illness.
They found that children who had received the flu vaccine had three times the risk of hospitalization, as compared to children who had not received the vaccine. In asthmatic children, there was a significantly higher risk of hospitalization in subjects who received the TIV, as compared to those who did not (p= 0.006). But no other measured factors—such as insurance plans or severity of asthma—appeared to affect risk of hospitalization.
“While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations,” said Dr. Joshi. “More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects.”
Session # C94: “Viral Infections in Childhood Respiratory Disease”
Abstract # 561: “Flu Vaccination in Asthmatics: Does It Work?”
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561
Close Window
ATS 2009 · San Diego
International Conference
Abstract Number: 561
Contact/Presenting Author: Avni Y. Joshi
Department/Institution: Internal Medicine, Mayo Clinic
Address: 200, First St. SW
City/State/Zip/Country: Rochester, MN, 55905
Phone: 01-507-284-2511 Fax: 01-507-284-0902 E-mail: joshi.avni@mayo.edu
ATS member: No Student or in training: Yes
Funding Source: None.
Abstract Category: 14.03 - Pediatric Asthma
Presentation format: Either Poster or Oral
Preview Disclosure
Travel Award: Yes
Publication of email address: Yes, joshi.avni@mayo.edu
I confirm that all authors listed on this abstract have knowledge of the abstract submission:
Yes
Title: Flu Vaccination in Asthmatics: Does It Work?
A. Y. Joshi, MD1, V. N. Iyer, MD,MPH1, M. F. Hartz, MD1, G. W. Volcheck, MD,Ph.D1, A. M. Patel,
MD1 and J. T. Li, MD,Ph.D1. 1Mayo Clinic College of Medicine, Rochester, MN.
INTRODUCTION: Influenza is known to be associated with asthma exacerbation but the
effectiveness of the trivalent inactivated flu vaccine (TIV) in asthmatics is unknown.
METHODS: We conducted a cohort study of all pediatric subjects( 6 months to 18 years age)
who were evaluated at Mayo Clinic, Rochester, MN, USA who had laboratory confirmed influenza
during each flu season from 1999-2006 to evaluate the efficacy of TIV. A case control analysis
was performed with the cases and the controls being the subjects with asthma who did and did not
required hospitalization with the influenza illness respectively.
RESULTS:
There were 236 subjects with laboratory confirmed influenza from 1996-2006.
In assessing the effectiveness of the TIV for preventing hospitalization with influenza in all
subjects, there was an overall trend towards higher rates of hospitalization in subjects who got the
TIV as compared to the ones who did not get the TIV( OR:2.97, CI: 1.3,6.7).Using Cochran-Mantel-
Haenszel (CMH) test for Asthma status stratification, there was a significant association between
hospitalization in asthmatic subjects and TIV (P=0.006).
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561 (1 of 2) [5/11/2009 1:43:56 PM]
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561
In the asthmatic subset:
There was no association between ER visit and receiving the TIV ,severity of asthma and the risk
of hospitalization or the hospital length of stay and receiving the TIV.
In assessing access to medical care, there was no association between hospitalizations and
health care insurance plans (Odds ratio:0.3, P= 0.13)
CONCLUSION:
1) TIV did not provide any protection against hospitalization in pediatric subjects’ esp. children with
asthma. On the contrary, we found a 3- fold increased risk of hospitalization in subjects who did
get the TIV vaccine.This may be a reflection not only of the vaccine effectiveness but also the
population of children who are more likely to get the vaccine.
2) More studies are needed to assess not only the immunogenicity but also efficacy of differentinfluenza vaccines in asthmatic subjects.
http://www.thoracic.org/sections/publications/press-releases/conference/articles/2009/abstracts-and-press-releases/joshi.pdf
What these doctors and other so called experts neglect to understand that although vaccinations are served up as a "one size fits all" program, they do not. Babies and children are dying from reactions to the vaccines and when the reason is not obvious, a caregive is being convicted under the guise of shaken baby syndrome or blunt force impact or whatever name the prosecution will utilize to sustain a conviction at all costs.
How about finding the real cause instead of being on a deadly witch hunt to convict someone? How about convicting the doctors or nurses that give these vaccines that cause injury or deaths? Perhaps if the doctors ran every imaginable test possible to rule out an underlying medical condition, a child might live or a person won't be wrongfully convicted. Has it been considered that doctors treating for SBS are the reasons why the child died? You have to treat for the correct diagnosis.
From Health Freedom Alliance:
An eight year study conducted at the Mayo Clinic, published by the American Thoracic Society suggests that there is a correlation between flu shots and risk of complications from influenza. The study evaluated every pediatric patient that was seen at the Mayo Clinic over the course of eight flu seasons to determine how much the flu shot prevented hospitalization from influenza in asthmatic children. ATS 2009, SAN DIEGO— The inactivated flu vaccine does not appear to be effective in preventing influenza-related hospitalizations in children, especially the ones with asthma. In fact, children who get the flu vaccine are more at risk for hospitalization than their peers who do not get the vaccine, according to new research that will be presented on Tuesday, May 19, at the 105th International Conference of the American Thoracic Society in San Diego.
Flu vaccine (trivalent inactivated flu vaccine—TIV) has unknown effects on asthmatics.
“The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine’s effectiveness has not been well-established,” said Avni Joshi, M.D., of the Mayo Clinic in Rochester, MN. “This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization.”
The CDC’s Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for all children aged six months to 18 years.
The National Asthma Education and Prevention Program (3rd revision) also recommends annual flu vaccination of asthmatic children older than six months. In order to determine whether the vaccine was effective in reducing the number of hospitalizations that all children, and especially the ones with asthma, faced over eight consecutive flu seasons, the researchers conducted a cohort study of 263 children who were evaluated at the Mayo Clinic in Minnesota from six months to 18 years of age, each of whom had had laboratory-confirmed influenza between 1996 to 2006. The investigators determined who had and had not received the flu vaccine, their asthma status and who did and did not require hospitalization. Records were reviewed for each subject with influenza-related illness for flu vaccination preceding the illness and hospitalization during that illness.
They found that children who had received the flu vaccine had three times the risk of hospitalization, as compared to children who had not received the vaccine. In asthmatic children, there was a significantly higher risk of hospitalization in subjects who received the TIV, as compared to those who did not (p= 0.006). But no other measured factors—such as insurance plans or severity of asthma—appeared to affect risk of hospitalization.
“While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations,” said Dr. Joshi. “More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects.”
Session # C94: “Viral Infections in Childhood Respiratory Disease”
Abstract # 561: “Flu Vaccination in Asthmatics: Does It Work?”
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561
Close Window
ATS 2009 · San Diego
International Conference
Abstract Number: 561
Contact/Presenting Author: Avni Y. Joshi
Department/Institution: Internal Medicine, Mayo Clinic
Address: 200, First St. SW
City/State/Zip/Country: Rochester, MN, 55905
Phone: 01-507-284-2511 Fax: 01-507-284-0902 E-mail: joshi.avni@mayo.edu
ATS member: No Student or in training: Yes
Funding Source: None.
Abstract Category: 14.03 - Pediatric Asthma
Presentation format: Either Poster or Oral
Preview Disclosure
Travel Award: Yes
Publication of email address: Yes, joshi.avni@mayo.edu
I confirm that all authors listed on this abstract have knowledge of the abstract submission:
Yes
Title: Flu Vaccination in Asthmatics: Does It Work?
A. Y. Joshi, MD1, V. N. Iyer, MD,MPH1, M. F. Hartz, MD1, G. W. Volcheck, MD,Ph.D1, A. M. Patel,
MD1 and J. T. Li, MD,Ph.D1. 1Mayo Clinic College of Medicine, Rochester, MN.
INTRODUCTION: Influenza is known to be associated with asthma exacerbation but the
effectiveness of the trivalent inactivated flu vaccine (TIV) in asthmatics is unknown.
METHODS: We conducted a cohort study of all pediatric subjects( 6 months to 18 years age)
who were evaluated at Mayo Clinic, Rochester, MN, USA who had laboratory confirmed influenza
during each flu season from 1999-2006 to evaluate the efficacy of TIV. A case control analysis
was performed with the cases and the controls being the subjects with asthma who did and did not
required hospitalization with the influenza illness respectively.
RESULTS:
There were 236 subjects with laboratory confirmed influenza from 1996-2006.
In assessing the effectiveness of the TIV for preventing hospitalization with influenza in all
subjects, there was an overall trend towards higher rates of hospitalization in subjects who got the
TIV as compared to the ones who did not get the TIV( OR:2.97, CI: 1.3,6.7).Using Cochran-Mantel-
Haenszel (CMH) test for Asthma status stratification, there was a significant association between
hospitalization in asthmatic subjects and TIV (P=0.006).
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561 (1 of 2) [5/11/2009 1:43:56 PM]
http://www.call4abstracts.com/ats/society_admin/abs_preview.php?absnum=561
In the asthmatic subset:
There was no association between ER visit and receiving the TIV ,severity of asthma and the risk
of hospitalization or the hospital length of stay and receiving the TIV.
In assessing access to medical care, there was no association between hospitalizations and
health care insurance plans (Odds ratio:0.3, P= 0.13)
CONCLUSION:
1) TIV did not provide any protection against hospitalization in pediatric subjects’ esp. children with
asthma. On the contrary, we found a 3- fold increased risk of hospitalization in subjects who did
get the TIV vaccine.This may be a reflection not only of the vaccine effectiveness but also the
population of children who are more likely to get the vaccine.
2) More studies are needed to assess not only the immunogenicity but also efficacy of differentinfluenza vaccines in asthmatic subjects.
http://www.thoracic.org/sections/publications/press-releases/conference/articles/2009/abstracts-and-press-releases/joshi.pdf
Saturday, December 12, 2009
Bond granted for woman accused of child abuse
Christine Ferretti / The Detroit News
Mount Clemens -- A Harrison Township woman who spent more than four years behind bars on a child abuse conviction was granted bond Wednesday as she awaits a new trial.
Julie Baumer's relatives and supporters hugged and shook hands after Macomb County Circuit Court Judge James M. Biernat outlined the terms of her release from the Huron Valley Correctional Facility in Ypsilanti.
"I feel justice has been done. She's innocent," said Julie's mother, Victoria Rose-Baumer. "We never expected the first conviction. It was unjust."
Biernat granted Baumer, 33, a new trial in November on claims her previous legal representation was inadequate. She was convicted in 2005 of first-degree child abuse for shaking her infant nephew, Philipp Baumer, and leaving him blind and brain-injured. The boy has since been adopted and renamed Ben Zentz.
Biernat set a cash or surety bond of $25,000.
Baumer will be required to wear a GPS tether and reside at the Grace Centers of Hope in Pontiac, a faith-based rehabilitation campus. She's also expected to begin working for her former Mount Clemens employer, Alliance Financial, next week.
Biernat prohibited Baumer from having contact with Ben or his new family, as well as young children. Ben's adoptive parents, Debi and Philip Zentz, who attended the hearing Wednesday, said the bond was reasonable.
"It'll be good for her to go reside at this facility and benefit from the programs they can offer her," said Debi Zentz, who has said the thought of a new trial is troubling. She just wants justice for Ben and for Baumer to serve the time she was given.
The judge's decision to grant a new trial followed a series of evidentiary hearings this fall in which Baumer's new attorneys -- Carl Marlinga and Charles Lugosi -- presented experts who testified that the boy's injuries were consistent with venous sinus thrombosis or a "childhood stroke," rather than shaking.
Biernat said Baumer's previous attorney deprived her of a substantial defense by failing to retain an expert who could back up the theory that a stroke may have caused Ben's condition.
The Macomb County Prosecutor's Office plans to challenge the judge's ruling with the state Court of Appeals. Once they do, Baumer and her attorneys will have to wait to see if the higher court will affirm Biernat's decision. The University of Michigan Innocence Clinic has agreed to represent Baumer on appeal. Baumer is serving a 10- to 15-year sentence.
Mount Clemens -- A Harrison Township woman who spent more than four years behind bars on a child abuse conviction was granted bond Wednesday as she awaits a new trial.
Julie Baumer's relatives and supporters hugged and shook hands after Macomb County Circuit Court Judge James M. Biernat outlined the terms of her release from the Huron Valley Correctional Facility in Ypsilanti.
"I feel justice has been done. She's innocent," said Julie's mother, Victoria Rose-Baumer. "We never expected the first conviction. It was unjust."
Biernat granted Baumer, 33, a new trial in November on claims her previous legal representation was inadequate. She was convicted in 2005 of first-degree child abuse for shaking her infant nephew, Philipp Baumer, and leaving him blind and brain-injured. The boy has since been adopted and renamed Ben Zentz.
Biernat set a cash or surety bond of $25,000.
Baumer will be required to wear a GPS tether and reside at the Grace Centers of Hope in Pontiac, a faith-based rehabilitation campus. She's also expected to begin working for her former Mount Clemens employer, Alliance Financial, next week.
Biernat prohibited Baumer from having contact with Ben or his new family, as well as young children. Ben's adoptive parents, Debi and Philip Zentz, who attended the hearing Wednesday, said the bond was reasonable.
"It'll be good for her to go reside at this facility and benefit from the programs they can offer her," said Debi Zentz, who has said the thought of a new trial is troubling. She just wants justice for Ben and for Baumer to serve the time she was given.
The judge's decision to grant a new trial followed a series of evidentiary hearings this fall in which Baumer's new attorneys -- Carl Marlinga and Charles Lugosi -- presented experts who testified that the boy's injuries were consistent with venous sinus thrombosis or a "childhood stroke," rather than shaking.
Biernat said Baumer's previous attorney deprived her of a substantial defense by failing to retain an expert who could back up the theory that a stroke may have caused Ben's condition.
The Macomb County Prosecutor's Office plans to challenge the judge's ruling with the state Court of Appeals. Once they do, Baumer and her attorneys will have to wait to see if the higher court will affirm Biernat's decision. The University of Michigan Innocence Clinic has agreed to represent Baumer on appeal. Baumer is serving a 10- to 15-year sentence.
Monday, December 7, 2009
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.
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.
Wednesday, October 21, 2009
Soldier acquitted of causing son’s death 10/21/09
One Innocent out of Thousands Received Justice!
Soldier acquitted of causing son’s death
Oct 21 2009 12:00AM By Melissa Braun Sun Staff Writer
It took three hours of deliberation and a “not guilty” verdict to pull a Fort Rucker soldier from what he described as the “hell” of his life for the past year.
Spc. Dedrick Fisher walked away Thursday night as a free man.
A Fort Rucker court-martial panel Oct. 15 found Fisher not guilty of all charges related to the death of his son Dedrick Jr.
Fisher was found not guilty of involuntary manslaughter and the lesser-included charges of negligent homicide and battery of a child under the age of 12.
Fisher had been under watch by Army officials after his infant son, Dedrick Jr., died at Dale Medical Center in Ozark Feb. 2 as a result of injuries he sustained three months earlier.
At that time, Fisher was accused of shaking his infant son, which caused several brain and retinal hemorrhages that resulted in his death.
A court-martial panel convened Oct. 13 to determine Fisher’s future in the United States Army and whether he would be a free man.
For almost two days, government prosecutors called witnesses who presented evidence that Fisher had lost his temper and turned his aggression on his son.
With his head bowed and making little eye contact, he listened as military police and doctors describe the trauma he allegedly inflicted on his son.
He showed little reaction as investigators testified Fisher had even admitted to shaking his son, citing a written statement where Fisher said, “My son is damn near dead because of me.”
After two days of listening to evidence against him, Fisher took the stand and recalled the events in November of last year when his son’s health roller–coasted out of control.
Fisher said he was feeding his son when he began choking.
“I said, ‘You need to slow down,’” he explained, adding that when the child whined a second time he gave him the bottle again.
“He started choking bad,” Fisher said.
He testified that he patted his son on the back and then placed him on the couch.
He left the child to go into the kitchen, not realizing his child’s health was quickly deteriorating.
Moments later, his wife realized Dedrick Jr. was not breathing and his heart had stopped beating.
The next few hours, Fisher said, were “a blur.”
From finding medical help to seeing his wife in handcuffs as they were interviewed about what happened to their son, Fisher said his temper continued to rise.
“My wife was getting emotionally tortured over this, my daughter was at someone’s house I didn’t know, my child was in the hospital sick and I was like (thinking) they (investigators) are not going to let us out of here until they get what they want,” he said, adding that is the reason why he admitted to shaking his child when he didn’t. “I told her (Fisher’s wife) that when we got out of there we were going straight to Birmingham (to Children’s Hospital where the infant had been transferred) and we are going to PCS (request for transfer) out of this post.”
During questioning from the Judge Advocate General government prosecutors Capt. Christopher Coy and Capt. Shawn Tate, Fisher continued explaining what he had given a false confession to the alleged crime.
“He (military police investigator Chief Warrant Officer 3 Raymond Massey) kept on asking me the same questions over and over and I just gave him what he wanted to hear,” he said, adding that the confession changed his life. “I look at all these folks giving their kids a yank like that (how he allegedly picked up his child) and look at me, going through all this and I didn’t even do nothing.”
After three days of testimony from Fisher, law enforcement and medical personnel the verdict ultimately hinged on expert testimonies.
Dr. Ronald H. Uscinski, a world-renowned neurosurgeon from Georgetown and an expert witness for the defense, testified that Fisher did not cause his child’s brain trauma.
“I do not believe that the findings on the diagnostic studies and histories indicate the child was injured on the day in question,” he said.
He said the infant, instead, died from brain trauma, a chronic subdural hematoma, he suffered at the time of his birth.
The injury, he further explained, was caused by overlapping sutures in the child’s brain that occurred as he was pushed through the birth canal and damaged a portion of his brain.
Symptoms of the injury manifested in Nov. 2008 –– the day Fisher went under investigation for abusing his son, Uscinski said.
Uscinski explained that through his work as a neurosurgeon he no longer believes in Shaken Baby Syndrome.
“It is against the laws of physics. Human beings cannot shake a baby hard enough to cause that kind of brain trauma,” he said. “You cannot shake a baby this size hard enough (to cause these internal injuries) without breaking its neck.”
Dedrick Jr. had no injuries to any bones including his neck.
The infant’s retinal hemorrhages, he said, could have been caused by an increase in blood pressure when the hematoma began to bleed once again, but also said they could have been caused by CPR pressure.
During his time as a neurosurgeon, Uscinski said he is also unaware of any situation in which the shaking of an infant was witnessed and also resulted in a subdural leak, which he says caused the death Dedrick Jr.
Prosecution witness Dr. Melissa Peters, of Children’s Hospital in Birmingham, testified that Dedrick Jr., did suffer isolated injuries in November that caused traumatic brain injury sever enough for him to live the last two months of his life connected to breathing and feeding tubes.
Peters said she first saw Dedrick Jr. while he was in the Intensive Care Unit.
Peters said the infant had bruises on his arm, suffered hemorrhages in two locations above the brain but inside the skull, and that he also had more than 50 multi-layered retinal hemorrhages consistent with shaking injuries.
As a pediatrician at the Children’s Hospital, Peters said she is very familiar with injuries a child suffers as a result of being shaken.
“This child had evidence of severe head injury,” she said.
She also explained that the infant’s birth records signified a normal birth and that overlapping sutures are somewhat common.
In her examination of Dedrick Jr., Peters said her findings were “consistent with acute head trauma which could have involved shaking.”
His injuries were not consistent, she further explained, with normal child care or play.
Retinal hemorrhaging, she said, would not be expected from a subdural leak, despite Uscinski’s testimony otherwise.
Uscinski did not personally exam the child, but relied on tests results, including two CT scans.
Fisher’s attorney, Victor Kelley, asked the panel to weigh the experts’ testimonies and remember Uscinski specializes in neurology unlike Peter, who he called a “child advocate.”
“It is just not right to be here to begin with,” Kelley said. “If they (investigators) had gotten the right information (medical diagnosis) to begin with we wouldn’t be.”
He asked the panel to also remember that if there was any reasonable doubt in their heads about Fisher’s guilt, they must acquit.
Only a majority consensus of the six-member panel was needed for a verdict.
Soldier acquitted of causing son’s death
Oct 21 2009 12:00AM By Melissa Braun Sun Staff Writer
It took three hours of deliberation and a “not guilty” verdict to pull a Fort Rucker soldier from what he described as the “hell” of his life for the past year.
Spc. Dedrick Fisher walked away Thursday night as a free man.
A Fort Rucker court-martial panel Oct. 15 found Fisher not guilty of all charges related to the death of his son Dedrick Jr.
Fisher was found not guilty of involuntary manslaughter and the lesser-included charges of negligent homicide and battery of a child under the age of 12.
Fisher had been under watch by Army officials after his infant son, Dedrick Jr., died at Dale Medical Center in Ozark Feb. 2 as a result of injuries he sustained three months earlier.
At that time, Fisher was accused of shaking his infant son, which caused several brain and retinal hemorrhages that resulted in his death.
A court-martial panel convened Oct. 13 to determine Fisher’s future in the United States Army and whether he would be a free man.
For almost two days, government prosecutors called witnesses who presented evidence that Fisher had lost his temper and turned his aggression on his son.
With his head bowed and making little eye contact, he listened as military police and doctors describe the trauma he allegedly inflicted on his son.
He showed little reaction as investigators testified Fisher had even admitted to shaking his son, citing a written statement where Fisher said, “My son is damn near dead because of me.”
After two days of listening to evidence against him, Fisher took the stand and recalled the events in November of last year when his son’s health roller–coasted out of control.
Fisher said he was feeding his son when he began choking.
“I said, ‘You need to slow down,’” he explained, adding that when the child whined a second time he gave him the bottle again.
“He started choking bad,” Fisher said.
He testified that he patted his son on the back and then placed him on the couch.
He left the child to go into the kitchen, not realizing his child’s health was quickly deteriorating.
Moments later, his wife realized Dedrick Jr. was not breathing and his heart had stopped beating.
The next few hours, Fisher said, were “a blur.”
From finding medical help to seeing his wife in handcuffs as they were interviewed about what happened to their son, Fisher said his temper continued to rise.
“My wife was getting emotionally tortured over this, my daughter was at someone’s house I didn’t know, my child was in the hospital sick and I was like (thinking) they (investigators) are not going to let us out of here until they get what they want,” he said, adding that is the reason why he admitted to shaking his child when he didn’t. “I told her (Fisher’s wife) that when we got out of there we were going straight to Birmingham (to Children’s Hospital where the infant had been transferred) and we are going to PCS (request for transfer) out of this post.”
During questioning from the Judge Advocate General government prosecutors Capt. Christopher Coy and Capt. Shawn Tate, Fisher continued explaining what he had given a false confession to the alleged crime.
“He (military police investigator Chief Warrant Officer 3 Raymond Massey) kept on asking me the same questions over and over and I just gave him what he wanted to hear,” he said, adding that the confession changed his life. “I look at all these folks giving their kids a yank like that (how he allegedly picked up his child) and look at me, going through all this and I didn’t even do nothing.”
After three days of testimony from Fisher, law enforcement and medical personnel the verdict ultimately hinged on expert testimonies.
Dr. Ronald H. Uscinski, a world-renowned neurosurgeon from Georgetown and an expert witness for the defense, testified that Fisher did not cause his child’s brain trauma.
“I do not believe that the findings on the diagnostic studies and histories indicate the child was injured on the day in question,” he said.
He said the infant, instead, died from brain trauma, a chronic subdural hematoma, he suffered at the time of his birth.
The injury, he further explained, was caused by overlapping sutures in the child’s brain that occurred as he was pushed through the birth canal and damaged a portion of his brain.
Symptoms of the injury manifested in Nov. 2008 –– the day Fisher went under investigation for abusing his son, Uscinski said.
Uscinski explained that through his work as a neurosurgeon he no longer believes in Shaken Baby Syndrome.
“It is against the laws of physics. Human beings cannot shake a baby hard enough to cause that kind of brain trauma,” he said. “You cannot shake a baby this size hard enough (to cause these internal injuries) without breaking its neck.”
Dedrick Jr. had no injuries to any bones including his neck.
The infant’s retinal hemorrhages, he said, could have been caused by an increase in blood pressure when the hematoma began to bleed once again, but also said they could have been caused by CPR pressure.
During his time as a neurosurgeon, Uscinski said he is also unaware of any situation in which the shaking of an infant was witnessed and also resulted in a subdural leak, which he says caused the death Dedrick Jr.
Prosecution witness Dr. Melissa Peters, of Children’s Hospital in Birmingham, testified that Dedrick Jr., did suffer isolated injuries in November that caused traumatic brain injury sever enough for him to live the last two months of his life connected to breathing and feeding tubes.
Peters said she first saw Dedrick Jr. while he was in the Intensive Care Unit.
Peters said the infant had bruises on his arm, suffered hemorrhages in two locations above the brain but inside the skull, and that he also had more than 50 multi-layered retinal hemorrhages consistent with shaking injuries.
As a pediatrician at the Children’s Hospital, Peters said she is very familiar with injuries a child suffers as a result of being shaken.
“This child had evidence of severe head injury,” she said.
She also explained that the infant’s birth records signified a normal birth and that overlapping sutures are somewhat common.
In her examination of Dedrick Jr., Peters said her findings were “consistent with acute head trauma which could have involved shaking.”
His injuries were not consistent, she further explained, with normal child care or play.
Retinal hemorrhaging, she said, would not be expected from a subdural leak, despite Uscinski’s testimony otherwise.
Uscinski did not personally exam the child, but relied on tests results, including two CT scans.
Fisher’s attorney, Victor Kelley, asked the panel to weigh the experts’ testimonies and remember Uscinski specializes in neurology unlike Peter, who he called a “child advocate.”
“It is just not right to be here to begin with,” Kelley said. “If they (investigators) had gotten the right information (medical diagnosis) to begin with we wouldn’t be.”
He asked the panel to also remember that if there was any reasonable doubt in their heads about Fisher’s guilt, they must acquit.
Only a majority consensus of the six-member panel was needed for a verdict.
Sunday, October 18, 2009
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:
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
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
Sunday, August 9, 2009
Click here for the whole story.
THE NEXT INNOCENCE PROJECT:
SHAKEN BABY SYNDROME AND THE CRIMINAL COURTS
DEBORAH TUERKHEIMER
Every year in this country, hundreds of people are convicted of having shaken a baby, most often to death. In a prosecution paradigm without precedent, expert medical testimony is used to establish that a crime occurred, that the defendant caused the infant's death by shaking, and that the shaking was sufficiently forceful to constitute depraved indifference to human life.
Shaken Baby Syndrome (SBS) is, in essence, a medical diagnosis of murder, one based solely on the presence of a diagnostic triad: retinal bleeding, bleeding in the protective layer of the brain, and brain swelling.
New scientific research has cast doubt on the forensic significance of this triad, thereby undermining the foundations of thousands of SBS convictions. Outside the United States, this scientific evolution has prompted systemic reevaluations of the prosecutorial paradigm. In contrast, our criminal justice system has failed to absorb the latest scientific knowledge. This is beginning to change, yet the response has been halting and inconsistent. To this day, triad-based convictions continue to be affirmed, and new prosecutions commenced, as a matter of course.
This Article identifies a criminal justice crisis and begins a conversation about its proper resolution. The conceptual implications of the inquiry—for scientific engagement in law's
shadow, for future systemic reform, and for the notion of innocence in a post-DNA world—should assist in the task of righting past wrongs and averting further injustice.
THE NEXT INNOCENCE PROJECT:
SHAKEN BABY SYNDROME AND THE CRIMINAL COURTS
DEBORAH TUERKHEIMER
Every year in this country, hundreds of people are convicted of having shaken a baby, most often to death. In a prosecution paradigm without precedent, expert medical testimony is used to establish that a crime occurred, that the defendant caused the infant's death by shaking, and that the shaking was sufficiently forceful to constitute depraved indifference to human life.
Shaken Baby Syndrome (SBS) is, in essence, a medical diagnosis of murder, one based solely on the presence of a diagnostic triad: retinal bleeding, bleeding in the protective layer of the brain, and brain swelling.
New scientific research has cast doubt on the forensic significance of this triad, thereby undermining the foundations of thousands of SBS convictions. Outside the United States, this scientific evolution has prompted systemic reevaluations of the prosecutorial paradigm. In contrast, our criminal justice system has failed to absorb the latest scientific knowledge. This is beginning to change, yet the response has been halting and inconsistent. To this day, triad-based convictions continue to be affirmed, and new prosecutions commenced, as a matter of course.
This Article identifies a criminal justice crisis and begins a conversation about its proper resolution. The conceptual implications of the inquiry—for scientific engagement in law's
shadow, for future systemic reform, and for the notion of innocence in a post-DNA world—should assist in the task of righting past wrongs and averting further injustice.
Friday, July 31, 2009
Baby's death ruled accident, mother still in jail
http://www.venturacountystar.com/news/2009/jul/30/babys-death-ruled-accidental-but-mother-still-in/
Baby's death ruled accident, mother still in jail
By Raul Hernandez (Contact) Thursday, July 30, 2009
The infant died from blunt-force trauma, according to the Ventura County Medical Examiner.
“The manner of death was ruled as accidental,” Chief Deputy Medical Examiner James Baroni said Wednesday.
The mother, Cecilia Garcia Cortes, 23, of Oxnard, has been in jail with bail set at $500,000 since her arrest in April.
Cortes’ lawyer, Barbara Lewis, who works for the Public Defender’s Office, said the baby was accidentally dropped by Cortes’ boyfriend.
The child died April 30, according to police, and Cortes was accused of fatally shaking the girl. Lewis said the autopsy was performed May 1, but she didn’t get a copy of the results from the District Attorney’s Office until July 17. She said she was told prosecutors received the results a day earlier.
Lewis said prosecutor Thomas Dunlevy indicated the district attorney is going to seek a second opinion, even though the office has relied on the Ventura County Medical Examiner to do hundreds of autopsies.
“There is no reason to doubt his opinion here,” she said.
Lewis said she will try to meet with Dunlevy this week or next to discuss the case.
An early disposition conference on the case is scheduled for Wednesday, Lewis said.
Dunlevy declined to comment. He said his office will conduct further investigation and know in the next few weeks whether the charges against Cortes will be dismissed.
Baroni said the child died because she didn’t get enough oxygen to the brain after the blunt-force trauma. He said the autopsy required further tests and everything had to be thoroughly reviewed before the medical examiner could issue the findings.
Lewis said Cortes has always maintained that the death was an accident. “She knew the truth would come out,” Lewis said.
Oxnard police initially alleged the infant was crying continuously and Cortes became upset with her. Police said they believed Cortes violently shook the baby to get her to stop crying.
The alleged incident occurred April 27 in the 4800 block of Saviers Road in Oxnard, where Cortes lived after having recently moved from Fillmore, according to police.
The baby stopped breathing several hours later, police said. The child was taken to the hospital and died three days later, police said.
Baby's death ruled accident, mother still in jail
By Raul Hernandez (Contact) Thursday, July 30, 2009
The infant died from blunt-force trauma, according to the Ventura County Medical Examiner.
“The manner of death was ruled as accidental,” Chief Deputy Medical Examiner James Baroni said Wednesday.
The mother, Cecilia Garcia Cortes, 23, of Oxnard, has been in jail with bail set at $500,000 since her arrest in April.
Cortes’ lawyer, Barbara Lewis, who works for the Public Defender’s Office, said the baby was accidentally dropped by Cortes’ boyfriend.
The child died April 30, according to police, and Cortes was accused of fatally shaking the girl. Lewis said the autopsy was performed May 1, but she didn’t get a copy of the results from the District Attorney’s Office until July 17. She said she was told prosecutors received the results a day earlier.
Lewis said prosecutor Thomas Dunlevy indicated the district attorney is going to seek a second opinion, even though the office has relied on the Ventura County Medical Examiner to do hundreds of autopsies.
“There is no reason to doubt his opinion here,” she said.
Lewis said she will try to meet with Dunlevy this week or next to discuss the case.
An early disposition conference on the case is scheduled for Wednesday, Lewis said.
Dunlevy declined to comment. He said his office will conduct further investigation and know in the next few weeks whether the charges against Cortes will be dismissed.
Baroni said the child died because she didn’t get enough oxygen to the brain after the blunt-force trauma. He said the autopsy required further tests and everything had to be thoroughly reviewed before the medical examiner could issue the findings.
Lewis said Cortes has always maintained that the death was an accident. “She knew the truth would come out,” Lewis said.
Oxnard police initially alleged the infant was crying continuously and Cortes became upset with her. Police said they believed Cortes violently shook the baby to get her to stop crying.
The alleged incident occurred April 27 in the 4800 block of Saviers Road in Oxnard, where Cortes lived after having recently moved from Fillmore, according to police.
The baby stopped breathing several hours later, police said. The child was taken to the hospital and died three days later, police said.
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.
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.
Wednesday, May 28, 2008
It's a sad time for justice when the convictions of not just one but many people are being relooked at due to one doctor's overzealous desire gets out of control. In Canada, an inquiry coined the Goudge Inquiry started to look at the forensic pathology of infants and small children by a man named Dr. Smith. I suspect Dr. Smith had good intentions as anyone who hurts babies and children ought to be punished to the fullest extent but when that need is overcome by too much passion, innocent people begin to suffer.
The purpose of the Goudge Commission was to:
The Commission's mandate is to conduct a systemic review and to assess the policies, procedures, practices, accountability and oversight mechanisms, quality control measures and institutional arrangements of pediatric forensic pathology in Ontario from 1981 to 2001 as they relate to its practice and use in investigations and criminal proceedings.
The Commission will also review and assess the legislative and regulatory provisions related to the practice of pediatric forensic pathology between 1981 and 2001 and any changes in the above after 2001.
The Commission is to make recommendations to restore and enhance public confidence in pediatric forensic pathology in Ontario and its future use in investigations and criminal proceedings.
The Government appointed Senator Larry Campbell to chair an expert medical and scientific panel which shall report to the Commissioner and provide information and advice to him.
The Commission's mandate does not include reporting on any individual cases that have been or may subject to a criminal investigation or proceeding.
http://www.goudgeinquiry.ca/
Prior to SBS hitting me personally, I believed all I read in the news stories and didn't question doctors. Funny how one moment in time can change lives so drastically.
The purpose of the Goudge Commission was to:
The Commission's mandate is to conduct a systemic review and to assess the policies, procedures, practices, accountability and oversight mechanisms, quality control measures and institutional arrangements of pediatric forensic pathology in Ontario from 1981 to 2001 as they relate to its practice and use in investigations and criminal proceedings.
The Commission will also review and assess the legislative and regulatory provisions related to the practice of pediatric forensic pathology between 1981 and 2001 and any changes in the above after 2001.
The Commission is to make recommendations to restore and enhance public confidence in pediatric forensic pathology in Ontario and its future use in investigations and criminal proceedings.
The Government appointed Senator Larry Campbell to chair an expert medical and scientific panel which shall report to the Commissioner and provide information and advice to him.
The Commission's mandate does not include reporting on any individual cases that have been or may subject to a criminal investigation or proceeding.
http://www.goudgeinquiry.ca/
Prior to SBS hitting me personally, I believed all I read in the news stories and didn't question doctors. Funny how one moment in time can change lives so drastically.
Wednesday, May 21, 2008
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?
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?
Monday, May 19, 2008
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 ...
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 ...
Friday, May 16, 2008
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/
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/
Monday, May 5, 2008
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.
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.
Subscribe to:
Posts (Atom)