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Houston Shaken Baby Defense: Shaking Baby Syndrome: A Diagnosis That Divides The Medical World

Posted on August 5, 2016 by Jesse Quackenbush

Video provided by NYT.

Perhaps no crime staggers the mind, or turns the stomach, more than the murder of a baby, and so it is not a surprise when law enforcement comes down hard on the presumed killers. Often enough, these are men and women accused of having succumbed to sudden rage or simmering frustration and literally shaken the life out of a helpless infant who would not stop crying or would not fall asleep.

Shaken baby syndrome has been a recognized diagnosis for several decades, though many medical professionals now prefer the term abusive head trauma. It is defined by a constellation of symptoms known as the triad: brain swelling, bleeding on the surface of the brain and bleeding behind the eyes. For years, those three symptoms by themselves were uniformly accepted as evidence that a crime had been committed, even in the absence of bruises, broken bones or other signs of abuse. While many doctors, maybe most, still swear by the diagnosis, a growing number have lost faith. Not that they doubt that some babies have been abused. But these skeptics assert that factors other than shaking, and having nothing to do with criminal behavior, may sometimes explain the triad.

Has the syndrome been diagnosed too liberally? Are some innocent parents and other caretakers being wrongly sent to prison? Those questions, at the complex intersection of medicine and the law, can stir strong emotions among doctors, parents and prosecutors. They shape this first installment in a new series of Retro Report, video documentaries that explore major news stories of the past and their enduring consequences.

The video’s starting point is a Massachusetts criminal case that introduced the concept of shaken baby syndrome to many Americans: the 1997 murder trial of Louise Woodward, an 18-year-old British au pair accused of having shaken an 8-month-old boy, Matthew Eappen, so aggressively that he died. Matthew also had injuries that may have predated Ms. Woodward’s joining the Eappen family in Newton, outside Boston. The focus, however, was on the triad of symptoms. To prosecution witnesses, they proved that the baby had been shaken violently, his head hitting some hard surface.

Throughout, Ms. Woodward insisted on her innocence. But a jury in state court found her guilty of second-degree murder, and she was sentenced to a prison term of 15 years to life. Within days, though, the trial judge called the murder conviction an injustice. He knocked down the charge to involuntary manslaughter, reducing the young woman’s sentence to time already served, 279 days. Many in Massachusetts and beyond were outraged. Nonetheless, Ms. Woodward was free to return to England.

The “nanny murder trial,” as headline writers called it, had an unfortunate subplot. In some quarters of public opinion, Matthew’s mother, Deborah Eappen, stood figuratively in the dock as well. A doctor — like her husband, Sunil Eappen — she found herself under the sort of attack many working women face to this day. The case, a New York Times article said in 1997, “put a spotlight on the backlash against working mothers who consign their children to the care of others.”

But the dominant issue was child abuse. Shaken baby syndrome is but one aspect of this phenomenon. It is a topic in which statistics can be elusive because reported episodes may not reflect the full extent of the problem. That said, a report issued in April by a division of the Department of Health and Human Services estimated that in 2013, more than 1,500 children in the United States, or four a day, died from various forms of abuse or neglect. Nearly three-fourths of the victims were under the age of 3. (Various studies over the years have suggested that a serious threat to a small child’s well-being is the presence of the mother’s live-in boyfriend.)

But after the trial, he rethought his testimony and in effect became a penitent. He is now convinced that the diagnosis has been invoked too readily in criminal cases and that other causes might explain any bleeding and brain swelling. They include infections, earlier injuries from accidental falls and even strokes that occurred in utero. Other doctors who share his outlook question whether just shaking an infant, without resorting to other forms of violence, could in fact produce the triad’s telltale signs. Testing that thesis, though, may verge on the impossible: Who in the name of responsible science is about to shake a roomful of babies to see what happens?

Without question, Dr. Barnes said, abuse exists, “and we have to do our duty to protect children.” But families need protection, too, he said, and in some criminal cases, “there is no doubt that errors have been made and injustices have resulted.” Were he able to testify again in the Woodward trial, he said, he would say that the medical findings do not confirm abuse and that the baby’s injuries “could have been accidental.”

One of the more exhaustive studies of shaken baby syndrome’s legal ramifications was conducted by The Washington Post and journalists from the Medill Justice Project at Northwestern University. In March, they published their analysis of about 1,800 abuse cases across the country that had reached resolution since 2001. Far more often than not — 1,600 cases — the result was a conviction. But the researchers found that in 200 cases, a substantial number, charges were dropped or dismissed, defendants were acquitted or convictions were overturned. The Retro Report video examines one such instance, involving Quentin Stone, a California man whom a jury last year cleared of charges that he had violently shaken his 3-month-old son to death.

Not that the medical establishment is starting to line up on Dr. Barnes’s side. Far from it. Dr. Robert W. Block, a former president of the American Academy of Pediatrics, stands firmly by the diagnosis, telling Retro Report that abusive head trauma is supported by decades of observation.

The divisions within the medical world run so deep that they pain a towering figure on this issue: Dr. A. Norman Guthkelch, a British doctor who in 1971 found a connection between baby-shaking and brain injury. “There are cases where people on both sides, both of whom I admire equally, are barely able to speak to one another, and that’s a shame,” Dr. Guthkelch, who turned 100 this month, told NPR in 2011. Yet he, too, has come to believe that the syndrome is applied too loosely in some criminal cases.

As the debate continues, Louise Woodward has carved out a new life in Shropshire, in central England, where she teaches dance. Married, she has a baby of her own now, a girl born 20 months ago. Even before her pregnancy, she was quoted as telling The Daily Mail: “I know there are some people waiting for me to have a baby so they can say nasty things. It upsets me, but that is not going to stop me leading my life. I am innocent. I have done nothing wrong.”

Story provided by New York Times.

If you have any questions or need legal advice, feel free to contact me directly at your convenience.

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Jesse Quackenbush
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