More Doctors Questioning 'Shaken-Baby Syndrome', Feb 2011

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More Doctors Questioning 'Shaken-Baby Syndrome'

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February 9, 2011

For years, cases involving shaken-baby syndrome were often open-and-shut

­ with the last person to care for the child labeled the abuser. But

Slate editor Bazelon reports that a growing number of

doctors say the syndrome could have alternate explanations.

Copyright © 2011 National Public Radio®. For personal, noncommercial use

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NEAL CONAN, host:

In 1993, forensic pathologist Huntington testified that

7-month-old Beard showed the characteristic symptoms of a

shaken-baby, and given the timing, her caregiver, Audrey Edmunds, had to

be responsible for her death.

Ten years later, Huntington said in a retrial, he was no longer

comfortable with that verdict, that other things could explain the

subdural bleeding, retinal hemorrhaging and brain swelling, and that new

research also throws doubt on the timing of the injury.

In last week's edition of The New York Times Magazine, senior Slate

editor Bazelon reported that shaken-baby cases may no longer be as

clear cut as previously believed, and that a fierce debate is underway.

Pediatricians, health care workers, what do you do when you suspect

shaken-baby syndrome? . Email us, talk@.... You could

also join the conversation on our website. That's at npr.org. Click on

TALK OF THE NATION.

Bazelon is senior editor at Slate, also a Truman Capote law and

media fellow at Yale Law School, and joins us now from a studio in North

Haven, Connecticut.

Nice to have you with us today.

Ms. EMILY BAZELON (Senior Editor, Slate): Thanks so much for having me.

CONAN: And the cases you talk about in your piece, these women who've

been exonerated after serving time, what's changed in the way that we now

understand shaken-baby syndrome?

Ms. BAZELON: One of the things that's changed, it relates to

Huntington's testimony as you were just talking about, and that is how

definitive doctors can be about timing and injury. It used to be that the

assumption was that every time you had evidence of the shaking - medical

evidence - that you knew, you assumed that the baby would immediately

stop breathing and go into a coma. And that meant that the last person

taking care of the baby was necessarily the guilty party.

Now doctors acknowledged that there are some cases - and there's a debate

about how rare this is - but that in at least a few cases it's possible

for a child to remain conscious for some amount of time. Not to be

totally normal, necessarily, but to be sleepy or fussy or not eating

regularly, as opposed to immediately unconscious.

CONAN: And there's also - your article talks about that those three

symptoms, subdural bleeding, retinal hemorrhaging, brain swelling - if

those three were present even without bruises or broken bones or other

injuries evident, doctors still said that used to be solid evidence of

shaken baby.

Ms. BAZELON: Doctors used to say that that had to be shaking, that it was

-there was only one explanation. And now we know - and again, there is a

big debate about how rare this is. But now we know there are possible

alternate causes of those symptoms. There are certain bleeding disorders

that cause those symptoms. Some doctors, though not all - many dispute

this - but some doctors think that it's possible for certain accidental

falls to cause those symptoms.

And so this is really the debate. It is a debate about, in criminal

court, where, if we're going to convict someone, then the standard is

beyond a reasonable doubt, whether there's always that level of certainty

in these criminal cases.

CONAN: Well, how many of these cases come up every year?

Ms. BAZELON: So there are between 12 and 14 hundred cases of children

attributed to abusive head injury every year. And we're talking about a

small subset of those cases in which they go to court - they are criminal

charges -and the only medical evidence of abuse are these internal

injuries that you described. And so no one - the numbers are a little

fuzzy. But the best estimates I was getting were that there are between

100 and 150 cases a year in this category.

CONAN: And this case goes back to, I guess, the most famous shaken baby

case, and that was - involved the English au pair Louise Woodward, who

was put on trial - and I guess a celebrated trial - about 20 years ago.

Ms. BAZELON: That's right. This is 1998. Louise Woodward was a

19-year-old British au pair. She was taking care of a baby who collapsed

in her care. This child wasn't - did not simply have internal bleeding

and swelling. He also had a skull fracture. And one of the big debates at

the trial was whether that skull fracture was old or whether it has been

inflicted, you know, in the few hours before he died, when he was in

Louise Woodward's care.

CONAN: And the verdict in that case was guilty. Yet Louise Woodward was,

well, dismissed with time served.

Ms. BAZELON: That's right. The jury believed the prosecution's experts,

who said essentially that the medical evidence meant that Woodward must

have abused this child, given that she was his caregiver before his

death. But the judge, without explaining why - trial judges don't have to

necessarily give reasons -he reduced the charges to involuntary

manslaughter and then let her go for time served.

CONAN: And the testimony in that case by Barry Scheck, who's since become

better known as one of the principals in the Innocence Project, but his

testimony seemed, you say, to lay the groundwork for doubts that have

since sprung up.

Ms. BAZELON: Right. Well, Scheck was the lawyer in that case, and then

there were a bunch of experts who were testifying on both sides, and

Scheck's strategy in that case, to really bring in doctors who had an

alternate explanation, at least for the timing of the baby's injuries -

this was the first big courtroom battle over shaken baby syndrome.

CONAN: And given the doubts that had been thrown up, are the convictions

that have occurred in other cases being reconsidered?

Ms. BAZELON: Right. Exactly. Then you have Audrey Edmunds' case. We were

talking about her earlier. She was running a small little day care inside

her house and a baby died in her care. When she went on trial in 1996, no

one really questioned the evidence about the timing. And so since Audrey

Edmunds had been the baby's caregiver and she had these - the baby had

these injuries, Edmunds was convicted.

Then, a decade later, she was having a hearing about whether she would

deserve a new trial or not. And Huntington, the pathologist who

had testified at the first trial, came back and said that he had

personally observed a child with subdural and retinal bleeding who had

been lucid for a period before collapsing, and that made him go back and

look at the literature. And he no longer felt confident about timing that

child's injuries.

And based on that, the Wisconsin Appeals Court said, you know, there's

really fierce disagreement now among doctors about this aspect of this

case, and as a result we are going to grant Audrey Edmunds a new trial.

The prosecutors then decided to drop the charges against her, and she was

released after serving nearly 12 years in prison.

CONAN: And does this suggest that someone else may have been responsible,

at least in some cases, or that there are these other - well, in some

cases, difficult births may have been responsible?

Ms. BAZELON: Well, the first possibility is certainly there. It is

certainly possible that most of these children were, in fact, abused and

what we just don't know with enough certainty is who did it. Then there

are other cases in which it's possible that there are alternate

explanations for these injuries that we don't fully understand now and

that more research really needs to be done to figure out how probable

that is or isn't.

CONAN: We're talking with Bazelon, who wrote " Shaken-Baby

Syndrome Faces New Questions in Courts " for last week's New York

Times Magazine.

You can find a link to that article on our website. Go to npr.org. Click

on TALK OF THE NATION. And you're listening to TALK OF THE NATION, which

is coming to you from NPR News.

And let's get a caller on the line. This is , with us from

Phoenix.

CYNTHIA (Caller): Yes. I would just like to thank Ms. Bazelon for her

article and bringing this to the front of the public. I used to be an

attorney. I'm actually no longer an attorney, but about 10 years ago I

represented a woman who was charged with shaken baby. She was convicted

on a second degree - excuse me, on a manslaughter. She had been tried,

and prosecution wanted to go for, actually, a first degree murder on this

charge. That - at the time England (technical difficulties)...

CONAN: We're having troubles. , somebody is trying to dial on your

phone.

CYNTHIA: Oh, dear.

CONAN: Yes. I think it's better now. They may have realized it.

CYNTHIA: All right. England, you know, 10 years ago was throwing out all

of their cases in which parents had been relieved of their children -

their children taken away, because of the medical evidence that was

coming out on that side of the world. And I think it's fantastic that the

American Medical Society is finally catching up with what science has

been showing on there's like 2,000 articles written by medical

professionals in other countries, in Sweden, in Germany, in Great

Britain, that have always been saying this. It's -I just think it's

wonderful that the American side is finally taking care of that.

CONAN: , thanks very much for the call. Appreciate it.

CYNTHIA: Thank you.

CONAN: Let's see if we can go next to - this is Marilyn. And Marilyn is

on the line from Vancouver in Canada.

Ms. MARILYN BARR (Executive Director, National Center on Shaken Baby

Syndrome): Yes. I'm calling - I'm out of the country now, but I'm the

executive director of the National Center on Shaken Baby Syndrome. I

completely disagree with the last caller, that the mainstream scientists

in other countries feel this way. And I think it's really important that

the public knows that shaken baby syndrome is real and recognized public

health problem.

We resented that the article indicated that there were all kinds of

people sitting in prisons that had been wrongfully convicted, although we

feel like everyone else, that we would not want anyone wrongfully

convicted. But it's important to know that mainstream scientists, medical

organizations like the American Academy of Pediatrics, Centers for

Disease Control, National Association of Medical Examiners, the Academy

of Ophthalmology, have all published statements and recognized shaken

baby syndrome.

I also think it's important for the public to know that every day teams

of physicians make very hard decisions in these cases to determine if

this injured child is a result of abuse. Let me tell you who these teams

are. They're the teams of pediatric radiologists, neurosurgeons and

pediatricians who work at your local children's hospitals. These are the

doctors that are - they're not in some child abuse clinic looking for

some abuse. The doctors agonize over these decisions, to say it might be

abuse. And they look at other possible explanations, including mimics. In

many of these cases there's other signs of physical abuse, and medical

examiners will tell you that when they're doing autopsies they find

numerous broken bones and bruises over the body of a dead baby. But it's

the head injury that kills the baby.

CONAN: Marilyn, we wanted to give Bazelon a chance to respond.

Ms. BAZELON: Well, I think this is exactly the intention the

intention(ph) here. And I'm so glad you called, because it is enormously

important for doctors to investigate these kinds of symptoms. And you're

right, much of the time there is other medical evidence of a history of

abuse. I was trying to pinpoint a smaller number of cases in which there

is no such other medical evidence and in which we may be possibly too

ready to convict people. And it seems to me that those adults also have

rights and a kind of, you know, an importance in this equation as well as

all the children who - yes, it is true, doctors are trying so hard to

protect in doing important work in trying to do that.

CONAN: And, Bazelon, if I read your article correctly, you argued

that about half the shaken baby cases, that only these internal injury

symptoms exist, to suggest that it happened.

Ms. BAZELON: Well, that's in the - the cases that go - that are

prosecuted. There are about 200 a year. And of those cases, between half

and three quarters, according to the prosecutors I talked to, there is

only medical evidence from the internal bleeding and the brain swelling

as opposed to things like fractures and bruises, which obviously that's a

whole different scenario for both doctors and for the legal system.

CONAN: But not to argue that there is no such as shaken baby syndrome,

clearly...

Ms. BAZELON: Absolutely, no. That is not the point I want people to take

from my piece.

CONAN: Marilyn?

Ms. BARR: Well, it was the point, , that you gave of - the title of

it was a flawed diagnosis, and so that certainly lends to the situation

that there's this whole bulk of physicians and people who were

incorrectly diagnosing this. And I just think that that impression is not

only completely wrong but very, very dangerous. And as you know, you talk

to many of the top people in world, actually, and they spend hours and

hours being interviewed by you. But the representation in the article was

more representative of the few, I'd say 10 or so, of the people - the

witnesses that are testifying in these cases over and over again in every

city...

CONAN: And Marilyn...

Ms. BARR: ...who are paid a high price to do so.

CONAN: And Marilyn, I don't want to break you off again, but we just have

a very few seconds left. And I want to give a chance to respond.

Ms. BAZELON: Well, it's true that some witnesses for the defense make

money doing so. It is also true that some witnesses for the prosecution

make money. And I think in the end this really has to be a debate that is

about the science, what the research does and doesn't show, and what we

could do to complete that picture.

CONAN: Marilyn, thanks very much for the call. We appreciate your time.

MARILYN: OK.

Ms. BARR: Bazelon, thank you very much for being with us today.

Ms. BAZELON: Thanks so much for having me.

CONAN: Senior Slate editor Bazelon joined us from a studio in North

Haven, Connecticut. You can find a link to her New York Times Magazine

piece at our website. Go to npr.org, click on TALK OF THE NATION.

Tomorrow - well, there'll be another program tomorrow. This is NPR News.

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