Sentinel Injuries in Infants Evaluated for Child Physical Abuse, Pediatrics, 11 March.
http://pediatrics.aappublications.org/content/early/2013/03/06/peds.2012-2780

Rethinking Shaken Baby Syndrome,
http://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome?sc=tw&cc=share

Finally, a Judge Calls Shaken Baby Diagnosis an “Article of Faith”

 

theory of shaken baby syndrome.

Tragic Case of Shaken Baby Syndrome Rooted in “Flimsy” Science: Expert

 

 

Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

http://jjie.org/fractured-leg-fractured-family-misdiagnosis-leads-allegations-of-abuse/43001

DELAYED DEATH IN SUDDEN INFANT DEATH SYNDROME

https://docs.google.com/viewer?a=v&pid=gmail&attid=0.2&thid=12fe128c88087f2c&mt=application/pdf&url=https://mail.google.com/mail/?ui%3D2%26ik%3Dfb0bdd0df1%26view%3Datt%26th%3D12fe128c88087f2c%26attid%3D0.2%26disp%3Dattd%26zw&sig=AHIEtbSV2C4LXmFAlVLWrBJvTwexhHDI9

Educating New Parents Cuts Shaken Baby Syndrome

 

http://article.wn.com/view/2011/10/24/Educating_New_Parents_Cuts_Shaken_Baby_Syndrome/

Harmful and Misleading Information Being Spread about Infant Sleep

http://www.prweb.com/releases/prwebinfant-

INFLICTED BRAIN INJURIES DO NOT DISCARD DIFFERENTIAL DIAGNOSIS

http://www.jpands.org/vol15no1/innis.pdf

VACCINES APPARENT LIFE THREATENING EVENTS BARLOWS DISEASE AND QUESTIONS ABOUT SHAKEN BABY SYNDROME

VACCINES APPARENT LIFE THREATENING EVENTS BARLOWS DISEASE AND QUESTIONS ABOUT SHAKEN BABY SYNDROME

https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1&thid=13a6cb77ce51f975&mt=application/pdf&url=https://mail.google.com/mail/u/0/?ui%3D2%26ik%3Dfb0bdd0df1%26view%3Datt%26th%3D13a6cb77ce51f975%26attid%3D0.1%26disp%3Dsafe%26zw&sig=AHIEtbR2yjkZ7t9d-JZwKDgXx453WKml2Q

Bone Diseases That Lead To False Allegations Of Non-Accidental Injury

http://www.zimbio.com/Osteogenesis+Imperfecta/articles/joTVp6tF8SX/Bone+Diseases+Lead+False+Allegations+Non+Accidental

Temporary Brittle Bone Disease and Infant Fractures

Temporary Brittle Bone Disease and Infant Fractures
http://archive.newsmax.com/archives/articles/2005/10/5/125542.shtml

The Unexonerated: Factually Innocent Defendants Who Plead Guilty

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2103787

New doubts in ‘shaken baby’ fatalities

http://www.azcentral.com/news/articles/20120904shaken-baby-fatalities-doubts.html?nclick_check=1#ixzz26diaFfDp

Vitamin D Deficiency in Critically Ill Children

http://pediatrics.aappublications.org/content/early/2012/08/01/peds

Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2048374

THE CASE FOR SHAKEN BABY SYNDROME REVIEW

http://www.mjlr.org/wp-content/uploads/2012/05/Burg_45.3.pdf

DISTINGUISHING BETWEEN INFLICTED AND NON INFLICTED BRAIN INJURY IN CHILDREN

http://adc.bmj.com/content/94/11/860.full.pdf+html

Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

http://www.bmj.com/rapid-response/2011/11/01/sudden-infant-death-explained

A new cause for retinal haemorrhage and disc oedema in child abuse

http://www.nature.com/eye/journal/v18/n1/full/6700480a.html

TRAUMATIC BRAIN INJURY AND SHAKEN BABY SYNDROME

http://www.actamedicaportuguesa.com/pdf/2011-24/5/805-808.pdf

Shaken baby syndrome: a search for truth

http://articles.chicagotribune.com/2005-06-12/features/0506120513_1_child-abu…

Shaken-Baby Syndrome Faces New Questions in Court

http://www.nytimes.com/2011/02/06/magazine/06baby-t.html?_r=2&pagewanted=all

MEDICINE DISCOVERS CHILD ABUSE

http://jama.jamanetwork.com/article.aspx?volume=300&issue=23&page=2796

Dubious ‘experts’ are paid to tear families apart

Dubious ‘experts’ are paid to tear families apart A new report condemns the shoddy standards of psychologists’ reports in our family courts.

Many mothers have been declared unfit on the strength of ‘very poor’ psychologists’ reports Photo: ALAMY

By

7:00PM GMT 17 Mar 2012

A long overdue scandal hit the headlines last week when a semi-official report exposed one of the murkiest corners of our child protection system – the way that supposed professional “experts” help social workers to remove children from their parents.

A study by Professor Jane Ireland, a forensic psychologist, for the Family Justice Council examined 126 psychological reports trawled at random from family court documents. It found that two thirds of them were “poor” or “very poor” in quality; that 20 per cent of their authors had no proper qualifications; and that no fewer than 90 per cent of the authors were not practising psychologists but appeared to earn their livings, wholly or partly, from writing reports for social workers. Already one psychologist, whose company has made nearly half a million pounds a year from such reports, is under investigation by the General Medical Council.

The picture Prof Ireland conveys is one with which I am only too familiar. I have seen how families can be torn apart largely on the basis of highly dubious psychological evidence designed, as John Hemming MP puts it, to “suit the demands of local authorities”. One mother lost her children, for instance, on the basis of a 235-page report, costing £14,000, which found that she was “likely to have a borderline personality disorder” – without the author ever having met her.

Another woman was found by a psychologist to be “a competent mother” – so the social workers went to a second witness, who found the same. They then commissioned a third, who at last came up with what they wanted: that the mother had, again, “a borderline personality disorder”. On that basis, her three children were sent for adoption.

A married couple lost their daughter because the father, who had had four “psychological assessments”, saw no reason to submit himself to a fifth. The Court of Appeal found that he seemed to be putting his “emotional needs before those of his child”, and ordered that the child be adopted.

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Damning as Prof Ireland’s report is, her remit was only to look at psychological assessments. An equally disturbing picture might emerge from examining other groups of medical “experts” who earn thousands of pounds from evidence which parents may not be allowed to challenge or even read.

One contentious area, for instance, is where parents are accused of having injured infants who are found to have small fractures to their bones. A fashionable theory, pioneered by a Dr Kleinman in the US, holds that such fractures are a sure indicator of “non-accidental injury”, ie the child must have been abused. In one case (which I was able to report last year because the judge, unusually, published his judgment) it was clear that all the four medical witnesses had supported this “Kleinman theory”, unquestioningly accepted by the judge.

But other experts strongly disagree, citing studies which suggest that such fractures may quite often arise naturally from a deficiency of vitamin D (as tests had shown was the case with this particular mother). When I showed the judgment to a doctor expert in this field, he immediately recognised three of the witnesses as doctors who “go round from one court to another to support the Kleinman theory”. Since no one was in court to challenge them, the heartbroken mother – like many before her – lost her son.

Several scandals have hit the headlines in recent years involving doctors struck off after making a reputation as witnesses, pushing some theory about “brittle bones”, “shaken baby syndrome” or “Munchausen syndrome by proxy” which was eventually exposed as fallacious. But these causes célèbres have centred on criminal courts, where evidence can be put more rigorously to the test than is required by the much laxer procedures of family courts. As I have observed before, once a court system is allowed to hide itself away behind a wall of secrecy, the chances are high that it will become corrupted. A perfect example is the role played in our family courts by many of these professional “experts”. The good work Prof Ireland has begun cannot be allowed to stop there.

PAEDIATRIC PATHOLOGY HEAD INJURIES IN CHILDREN

http://www.attorneygeneral.jus.gov.on.ca/inquiries/goudge/policy_research/pdf/Limits_and_Controversies-CORDNER.pdf

retinal hemorrhage

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1793090/pdf/archdisch00655-0095.pdf

NON ACCIDENTAL TRAUMA AND EPIDEMIOLOGY OF CHILD ABUSE

http://www.springerlink.com/content/g7500m201423g81k/fulltext.pdf

REVIEW OF SHAKEN BABY CASES IN ONTARIO

http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/sbdrt/sbdrt.pdf

SHAKEN BABY SYNDROME

https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1&thid=13718d3bc0696ceb&mt=application/msword&url=https://mail.google.com/mail/?ui%3D2%26ik%3Dfb0bdd0df1%26view%3Datt%26th%3D13718d3bc0696ceb%26attid%3D0.1%26disp%3Dsafe%26zw&sig=AHIEtbTw0AhRnOlfM2RDs4rpttq3gdtv0Q&pli=1

Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2048374##

LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE CHILD FINALLY RETURNED

http://www.familylawweek.co.uk/site.aspx?i=ed97208

LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE

NEW MODALITIES IN THE MANAGEMENT OF OSTEOGENESIS IMPERFECTA

http://med.shams.edu.eg/protocols/orthopedics/MS-2008-Orth-Yasser%2…

JOINT LAXITY IN THE PARENTS OF CHILDREN WITH TEMPORARY BRITTLE BONE DISEASE

http://uqu.edu.sa/files2/tiny_mce/plugins/filemanager/files/4210200

TODLERS FRACTURE-VISUAL DIAGNOSIS

http://peds.stanford.edu/Tools/documents/ToddlersFractureinInfant.pdf

Vitamin D deficiency rickets: another shattered family

http://www.vitamindcouncil.org/?o=3361

VITAMIN D DEFICIENCY AND FRACTURES IN CHILDHOOD

https://mywebspace.wisc.edu/hmarleau/web/j%20peds/2011-11/Paterson_Schilling.pdf

RICKETS FAMILY COURT CASE JUDGMENT

http://www.familylawweek.co.uk/site.aspx?i=ed97208

Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

Published: 24 March 2011
Annex A: Case Law

R v Cannings [2004]
R v Harris, Rock, Cherry and Faulder [2005]
R v Kai-Whitewind [2005]
R v Allen [2005]
A Local Authority v S [2009]
R v Reed and Reed and R v Garmson [2009]
R v Henderson, Butler and Oyediran [2010]

R v Cannings [2004] EWCA Crim 01

See information in Background section in guidance.
R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980

A number of NAHI cases were identified by the CPS and the Court of Appeal as being suitable for being heard together to ensure that a comprehensive judgment could be made by the Court of Appeal in order to guide the handling of such cases in the future.

The Court of Appeal concluded that the unified hypothesis could no longer be considered as a credible or alternative cause to the accepted triad hypothesis. In the course of the Harris trial, Dr. Geddes (the creator of the unified hypothesis) agreed that her research was incomplete.

The pathological features themselves are observable facts, although the mechanisms that cause them could be open to interpretation.

The Court felt that the triad of pathological features provided strong evidence towards a finding that the injuries were non-accidental but could not alone be conclusive of the cause of death.

In determining the degree of force required to cause the triad of pathological features, the Court identified four general propositions whilst indicating that there was no scientific method of correlating the amount of force used and the severity of the damage caused:

The more severe the injury the more probable that they were caused by greater force than mere ‘rough handling’;
Cases of serious injuries caused by [apparently] very minor force as may occur in normal or rough handling of an infant, are likely to be extremely rare;
There will be cases where a [apparently] small degree of force or a minor fall will cause very severe injuries; and
It is not possible to conclude that age [of the child] is a factor in deciding whether injuries are caused by strong force or a minimal degree of force or impact.

Cases of alleged NAHI are fact specific and will be determined on their individual characteristics. All the circumstances, and particularly the clinical picture, must be taken into account. The characteristics of the individual components of the triad are particularly vital to its interpretation.
R v Kai-Whitewind [2005] EWCA Crim 1092

This case is important in outlining the scope of the Cannings judgment:

“All this suggests that, for the time being [due to the current state of medical knowledge], where a full investigation into two or more sudden unexplained infants deaths in the same family is followed by a serious disagreement between reputable experts about the cause of death, and a body of such expert evidence concludes that natural causes, whether explained or unexplained, cannot be excluded as a reasonable (and not a fanciful) possibility, the prosecution of a parent or parents for murder should not be started, or continued, unless there is additional cogent evidence extraneous to the expert evidence which tends to support the conclusion that the infant, or where there is more than one death, one of the infants, was deliberately harmed.”

The defence in this case sought to argue that the Cannings judgment extended to other sudden infant death cases where there was a conflict of expert opinion.

In not allowing the appeal, Judge LJ stated that the Cannings case was only intended to apply to cases that depended on inferences based on coincidence, or the unlikelihood of two or more infant deaths in the same family, or one death where another child had suffered unexplained apparent life-threatening events.

The allegation against the appellant in Kai-Whitewind arose from a single death and could be distinguished from Cannings. Moreover, unlike the case of Cannings, Kai-Whitewind’s conviction had not been based entirely on conflicting expert opinion; there was additional cogent evidence.

It was for the jury to evaluate the expert evidence, taking into account the facts found at the post mortem, as well as upon admission to hospital, and bearing in mind that the findings related to an infant whose mother:

had spoken about killing him;
had difficulties bonding with him;
might have delayed reporting his death; and
had elected not to give evidence.

The Court concluded that there was ample evidence before the jury to justify the verdict and the conviction for murder was safe.
R v Allen [2005] EWCA Crim 1344

The appellant was convicted of the murder of his baby son following an incident in which it was alleged the child suffered injuries caused by shaking, impact or a combination of the two. This incident had followed a previous one the week before as a result of which the child was detained in hospital for a number of days.

On appeal, the Court held that the evidence of the previous incident was relevant in order to prove the necessary intent on the day of the fatal act, and that there was sufficient evidence for the jury to convict of murder as opposed to manslaughter. In addition to the triad of injuries, and the previous incident which the Crown said was due to the appellant’s actions, evidence was found of bruising to the back of the child’s head.

The Court also held that the acceptability of the medical evidence was a matter for the jury (Paragraph 69).

The Court concluded that the appellant’s conviction for murder was safe.
A Local Authority v S [2009] EWHC 2115 (Fam)

This case (ALA v S [2009] EWHC 2115 (Fam)) was an application by the local authority for a care order under S.31 of the Children Act 1989 in relation to S, who was born on 17th March 2006 and who had just turned three. (para 1)

The proceedings arose out of the death of a second child of the family, Z, who collapsed at home on 29th October 2007 when he was thirteen weeks old. He died on 1st November 2007. (para 3)

In ALA v S, Mrs Justice King said “This is a case where the allegation is that Z died as a result of a shake or a shaking/impact injury. The classic features of such a non-accidental injury, it is said were present, namely encephalopathy, subdural haemorrhage and retinal haemorrhage. This combination of injuries is known as “the triad” (para 29). She determined the facts of the case against the backdrop of the current law; the judgments handed down by the House of Lords as recently as 11th June 2008 in Re B [2008] (Children) UKHL 35, and adopted the descriptions given by the Court of Appeal, Criminal Division, in its judgment on 21st July 2005 in R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980 paras.63-65 (para 30):

“As already stated, when the three elements of the triad coincide, for some years conventional medical opinion has been that this is diagnostic of NAHI. Typically the brain is found to be encephalopathic; bleeding is found in the subdural space between the dura and the arachnoid subdural haemorrhages; and there are retinal haemorrhages. There may also be other pathological signs such as subarachnoid bleeding and injuries at the cranio-cervical junction. Further, there may be injuries to nerve tissue (axonal injuries) and external signs of broken bones, bruising and other obvious injuries such as extradural oedema (bruising). Determining these findings requires medical experts from a number of different disciplines interpreting often very small signs within the complex structures of an infant’s brain and surrounding tissue.

The mechanism for these injuries is said to be the shaking of the infant, with or without impact on a solid surface, which moves the brain within the skull damaging the brain and shearing the bridging veins between the dura and the arachnoid. The shaking may also cause retinal haemorrhages. In the sense that the explanation for the triad is said to be caused by shaking and/or impact it also is a unified hypothesis, albeit that each element is said to be caused individually by trauma.

The triad of injuries becomes central to a diagnosis of NAHI when there are no other signs or symptoms of trauma such as bruises or fractures.” (ibid.)

In this case (ALA v S) not only were there a considerable number of experts, but Mrs Justice King was asked specifically to make serious adverse findings in relation to two of those experts, Dr. Cohen and Dr. Squier (para 33). In Re LU and LB [2004] EWCA Civ 567, the Court of Appeal provided guidelines for expert witnesses following the earlier case of R v Cannings. At para.23, Butler-Sloss P. gave the following guidelines:

i) The cause of an injury or an episode that cannot be explained scientifically remains equivocal.

ii) Recurrence is not in itself probative.

iii) Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of natural cause.

iv) The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour propre is at stake, or the expert who has developed a scientific prejudice.

v) The judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts or that scientific research will throw light into corners that are at present dark (ibid).

The approach of the court to expert opinion it was submitted, must include the need to evaluate the witnesses and the soundness of each of their opinions. The mere expression, of a belief by a witness, however eminent, does not suffice. The court’s evaluation of the witnesses, it was submitted should follow Ryder J. in A County Council v X Y and Z [2005] 2 FLR 129:

“… involves an examination of the reasons given for his opinions and … the extent to which they are supported by the evidence.” (para 34)

The judge must also examine:

“… the internal consistency and logic of his evidence; his precision and accuracy of thought… the extent to which a witness has conceived an opinion and is reluctant to re-examine it in light of later evidence … whether or not a witness is biased or lacks independence.” (para 35)

Summary positions:

“Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd all regard non-accidental head injury as the most likely cause of all Z’s injuries and consider it improbable, or highly improbable, that the other suggested causes could have caused the triad and Z’s death. (para 57)

“Dr. Squier and Dr. Cohen regard non-accidental head injury as possible, but unlikely, in the absence of any other bony or soft-tissue injury, or other specific post-mortem evidence of trauma. Dr. Squier agreed that the triad seen in Z was also seen in cases of frank, inflicted trauma and in accidental trauma. Dr. Squier and Dr. Cohen consider the most likely cause of the primary event to be either a choking incident or a heart arrhythmia combined with the effects of prolonged CPR followed by resuscitation. (para 58)

“Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd each hold what might be called the mainstream view of non-accidental head injuries as encapsulated in the judgments of the Court of Appeal in R v Harris. None accept that hypoxia in the absence of trauma is a cause of subdural haemorrhages and retinal haemorrhages of the type seen in Z. Dr. Al-Sarraj summed up the approach which HHJ King found each of this group of experts regarded as the proper approach in considering a case where the triad is present. Dr. Al-Sarraj told the court that: (para 60)

“Dr. Squier and Dr. Cohen have a very different approach in two important areas:

i)

a) Dr. Cohen does not regard trauma as a proper diagnosis where the triad is present, but there are no external injuries such as bruises or fractures and /or a witness to the alleged shaking event.
b) Dr. Squier regards trauma as very important. She is of the opinion that the triad, in the absence of evidence of trauma, is simply “no evidence of shaken baby syndrome”. The triad of injuries may be due to many other factors that are not trauma. She does not accept that the triad is necessarily a strong indicator of shaken baby syndrome. In the opinion of Dr. Squier, shaking alone may cause the triad, but the level of violence required is such that many people would be incapable of it and it would break the child’s neck. She said, in terms, that she would never advise the court that trauma was the probable cause absent external injury, either seen physically with the naked eye or found at post-mortem.

ii) Both Dr. Cohen and Dr. Squier subscribe to the Geddes III hypothesis in one form or another. Put at its simplest, each are of the view that hypoxia in children can lead to subdural haemorrhages and retinal haemorrhages in the absence of trauma.” (para 63, i, ii, iii)

In considering the evidence of Dr. Cohen and Dr. Squier, Mrs Justice King had in mind the guidance of Butler-Sloss P. in Re LU and LB (set out above), and in particular: (para 197)

That the court must be on guard against the over-dogmatic expert … who has developed a scientific prejudice; and
A judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts.

“The latter is of importance in the present case where it is accepted by all that there is much to learn and much which is not yet understood about so-called shaken baby syndrome and the triad. Dr. Cohen and Dr. Squier each agree with Geddes III. Dr. Cohen and Dr. Squier each believe that in the absence of additional external injuries, such as grip marks or fractures, there is no reliable evidence of shaken baby syndrome. Dr. Squier does not accept the triad to be a strong indicator of shaken baby syndrome. (198)

“These views are, undoubtedly, controversial. They go against the mainstream of current thinking and the analysis of the Court of Appeal in R v. Harris. Dr. Al-Sarraj told the court that his views are in line with mainstream opinion. Mainstream opinion in all the other specialities is the same as his, that is to say that hypoxia cannot cause subdural haemorrhages. Al-Sarraj told the court that there are 40-44 neuropathologists in the country of whom a maximum of 10 or 12 are forensic neuropathologists. To his knowledge, the only neuropathologist in the UK believing that hypoxia can cause subdural haemorrhages is Dr. Waney Squier. In addition, he said there are two or three other people who share her opinion who are working in different, but related, specialities, of whom Dr. Cohen and Dr. Scheimberg (Dr. Cohen’s co-author) are presumably two. (para 199)”

It was observed that “They come in all the defence cases, so you do not realise that they are in such a minority.” Dr. Cohen and Dr. Squier support Geddes III, even though Dr. Geddes herself in Harris withdrew from her own unified hypothesis. (ibid.)

Dr. Cohen and Dr. Squier maintain their position that in the absence of external injuries trauma cannot be established despite the Court of Appeal’s conclusion that:

“The triad of injuries becomes central to a diagnosis of non-accidental injury where there are no other signs or symptoms of trauma, such as bruises or fractures.” (para 201)

In considering the evidence of Dr. Cohen and Dr Squier, Mrs Justice King reminded herself that four years have passed since Dr. Geddes accepted that her unified hypothesis could no longer credibly be put forward. Dr. Cohen and Dr. Squier regard themselves as having built on her work. She also noted that the next generation of experts and scientific research may, as Butler-Sloss P. said:

“Throw light into corners that were then dark and that the hypothesis of Dr. Geddes may yet be proven to be in all, or in part, correct.” (para 202)

The judge went on to consider whether or not these experts have “developed a scientific prejudice” or whether they are in the vanguard of research and learning. (para 203)

In the context of the evidence given by Drs. Cohen and Squier she considered whether their respective beliefs in:

(i) Geddes III
(ii) That trauma may only be regarded as likely causation where there is a triad plus additional external injury (or alternatively a witness) has led to their conviction in respect of SBS overwhelming their forensic analysis of the case. (para 204)

She decided that there were three areas which the court should consider in relation to each of Drs. Cohen and Squier in order to determine that issue namely:

(i) Their use of research material;
(ii) Their willingness to defer to the experts in another field and as part of that their acceptance of the importance of confining their respective opinion to their own expertise and;
(iii) The importance in any forensic examination of factual accuracy (para 205)

“To illustrate: Dr. Cohen accepted in evidence that for the purposes of her study the eyes of the foetuses or neonates were not examined. She said there were research papers confirming that hypoxia leads to retinal haemorrhages. That evidence is without exception at odds with the combined view of all the ophthalmic expertise. (para 225 (6))

“It was put to Dr Cohen that she had employed the head circumference point to bolster her hypothesis. This she denied. She said that it could have been an old birth bleed, or a re-bleed, but she now thought the baby may have had a re-bleed. She said she could not exclude re-bleed as a primary cause, but that she thought it was secondary. Finally, she said, “we do not know the cause of his collapse”. (para 270)

Mrs Justice King felt that “Ultimately, her evidence was confusing and unhelpful.”(ibid.)

Moving on to Dr Squier, the judge observed that “any court dealing with these cases on a regular basis will be aware that Dr. Squier is a strong believer that many cases hitherto regarded as SBS have in fact been precipitated by a choke and that there has thereafter been a cascade of events, including hypoxia, which has been responsible for the subdural haemorrhages and retinal haemorrhages.” (para 245)

She declared that Dr Squier’s view is a legitimate one and an appropriate line of research, (para 246) went on to say that:

“All agree that much remains unknown about SBS and the triad. It is essential, however, that Dr. Squier and others engaged on such research avoid becoming a zealots with the consequence that scientific rigour is lost or sacrificed. (para 246)

“These Courts rely on the professionalism and rigor of the experts who come before them. That means not only drawing the Court’s attention to research that is contrary to their view, but that the experts are rigorous in the use they make of research papers. Dr. Squier’s suggestion that there were “well documented cases of choking, leading to subdural haemorrhages and retinal haemorrhages” by reference to the two articles analysed above is disquieting. It should be borne in mind that Dr. Squier relied upon these so called “well documented cases” in support of her hypothesis as to the cause of Z’s death; the subject of this enquiry. She should have, at the very least, drawn the court’s attention to the fact that the cases in question were cases where the child had been shaken and that in one of them had been regarded as a case of non accidental injury resulting in the child being taken into care as a result of the incident. (para 247)

“Dr. Bonshek referred to Dr. Squier’s use of these articles as being “disingenuous”. I feel driven, with regret, to agree. (para 248)

“I do not doubt the commitment of Dr. Squier and Dr. Cohen to the advancement of the understanding of Shaken Baby Syndrome. As already indicated, I make no criticism and, indeed, it would be wrong to do so, of the fact that neither of them hold mainstream views. There is a significant fundamental difference between academic theories and hypotheses, on the one hand, and the rigorous forensic analysis which is required in care proceedings, on the other. In care proceedings the parents of the children concerned face allegations of the most serious type and they are therefore entitled to expect the experts commissioned to report to the court to be meticulous in both their analysis of the data and in their presentation to the court of their expert forensic opinion.(para 284)

“Dr. Squier and Dr. Cohen, I find with regret, have each fallen into that category of expert identified by Butler-Sloss P. in Re LU & LB, namely the expert who has developed a scientific prejudice. As a consequence, I accept the submission of the Local Authority that Dr. Squier has permitted her convictions to lead her analysis. The very fact that she said that she would, in future, be content to report Z’s case as a “well described case of choking leading to subdural haemorrhage and retinal haemorrhages, subject to the exclusion of cardiac defect” sums up her approach in one concise example. Another, is the fact that each of the significant factual errors made by her served to support her hypothesis of choking and hypoxia. (para 285)

“The error in relation to Z’s head circumference was not the only serious factual error made by Dr. Squier. In her written material, Dr. Squier recorded that the paramedic at the scene had noted “pink frothy sputum running out of Z’s nostrils”. She also noted that at the hospital, “milk was noticed in the throat and nose”. She said in her oral evidence, however, that there was evidence of aspiration as a contributory cause and so choking must be a likely explanation. In support of this proposition she said:

“The child was found with milk and vomit in his airways by the ambulance man.” (para 280)

“This was not only wrong, but misleading.” (para 281)

R v Reed and Reed; R v Garmson [2009] EWCA Crim 2698

The Court of Appeal dismissed two joined appeal cases involving Low Copy Number (LCN) DNA analysis. Whilst confirming that there had been no substantive attack on the science of LCN analysis, the Court set out explicitly how it expects cases involving expert evidence to pay the closest attention to the requirements of Part 33 of The Criminal Procedure Rules and the need to agree evidence or identify issues at an early stage (Part 3).

The Court did not accept the evidence provided by the defence expert witness, Dr Allan Jamieson and went on to question how his evidence was admissible in the Omagh boming case (R v Hoey) as that was the first occasion he had given an opinion regarding LCN DNA analysis. The Court ruled that an appropriately experienced scientist is fully entitled to offer an opinion […], though emphasised that “it is the duty of the Crown and the defence to ensure that the necessary steps are taken to bring the matter back before the judge where a disagreement is identified” (p131 iii), which must occur before the trial.
R v Henderson, Butler and Oyediran [2010] EWCA Crim 1269

The key principle set out in this case was the need to consider each case on its own merits; Henderson & Others was not an authority for removing complex medical evidence from the jury.

The Court of Appeal made it very clear that the complex medical issues arising in cases of alleged NAHI in babies must be dealt with by counsel and judges suitably experienced, who are thus able clearly to set out the points made by each expert in a way that assists the jury to consider the evidence.

Further Points made:

The court in line with the approach taken by the police and prosecution, rejected the ‘unified hypothesis’.
No-one in the appeal suggested that the presence of the triad, even with the characteristics demonstrated in these cases, was conclusive or provided a certain diagnosis.
It will usually be necessary for the court to direct a meeting of experts so that a statement can be prepared on areas of agreement and disagreement. The essential medical issues which the jury have to resolve should be clear by the time the trial starts.
An expert’s evidence, Dr Leestma’s, was rejected as it was more historic and far more limited than that of Dr Al-Sarraj. Dr Leestma had not conducted autopsies or given evidence in cases involved with baby-shaking for many years. In order to establish the appropriate level and relevance of expertise, questions that should be considered by the jury include:
Has the witness gone outside his area of expertise?
Can the witness point to a recognised, peer-reviewed, source for the opinion?
Is the clinical experience of the witness up-to-date and equal to the experience of others whose evidence he seeks to contradict?
The fact that an expert is in clinical practice at the time he makes his report is of significance as they can learn and develop from continuing experience. See also Annex C, The report of a working group convened by The Royal College of Pathologists and The Royal College of Paediatrics and Child Health: “Judges should also ensure that experts have recent clinical experience”.
Any conclusion of any court as to the medical evidence depends upon the evidence before that court, as no appellate jurisprudence can provide authority for a medical proposition.
The exact occasions upon which injuries occurred do not need to be established when deliberate injury has been caused. The nature and severity of the injury in Oyediran was a sufficient basis to establish a murderous intent.
The previously accepted proposition that only trauma can cause retinal folds was shown to be incorrect. The evidence of this was from a case in which perimacular folds associated with extensive retinal haemorrhages emerged not due to trauma, but rather to acute myeloid leukaemia suffered by a 14 year-old.
It was suggested that the judge who is to hear a particular case should deal with all pre-trial hearings, except for those in which no issue of substance is to be considered; and the judge should have experience of the complex issues and understanding of the medical learning.

Doctor gagged for doubting shaken baby syndrome

http://www.newworldorderreport.com/News/tabid/266/ID/4825/Doctor-gagged-for-doubting-shaken-baby-syndrome.aspx

Grandmother In High-Profile Shaken Baby Case Has Sentence Commuted

http://www.npr.org/blogs/thetwo-way/2012/04/06/150145744/grandmother-in-high-profile-shaken-baby-case-has-sentence-commuted

Increase in Vaccines Causes Cot Death

S

On May 4th 2011 a new study by Neil Z Miller and Gary S Goldman was published online by SAGE, entitled Infant mortality rates regressed against number of vaccine doses ro… This study, is another in a long line of studies revealing evidence showing the more vaccines a baby receives the more chance they have of dying from Sudden Infant Death Syndrome.

Miller and Goldman look for a possible correlation between vaccines and Infant Mortality Rates.(IMR). Looking at 34 countries, they research the number of infants dying of SIDS per 1000 babies and the number of doses of vaccine that each country is giving to babies under 1yr. Miller and Goldman then look for a correlation between the number of deaths and the number of doses of vaccines given. The hypothesis they were looking to prove was that the greater the number of vaccine doses given to infants before the age of 1yr, the higher the IMR would be. Their hypothesis was proven conclusively as the countries giving fewer doses of vaccines were the countries with the lowest Infant Mortality Rate.

The authors grouped the countries by vaccine dosage. 12–14, 15–17, 18–20, 21–23, and 24–26. When studied, the group in the 12 – 14 dose range, Sweden, Japan, Iceland, Norway, Denmark and Finland were the countries which had the lowest IMR per 1000 live births.

Sweden had a total of 12 vaccine doses given and showed a 2.75 IMR compared with the USA who had a total of 26 vaccine doses given and an IMR of 6.22. The USA came out as having the highest IMR rate as well as the highest number of vaccine doses. Miller and Goldman wrote:

“In 2009, there were approximately 4.5 million live births and 28,000 infant deaths in the United States, resulting in an infant mortality rate of 6.22/1000″.

Vaccine doses do not indicate the number of vaccines given but the total vaccine doses overall, as many vaccines include more than 1 vaccine dose e.g. DPaT is a 3 dose vaccine.

Of course as with all studies variables existed and these were discussed and taken into consideration.

This is not the first study showing similar results. Professionals have been noticing a correlation between vaccines and SIDS for many years. The authors mention many of these in their excellent paper.

A study not mentioned in Miller and Goldman’s paper was the Cotwatch Study written by Dr Viera Scheibner. I feel that this study is one of the most important studies ever produced. The reason for this is because Dr Viera Scheibner was not looking for any correlation between vaccines and SIDS at the time.

In 1985-1986 Dr Scheibner and her late husband Leif Karlsson (a Swedish electronics engineer specializing in patient monitoring systems) developed a pioneering true breathing monitor which they called Cotwatch, A ‘true breathing monitor’ is different from standard breathing monitors because it’s electronics separates the babies heart beat and breathing and only the breathing delays the alarm. This is unlike other monitors which take any movement as breathing. On studying the results Scheibner and Karlsson found that the charts produced by their monitor revealed that whenever the babies had had a vaccination flareups of stress induced breathing patterns occurred. The patterns seemed to appear on specific times and days following the vaccination which they named ‘critical hours and days’.

This proved conclusively that it was the vaccines that were causing the babies to have periods of stress-induced breathing. In some cases this led ultimately to the babies death.

Another study pre-dating this study and also proving that vaccines were causing infants to die was by Baraff LJ et al (1983) Pediatr Infect Dis. 1983 Jan-Feb;2(1):7-11. PMID: 6835859; UI: 83169234 Possible temporal association between diphtheria-tetanus toxoid-per…. He wrote:

“Because diphtheria and tetanus toxoids pertussis (DTP) vaccine is routinely given during the period of highest incidence of sudden infant death syndrome (SIDS), this study was undertaken to determine if there is a temporal association between DTP immunization and SIDS. Parents of 145 SIDS victims who died in Los Angeles County between January 1, 1979, and August 23, 1980, were contacted and interviewed regarding their child’s recent immunization history. Fifty-three had received a DTP immunization. Of these 53, 27 had received a DTP immunization within 28 days of death. Six SI Ddeaths occurred within 24 hours and 17 occurred within 1 week of DTP immunization.”

In recent years SIDS deaths have been called a number of different things including SUID or Sudden Unexplained Infant Deaths and suffocation. Many of the babies dying have been found to have a triad of bleeds in the brain. These bleeds are being put down to the parents or care givers abusing their children often under the guise of

Shaken Baby Syndrome,Shaken Impact Syndrome,Abusive Head Trauma,Pediatric Traumatic Brain Injury,Shaken Brain Trauma,Whiplash Shaken Infant Syndrome,Non Accidental Head Injury.

Many professionals believe that this is in a bid to cover up the true extent of the problem and hide the fact that vaccines are harming our children.

These professionals include

Dr Michael Innis MBBS, DTM&H, FRCPA and FRCPath
Professor Gordon Stewart, M.D Emeritus professor of Public Health
Dr Edward Yazbak M.D. F.A.A.P
Dr Archie Kalokerinos M.D MBBS PhD FAPM
Charles Pragnell Independent social care management consultant, a Child/Family Advocate, and an Expert Defence Witness – Child Protection
Lisa Blakemore-Brown – Psychologist, Autism specialist, Expert Witness and Author
Dr Viera Scheibner (PhD.) Principle Retired Scientist
William C Torch, a retired pediatric neurologist
Dr John Plunkett – Anatomic Pathology & Clinical Pathology, Forensic Pathology
Dr Horace. Gardner – Ophthalmologist,
Dr Harold Buttram – MD, FAACP.
Dr Zachary Bravos – Legal Counsel,
Neil Z Miller Medical research journalist
Dr Kenneth Stoller M.D

The list is endless. If there was not a substantial provable link then why would all these highly qualified professionals and many many more be writing papers claiming that they have evidence proving that vaccines are causing the death of many children?

Neil Millers paper is as conclusive as it can be that vaccines can and do kill very young babies. When is the world going to wake up to this? Vaccines need to be considered as a differential diagnosis to SIDS and SBS and professionals have been saying this for years. On 20th July 2007 Lisa Blakemore-Brown made this comment Times Online

“Professor Sir Roy Meadow also works in the area of vaccine research in which
cot death is one of the adverse reactions.

On 6th July 1988 in Room 1611/12 Market Towers, he sat with others including Professor Elizabeth Miller, epidemiologist for the vaccine programmer and Dr David Salisbury, with a similar remit at the Department of Health in the Joint Sub Committee on Adverse Reactions to vaccines and immunization.

During these meetings held over many years, deaths of babies were
routinely discussed.

Leading medics have written to other medics about three and four children dying in one family within one area where the rate of cot death was much higher than in other parts of the country. At least two families reported how the deaths followed vaccines.

So why is a vaccine reaction, clearly well known to the inner medical circle, NEVER mentioned as part of the differential diagnosis?

Even now Hey and Bacon fail to even mention it.

Its time the public knew about all this Lisa Blakemore-Brown, London, UK”

How right she is, I wrote on VacTruth only a couple of week ago how Prof David Southall who is involved in aid work, sending vaccines to the third world, has known for nearly twenty years that children can die from breathing problems after a vaccine. How can parents ever trust that vaccines are safe, when evidence proves that giving multiple vaccines to young babies can be very dangerous? A full investigation needs to take place immediately investigating all vaccines. Unless governments around the world can disprove what these professionals are saying the take up for vaccines will continue on a downwards spiral.

Clemency Granted for Shirley Smith

http://onsbs.com/2012/04/06/clemency-granted-for-shirley-smith/

  • Alison Stevens Parents Against Injustice speaking on Southside broadcasting radio.

  • Alison Stevens Parents Against Injustice speaking on Southside broadcasting radio.1

  • Alison Stevens Parents Against Injustice speaking on Southside broadcasting radio.

  • Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

    http://jjie.org/fractured-leg-fractured-family-misdiagnosis-leads-allegations-of-abuse/43001
    Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

  • Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

    http://jjie.org/fractured-leg-fractured-family-misdiagnosis-leads-allegations-of-abuse/43001

    Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

  • mbc in a week: Brittle Bone Disease – العظام الزجاجية

    http://www.youtube.com/watch?feature=player_embedded&v=_dpalWQU1Q0
    mbc in a week: Brittle Bone Disease – العظام الزجاجية

  • mbc in a week: Brittle Bone Disease – العظام الزجاجية

    http://www.youtube.com/watch?feature=player_embedded&v=_dpalWQU1Q0

    mbc in a week: Brittle Bone Disease – العظام الزجاجية

  • We lost our kids for 5 years after wrongful ‘shaken baby’ conviction

    We lost our kids for 5 years after wrongful ‘shaken baby’ conviction

    Dread for dad jailed after saving daughter’s life

    Ben, Jennie and Izzy Butler

    Reunited … Ben and Jennie with their second child, Izzy
    Sonja Horsman
    By ANTONELLA LAZZERI
    Published: 17th October 2012

    FIVE years ago doting dad Ben Butler saved his baby daughter’s life when she stopped breathing – and soon found himself in JAIL.

    After clearing tiny Ellie’s airway, Ben rushed her to hospital, where doctors found head injuries similar to those caused when a baby is shaken.

    To his horror, he was accused of grievous bodily harm and cruelty — crimes for which he was eventually convicted and sent to prison.

    He had to stay on a wing full of PAEDOPHILES — and share his cell with a convicted child abuser.

    Ellie's cyst

    Kept from jury … Ellie’s cyst, circled
    Sonja Horsman

    Meanwhile, beautiful Ellie and her sister Izzy were put in foster care.

    And it was all a terrible mistake.

    Ben’s conviction was quashed in 2010 after new medical evidence showed six-week-old Ellie’s injuries were caused by a traumatic birth.

    An appeal judge described the case as a “gross miscarriage of justice”.

    But Ben, 33, and girlfriend Jennie Gray, 32, had to battle for two more years in the Family Court to get their girls back home.

    They finally won that ruling just last week.

    Removals man Ben said yesterday: “We should be over the moon. But my fear is we will never, ever be able to be a real family again.

    “Ellie has been away from us for over five years. And Izzy came home last week and for the first few days was confused and upset.

    “It tore me apart to see her sitting there crying for her foster parents.

    “My fear is that although I’ve been cleared my family has been destroyed forever.”

    The nightmare began in February 2007 when Ben, who was then separated from Jennie, took charge of baby Ellie for a night.

    Graphic designer Jennie had no qualms about leaving the newborn.

    She recalled: “If anything, he was an over-protective dad.

    “He would text me things like, ‘I think I’ve given her too much milk!’”

    Ben said: “From the moment I saw her I fell in love. I just adored her and wanted to be a hands-on dad. I saw her as much as I could, even having her overnight if I could.”

    That night in February, Jennie dropped Ellie off as usual.

    Ben said: “I tried to give her her feed but she didn’t want it.

    “So I placed her in her car seat on the floor right by me. She seemed OK so I started to play a computer game on the telly.

    “Then I suddenly saw her little arms were flopped down by her sides.

    “When I went to her she had gone all limp, really white and was making a funny noise as if she was struggling to breathe.

    “I started screaming at my flatmate to call 999. He did and on the emergency call tape you can hear me in a blind panic, giving her mouth-to-mouth and everything.

    “Then at one stage I pushed my finger down her throat and she suddenly gasped and started breathing again.

    “That gasp — it’s so loud you can even hear it on the 999 tape.”

    It later turned out that Ellie had a cyst in her throat, that quick-thinking Ben had pushed out of the way.

    The cyst is clearly visible on a scan taken in hospital — but it was NEVER shown to the original jury.

    Ben, of Sutton, Surrey, said: “If they had seen it I believe they would never have found me guilty.

    “Instead of trying to kill her, I saved her life.”

    Police and social workers were called in despite doctors at first telling the parents that they believed — correctly — that the brain bleeding and swelling they picked up had been caused at birth.

    Ben Butler and daughter

    ‘Gross miscarriage of justice’ … Ben has finally got his kids back, two years after his acquittal
    Sonja Horsman

    Furious Jennie, who had noticed the baby sometimes had breathing problems but was told by the doctor and the midwife not to worry, said: “Ellie had no other injuries, no bruises, no fractures, nothing.

    “That is almost unheard of in shaken babies.”

    Ben added: “Two weeks later I was arrested and charged with GBH with intent.

    “Jen wouldn’t go against me, so Ellie was taken into care.

    “At one stage Jen was told by social workers, ‘If you say Mr Butler is guilty, you have more chance of getting your baby back.’”

    Jennie added: “I know some people say I should have done that so I could have my child — but I couldn’t do that to Ben. It wasn’t right.

    “I had to pack up all her little things and then hand them over to the foster carer.

    “When I left her home I just collapsed screaming on her doorstep.

    “I missed all her milestones — her first smile, her first steps.”

    While awaiting trial the Family Court ruled Ben could see Ellie twice a year for four hours.

    Jennie was allowed contact with her baby six times a year for two hours at a time — but felt she could not keep protesting.

    Weeping, the mum said: “I had to do everything social services said because I was so scared of Ellie being adopted and then I would have lost her forever.”

    Finally in March 2009 Ben faced trial at Croydon Crown Court.

    He said: “It all revolved around medical evidence. But unless you were a qualified medic I can’t see how you’d understand any of it.”

    To his horror he was found guilty and sentenced to 18 months’ imprisonment.

    Ben said: “I had to serve my time on the nonces’ wing.

    “It was hideous, being in with men that had done unspeakable things to children.

    “I never spoke a word to any of them the whole time.

    “I couldn’t even have a photo of Ellie in there in case any paedos got off on it.”

    Finally after three-and-a-half months he was freed, pending appeal. He could not wait to see his little girl again. She was now growing up with Jennie’s parents.

    He said: “I was allowed to go and see Ellie but she didn’t even know who I was — it was heartbreaking.”

    Brought back together by their battles, he and Jennie started seeing each other again and she became pregnant.

    She revealed: “I was terrified that social services would take my baby away.

    “So I registered under a false name 60 miles away from where I was living.

    “I kept the pregnancy a secret from everyone.

    “I had Izzy, but when the baby was six months old someone tipped off social services.

    “I was driving down the motorway and six police cars started chasing me.

    “They pulled me over and arrested me on suspicion of child neglect.

    “They wouldn’t even let me say goodbye to Izzy.”

    Ellie Butler

    Recovered … Ellie today as a healthy five-year-old
    Sonja Horsman

    So Izzy too went into care — to strangers, this time. And she stayed there despite Ben’s conviction being overturned in 2010.

    By this time Ben was an expert on shaken babies.

    He said: “I had spent years researching shaken baby syndrome on the internet.

    “There wasn’t a case like ours ever. In all cases of shaken baby syndrome the baby had either died, or been brain damaged.

    “Ellie was perfect. I also had medical experts who testified about her cyst and how I had probably saved her life.”

    The family was finally reunited by High Court judge Mrs Justice Hogg, who ruled that the local authority — which had argued Izzy, now three, was still at risk — must hand the youngster back.

    The judge concluded: “It is a joy for me to oversee the return of a child to her parents.”

    But while Izzy is back, Ellie, now five, is so attached to her grandparents that Ben and Jennie fear bringing her back home full-time immediately.

    Furious Ben said: “My life, Jennie’s life and the girls’ lives have been virtually destroyed.

    “Whatever chance we had of being a family was taken away — I have never seen Izzy at Christmas, or on her birthday.”

    Jennie admitted: “At times I felt I couldn’t go on. I just wanted to die but Ben kept me alive. He said we had to fight, fight, fight.

    “But we really don’t know how the future will go — I fear Ellie has been away from us too long.”

    ‘Expert’ opinion in the dock

    By JANE ATKINSON

    Louise Woodward

    Early conviction … Louise Woodward

    DOCTORS first identified “shaken baby syndrome” in the late Sixties.

    The symptoms were laid down as brain swelling, bleeding between the skull and brain and bleeding in the retinas.

    It was a diagnosis that explained the deaths of babies who had all these injuries but no external bruising or fractures.

    Natural causes were not considered.

    But new evidence suggests bleeding in the brain can happen WITHOUT trauma.

    The syndrome hit the headlines in 1997 when 19-year-old British au pair Louise Woodward was convicted of involuntary manslaughter by a court in Massachusetts.

    The victim was eight-month-old Matthew Eappen, who died from injuries an expert said was characteristic of the syndrome.

    Soon others were also being accused.

    In 1999 Michael Faulder from Gateshead was jailed for two-and-a-half years after being wrongly accused of almost shaking his seven-week-old son to death. It took him six years to clear his name.

    He had dropped the baby accidentally while placing him in a buggy.

    In 2000 Lorraine Harris of Derbyshire was convicted of manslaughter and given a three-year sentence over the death of her 16-week-old son Patrick.

    Her conviction was quashed in 2005 by the Court of Appeal when her lawyers argued that medical opinion on shaken baby syndrome had changed since her conviction.

    Read more: http://www.thesun.co.uk/sol/homepage/woman/real_life/4593440/Father-who-overturned-Shaken-Baby-conviction-fears-family-life-ruined.html#ixzz29eZUrkYr

  • INFLICTED BRAIN INJURIES DO NOT DISCARD DIFFERENTIAL DIAGNOSIS

    http://www.jpands.org/vol15no1/innis.pdf

    INFLICTED BRAIN INJURIES DO NOT DISCARD DIFFERENTIAL DIAGNOSIS

  • INFLICTED BRAIN INJURIES DO NOT DISCARD DIFFERENTIAL DIAGNOSIS

    http://www.jpands.org/vol15no1/innis.pdf

    INFLICTED BRAIN INJURIES DO NOT DISCARD DIFFERENTIAL DIAGNOSIS

  • VACCINES APPARENT LIFE THREATENING EVENTS BARLOWS DISEASE AND QUESTIONS ABOUT SHAKEN BABY SYNDROME

  • VACCINES APPARENT LIFE THREATENING EVENTS BARLOWS DISEASE AND QUESTIONS ABOUT SHAKEN BABY SYNDROME

  • Bone Diseases That Lead To False Allegations Of Non-Accidental Injury

    Bone Diseases That Lead To False Allegations Of Non-Accidental Injury

    http://www.zimbio.com/Osteogenesis+Imperfecta/articles/joTVp6tF8SX/…

  • Bone Diseases That Lead To False Allegations Of Non-Accidental Injury

  • Hogg J sets aside findings of abuse and clears way for family to be reunited

    http://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/lb-sutton-gray-butler-judgment-12102012.pdf

    Hogg J sets aside findings of abuse and clears way for family to be reunited

  • Hogg J sets aside findings of abuse and clears way for family to be reunited

    http://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/lb-sutton-gray-butler-judgment-12102012.pdf

    Hogg J sets aside findings of abuse and clears way for family to be reunited

  • Bitter pills

  • Temporary Brittle Bone Disease and Infant Fractures

    Temporary Brittle Bone Disease and Infant Fractures
    http://archive.newsmax.com/archives/articles/2005/10/5/125542.shtml

  • Temporary Brittle Bone Disease and Infant Fractures

    Temporary Brittle Bone Disease and Infant Fractures

    http://archive.newsmax.com/archives/articles/2005/10/5/125542.shtml

  • Temporary Brittle Bone Disease and Infant Fractures

    http://archive.newsmax.com/archives/articles/2005/10/5/125542.shtml

    Temporary Brittle Bone Disease and Infant Fracture

  • Child Abuse Is Erroneously Over-Diagnosed

    Child Abuse Is Erroneously Over-Diagnosed
    http://news.heartland.org/newspaper-article/2008/06/01/child-abuse-

  • Child Abuse Is Erroneously Over-Diagnosed

  • Couple win back children from social services after High Court battle

    Couple win back children from social services after High Court battle

    A couple whose two daughters were taken away by social services have been praised by a judge for “weathering the storm” of a lengthy High Court battle to win them back.

    The Court of Appeal ruled that the father had a right to know his secret accuser's identity

    A father who was wrongly convicted of cruelty to one of his two daughters and had them taken away by social services has won their return after a High Court legal battle. Photo: Alamy

    10:31PM BST 12 Oct 2012

    Ben Butler, 32, and his former partner, Jennie Gray, also 32, lost their children after he was accused of shaking their baby Ellie when she was seven weeks old. There followed a nightmare that lasted five and a half years.

    Mr Butler served time in jail on a wing for paedophiles, while Miss Gray decided to terminate a third pregnancy fearing this child would also be taken away from her, leading to serious complications which mean she cannot have any more children.

    Mr Butler had his convictions for cruelty and causing grievous bodily harm to his daughter quashed by the Court of Appeal in June 2010.

    However, he and Miss Gray, from Sutton, Surrey, then had to fight for more than two years before the Family Division of the High Court in London ruled that Ellie, now five, and her younger sister, Isabella, three, should be returned to them.

    In a judgment made public on Friday, Mrs Justice Hogg said it was a rare “joy” for her to oversee a child being reunited with her parents.

    The judge exonerated the father over the “shaken baby” allegations and the mother from accusations that she failed to protect Ellie from abuse.

    Recognising that Mr Butler and Miss Gray had been through an “extraordinarily difficult time”, Mrs Justice Hogg said: “The parents have weathered the storm. They have each been resilient and determined, and shown tenacity and courage.

    “I hope now that the record is put straight, that with their tenacity they will be able to put behind them those difficulties and look forward to a more positive future.”

    The parents’ long ordeal began in February 2007 when Mr Butler noticed that Ellie had gone limp and was gasping for air.

    She was taken to St Helier Hospital in Sutton, where doctors diagnosed bleeding on the brain, bleeding in the eye and swelling of brain tissue, the “triad” of injuries seen as indicators of a shaken baby who has been deliberately injured.

    Mr Butler insisted he had not hurt his daughter and Miss Gray supported him. A different team of doctors said Ellie’s head injury was in fact caused at birth, and she went on to make a full recovery.

    However, the father was arrested, charged and found guilty at Croydon Crown Court in March 2009. He was jailed for 18 months and sent to Littlehey Prison in Cambridgeshire, where he shared a cell with a man who had been convicted of sexual assault.

    Mr Butler, a former removal man, was cleared after the Court of Appeal ruled that the trial judge’s summing-up to the jury was defective and the conviction was unsafe.

    He said after his acquittal: “These three-and-a-half years have been horrendous. I can’t believe that it’s taken so long to clear my name.

    “I can’t believe so much money has been wasted on prosecuting an innocent person when there was so much evidence that it wasn’t a shaken baby case.”

    Sutton Council’s social services continued to argue that the family court should uphold the abuse findings it originally made against Mr Butler and endorse the local authority’s plans for Isabella’s adoption.

    The council contended that Isabella was “at significant risk of harm” in her mother’s care and she had lied about the extent of her continuing relationship with Mr Butler.

    However, Mrs Justice Hogg ruled that the local authority could not establish that Ellie had been shaken and said its findings must be set aside.

    She concluded in her judgment: “It is seldom that I see a ‘happy end’ in public law proceedings. It is a joy for me to oversee the return of a child to her parents.

  • PAIN BRENDAN FLEMING CASE-Adoption halted as court told baby milk led to ‘innocent’ couple being accuse of abuse

    Vitamin supplements in baby milk may have led an innocent couple being condemned for battering their newborn son, a top family judge has heard

    Adoption halted as court told baby milk led to 'innocent' couple being accuse of abuse

    Adoption halted as court told baby milk led to ‘innocent’ couple being accuse of abuse Photo: ALAMY

    By , Social Affairs Editor

    11:58AM BST 20 Sep 2012

    The boy, who cannot be named, was taken away from his parents and was poised to be adopted after multiple broken bones were put down to child abuse.

    But Lord Justice McFarlane halted the process yesterday after hearing how an extraordinary combination of medical events could have led to a case of congenital rickets being overlooked.

    The parents, who have fought a three-year custody battle, have been given a final chance to get their son back.

    It came after lawyers had what they described as a “light bulb moment” and understood the full significance of the child’s medical records.

    Michael Shrimpton, for the family, who are from the north of England, told the Court of Appeal in London that there is evidence that the boy was born with a Vitamin D deficiency, inherited from his mother, leading to “soft bones” and rickets.

    It suggests that the broken bones could have occurred during his difficult forceps birth, or even in the womb.

    Blood tests to check for signs of vitamin deficiency, when the boy was four weeks old were normal.

    But the court heard hat it is possible that it was “masked” by the formula milk given to him by his mother – which contained Vitamin D supplements.

    He added that there was “striking” evidence of severe abnormalities in the functioning of the baby boy’s liver, an organ instrumental in processing Vitamin D.

    The judge temporarily halted the adoption process and ordered urgent medical reports.

    Having a child taken away is an “exceptionally awful” ordeal, he remarked, adding that it was essential to examine whether the Vitamin D deficiency explanation for the boy’s injuries was “more than an intellectual possibility”.

    He also noted that there was no evidence of emotional difficulties, domestic violence, alcohol or drug abuse, or any signs of dysfunction within the family, to indicate a risk of child abuse.

    Mr Shrimpton said that one of the country’s top endocrinologists, Professor Stephen Nussey, who has carried out pioneering work on the causes and effects of Vitamin D deficiency, will be instructed to carry out that task if he is available at short notice.

    Observing that medical knowledge on the causes of infant injuries is in a state of constant movement, the barrister added: “This is an important case. It is starting to take on the appearance of a leading test case”.

    After hearing expert evidence in June last year, a judge at Sheffield High Court ruled that one or other of the parents must have been responsible for the baby’s injuries. The same judge refused to change her mind earlier this year and freed the boy for adoption.

    However, Lord Justice McFarlane observed: “Medical knowledge of how some children may have bones that are more susceptible to injury than normal children has moved on”.

    Emphasising the extreme urgency of the case in light of plans for the boy’s imminent adoption, the judge gave the parents 28 days to obtain a report from Professor Nussey, or another expert, in support of their case.

    The local authority involved in the case had informed the Appeal Court that suitable adoptive parents have already been found for the boy but no further steps in the process would be taken prior to the court ruling on the case.

    The case will return to the Appeal Court once the expert medical report has been obtained.

  • The Unexonerated: Factually Innocent Defendants Who Plead Guilty

  • The Unexonerated: Factually Innocent Defendants Who Plead Guilty

    http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2103787

    The Unexonerated: Factually Innocent Defendants Who Plead Guilty

  • New doubts in ‘shaken baby’ fatalities

  • New doubts in ‘shaken baby’ fatalities

  • Baby is taken from parents after social workers ‘mistook rickets for child abuse

    An extraordinary sequence of medical events led to a case of congenital rickets being viewed as horrific child abuse by social workers, experts and a judge, and the baby boy being taken from his distraught family and put up for adoption.

    Now, however, the parents have been given a final chance to get back their little boy – now aged almost three – from the care system.

    This comes after lawyers had a “light bulb moment” and understood the full significance of the youngster’s medical records.

    Michael Shrimpton, for the family, who come from the Sheffield area, told London’s Appeal Court that there is evidence that the boy was born with a Vitamin D deficiency, inherited from his mother, and that this led to “soft bones” and rickets.

    Although blood tests carried out on the baby boy when he was four weeks old were normal, the barrister said his congenital condition would by then have been “masked” by the formula milk given to him by his mother, which contained Vitamin D supplements.

    Mr Shrimpton argued that rickets was the true explanation for multiple broken bones suffered by the baby, which could have been caused during his difficult forceps birth or even in-utero while his mother was still pregnant.

    The barrister pointed to “striking” medical records which showed severe abnormalities in the functioning of the baby boy’s liver, an organ which is instrumental in the processing of Vitamin D.

    Now, with the boy on the verge of being adopted, Lord Justice McFarlane has intervened in the case, directing that the evidence be reviewed by a fresh medical expert.

    Mr Shrimpton said that one of the country’s top endocrinologists, Professor Stephen Nussey, who has carried out pioneering work on the causes and effects of Vitamin D deficiency, will be instructed to carry out that task if he is available to do so at short notice.

    Observing that medical knowledge on the causes of infant injuries is in a state of contant movement, the barrister added: “This is an important case.

    “It is starting to take on the appearance of a leading test case.”

    After hearing expert evidence in June last year, a judge at Sheffield High Court ruled that one or other of the parents must have been responsible for the baby’s catalogue of injuries.

    The same judge refused to change her mind earlier this year and went on to free the boy for adoption.

    However, Lord Justice McFarlane observed: “Medical knowledge of how some children may have bones that are more susceptible to injury than normal children has moved on”.

    He added that there was no evidence of emotional difficulties, domestic violence, alcohol or drug abuse, or any other signs of dysfunction within the family, which could indicate a risk of child abuse.

    Emphasising the extreme urgency of the case, in light of plans for the boy’s imminent adoption, the judge gave the parents 28 days to obtain a report from Professor Nussey, or another expert, in support of their case.

    Recognising the parents’ “exceptionally awful” experience in having their child taken from them, the judge said that the court would carefully examine whether the Vitamin D deficiency explanation for the boy’s injuries was “more than an intellectual possibility”.

    The local authority involved in the case had informed the Appeal Court that suitable adoptive parents have already been found for the two-year-old boy, but no further steps in the process would be taken prior to the court ruling on the case.

    The case is set to return to the Appeal Court once the expert medical report has been obtained.

    In December last year, figures obtained by the Yorkshire Post revealed a sharp increase in the number of cases of rickets across the region.

  • Adoption halted as court told baby milk led to ‘innocent’ couple being accuse of abuse

    Adoption halted as court told baby milk led to ‘innocent’ couple being accuse of abuse

    Vitamin supplements in baby milk may have led an innocent couple being condemned for battering their newborn son, a top family judge has heard

    Adoption halted as court told baby milk led to 'innocent' couple being accuse of abuse

    Adoption halted as court told baby milk led to ‘innocent’ couple being accuse of abuse Photo: ALAMY

    By , Social Affairs Editor

    11:58AM BST 20 Sep 2012

    The boy, who cannot be named, was taken away from his parents and was poised to be adopted after multiple broken bones were put down to child abuse.

    But Lord Justice McFarlane halted the process yesterday after hearing how an extraordinary combination of medical events could have led to a case of congenital rickets being overlooked.

    The parents, who have fought a three-year custody battle, have been given a final chance to get their son back.

    It came after lawyers had what they described as a “light bulb moment” and understood the full significance of the child’s medical records.

    Michael Shrimpton, for the family, who are from the north of England, told the Court of Appeal in London that there is evidence that the boy was born with a Vitamin D deficiency, inherited from his mother, leading to “soft bones” and rickets.

    It suggests that the broken bones could have occurred during his difficult forceps birth, or even in the womb.

    Blood tests to check for signs of vitamin deficiency, when the boy was four weeks old were normal.

    But the court heard hat it is possible that it was “masked” by the formula milk given to him by his mother – which contained Vitamin D supplements.

    He added that there was “striking” evidence of severe abnormalities in the functioning of the baby boy’s liver, an organ instrumental in processing Vitamin D.

    The judge temporarily halted the adoption process and ordered urgent medical reports.

    Having a child taken away is an “exceptionally awful” ordeal, he remarked, adding that it was essential to examine whether the Vitamin D deficiency explanation for the boy’s injuries was “more than an intellectual possibility”.

    He also noted that there was no evidence of emotional difficulties, domestic violence, alcohol or drug abuse, or any signs of dysfunction within the family, to indicate a risk of child abuse.

    Mr Shrimpton said that one of the country’s top endocrinologists, Professor Stephen Nussey, who has carried out pioneering work on the causes and effects of Vitamin D deficiency, will be instructed to carry out that task if he is available at short notice.

    Observing that medical knowledge on the causes of infant injuries is in a state of constant movement, the barrister added: “This is an important case. It is starting to take on the appearance of a leading test case”.

    After hearing expert evidence in June last year, a judge at Sheffield High Court ruled that one or other of the parents must have been responsible for the baby’s injuries. The same judge refused to change her mind earlier this year and freed the boy for adoption.

    However, Lord Justice McFarlane observed: “Medical knowledge of how some children may have bones that are more susceptible to injury than normal children has moved on”.

    Emphasising the extreme urgency of the case in light of plans for the boy’s imminent adoption, the judge gave the parents 28 days to obtain a report from Professor Nussey, or another expert, in support of their case.

    The local authority involved in the case had informed the Appeal Court that suitable adoptive parents have already been found for the boy but no further steps in the process would be taken prior to the court ruling on the case.

    The case will return to the Appeal Court once the expert medical report has been obtained.

  • Bite Mark Analysis: The Biggest Fail of All Failed Evidence

  • Bite Mark Analysis: The Biggest Fail of All Failed Evidence

  • North West region records highest number of unexplained infant deaths

  • Vitamin D Deficiency in Critically Ill Children

    Vitamin D Deficiency in Critically Ill Children

    http://pediatrics.aappublications.org/content/early/2012/08/01/peds

  • Vitamin D Deficiency in Critically Ill Children

    Vitamin D Deficiency in Critically Ill Children

  • State to indict father in ‘shaking twins’ affair

    State to indict father in ‘shaking twins’ affair

    http://www.jpost.com/NationalNews/Article.aspx?id=278755

  • State to indict father in ‘shaking twins’ affair

    State to indict father in ‘shaking twins’ affair

    http://www.jpost.com/NationalNews/Article.aspx?id=278755

  • State to indict father in ‘shaking twins’ affair

    State to indict father in ‘shaking twins’ affair

  • Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

    http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2048374
    Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

  • Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

  • THE CASE FOR SHAKEN BABY SYNDROME REVIEW

    THE CASE FOR SHAKEN BABY SYNDROME REVIEW

    http://www.mjlr.org/wp-content/uploads/2012/05/Burg_45.3.pdf

  • THE CASE FOR SHAKEN BABY SYNDROME REVIEW

  • DISTINGUISHING BETWEEN INFLICTED AND NON INFLICTED BRAIN INJURY IN CHILDREN

    DISTINGUISHING BETWEEN INFLICTED AND NON INFLICTED BRAIN INJURY IN CHILDREN

    http://adc.bmj.com/content/94/11/860.full.pdf+html

  • DISTINGUISHING BETWEEN INFLICTED AND NON INFLICTED BRAIN INJURY IN CHILDREN

  • Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

    http://www.bmj.com/rapid-response/2011/11/01/sudden-infant-death-explained
    Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

  • Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

    http://www.bmj.com/rapid-response/2011/11/01/sudden-infant-death-explained

    Uncertainty in classification of repeat sudden unexpected infant deaths in Care of the Next Infant programme

  • A new cause for retinal haemorrhage and disc oedema in child abuse

    http://www.nature.com/eye/journal/v18/n1/full/6700480a.html
    A new cause for retinal haemorrhage and disc oedema in child abuse

  • A new cause for retinal haemorrhage and disc oedema in child abuse

    http://www.nature.com/eye/journal/v18/n1/full/6700480a.html

    A new cause for retinal haemorrhage and disc oedema in child abuse

  • TRAUMATIC BRAIN INJURY AND SHAKEN BABY SYNDROME

    http://www.actamedicaportuguesa.com/pdf/2011-24/5/805-808.pdf

    TRAUMATIC BRAIN INJURY AND SHAKEN BABY SYNDROME

  • TRAUMATIC BRAIN INJURY AND SHAKEN BABY SYNDROME

    http://www.actamedicaportuguesa.com/pdf/2011-24/5/805-808.pdf

    TRAUMATIC BRAIN INJURY AND SHAKEN BABY SYNDROME

  • MULTI FRACTURES OF THE LONG BONES IN INFANTS

  • MULTI FRACTURES OF THE LONG BONES IN INFANTS

  • Shaken baby syndrome: a search for truth

  • Shaken baby syndrome: a search for truth

  • Dad vows to fight Starship slur

  • Dad vows to fight Starship slur

  • Shaken-Baby Syndrome Faces New Questions in Court

    http://www.nytimes.com/2011/02/06/magazine/06baby-t.html?_r=2&pagewanted=all
    Shaken-Baby Syndrome Faces New Questions in Court

  • Shaken-Baby Syndrome Faces New Questions in Court

    http://www.nytimes.com/2011/02/06/magazine/06baby-t.html?_r=2&pagewanted=all

    Shaken-Baby Syndrome Faces New Questions in Court

  • Grandmother who fell carrying baby liable for head injuries after son-in-law sues

  • Grandmother who fell carrying baby liable for head injuries after son-in-law sues

  • CARE PROCEEDINGS BROKEN BABY OR BROKEN SCIENCE?

  • CARE PROCEEDINGS BROKEN BABY OR BROKEN SCIENCE?

  • MEDICINE DISCOVERS CHILD ABUSE

  • MEDICINE DISCOVERS CHILD ABUSE

  • Rise in cases in which parents are wrongly accused of harming their children

  • Rise in cases in which parents are wrongly accused of harming their children

  • Parents reunited with baby after court rules fractures were caused by rickets

    Parents reunited with baby after court rules fractures were caused by rickets

    Couple are second in two weeks to have child returned from care after court ruling that injuries were not caused by abuse.

    Rohan Wray and Chana al-Alas

    Rohan Wray and Chana al-Alas, who were reunited with their daughter last month after being cleared of killing their son, who had congenital rickets. Photograph: Sean Dempsey/PA Wire/Press Association Images

    A couple accused of abusing their baby after 17 fractures were discovered have welcomed a court ruling which found that the fractures were not caused by abuse but by the bone-weakening disease rickets.

    The case is the second in two weeks where a court has found rickets rather than abuse was the cause of fractures in a baby.

    After the abuse allegations were made, the couple’s baby was removed from them by social services last October when he was six months old and taken into care. He has spent half of his life in care.

    The couple wept with joy after being vindicated and were ecstatic when they were reunited with their baby soon after the ruling in the family court last Friday. The judge in the case has called for more research into vitamin D deficiency and rickets.

    Last month, Chana al-Alas and her partner Rohan Wray had their second child, Jayda, returned to them following a hearing in the family court. The couple were acquitted at the Old Bailey last December of killing their older son, Jayden, whose multiple fractures were found to be caused by congenital rickets, not child abuse. Jayda was removed from her parents at birth because of the allegations against them.

    Like Alas, the mother in this case was found to be deficient in vitamin D and has been diagnosed with osteomalacia, a condition similar to rickets. This vitamin D deficiency can be passed from mothers to their babies during pregnancy. Following the judgment the couple are calling for women to be routinely tested for vitamin D deficiency in pregnancy.

    Last October, the baby fell from a sofa and his parents took him to a London hospital to be checked over. A broken leg was diagnosed. Further x-rays revealed 17 fractures and the couple were suspected of abusing the boy and police and social services were called.

    “The doctor told us our son’s levels of calcium and vitamin D were very low but kept saying his broken bones were a result of non-accidental injury,” said the mother.

    Although the hospital diagnosed vitamin D deficiency and rickets, social services applied to the family court for a care order and asked the court to decide whether the baby’s injuries were non-accidental.

    The judge ruled that the local authority had not satisfied the court that the injuries were non-accidental. Positive evidence was given about the parents’ care for their baby and the judge acknowledged the heartache caused to the parents when their baby was taken away from them.

    When the fractures were diagnosed the mother stayed in hospital with her son for 20 days. “Then they took him away from me and gave him to a foster carer. I was still breastfeeding him and had never been apart from him for even a minute before,” she said. “I was completely devastated. I had never missed a single antenatal appointment but no one ever checked my vitamin D levels.

    “The whole thing was like a bad dream. How could I abuse my own child? Our baby had always been so happy. I had taken him to be weighed regularly and nobody had ever expressed any concerns. We even submitted him for a university research programme about brain development. We had nothing to hide.

    “I’m pregnant at the moment and they threatened to take the new baby away from us when it’s born if the court found we had abused our first child. Doctors and social services have made a mistake.”

    The family’s solicitor, Kevin Skinner of Goodman Ray, said opinion was divided among medical professionals about whether rickets could cause fractures. He said this kind of court proceeding was devastating for parents and supported the judge’s call for more research into rickets and vitamin D deficiency.

    “After the miscarriage of justice suffered by Jayden’s parents it is sad and frustrating to have other parents going through a similar experience just because their child is suffering from a relatively common medical condition. To be accused of abusing a child is terrible for any parent,” he said.

    Among the UK’s adult population, an estimated 50% of white people and 90% of black and Asian people have some degree of vitamin D deficiency.

  • PAEDIATRIC PATHOLOGY HEAD INJURIES IN CHILDREN

  • PAEDIATRIC PATHOLOGY HEAD INJURIES IN CHILDREN

  • retinal hemorrhage

  • retinal hemorrhage

  • NON ACCIDENTAL TRAUMA AND EPIDEMIOLOGY OF CHILD ABUSE

    NON ACCIDENTAL TRAUMA AND EPIDEMIOLOGY OF CHILD ABUSE

    http://www.springerlink.com/content/g7500m201423g81k/fulltext.pdf

  • NON ACCIDENTAL TRAUMA AND EPIDEMIOLOGY OF CHILD ABUSE

    NON ACCIDENTAL TRAUMA AND EPIDEMIOLOGY OF CHILD ABUSE

    http://www.springerlink.com/content/g7500m201423g81k/fulltext.pdf

  • FAMILY COURT JUDGMENT-WRAY CASE

    FAMILY COURT JUDGMENT

    (FD10C00445 LB of Islington v Al Alas and Wray Approved Judgment 19 April 2012)

  • FAMILY COURT JUDGMENT

  • REVIEW OF SHAKEN BABY CASES IN ONTARIO

  • REVIEW OF SHAKEN BABY CASES IN ONTARIO

  • GENA LAW REVIEW SHAKEN BABY SYNDROME

  • GENA LAW REVIEW SHAKEN BABY SYNDROME

  • Dr. Mary Case Interview shaken baby syndrome

  • SHAKEN BABY SYNDROME

  • SHAKEN BABY SYNDROME

  • Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

    Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

    http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2048374##

  • Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

    Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

  • Forensic Science Shaken Baby Cases 2010

    Forensic Science Shaken Baby Cases 2010

    http://parentsagainstinjustice.com/128154404

  • Forensic Science Shaken Baby Cases 2010

    Forensic Science Shaken Baby Cases 2010

  • RICKETS VERSUS ABUSE A NATIONAL AND INTERNATIONAL EPIDEMIC

    RICKETS VERSUS ABUSE A NATIONAL AND INTERNATIONAL EPIDEMIC

    http://parentsagainstinjustice.com/rickets-versus-abuse

  • RICKETS VERSUS ABUSE A NATIONAL AND INTERNATIONAL EPIDEMIC

    RICKETS VERSUS ABUSE A NATIONAL AND INTERNATIONAL EPIDEMIC

  • IMAGING IN NON ACCIDENTAL INJURY AND THE MIMICS

    IMAGING IN NON ACCIDENTAL INJURY AND THE MIMICS

    http://parentsagainstinjustice.com/128152444

  • IMAGING IN NON ACCIDENTAL INJURY AND THE MIMICS

    IMAGING IN NON ACCIDENTAL INJURY AND THE MIMICS

  • Parents take son to hospital for bump on the head and are stopped from seeing their kids alone for seven months following false abuse claims

    Parents take son to hospital for bump on the head and are stopped from seeing their kids alone for seven months following false abuse claims

    Chris and Julia Norton were ­interviewed by police and forced to sign over the ­children to Julia’s parents

    Torn apart: Julia and Chris Norton who's son Harry age 2 has a brittle bone conditon
    Torn apart: Julia and Chris Norton who’s son Harry age 2 has a brittle bone conditon
    Sunday Mirror/Roland Leon

    A couple were banned from being alone with their two young children after they were wrongly accused of abusing their baby.

    Worried Chris and Julia Norton took 10-week-old Harry to ­hospital when a lump appeared on his head… but doctors blamed THEM for causing the injury.

    Harry was later ­diagnosed with osteogenesis ­imperfecta, a rare brittle-bone disease which means a light touch can snap his bones. But it was seven months before the ordeal was over. In that time, social services were called and Harry and older sister Vicky were placed on the “at-risk” ­register.

    Chris and Julia were ­interviewed by police and forced to sign over the ­children to Julia’s parents. The family had to move in with the parents just to be with Harry, now two, and Vicky, four.

    Julia, 38, from St Ives, Cambs, said: “The accusations against my husband and I were like a sick joke. We were so scared.”

    The disturbing story is part of a rising trend of cases. The number of children taken into care is set to hit a new high in a surge known as the Baby P ­Effect after the horrifying 2007 death of 17-month-old Peter ­Connelly.

    Julia and Chris, 46, first took Harry to Hinchingbrooke ­Hospital in Cambridge after a bruise ­appeared on his chest in 2009.

    Doctors thought it was an ­allergic reaction to a spider bite and he was sent home. But more bruises followed. And when the lump ­appeared on his head, his anxious parents took him back to hospital. Julia said: “The doctor asked if we knew where it had come from. Then she said they were trained to suspect abuse.  I  couldn’t believe we were accused of ­harming our baby.”

    After the family moved in with Julia’s parents, she wasn’t even allowed to change Harry’s nappy on her own. “The children weren’t allowed to sleep in the same room as us either,” she said.

    All allegations against Julia and Chris have been dropped and they are speaking out now to raise ­awareness of parents wrongly ­accused of harming their children.Matthew Winn, of Cambs ­Community Services NHS Trust, said: “We are sorry… we’ve worked with the Nortons to introduce improvements to prevent distress to other families in future, while not ­compromising child safety.”

  • UK couple cleared of son’s murder calls for probe

    UK couple cleared of son’s murder calls for probe

    AP) — A young British couple has been reunited with their infant daughter after a long legal battle that dragged on even after they were cleared of murdering their 4-month-old son.

    Rohan Wray and Chana Al-Alas

    Rohan Wray, 22, and Chana Al-Alas, 19, were charged with murder after their son Jayden suffered a fractured skull and died of brain damage in 2009.

    The baby boy was diagnosed post-mortem with severe rickets, which causes bones to become soft and which some experts said was the cause behind Jayden’s fractures.

    Jayden’s parents blame the hospitals that treated their son for failing to spot the rickets, but the hospitals say they worked very hard to save his life, and medical professionals continue to disagree over what caused the baby’s death.

    A judge’s ruling in their favour at the High Court’s Family Division on Thursday allowed Al-Alas to be reunited with Jayda, the little girl she had been forced to relinquish to state custody immediately after giving birth in October 2010 amid the murder case.

    The mother and daughter had remained apart, even after Al-Alas was cleared in the criminal case, because of a civil suit filed in family courts by the London Borough of Islington alleging that, despite having rickets, Jayden suffered fractures caused by “non-accidental injury” and “died as a result of inflicted trauma caused to him whilst in the care of the parents.”

    The judge handling the civil suit found those allegations to be unproven in a ruling issued Thursday and made public Friday, leading baby Jayda to be returned to her parents.

    A lawyer for Al-Alas said Friday it’s not yet clear if her client and Jayden’s father will sue the hospitals after going through a two-and-a-half year ordeal.

    “It’s whether they want to go through another four years of litigation,” said Al-Alas’ lawyer, Ann Thompson. “They’ve got a little baby back at home with them and they’re really enjoying her. They just want to enjoy that.”

    The initial decision to file criminal murder charges, even after the post-mortem identified rickets, showed that police were trying to force a theory of trauma when other explanations were apparent, according to Thompson.

    Rickets causes problems in bone development and can result in soft or deformed bones, like bowed legs or a curved spine. It is most commonly caused by a lack of calcium and vitamin D; in rare cases, it is the result of a genetic disorder.

    Cases of the disease have been rising in the U.K. in recent years, and doctors have told parents to ensure their children get enough nutrients and sunlight. Children of Asian, African-Caribbean and Middle Eastern descent are at higher risk because their skin is often darker and they need more sunlight to get enough vitamin D.

    At the six-week criminal trial, 60 medical professional and expert witnesses failed to agree on the cause of Jayden’s death. Al-Alas and Wray were ultimately cleared of the criminal charges.

    The couple now accuse Great Ormond Street and University College Hospital of jumping to conclusions about child abuse without properly investigating, saying the hospitals should be investigated for failing to spot rickets.

    But the hospitals – expressing sympathy for the family – have defended their treatment.

    Great Ormond Street said in a statement that Jayden’s was a complicated case where the physical signs were much clearer post mortem.

    The hospital said it “never took any position on whether any specific person caused these injuries” and that the “sad clinical outcome” for Jayden would not have been any different if rickets had been diagnosed.

    University College Hospital said in a statement that its clinicians “acted with Jayden’s interests at heart.”

  • VACCINE LIFE THREATENING RESULTS BARLOWS DISEASE

    VACCINE LIFE THREATENING RESULTS BARLOWS DISEASE

    http://www.jpands.org/vol11no1/innis.pdf

  • VACCINE LIFE THREATENING RESULTS BARLOWS DISEASE

    VACCINE LIFE THREATENING RESULTS BARLOWS DISEASE

    http://www.jpands.org/vol11no1/innis.pdf

  • Accused of killing our son… then robbed of our newborn daughter: The couple wrongly blamed for shaking their rickets-stricken baby to death relive their horrific ordeal

    Accused of killing our son… then robbed of our newborn daughter: The couple wrongly blamed for shaking their rickets-stricken baby to death relive their horrific ordeal

    • Rohan Wray and Chana Al-Alas endured murder trial over death of Jayden
    • Police and doctors adamant they had beaten him and damaged his brain
    • But cleared after post-mortem revealed he had bone-weakening disease
    • Then forced to face another hearing to win back custody of daughter Jayda
    • ‘We’ve had no apologies from those who caused us this unforgivable agony’

    By Sue Reid

    PUBLISHED: 01:34, 24 April 2012 | UPDATED: 01:37, 24 April 2012

    Jayda Wray came home on Good Friday for the first time.

    The excited little girl, wearing a bright red cardigan, was carried through the front door by her father and mother, who had waited since the day she was born for the precious moment.

    At their neat London home, the young  parents watched wide-eyed Jayda play with new toys laid out on the floor.

    'Agony': Rohan Wray and Chana Al-Alas reunited with baby daughter Jayda, who was taken away from them after the couple were wrongly accused of murdering their son, Jayden‘Agony’: Rohan Wray and Chana Al-Alas reunited with baby daughter Jayda, who was taken away from them after the couple were wrongly accused of murdering their son, Jayden

    That evening, they bathed their little girl before she went contentedly to sleep.

    ‘When she woke the next morning she was so happy, as if she had been with us all her life,’ says her 22-year-old father Rohan now.

    Yet behind this image of contented family life is a story so horrendous it’s hard to believe it happened in Britain in the 21st century. It has frightening echoes of Stalin’s Russia or the events in a Kafka novel.

    Jayda was taken by social workers from her mother, Chana, now 19, the minute she was born in October 2010 and has, at 17 months old, only just been returned.

    No apologies: Chana cuddles a two-month-old Jayden, who doctors and police believed had been gripped and twisted so brutally by his parents that it shattered bones throughout his body
    No apologies: Chana cuddles a two-month-old Jayden, who doctors and police believed had been gripped and twisted so brutally by his parents that it shattered bones throughout his body. They were cleared after it later transpired he had the bone-weakening disease rickets

    Chana was not even allowed to hold her daughter before she was given to a foster family who hoped to adopt her.

    For she and Rohan had been accused of one of the worst crimes imaginable: shaking and beating to death Jayda’s older brother, Jayden, a year and a half earlier, when he was four months old.

    Scotland Yard detectives and doctors at the world famous children’s hospital, Great Ormond Street, believed the couple had gripped and twisted Jayden so brutally that bones throughout his body shattered, while blows to his head damaged his brain.

    It was only after a six-week murder trial at the Old Bailey last year that the couple were cleared of all wrongdoing.

    The judge ordered the jury to find them not guilty because a post-mortem revealed for the first time that Jayden had been born with rickets — a serious disease, linked to a lack of vitamin D, which causes seizures, weakens children’s skulls and causes their bones to break easily.

    These are symptoms that closely mimic those of a deliberately shaken baby.

    Cruel: After arresting them for grievous bodily harm, the Metropolitan police stopped the couple from seeing Jayden (pictured) before he died, three days after falling ill at homeCruel: After arresting them for grievous bodily harm, the Metropolitan police stopped the couple from seeing Jayden (pictured) before he died, three days after falling ill at home

    Doctors had, it transpired at the hearing, missed a vital clue when Jayden became ill and died three days later. They failed to detect Jayden had rickets, caused because Chana had so little vitamin D in her body that her son had not received it in the womb, or when she breastfed him.

    But despite the couple being exonerated in December, their local authority in Islington continued to suspect them of causing Jayden’s death. Social workers refused to hand over their daughter, still with foster parents, and made them face a second hearing in a family court which ended just before Easter.

    At the end of this hearing, High Court judge Mrs Justice Theis also ruled the couple were blameless, and said Jayda should go home immediately. And last week, the judge made public an important written judgment on the Wray family’s case.

    It highlighted a growing epidemic of rickets among children in Britain, often caused by them or their mothers being deprived of sunlight in countries of the northern hemisphere.

    The judge called for more research so medics spot rickets and do not jump to conclusions that a child with broken bones has been abused

    The judge called for more research so medics spot rickets and do not jump to conclusions that a child with broken bones has been abused. She also pinpointed a failure by doctors to treat Jayden for seizures, often provoked by a vitamin D deficiency. This, she said, led to brain damage, which in turn may have played a role in the boy’s death.

    But what happened to the Wray family is not an isolated case. The return of rickets — thought to have been eradicated in this country a century ago — has led to an alarming rise in false allegations of parents shaking children to death.

    Yet when Jayden was rushed by his parents to University College Hospital in London on July 22, 2009, rickets wasn’t detected from an X-ray.

    The child, who was soon having seizures and becoming dangerously ill, was rushed to London’s Great Ormond Street, where radiologists also examined X-ray images. They, too, failed to spot he had rickets.

    When, later the same day at Great Ormond Street, scans showed a multitude of fractures all over Jayden’s body and head, the finger of blame was pointed directly at Rohan and Chana.

    'Dangerous allegations': Rohan and Chana at the Old Bailey, where they had to endure a six-week murder trial before being found not guilty when evidence revealed Jayden had been ill rather than abused‘Dangerous allegations’: Rohan and Chana at the Old Bailey, where they had to endure a six-week murder trial before being found not guilty when evidence revealed Jayden had been ill rather than abused

    Some might say it is easy to understand how the medics, when examining a young child with what looked like serious shaking injuries, thought the parents had hurt him. Yet that can hardly excuse their failure to diagnose his rickets — and the horrific ordeal the couple suffered.

    Jayden’s parents were accused by doctors of breaking his skull, his knee, elbow, shoulder, hip, ankle and wrist. Medics believed he had been intentionally shaken, and had his head hit on something hard.

    The Metropolitan police were called in, and the couple were arrested at the hospital in the middle of the night, and charged with causing him grievous bodily harm.

    Police stopped them from seeing their son before he died, on July 25, 2009, three days after falling ill at home. Cruelly, they were barred from a cot-side christening of Jayden by a vicar, which they had requested. It was watched only by nurses.

    ‘We never saw Jayden alive again from the moment of our arrest, because doctors and police thought we might harm him again’

    Rohan Wray

    ‘We never saw Jayden alive again from the moment of our arrest, because doctors and police thought we might harm him again,’ recalls Rohan. ‘The next time we were close to Jayden was at his funeral just before Christmas last year, when we’d been cleared of murder and his body was released by Scotland Yard.

    ‘Yet we have received no apologies from those who caused us this unforgivable agony. There are medical staff who, we believe, should be disciplined over Jayden’s death. Since the tragedy of Baby P, doctors, the police and social workers have become over-keen to snatch children from innocent parents.’

    And Chana adds: ‘These people in positions of authority made allegations against us without any proof, or discovering Jayden had rickets. This is dangerous.’

    Rohan and Chana met through friends when Chana was 14 and still a schoolgirl. When she gave birth to Jayden aged 16, he was a much-wanted and loved baby.

    The young parents attended all the antenatal appointments at the hospital or GP’s surgery. And after he was born, no one — from the health visitor to local doctors — saw as much as a bruise on the boy.

    The couple’s nightmare started when they woke at five one morning in July 2009. They found Jayden, who slept in a cot in their room, with his tongue stuck to the top of his mouth and refusing to be breastfed.

    Rohan says: ‘We thought he looked very sleepy, and saw his mouth would not open properly. But he had suspected flu a week or two before, and we thought he was still ill.’

    Second torment: Rohan and Chana after their victory in the High Court, where they had to face similar accusations after the local authority refused to hand back their daughter, JaydaSecond torment: Rohan and Chana after their victory in the High Court, where they had to face similar accusations after the local authority refused to hand back their daughter, Jayda

    Rohan walked around with his son in his arms. The couple put Jayden in his baby bouncer, and tried waving a set of keys, his favourite plaything, in front of his face. The boy reached out for them, and followed them with his eyes. But still he refused to breastfeed.

    The couple then rang University College Hospital near their home. But when Rohan described his son’s symptoms to a doctor, he was told it did not sound like ‘anything serious’ and to take the baby to a GP.

    Rohan phoned his local doctor’s surgery for an appointment the instant it opened at 8.30am.

    The doctor they saw, a student in his second year of training, examined the baby and found little amiss. But he told them to go to University College Hospital paediatric walk-in clinic to double-check on him.

    They travelled there by bus, and a paediatric specialist said there was nothing wrong with the child, apart from him not opening his mouth. One doctor even pronounced him as ‘fit as a fiddle’.

    Crucially, nothing was ever done at the hospital to deal with the seizures he had started having.

    During the day, doctors decided to scan Jayden’s body. While rickets was never suspected, those initial scans showed Jayden had a fracture to his skull and that his arms were broken.

    By 6pm, his condition had worsened and doctors said they wanted to send him to Great Ormond Street. They warned his parents that the baby might not even make the journey by ambulance. CCTV hospital footage shows Chana collapsing to the floor in grief.

    That night, at Great Ormond Street, a paediatric consultant also told the couple that Jayden was unlikely to survive.

    Rohan says: ‘It was like, “Oh sorry to be so blunt, but you know your son is going to die.” I asked the consultant what had caused this — and he just glared at me as if he believed we had done something to our son.’

    It emerged at the criminal and family court hearings that the consultant had that night written in the child’s medical records: ‘In the absence of any explanation, this has all the features of inflicted head trauma.’

    The couple were later arrested by police, alerted by the hospital, for suspected grievous bodily harm.

    Two days later, they were told Jayden had died. The following year the police changed  the charges to murder. Chana — by then seven months pregnant with Jayda — was sent to Holloway prison to await a Crown Court hearing.

    Rohan was also sent to prison for two months at the start of the murder inquiry. At other stages, he had to wear a tag, obey a strict curfew and for a time was banned from seeing or speaking to Chana.

    When she gave birth to Jayda, their daughter was taken from her, and the couple were only allowed to see her, supervised, for a few hours a week. They were barred from visiting her on Christmas Day two years running.

    Rohan says: ‘I blame University College Hospital for killing our child.

    ‘We want an investigation into how Jayden died — and why our daughter was taken from us. We are taking legal advice on suing the police, and the hospitals that treated him.’

    There may be some who still doubt the couple’s innocence, but the fact is they have been cleared — twice.

    Their solicitor, Jenny Wiltshire, says: ‘So many lessons must be learned. Doctors should be aware of the dangers of vitamin D deficiency in mothers and their babies and must be trained to spot signs of rickets on X-rays.’

    It was only by chance that an eminent paediatric pathologist, Dr Irene Scheimberg, was called to give evidence at the couple’s murder trial. She conducted a post-mortem on Jayden and found ‘obvious sign of rickets’, including weak bones and a weak skull.

    Rohan says: ‘If Dr Scheimberg had not done the autopsy, we would have been found guilty of murder and Jayda would have been put up for adoption.

    ‘Not only would we have lost our son, but we would never have seen our daughter again.’

    Read more: http://www.dailymail.co.uk/news/article-2134226/Jayden-Wray-death-Couple-wrongly-blamed-shaking-rickets-stricken-baby-death-relive-horrific-ordeal.html#ixzz1sxr2f3Q6

  • Baby’s parents demand rickets death hospital inquiry

    Baby’s parents demand rickets death hospital inquiry

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    Rohan Wray and Channa Al-Alas said they felt like one doctor was accusing them of harming their child

    A young couple acquitted of murdering their four-month-old son have called for an inquiry into two London hospitals responsible for his care.

    Rohan Wray, 22, and Chana Al-Alas, 19, of London, were accused of abusing baby Jayden but his fractures were later found to have been caused by rickets.

    They told the BBC that the Great Ormond Street and University College hospitals should have diagnosed the disease.

    The hospitals have defended their care of Jayden before his death in 2009.

    A University College Hospital spokesman said its clinicians “acted with Jayden’s interests at heart”.

    “We regret that we were unable to reverse his deteriorating condition despite our intensive efforts in the short time he stayed with us. We would like to offer our sincere condolences to Jayden’s parents,” he said.

    Continue reading the main story

    Analysis

    Andrew Hosken BBC Today programme

    It is difficult to hear of a more astonishing ordeal than that endured by the parents of baby Jayden.

    Accused of murdering their first child who died of natural causes, the couple had to suffer the shock of seeing their second baby taken away in the delivery room and taken into care.

    They were acquitted of murder at the Old Bailey last December but have not been able to speak until now due to their family court battle to have their baby daughter Jayda returned to them.

    That fight ended successfully on Thursday. For almost three years, they were treated as murder suspects not only by police and medical experts but also strangers in the street who recognised them from newspaper reports.

    Both parents want their story told and an inquiry held to help other innocent parents in similar circumstances.

    Solicitors and other medical experts say there are many other parents also accused of abuse and murder of children where rickets is later found to be the cause.

    Great Ormond Street said the rickets abnormalities had been less obvious to hospital radiologists than at the later autopsy and that it regretted the family’s distressing time.

    Criminal charges against Jayden’s parents were dropped in December 2011, after witnesses were unable to agree on the cause of the boy’s death. But civil action was then taken by the local authority, Islington, which said Jayden had died from trauma inflicted on him by his parents.

    ‘Horrible two years’

    On Thursday, family court judge Mrs Justice Theis cleared Jayden’s parents of responsibility for the death of their son and criticised the two hospitals for what she described as sub-optimal care.

    Jayden had a fractured skull and died from brain damage and swelling. He had been suffering from severe rickets, a disease caused by vitamin-D deficiency that causes bones to become soft.

    In their first broadcast interview, given to BBC Radio 4’s Today programme, Jayden’s mother and father voiced their anger at Great Ormond Street and University College hospitals.

    They described being asked at University College Hospital (UCH) if they knew how Jayden’s injuries had occurred.

    “I said apart from him rolling over in his cot and hitting his head on the side of the bars I can’t think of any other explanation because we haven’t dropped him, nothing’s dropped on him,” Mr Wray said. “The look from them was that simply they didn’t believe my explanation.”

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    Dr Arun Ghosh, GP explains why some people are more likely to get rickets

    The couple said they believed that Jayden would still be alive had his condition been correctly diagnosed at UCH and that they blamed both hospitals for his death.

    Ms Al-Alas said they were prevented from seeing Jayden after he was transferred to Great Ormond Street and later learned the hospital had spent four hours getting his injuries scanned.

    “He wasn’t being treated then. They didn’t know his brain readings – they wasn’t checking that – they was just concentrating on getting the right pictures and he could’ve been treated then as well.” Lessons needed to be learned, she said.

    Mr Wray said it had been a “horrible, horrible two years”.

    “I really feel that they didn’t really know what they were doing and they just pre-judged us way too early,” he said. “You should actually be treated as innocent until proven guilty and not guilty until proven innocent.”

    ‘Nightmare went on’

    In a statement, a Great Ormond Street Hospital spokesman said the decision to prosecute Jayden’s parents was taken by the Crown Prosecution Service (CPS) after rickets had been diagnosed following Jayden’s death.

    “It is therefore fair to say that GOSH’s radiological opinion was not the determining factor in that decision. Nor would a diagnosis of rickets at GOSH have altered the clinical outcome,” he said.

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    “It is not for the trust to decide legal issues of criminal responsibility. We never took any position on whether any specific person caused these injuries.”

    A CPS spokesman said: “In bringing this prosecution we considered all of the evidence in detail and our policy on non-accidental head injuries, and were satisfied that there was a realistic prospect of conviction. There was no criticism of the CPS by the judge for bringing this case.”

    In her High Court ruling, Mrs Justice Theis said she could not be satisfied “on the balance of probabilities” that any of the fractures or the “traumatised fissure” were “as a result of inflicted deliberate harm caused to Jayden by either of these parents”.

    Mrs Justice Theis concluded that more research was needed on the impact of vitamin D deficiency and rickets on babies aged under six months.

    The couple’s daughter, who has been in the care of Islington since her birth in October 2010, has now been returned to them.

  • BILL BACHE SOLICITOR LETTER TO THE TIMES REGARDING SHAKEN BABY SYNDROME

  • BILL BACHE SOLICITOR LETTER TO THE TIMES REGARDING SHAKEN BABY SYNDROME

  • LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE CHILD FINALLY RETURNED

    LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE CHILD FINALLY RETURNED

    http://www.familylawweek.co.uk/site.aspx?i=ed97208

    LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE

  • LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE CHILD FINALLY RETURNED

    LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE CHILD FINALLY RETURNED

    http://www.familylawweek.co.uk/site.aspx?i=ed97208

    LB of Islington v Al Alas and Wray [2012] EWHC 865 (Fam)-RICKETS CASE

  • NEW MODALITIES IN THE MANAGEMENT OF OSTEOGENESIS IMPERFECTA

  • NEW MODALITIES IN THE MANAGEMENT OF OSTEOGENESIS IMPERFECTA

  • JOINT LAXITY IN THE PARENTS OF CHILDREN WITH TEMPORARY BRITTLE BONE DISEASE

  • JOINT LAXITY IN THE PARENTS OF CHILDREN WITH TEMPORARY BRITTLE BONE DISEASE

  • TODLERS FRACTURE-VISUAL DIAGNOSIS

  • TODLERS FRACTURE-VISUAL DIAGNOSIS

  • MULTIPLE FRACTURES IN CHILDREN SCURVY OR NON ACCIDENTAL INJURY

    http://parentsagainstinjustice.com/pages/multiple-fractures-in-children-scurvy-or-non
    MULTIPLE FRACTURES IN CHILDREN SCURVY OR NON ACCIDENTAL INJURY

  • MULTIPLE FRACTURES IN CHILDREN SCURVY OR NON ACCIDENTAL INJURY

  • Vitamin D deficiency rickets: another shattered family

    http://www.vitamindcouncil.org/?o=3361
    Vitamin D deficiency rickets: another shattered family

  • Vitamin D deficiency rickets: another shattered family

    http://www.vitamindcouncil.org/?o=3361

    Vitamin D deficiency rickets: another shattered family

  • LONG TERM FOLLOW UP OF CHILDREN THOUGHT TO BE HAVING TEMPORARY BRITTLE BONE DISEASE

    LONG TERM FOLLOW UP OF CHILDREN THOUGHT TO BE HAVING TEMPORARY BRITTLE BONE DISEASE

    http://parentsagainstinjustice.com/long-term-follow-up-of-children-

  • LONG TERM FOLLOW UP OF CHILDREN THOUGHT TO BE HAVING TEMPORARY BRITTLE BONE DISEASE

    LONG TERM FOLLOW UP OF CHILDREN THOUGHT TO BE HAVING TEMPORARY BRITTLE BONE DISEASE

    http://parentsagainstinjustice.com/long-term-follow-up-of-children-…

  • VITAMIN D DEFICIENCY AND FRACTURES IN CHILDHOOD

  • VITAMIN D DEFICIENCY AND FRACTURES IN CHILDHOOD

  • Baby Jayden case renews concerns over rickets and ‘child abuse’ allegations

    Baby Jayden case renews concerns over rickets and ‘child abuse’ allegations

    Fears grow that rising levels of vitamin-D deficiency may be leading to more cases of rickets being misdiagnosed as child abuse

    Rohan Wray and Chana al-Alas, who were cleared of murdering four-month-old Jayden

    Rohan Wray and Chana al-Alas have just had their second child returned to them by the court after she was taken into care at birth following Jayden’s death. Photograph: Sean Dempsey/PA

    Concern is mounting about dangerously low levels of vitamin D in pregnant women and two hospitals’ failure to identify rickets after the death of Jayden Wray, a baby who suffered from the disease.

    Chana al-Alas, who was just 16 when she fell pregnant, and her partner Rohan Wray, then 19, were acquitted at the Old Bailey last December of killing Jayden. Multiple fractures found after his death in 2009 were caused by congenital rickets, which was undetected in his 18 weeks of life, and not by abuse, the court found.

    The couple, now 19 and 22, had their second child returned to them by the family court this week. Jayda, now 18 months old, was taken into care at birth for her own safety because of the allegations against her parents.

    Questions are being asked about the levels of specialist expertise of the radiology departments at two London hospitals, University College London and Great Ormond Street hospital (GOSH), which failed to identify rickets in baby Jayden while he was alive.

    At the family court, Mrs Justice Theis said there had been only one other case in the last 30 years of such severe rickets in so young a baby. “This case has demonstrated the difficulties in identifying rickets just by images. In this case it was queried by the radiologist at UCLH, missed by the radiologists at GOSH and picked up by the paediatric pathologist,” she said in her written judgment, but she added that the baby received “sub-optimal care” from the two hospitals.

    Great Ormond Street said that Jayden had a full skeletal survey on 23 July 2009 that found multiple fractures but said it would not have been obvious to hospital radiologists that these were caused by weak bones. “It is clear to us from the judgment that this was an atypical case where abnormalities were much less visible on the radiology, than were shown by the postmortem,” GOSH said in a statement.

    It had subsequently commissioned an independent review of radiology issues arising from the case by Dr Stephen Chapman, of Birmingham Children’s hospital. This said: “It would have been best practice to raise the possibility of an underlying bone disease in the report (eg. vitamin D deficiency/rickets) …” but concluded that it was “not an obvious case of rickets”.

    But a former GOSH paediatric radiologist, Karen Rosendahl, disputed that, in general, cases of rickets were necessarily hard to detect on a survey. She saidtold the Guardian: “It’s very often not particularly difficult to see but you need experience. It’s complex. You need five to 10 years of experience to get the diagnosis correct.”

    Rosendahl, who specialises in multi-skeletal (MSK) radiology, claimed in a BBC London documentary this week that GOSH had not replaced experienced MSK radiologists who had left in recent years, and this had led to misdiagnosis in cases of suspected child abuse.

    Dr Rosendahl, who is now a consultant paediatric radiologist at Haukeland University hospital in Bergen, Norway, having left GOSH in April 2010, told the BBC: “I have concerns about children’s safety. One particular case was misdiagnosed and had the wrong sort of treatment. Another case was misdiagnosed as abuse when it wasn’t abuse.”

    The hospital said it accepted that it had lost MSK specialists but strongly rejected the claim and said that child protection work was a core part of the work of all its paediatric radiologists. GOSH said the decision to prosecute Jayden’s parents for causing his death was taken by the Crown Prosecution Service after rickets had been diagnosed at a postmortem examination. “It is therefore fair to say that GOSH’s radiological opinion was not the determining factor in that decision. Neither would a diagnosis of rickets at GOSH altered the sad clinical outcome.”

    The Jayden case is the latest in a line of high-profile controversies to hit Great Ormond Street. In May 2009 it was criticised by the NHS regulator over a catalogue of errors and failures,which meant serious injuries inflicted on Peter Connelly, the toddler known as Baby P, were not spotted. Peter had died in 2008 at the hands of his mother and her lodgers, shortly after being examined by a GOSH doctor in Haringey, north London.

    A year later MPs called for an investigation after 50 GOSH consultants signed a letter of no-confidence in the chief executive, Jane Collins amid allegations of “fear and intimidation” at the trust. This week a BBC London documentary alleged GOSH had bullied staff and tried to cover up clinical failures, charges the hospital rejected.

    Alas breast-fed Jayden, but this made his condition worse because her own vitamin D levels were so low. There is growing concern about deficiencies in mothers and their babies. Last year, Andrew Walker, coroner for north London, wrote to the health secretary, Andrew Lansley, asking him to ensure “greater public awareness” of the issue after a three-month old boy died of an infection to which low levels of vitamin D contributed. In February, the UK’s four chief medical officers issued an important reminder to GPs of the need for pregnant and breastfeeding women to take supplements. Breast-fed babies and those whose mothers did not take supplements should also be given vitamin D.

  • RICKETS FAMILY COURT CASE JUDGMENT

    RICKETS FAMILY COURT CASE JUDGMENT

    http://www.familylawweek.co.uk/site.aspx?i=ed97208

  • RICKETS FAMILY COURT CASE JUDGMENT

    RICKETS FAMILY COURT CASE JUDGMENT

    http://www.familylawweek.co.uk/site.aspx?i=ed97208

  • Dubious ‘experts’ are paid to tear families apart

    Dubious ‘experts’ are paid to tear families apart

    A new report condemns the shoddy standards of psychologists’ reports in our family courts.

    Our 'child protection' system is tearing many families apart

    Many mothers have been declared unfit on the strength of ‘very poor’ psychologists’ reports Photo: ALAMY

    7:00PM GMT 17 Mar 2012

    A long overdue scandal hit the headlines last week when a semi-official report exposed one of the murkiest corners of our child protection system – the way that supposed professional “experts” help social workers to remove children from their parents.

    A study by Professor Jane Ireland, a forensic psychologist, for the Family Justice Council examined 126 psychological reports trawled at random from family court documents. It found that two thirds of them were “poor” or “very poor” in quality; that 20 per cent of their authors had no proper qualifications; and that no fewer than 90 per cent of the authors were not practising psychologists but appeared to earn their livings, wholly or partly, from writing reports for social workers. Already one psychologist, whose company has made nearly half a million pounds a year from such reports, is under investigation by the General Medical Council.

    The picture Prof Ireland conveys is one with which I am only too familiar. I have seen how families can be torn apart largely on the basis of highly dubious psychological evidence designed, as John Hemming MP puts it, to “suit the demands of local authorities”. One mother lost her children, for instance, on the basis of a 235-page report, costing £14,000, which found that she was “likely to have a borderline personality disorder” – without the author ever having met her.

    Another woman was found by a psychologist to be “a competent mother” – so the social workers went to a second witness, who found the same. They then commissioned a third, who at last came up with what they wanted: that the mother had, again, “a borderline personality disorder”. On that basis, her three children were sent for adoption.

    A married couple lost their daughter because the father, who had had four “psychological assessments”, saw no reason to submit himself to a fifth. The Court of Appeal found that he seemed to be putting his “emotional needs before those of his child”, and ordered that the child be adopted.

    Damning as Prof Ireland’s report is, her remit was only to look at psychological assessments. An equally disturbing picture might emerge from examining other groups of medical “experts” who earn thousands of pounds from evidence which parents may not be allowed to challenge or even read.

    One contentious area, for instance, is where parents are accused of having injured infants who are found to have small fractures to their bones. A fashionable theory, pioneered by a Dr Kleinman in the US, holds that such fractures are a sure indicator of “non-accidental injury”, ie the child must have been abused. In one case (which I was able to report last year because the judge, unusually, published his judgment) it was clear that all the four medical witnesses had supported this “Kleinman theory”, unquestioningly accepted by the judge.

    But other experts strongly disagree, citing studies which suggest that such fractures may quite often arise naturally from a deficiency of vitamin D (as tests had shown was the case with this particular mother). When I showed the judgment to a doctor expert in this field, he immediately recognised three of the witnesses as doctors who “go round from one court to another to support the Kleinman theory”. Since no one was in court to challenge them, the heartbroken mother – like many before her – lost her son.

    Several scandals have hit the headlines in recent years involving doctors struck off after making a reputation as witnesses, pushing some theory about “brittle bones”, “shaken baby syndrome” or “Munchausen syndrome by proxy” which was eventually exposed as fallacious. But these causes célèbres have centred on criminal courts, where evidence can be put more rigorously to the test than is required by the much laxer procedures of family courts. As I have observed before, once a court system is allowed to hide itself away behind a wall of secrecy, the chances are high that it will become corrupted. A perfect example is the role played in our family courts by many of these professional “experts”. The good work Prof Ireland has begun cannot be allowed to stop there.

  • Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

    Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

    Published: 24 March 2011
    Annex A: Case Law

    R v Cannings [2004]
    R v Harris, Rock, Cherry and Faulder [2005]
    R v Kai-Whitewind [2005]
    R v Allen [2005]
    A Local Authority v S [2009]
    R v Reed and Reed and R v Garmson [2009]
    R v Henderson, Butler and Oyediran [2010]

    R v Cannings [2004] EWCA Crim 01

    See information in Background section in guidance.
    R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980

    A number of NAHI cases were identified by the CPS and the Court of Appeal as being suitable for being heard together to ensure that a comprehensive judgment could be made by the Court of Appeal in order to guide the handling of such cases in the future.

    The Court of Appeal concluded that the unified hypothesis could no longer be considered as a credible or alternative cause to the accepted triad hypothesis. In the course of the Harris trial, Dr. Geddes (the creator of the unified hypothesis) agreed that her research was incomplete.

    The pathological features themselves are observable facts, although the mechanisms that cause them could be open to interpretation.

    The Court felt that the triad of pathological features provided strong evidence towards a finding that the injuries were non-accidental but could not alone be conclusive of the cause of death.

    In determining the degree of force required to cause the triad of pathological features, the Court identified four general propositions whilst indicating that there was no scientific method of correlating the amount of force used and the severity of the damage caused:

    The more severe the injury the more probable that they were caused by greater force than mere ‘rough handling’;
    Cases of serious injuries caused by [apparently] very minor force as may occur in normal or rough handling of an infant, are likely to be extremely rare;
    There will be cases where a [apparently] small degree of force or a minor fall will cause very severe injuries; and
    It is not possible to conclude that age [of the child] is a factor in deciding whether injuries are caused by strong force or a minimal degree of force or impact.

    Cases of alleged NAHI are fact specific and will be determined on their individual characteristics. All the circumstances, and particularly the clinical picture, must be taken into account. The characteristics of the individual components of the triad are particularly vital to its interpretation.
    R v Kai-Whitewind [2005] EWCA Crim 1092

    This case is important in outlining the scope of the Cannings judgment:

    “All this suggests that, for the time being [due to the current state of medical knowledge], where a full investigation into two or more sudden unexplained infants deaths in the same family is followed by a serious disagreement between reputable experts about the cause of death, and a body of such expert evidence concludes that natural causes, whether explained or unexplained, cannot be excluded as a reasonable (and not a fanciful) possibility, the prosecution of a parent or parents for murder should not be started, or continued, unless there is additional cogent evidence extraneous to the expert evidence which tends to support the conclusion that the infant, or where there is more than one death, one of the infants, was deliberately harmed.”

    The defence in this case sought to argue that the Cannings judgment extended to other sudden infant death cases where there was a conflict of expert opinion.

    In not allowing the appeal, Judge LJ stated that the Cannings case was only intended to apply to cases that depended on inferences based on coincidence, or the unlikelihood of two or more infant deaths in the same family, or one death where another child had suffered unexplained apparent life-threatening events.

    The allegation against the appellant in Kai-Whitewind arose from a single death and could be distinguished from Cannings. Moreover, unlike the case of Cannings, Kai-Whitewind’s conviction had not been based entirely on conflicting expert opinion; there was additional cogent evidence.

    It was for the jury to evaluate the expert evidence, taking into account the facts found at the post mortem, as well as upon admission to hospital, and bearing in mind that the findings related to an infant whose mother:

    had spoken about killing him;
    had difficulties bonding with him;
    might have delayed reporting his death; and
    had elected not to give evidence.

    The Court concluded that there was ample evidence before the jury to justify the verdict and the conviction for murder was safe.
    R v Allen [2005] EWCA Crim 1344

    The appellant was convicted of the murder of his baby son following an incident in which it was alleged the child suffered injuries caused by shaking, impact or a combination of the two. This incident had followed a previous one the week before as a result of which the child was detained in hospital for a number of days.

    On appeal, the Court held that the evidence of the previous incident was relevant in order to prove the necessary intent on the day of the fatal act, and that there was sufficient evidence for the jury to convict of murder as opposed to manslaughter. In addition to the triad of injuries, and the previous incident which the Crown said was due to the appellant’s actions, evidence was found of bruising to the back of the child’s head.

    The Court also held that the acceptability of the medical evidence was a matter for the jury (Paragraph 69).

    The Court concluded that the appellant’s conviction for murder was safe.
    A Local Authority v S [2009] EWHC 2115 (Fam)

    This case (ALA v S [2009] EWHC 2115 (Fam)) was an application by the local authority for a care order under S.31 of the Children Act 1989 in relation to S, who was born on 17th March 2006 and who had just turned three. (para 1)

    The proceedings arose out of the death of a second child of the family, Z, who collapsed at home on 29th October 2007 when he was thirteen weeks old. He died on 1st November 2007. (para 3)

    In ALA v S, Mrs Justice King said “This is a case where the allegation is that Z died as a result of a shake or a shaking/impact injury. The classic features of such a non-accidental injury, it is said were present, namely encephalopathy, subdural haemorrhage and retinal haemorrhage. This combination of injuries is known as “the triad” (para 29). She determined the facts of the case against the backdrop of the current law; the judgments handed down by the House of Lords as recently as 11th June 2008 in Re B [2008] (Children) UKHL 35, and adopted the descriptions given by the Court of Appeal, Criminal Division, in its judgment on 21st July 2005 in R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980 paras.63-65 (para 30):

    “As already stated, when the three elements of the triad coincide, for some years conventional medical opinion has been that this is diagnostic of NAHI. Typically the brain is found to be encephalopathic; bleeding is found in the subdural space between the dura and the arachnoid subdural haemorrhages; and there are retinal haemorrhages. There may also be other pathological signs such as subarachnoid bleeding and injuries at the cranio-cervical junction. Further, there may be injuries to nerve tissue (axonal injuries) and external signs of broken bones, bruising and other obvious injuries such as extradural oedema (bruising). Determining these findings requires medical experts from a number of different disciplines interpreting often very small signs within the complex structures of an infant’s brain and surrounding tissue.

    The mechanism for these injuries is said to be the shaking of the infant, with or without impact on a solid surface, which moves the brain within the skull damaging the brain and shearing the bridging veins between the dura and the arachnoid. The shaking may also cause retinal haemorrhages. In the sense that the explanation for the triad is said to be caused by shaking and/or impact it also is a unified hypothesis, albeit that each element is said to be caused individually by trauma.

    The triad of injuries becomes central to a diagnosis of NAHI when there are no other signs or symptoms of trauma such as bruises or fractures.” (ibid.)

    In this case (ALA v S) not only were there a considerable number of experts, but Mrs Justice King was asked specifically to make serious adverse findings in relation to two of those experts, Dr. Cohen and Dr. Squier (para 33). In Re LU and LB [2004] EWCA Civ 567, the Court of Appeal provided guidelines for expert witnesses following the earlier case of R v Cannings. At para.23, Butler-Sloss P. gave the following guidelines:

    i) The cause of an injury or an episode that cannot be explained scientifically remains equivocal.

    ii) Recurrence is not in itself probative.

    iii) Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of natural cause.

    iv) The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour propre is at stake, or the expert who has developed a scientific prejudice.

    v) The judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts or that scientific research will throw light into corners that are at present dark (ibid).

    The approach of the court to expert opinion it was submitted, must include the need to evaluate the witnesses and the soundness of each of their opinions. The mere expression, of a belief by a witness, however eminent, does not suffice. The court’s evaluation of the witnesses, it was submitted should follow Ryder J. in A County Council v X Y and Z [2005] 2 FLR 129:

    “… involves an examination of the reasons given for his opinions and … the extent to which they are supported by the evidence.” (para 34)

    The judge must also examine:

    “… the internal consistency and logic of his evidence; his precision and accuracy of thought… the extent to which a witness has conceived an opinion and is reluctant to re-examine it in light of later evidence … whether or not a witness is biased or lacks independence.” (para 35)

    Summary positions:

    “Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd all regard non-accidental head injury as the most likely cause of all Z’s injuries and consider it improbable, or highly improbable, that the other suggested causes could have caused the triad and Z’s death. (para 57)

    “Dr. Squier and Dr. Cohen regard non-accidental head injury as possible, but unlikely, in the absence of any other bony or soft-tissue injury, or other specific post-mortem evidence of trauma. Dr. Squier agreed that the triad seen in Z was also seen in cases of frank, inflicted trauma and in accidental trauma. Dr. Squier and Dr. Cohen consider the most likely cause of the primary event to be either a choking incident or a heart arrhythmia combined with the effects of prolonged CPR followed by resuscitation. (para 58)

    “Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd each hold what might be called the mainstream view of non-accidental head injuries as encapsulated in the judgments of the Court of Appeal in R v Harris. None accept that hypoxia in the absence of trauma is a cause of subdural haemorrhages and retinal haemorrhages of the type seen in Z. Dr. Al-Sarraj summed up the approach which HHJ King found each of this group of experts regarded as the proper approach in considering a case where the triad is present. Dr. Al-Sarraj told the court that: (para 60)

    “Dr. Squier and Dr. Cohen have a very different approach in two important areas:

    i)

    a) Dr. Cohen does not regard trauma as a proper diagnosis where the triad is present, but there are no external injuries such as bruises or fractures and /or a witness to the alleged shaking event.
    b) Dr. Squier regards trauma as very important. She is of the opinion that the triad, in the absence of evidence of trauma, is simply “no evidence of shaken baby syndrome”. The triad of injuries may be due to many other factors that are not trauma. She does not accept that the triad is necessarily a strong indicator of shaken baby syndrome. In the opinion of Dr. Squier, shaking alone may cause the triad, but the level of violence required is such that many people would be incapable of it and it would break the child’s neck. She said, in terms, that she would never advise the court that trauma was the probable cause absent external injury, either seen physically with the naked eye or found at post-mortem.

    ii) Both Dr. Cohen and Dr. Squier subscribe to the Geddes III hypothesis in one form or another. Put at its simplest, each are of the view that hypoxia in children can lead to subdural haemorrhages and retinal haemorrhages in the absence of trauma.” (para 63, i, ii, iii)

    In considering the evidence of Dr. Cohen and Dr. Squier, Mrs Justice King had in mind the guidance of Butler-Sloss P. in Re LU and LB (set out above), and in particular: (para 197)

    That the court must be on guard against the over-dogmatic expert … who has developed a scientific prejudice; and
    A judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts.

    “The latter is of importance in the present case where it is accepted by all that there is much to learn and much which is not yet understood about so-called shaken baby syndrome and the triad. Dr. Cohen and Dr. Squier each agree with Geddes III. Dr. Cohen and Dr. Squier each believe that in the absence of additional external injuries, such as grip marks or fractures, there is no reliable evidence of shaken baby syndrome. Dr. Squier does not accept the triad to be a strong indicator of shaken baby syndrome. (198)

    “These views are, undoubtedly, controversial. They go against the mainstream of current thinking and the analysis of the Court of Appeal in R v. Harris. Dr. Al-Sarraj told the court that his views are in line with mainstream opinion. Mainstream opinion in all the other specialities is the same as his, that is to say that hypoxia cannot cause subdural haemorrhages. Al-Sarraj told the court that there are 40-44 neuropathologists in the country of whom a maximum of 10 or 12 are forensic neuropathologists. To his knowledge, the only neuropathologist in the UK believing that hypoxia can cause subdural haemorrhages is Dr. Waney Squier. In addition, he said there are two or three other people who share her opinion who are working in different, but related, specialities, of whom Dr. Cohen and Dr. Scheimberg (Dr. Cohen’s co-author) are presumably two. (para 199)”

    It was observed that “They come in all the defence cases, so you do not realise that they are in such a minority.” Dr. Cohen and Dr. Squier support Geddes III, even though Dr. Geddes herself in Harris withdrew from her own unified hypothesis. (ibid.)

    Dr. Cohen and Dr. Squier maintain their position that in the absence of external injuries trauma cannot be established despite the Court of Appeal’s conclusion that:

    “The triad of injuries becomes central to a diagnosis of non-accidental injury where there are no other signs or symptoms of trauma, such as bruises or fractures.” (para 201)

    In considering the evidence of Dr. Cohen and Dr Squier, Mrs Justice King reminded herself that four years have passed since Dr. Geddes accepted that her unified hypothesis could no longer credibly be put forward. Dr. Cohen and Dr. Squier regard themselves as having built on her work. She also noted that the next generation of experts and scientific research may, as Butler-Sloss P. said:

    “Throw light into corners that were then dark and that the hypothesis of Dr. Geddes may yet be proven to be in all, or in part, correct.” (para 202)

    The judge went on to consider whether or not these experts have “developed a scientific prejudice” or whether they are in the vanguard of research and learning. (para 203)

    In the context of the evidence given by Drs. Cohen and Squier she considered whether their respective beliefs in:

    (i) Geddes III
    (ii) That trauma may only be regarded as likely causation where there is a triad plus additional external injury (or alternatively a witness) has led to their conviction in respect of SBS overwhelming their forensic analysis of the case. (para 204)

    She decided that there were three areas which the court should consider in relation to each of Drs. Cohen and Squier in order to determine that issue namely:

    (i) Their use of research material;
    (ii) Their willingness to defer to the experts in another field and as part of that their acceptance of the importance of confining their respective opinion to their own expertise and;
    (iii) The importance in any forensic examination of factual accuracy (para 205)

    “To illustrate: Dr. Cohen accepted in evidence that for the purposes of her study the eyes of the foetuses or neonates were not examined. She said there were research papers confirming that hypoxia leads to retinal haemorrhages. That evidence is without exception at odds with the combined view of all the ophthalmic expertise. (para 225 (6))

    “It was put to Dr Cohen that she had employed the head circumference point to bolster her hypothesis. This she denied. She said that it could have been an old birth bleed, or a re-bleed, but she now thought the baby may have had a re-bleed. She said she could not exclude re-bleed as a primary cause, but that she thought it was secondary. Finally, she said, “we do not know the cause of his collapse”. (para 270)

    Mrs Justice King felt that “Ultimately, her evidence was confusing and unhelpful.”(ibid.)

    Moving on to Dr Squier, the judge observed that “any court dealing with these cases on a regular basis will be aware that Dr. Squier is a strong believer that many cases hitherto regarded as SBS have in fact been precipitated by a choke and that there has thereafter been a cascade of events, including hypoxia, which has been responsible for the subdural haemorrhages and retinal haemorrhages.” (para 245)

    She declared that Dr Squier’s view is a legitimate one and an appropriate line of research, (para 246) went on to say that:

    “All agree that much remains unknown about SBS and the triad. It is essential, however, that Dr. Squier and others engaged on such research avoid becoming a zealots with the consequence that scientific rigour is lost or sacrificed. (para 246)

    “These Courts rely on the professionalism and rigor of the experts who come before them. That means not only drawing the Court’s attention to research that is contrary to their view, but that the experts are rigorous in the use they make of research papers. Dr. Squier’s suggestion that there were “well documented cases of choking, leading to subdural haemorrhages and retinal haemorrhages” by reference to the two articles analysed above is disquieting. It should be borne in mind that Dr. Squier relied upon these so called “well documented cases” in support of her hypothesis as to the cause of Z’s death; the subject of this enquiry. She should have, at the very least, drawn the court’s attention to the fact that the cases in question were cases where the child had been shaken and that in one of them had been regarded as a case of non accidental injury resulting in the child being taken into care as a result of the incident. (para 247)

    “Dr. Bonshek referred to Dr. Squier’s use of these articles as being “disingenuous”. I feel driven, with regret, to agree. (para 248)

    “I do not doubt the commitment of Dr. Squier and Dr. Cohen to the advancement of the understanding of Shaken Baby Syndrome. As already indicated, I make no criticism and, indeed, it would be wrong to do so, of the fact that neither of them hold mainstream views. There is a significant fundamental difference between academic theories and hypotheses, on the one hand, and the rigorous forensic analysis which is required in care proceedings, on the other. In care proceedings the parents of the children concerned face allegations of the most serious type and they are therefore entitled to expect the experts commissioned to report to the court to be meticulous in both their analysis of the data and in their presentation to the court of their expert forensic opinion.(para 284)

    “Dr. Squier and Dr. Cohen, I find with regret, have each fallen into that category of expert identified by Butler-Sloss P. in Re LU & LB, namely the expert who has developed a scientific prejudice. As a consequence, I accept the submission of the Local Authority that Dr. Squier has permitted her convictions to lead her analysis. The very fact that she said that she would, in future, be content to report Z’s case as a “well described case of choking leading to subdural haemorrhage and retinal haemorrhages, subject to the exclusion of cardiac defect” sums up her approach in one concise example. Another, is the fact that each of the significant factual errors made by her served to support her hypothesis of choking and hypoxia. (para 285)

    “The error in relation to Z’s head circumference was not the only serious factual error made by Dr. Squier. In her written material, Dr. Squier recorded that the paramedic at the scene had noted “pink frothy sputum running out of Z’s nostrils”. She also noted that at the hospital, “milk was noticed in the throat and nose”. She said in her oral evidence, however, that there was evidence of aspiration as a contributory cause and so choking must be a likely explanation. In support of this proposition she said:

    “The child was found with milk and vomit in his airways by the ambulance man.” (para 280)

    “This was not only wrong, but misleading.” (para 281)

    R v Reed and Reed; R v Garmson [2009] EWCA Crim 2698

    The Court of Appeal dismissed two joined appeal cases involving Low Copy Number (LCN) DNA analysis. Whilst confirming that there had been no substantive attack on the science of LCN analysis, the Court set out explicitly how it expects cases involving expert evidence to pay the closest attention to the requirements of Part 33 of The Criminal Procedure Rules and the need to agree evidence or identify issues at an early stage (Part 3).

    The Court did not accept the evidence provided by the defence expert witness, Dr Allan Jamieson and went on to question how his evidence was admissible in the Omagh boming case (R v Hoey) as that was the first occasion he had given an opinion regarding LCN DNA analysis. The Court ruled that an appropriately experienced scientist is fully entitled to offer an opinion […], though emphasised that “it is the duty of the Crown and the defence to ensure that the necessary steps are taken to bring the matter back before the judge where a disagreement is identified” (p131 iii), which must occur before the trial.
    R v Henderson, Butler and Oyediran [2010] EWCA Crim 1269

    The key principle set out in this case was the need to consider each case on its own merits; Henderson & Others was not an authority for removing complex medical evidence from the jury.

    The Court of Appeal made it very clear that the complex medical issues arising in cases of alleged NAHI in babies must be dealt with by counsel and judges suitably experienced, who are thus able clearly to set out the points made by each expert in a way that assists the jury to consider the evidence.

    Further Points made:

    The court in line with the approach taken by the police and prosecution, rejected the ‘unified hypothesis’.
    No-one in the appeal suggested that the presence of the triad, even with the characteristics demonstrated in these cases, was conclusive or provided a certain diagnosis.
    It will usually be necessary for the court to direct a meeting of experts so that a statement can be prepared on areas of agreement and disagreement. The essential medical issues which the jury have to resolve should be clear by the time the trial starts.
    An expert’s evidence, Dr Leestma’s, was rejected as it was more historic and far more limited than that of Dr Al-Sarraj. Dr Leestma had not conducted autopsies or given evidence in cases involved with baby-shaking for many years. In order to establish the appropriate level and relevance of expertise, questions that should be considered by the jury include:
    Has the witness gone outside his area of expertise?
    Can the witness point to a recognised, peer-reviewed, source for the opinion?
    Is the clinical experience of the witness up-to-date and equal to the experience of others whose evidence he seeks to contradict?
    The fact that an expert is in clinical practice at the time he makes his report is of significance as they can learn and develop from continuing experience. See also Annex C, The report of a working group convened by The Royal College of Pathologists and The Royal College of Paediatrics and Child Health: “Judges should also ensure that experts have recent clinical experience”.
    Any conclusion of any court as to the medical evidence depends upon the evidence before that court, as no appellate jurisprudence can provide authority for a medical proposition.
    The exact occasions upon which injuries occurred do not need to be established when deliberate injury has been caused. The nature and severity of the injury in Oyediran was a sufficient basis to establish a murderous intent.
    The previously accepted proposition that only trauma can cause retinal folds was shown to be incorrect. The evidence of this was from a case in which perimacular folds associated with extensive retinal haemorrhages emerged not due to trauma, but rather to acute myeloid leukaemia suffered by a 14 year-old.
    It was suggested that the judge who is to hear a particular case should deal with all pre-trial hearings, except for those in which no issue of substance is to be considered; and the judge should have experience of the complex issues and understanding of the medical learning.

  • Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

    Non Accidental Head Injury Cases (NAHI, formerly referred to as Shaken Baby Syndrome [SBS]) – Prosecution Approach

    Published: 24 March 2011

    Annex A: Case Law

    R v Cannings [2004] EWCA Crim 01

    See information in Background section in guidance.

    R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980

    A number of NAHI cases were identified by the CPS and the Court of Appeal as being suitable for being heard together to ensure that a comprehensive judgment could be made by the Court of Appeal in order to guide the handling of such cases in the future.

    The Court of Appeal concluded that the unified hypothesis could no longer be considered as a credible or alternative cause to the accepted triad hypothesis. In the course of the Harris trial, Dr. Geddes (the creator of the unified hypothesis) agreed that her research was incomplete.

    The pathological features themselves are observable facts, although the mechanisms that cause them could be open to interpretation.

    The Court felt that the triad of pathological features provided strong evidence towards a finding that the injuries were non-accidental but could not alone be conclusive of the cause of death.

    In determining the degree of force required to cause the triad of pathological features, the Court identified four general propositions whilst indicating that there was no scientific method of correlating the amount of force used and the severity of the damage caused:

    1. The more severe the injury the more probable that they were caused by greater force than mere ‘rough handling’;
    2. Cases of serious injuries caused by [apparently] very minor force as may occur in normal or rough handling of an infant, are likely to be extremely rare;
    3. There will be cases where a [apparently] small degree of force or a minor fall will cause very severe injuries; and
    4. It is not possible to conclude that age [of the child] is a factor in deciding whether injuries are caused by strong force or a minimal degree of force or impact.

    Cases of alleged NAHI are fact specific and will be determined on their individual characteristics. All the circumstances, and particularly the clinical picture, must be taken into account. The characteristics of the individual components of the triad are particularly vital to its interpretation.

    R v Kai-Whitewind [2005] EWCA Crim 1092

    This case is important in outlining the scope of the Cannings judgment:

    “All this suggests that, for the time being [due to the current state of medical knowledge], where a full investigation into two or more sudden unexplained infants deaths in the same family is followed by a serious disagreement between reputable experts about the cause of death, and a body of such expert evidence concludes that natural causes, whether explained or unexplained, cannot be excluded as a reasonable (and not a fanciful) possibility, the prosecution of a parent or parents for murder should not be started, or continued, unless there is additional cogent evidence extraneous to the expert evidence which tends to support the conclusion that the infant, or where there is more than one death, one of the infants, was deliberately harmed.”

    The defence in this case sought to argue that the Cannings judgment extended to other sudden infant death cases where there was a conflict of expert opinion.

    In not allowing the appeal, Judge LJ stated that the Cannings case was only intended to apply to cases that depended on inferences based on coincidence, or the unlikelihood of two or more infant deaths in the same family, or one death where another child had suffered unexplained apparent life-threatening events.

    The allegation against the appellant in Kai-Whitewind arose from a single death and could be distinguished from Cannings. Moreover, unlike the case of Cannings, Kai-Whitewind’s conviction had not been based entirely on conflicting expert opinion; there was additional cogent evidence.

    It was for the jury to evaluate the expert evidence, taking into account the facts found at the post mortem, as well as upon admission to hospital, and bearing in mind that the findings related to an infant whose mother:

    • had spoken about killing him;
    • had difficulties bonding with him;
    • might have delayed reporting his death; and
    • had elected not to give evidence.

    The Court concluded that there was ample evidence before the jury to justify the verdict and the conviction for murder was safe.

    R v Allen [2005] EWCA Crim 1344

    The appellant was convicted of the murder of his baby son following an incident in which it was alleged the child suffered injuries caused by shaking, impact or a combination of the two. This incident had followed a previous one the week before as a result of which the child was detained in hospital for a number of days.

    On appeal, the Court held that the evidence of the previous incident was relevant in order to prove the necessary intent on the day of the fatal act, and that there was sufficient evidence for the jury to convict of murder as opposed to manslaughter. In addition to the triad of injuries, and the previous incident which the Crown said was due to the appellant’s actions, evidence was found of bruising to the back of the child’s head.

    The Court also held that the acceptability of the medical evidence was a matter for the jury (Paragraph 69).

    The Court concluded that the appellant’s conviction for murder was safe.

    A Local Authority v S [2009] EWHC 2115 (Fam)

    This case (ALA v S [2009] EWHC 2115 (Fam)) was an application by the local authority for a care order under S.31 of the Children Act 1989 in relation to S, who was born on 17th March 2006 and who had just turned three. (para 1)

    The proceedings arose out of the death of a second child of the family, Z, who collapsed at home on 29th October 2007 when he was thirteen weeks old. He died on 1st November 2007. (para 3)

    In ALA v S, Mrs Justice King said “This is a case where the allegation is that Z died as a result of a shake or a shaking/impact injury. The classic features of such a non-accidental injury, it is said were present, namely encephalopathy, subdural haemorrhage and retinal haemorrhage. This combination of injuries is known as “the triad” (para 29). She determined the facts of the case against the backdrop of the current law; the judgments handed down by the House of Lords as recently as 11th June 2008 in Re B [2008] (Children) UKHL 35, and adopted the descriptions given by the Court of Appeal, Criminal Division, in its judgment on 21st July 2005 in R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980 paras.63-65 (para 30):

    “As already stated, when the three elements of the triad coincide, for some years conventional medical opinion has been that this is diagnostic of NAHI. Typically the brain is found to be encephalopathic; bleeding is found in the subdural space between the dura and the arachnoid subdural haemorrhages; and there are retinal haemorrhages. There may also be other pathological signs such as subarachnoid bleeding and injuries at the cranio-cervical junction. Further, there may be injuries to nerve tissue (axonal injuries) and external signs of broken bones, bruising and other obvious injuries such as extradural oedema (bruising). Determining these findings requires medical experts from a number of different disciplines interpreting often very small signs within the complex structures of an infant’s brain and surrounding tissue.

    The mechanism for these injuries is said to be the shaking of the infant, with or without impact on a solid surface, which moves the brain within the skull damaging the brain and shearing the bridging veins between the dura and the arachnoid. The shaking may also cause retinal haemorrhages. In the sense that the explanation for the triad is said to be caused by shaking and/or impact it also is a unified hypothesis, albeit that each element is said to be caused individually by trauma.

    The triad of injuries becomes central to a diagnosis of NAHI when there are no other signs or symptoms of trauma such as bruises or fractures.” (ibid.)

    In this case (ALA v S) not only were there a considerable number of experts, but Mrs Justice King was asked specifically to make serious adverse findings in relation to two of those experts, Dr. Cohen and Dr. Squier (para 33). In Re LU and LB [2004] EWCA Civ 567, the Court of Appeal provided guidelines for expert witnesses following the earlier case of R v Cannings. At para.23, Butler-Sloss P. gave the following guidelines:

    i) The cause of an injury or an episode that cannot be explained scientifically remains equivocal.

    ii) Recurrence is not in itself probative.

    iii) Particular caution is necessary in any case where the medical experts disagree, one opinion declining to exclude a reasonable possibility of natural cause.

    iv) The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour propre is at stake, or the expert who has developed a scientific prejudice.

    v) The judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts or that scientific research will throw light into corners that are at present dark (ibid).

    The approach of the court to expert opinion it was submitted, must include the need to evaluate the witnesses and the soundness of each of their opinions. The mere expression, of a belief by a witness, however eminent, does not suffice. The court’s evaluation of the witnesses, it was submitted should follow Ryder J. in A County Council v X Y and Z [2005] 2 FLR 129:

    “… involves an examination of the reasons given for his opinions and … the extent to which they are supported by the evidence.” (para 34)

    The judge must also examine:

    “… the internal consistency and logic of his evidence; his precision and accuracy of thought… the extent to which a witness has conceived an opinion and is reluctant to re-examine it in light of later evidence … whether or not a witness is biased or lacks independence.” (para 35)

    Summary positions:

    “Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd all regard non-accidental head injury as the most likely cause of all Z’s injuries and consider it improbable, or highly improbable, that the other suggested causes could have caused the triad and Z’s death. (para 57)

    “Dr. Squier and Dr. Cohen regard non-accidental head injury as possible, but unlikely, in the absence of any other bony or soft-tissue injury, or other specific post-mortem evidence of trauma. Dr. Squier agreed that the triad seen in Z was also seen in cases of frank, inflicted trauma and in accidental trauma. Dr. Squier and Dr. Cohen consider the most likely cause of the primary event to be either a choking incident or a heart arrhythmia combined with the effects of prolonged CPR followed by resuscitation. (para 58)

    “Drs. Cary, Al-Sarraj, Bonshek, Peters, Richards, Professor Luthert and Mr. Lloyd each hold what might be called the mainstream view of non-accidental head injuries as encapsulated in the judgments of the Court of Appeal in R v Harris. None accept that hypoxia in the absence of trauma is a cause of subdural haemorrhages and retinal haemorrhages of the type seen in Z. Dr. Al-Sarraj summed up the approach which HHJ King found each of this group of experts regarded as the proper approach in considering a case where the triad is present. Dr. Al-Sarraj told the court that: (para 60)

    “Dr. Squier and Dr. Cohen have a very different approach in two important areas:

    i)

    a) Dr. Cohen does not regard trauma as a proper diagnosis where the triad is present, but there are no external injuries such as bruises or fractures and /or a witness to the alleged shaking event.
    b) Dr. Squier regards trauma as very important. She is of the opinion that the triad, in the absence of evidence of trauma, is simply “no evidence of shaken baby syndrome”. The triad of injuries may be due to many other factors that are not trauma. She does not accept that the triad is necessarily a strong indicator of shaken baby syndrome. In the opinion of Dr. Squier, shaking alone may cause the triad, but the level of violence required is such that many people would be incapable of it and it would break the child’s neck. She said, in terms, that she would never advise the court that trauma was the probable cause absent external injury, either seen physically with the naked eye or found at post-mortem.

    ii) Both Dr. Cohen and Dr. Squier subscribe to the Geddes III hypothesis in one form or another. Put at its simplest, each are of the view that hypoxia in children can lead to subdural haemorrhages and retinal haemorrhages in the absence of trauma.” (para 63, i, ii, iii)

    In considering the evidence of Dr. Cohen and Dr. Squier, Mrs Justice King had in mind the guidance of Butler-Sloss P. in Re LU and LB (set out above), and in particular: (para 197)

    1. That the court must be on guard against the over-dogmatic expert … who has developed a scientific prejudice; and
    2. A judge in care proceedings must never forget that today’s medical certainty may be discarded by the next generation of experts.

    “The latter is of importance in the present case where it is accepted by all that there is much to learn and much which is not yet understood about so-called shaken baby syndrome and the triad. Dr. Cohen and Dr. Squier each agree with Geddes III. Dr. Cohen and Dr. Squier each believe that in the absence of additional external injuries, such as grip marks or fractures, there is no reliable evidence of shaken baby syndrome. Dr. Squier does not accept the triad to be a strong indicator of shaken baby syndrome. (198)

    “These views are, undoubtedly, controversial. They go against the mainstream of current thinking and the analysis of the Court of Appeal in R v. Harris. Dr. Al-Sarraj told the court that his views are in line with mainstream opinion. Mainstream opinion in all the other specialities is the same as his, that is to say that hypoxia cannot cause subdural haemorrhages. Al-Sarraj told the court that there are 40-44 neuropathologists in the country of whom a maximum of 10 or 12 are forensic neuropathologists. To his knowledge, the only neuropathologist in the UK believing that hypoxia can cause subdural haemorrhages is Dr. Waney Squier. In addition, he said there are two or three other people who share her opinion who are working in different, but related, specialities, of whom Dr. Cohen and Dr. Scheimberg (Dr. Cohen’s co-author) are presumably two. (para 199)”

    It was observed that “They come in all the defence cases, so you do not realise that they are in such a minority.” Dr. Cohen and Dr. Squier support Geddes III, even though Dr. Geddes herself in Harris withdrew from her own unified hypothesis. (ibid.)

    Dr. Cohen and Dr. Squier maintain their position that in the absence of external injuries trauma cannot be established despite the Court of Appeal’s conclusion that:

    “The triad of injuries becomes central to a diagnosis of non-accidental injury where there are no other signs or symptoms of trauma, such as bruises or fractures.” (para 201)

    In considering the evidence of Dr. Cohen and Dr Squier, Mrs Justice King reminded herself that four years have passed since Dr. Geddes accepted that her unified hypothesis could no longer credibly be put forward. Dr. Cohen and Dr. Squier regard themselves as having built on her work. She also noted that the next generation of experts and scientific research may, as Butler-Sloss P. said:

    “Throw light into corners that were then dark and that the hypothesis of Dr. Geddes may yet be proven to be in all, or in part, correct.” (para 202)

    The judge went on to consider whether or not these experts have “developed a scientific prejudice” or whether they are in the vanguard of research and learning. (para 203)

    In the context of the evidence given by Drs. Cohen and Squier she considered whether their respective beliefs in:

    (i) Geddes III
    (ii) That trauma may only be regarded as likely causation where there is a triad plus additional external injury (or alternatively a witness) has led to their conviction in respect of SBS overwhelming their forensic analysis of the case. (para 204)

    She decided that there were three areas which the court should consider in relation to each of Drs. Cohen and Squier in order to determine that issue namely:

    (i) Their use of research material;
    (ii) Their willingness to defer to the experts in another field and as part of that their acceptance of the importance of confining their respective opinion to their own expertise and;
    (iii) The importance in any forensic examination of factual accuracy (para 205)

    “To illustrate: Dr. Cohen accepted in evidence that for the purposes of her study the eyes of the foetuses or neonates were not examined. She said there were research papers confirming that hypoxia leads to retinal haemorrhages. That evidence is without exception at odds with the combined view of all the ophthalmic expertise. (para 225 (6))

    “It was put to Dr Cohen that she had employed the head circumference point to bolster her hypothesis. This she denied. She said that it could have been an old birth bleed, or a re-bleed, but she now thought the baby may have had a re-bleed. She said she could not exclude re-bleed as a primary cause, but that she thought it was secondary. Finally, she said, “we do not know the cause of his collapse”. (para 270)

    Mrs Justice King felt that “Ultimately, her evidence was confusing and unhelpful.”(ibid.)

    Moving on to Dr Squier, the judge observed that “any court dealing with these cases on a regular basis will be aware that Dr. Squier is a strong believer that many cases hitherto regarded as SBS have in fact been precipitated by a choke and that there has thereafter been a cascade of events, including hypoxia, which has been responsible for the subdural haemorrhages and retinal haemorrhages.” (para 245)

    She declared that Dr Squier’s view is a legitimate one and an appropriate line of research, (para 246) went on to say that:

    “All agree that much remains unknown about SBS and the triad. It is essential, however, that Dr. Squier and others engaged on such research avoid becoming a zealots with the consequence that scientific rigour is lost or sacrificed. (para 246)

    “These Courts rely on the professionalism and rigor of the experts who come before them. That means not only drawing the Court’s attention to research that is contrary to their view, but that the experts are rigorous in the use they make of research papers. Dr. Squier’s suggestion that there were “well documented cases of choking, leading to subdural haemorrhages and retinal haemorrhages” by reference to the two articles analysed above is disquieting. It should be borne in mind that Dr. Squier relied upon these so called “well documented cases” in support of her hypothesis as to the cause of Z’s death; the subject of this enquiry. She should have, at the very least, drawn the court’s attention to the fact that the cases in question were cases where the child had been shaken and that in one of them had been regarded as a case of non accidental injury resulting in the child being taken into care as a result of the incident. (para 247)

    “Dr. Bonshek referred to Dr. Squier’s use of these articles as being “disingenuous”. I feel driven, with regret, to agree. (para 248)

    “I do not doubt the commitment of Dr. Squier and Dr. Cohen to the advancement of the understanding of Shaken Baby Syndrome. As already indicated, I make no criticism and, indeed, it would be wrong to do so, of the fact that neither of them hold mainstream views. There is a significant fundamental difference between academic theories and hypotheses, on the one hand, and the rigorous forensic analysis which is required in care proceedings, on the other. In care proceedings the parents of the children concerned face allegations of the most serious type and they are therefore entitled to expect the experts commissioned to report to the court to be meticulous in both their analysis of the data and in their presentation to the court of their expert forensic opinion.(para 284)

    “Dr. Squier and Dr. Cohen, I find with regret, have each fallen into that category of expert identified by Butler-Sloss P. in Re LU & LB, namely the expert who has developed a scientific prejudice. As a consequence, I accept the submission of the Local Authority that Dr. Squier has permitted her convictions to lead her analysis. The very fact that she said that she would, in future, be content to report Z’s case as a “well described case of choking leading to subdural haemorrhage and retinal haemorrhages, subject to the exclusion of cardiac defect” sums up her approach in one concise example. Another, is the fact that each of the significant factual errors made by her served to support her hypothesis of choking and hypoxia. (para 285)

    “The error in relation to Z’s head circumference was not the only serious factual error made by Dr. Squier. In her written material, Dr. Squier recorded that the paramedic at the scene had noted “pink frothy sputum running out of Z’s nostrils”. She also noted that at the hospital, “milk was noticed in the throat and nose”. She said in her oral evidence, however, that there was evidence of aspiration as a contributory cause and so choking must be a likely explanation. In support of this proposition she said:

    “The child was found with milk and vomit in his airways by the ambulance man.” (para 280)

    “This was not only wrong, but misleading.” (para 281)

    R v Reed and Reed; R v Garmson [2009] EWCA Crim 2698

    The Court of Appeal dismissed two joined appeal cases involving Low Copy Number (LCN) DNA analysis. Whilst confirming that there had been no substantive attack on the science of LCN analysis, the Court set out explicitly how it expects cases involving expert evidence to pay the closest attention to the requirements of Part 33 of The Criminal Procedure Rules and the need to agree evidence or identify issues at an early stage (Part 3).

    The Court did not accept the evidence provided by the defence expert witness, Dr Allan Jamieson and went on to question how his evidence was admissible in the Omagh boming case (R v Hoey) as that was the first occasion he had given an opinion regarding LCN DNA analysis. The Court ruled that an appropriately experienced scientist is fully entitled to offer an opinion […], though emphasised that “it is the duty of the Crown and the defence to ensure that the necessary steps are taken to bring the matter back before the judge where a disagreement is identified” (p131 iii), which must occur before the trial.

    R v Henderson, Butler and Oyediran [2010] EWCA Crim 1269

    The key principle set out in this case was the need to consider each case on its own merits; Henderson & Others was not an authority for removing complex medical evidence from the jury.

    The Court of Appeal made it very clear that the complex medical issues arising in cases of alleged NAHI in babies must be dealt with by counsel and judges suitably experienced, who are thus able clearly to set out the points made by each expert in a way that assists the jury to consider the evidence.

    Further Points made:

    • The court in line with the approach taken by the police and prosecution, rejected the ‘unified hypothesis’.
    • No-one in the appeal suggested that the presence of the triad, even with the characteristics demonstrated in these cases, was conclusive or provided a certain diagnosis.
    • It will usually be necessary for the court to direct a meeting of experts so that a statement can be prepared on areas of agreement and disagreement. The essential medical issues which the jury have to resolve should be clear by the time the trial starts.
    • An expert’s evidence, Dr Leestma’s, was rejected as it was more historic and far more limited than that of Dr Al-Sarraj. Dr Leestma had not conducted autopsies or given evidence in cases involved with baby-shaking for many years.  In order to establish the appropriate level and relevance of expertise, questions that should be considered by the jury include:
      • Has the witness gone outside his area of expertise?
      • Can the witness point to a recognised, peer-reviewed, source for the opinion?
      • Is the clinical experience of the witness up-to-date and equal to the experience of others whose evidence he seeks to contradict?
    • The fact that an expert is in clinical practice at the time he makes his report is of significance as they can learn and develop from continuing experience. See also Annex C, The report of a working group convened by The Royal College of Pathologists and The Royal College of Paediatrics and Child Health: “Judges should also ensure that experts have recent clinical experience”.
    • Any conclusion of any court as to the medical evidence depends upon the evidence before that court, as no appellate jurisprudence can provide authority for a medical proposition.
    • The exact occasions upon which injuries occurred do not need to be established when deliberate injury has been caused. The nature and severity of the injury in Oyediran was a sufficient basis to establish a murderous intent.
    • The previously accepted proposition that only trauma can cause retinal folds was shown to be incorrect. The evidence of this was from a case in which perimacular folds associated with extensive retinal haemorrhages emerged not due to trauma, but rather to acute myeloid leukaemia suffered by a 14 year-old.
    • It was suggested that the judge who is to hear a particular case should deal with all pre-trial hearings, except for those in which no issue of substance is to be considered; and the judge should have experience of the complex issues and understanding of the medical learning.
  • DIFFERENT KINDS OF FRACTURES

  • DIFFERENT KINDS OF FRACTURES

  • Doctor gagged for doubting shaken baby syndrome

  • Grandmother In High-Profile Shaken Baby Case Has Sentence Commuted

  • Grandmother In High-Profile Shaken Baby Case Has Sentence Commuted

  • Increase in Vaccines Causes Cot Death

    S

    On May 4th 2011 a new study by Neil Z Miller and Gary S Goldman was published online by SAGE, entitled Infant mortality rates regressed against number of vaccine doses ro… This study, is another in a long line of studies revealing evidence showing the more vaccines a baby receives the more chance they have of dying from Sudden Infant Death Syndrome.

    Miller and Goldman look for a possible correlation between vaccines and Infant Mortality Rates.(IMR). Looking at 34 countries, they research the number of infants dying of SIDS per 1000 babies and the number of doses of vaccine that each country is giving to babies under 1yr. Miller and Goldman then look for a correlation between the number of deaths and the number of doses of vaccines given. The hypothesis they were looking to prove was that the greater the number of vaccine doses given to infants before the age of 1yr, the higher the IMR would be. Their hypothesis was proven conclusively as the countries giving fewer doses of vaccines were the countries with the lowest Infant Mortality Rate.

    The authors grouped the countries by vaccine dosage. 12–14, 15–17, 18–20, 21–23, and 24–26. When studied, the group in the 12 – 14 dose range, Sweden, Japan, Iceland, Norway, Denmark and Finland were the countries which had the lowest IMR per 1000 live births.

    Sweden had a total of 12 vaccine doses given and showed a 2.75 IMR compared with the USA who had a total of 26 vaccine doses given and an IMR of 6.22. The USA came out as having the highest IMR rate as well as the highest number of vaccine doses. Miller and Goldman wrote:

    “In 2009, there were approximately 4.5 million live births and 28,000 infant deaths in the United States, resulting in an infant mortality rate of 6.22/1000″.

    Vaccine doses do not indicate the number of vaccines given but the total vaccine doses overall, as many vaccines include more than 1 vaccine dose e.g. DPaT is a 3 dose vaccine.

    Of course as with all studies variables existed and these were discussed and taken into consideration.

    This is not the first study showing similar results. Professionals have been noticing a correlation between vaccines and SIDS for many years. The authors mention many of these in their excellent paper.

    A study not mentioned in Miller and Goldman’s paper was the Cotwatch Study written by Dr Viera Scheibner. I feel that this study is one of the most important studies ever produced. The reason for this is because Dr Viera Scheibner was not looking for any correlation between vaccines and SIDS at the time.

    In 1985-1986 Dr Scheibner and her late husband Leif Karlsson (a Swedish electronics engineer specializing in patient monitoring systems) developed a pioneering true breathing monitor which they called Cotwatch, A ‘true breathing monitor’ is different from standard breathing monitors because it’s electronics separates the babies heart beat and breathing and only the breathing delays the alarm. This is unlike other monitors which take any movement as breathing. On studying the results Scheibner and Karlsson found that the charts produced by their monitor revealed that whenever the babies had had a vaccination flareups of stress induced breathing patterns occurred. The patterns seemed to appear on specific times and days following the vaccination which they named ‘critical hours and days’.

    This proved conclusively that it was the vaccines that were causing the babies to have periods of stress-induced breathing. In some cases this led ultimately to the babies death.

    Another study pre-dating this study and also proving that vaccines were causing infants to die was by Baraff LJ et al (1983) Pediatr Infect Dis. 1983 Jan-Feb;2(1):7-11. PMID: 6835859; UI: 83169234 Possible temporal association between diphtheria-tetanus toxoid-per…. He wrote:

    “Because diphtheria and tetanus toxoids pertussis (DTP) vaccine is routinely given during the period of highest incidence of sudden infant death syndrome (SIDS), this study was undertaken to determine if there is a temporal association between DTP immunization and SIDS. Parents of 145 SIDS victims who died in Los Angeles County between January 1, 1979, and August 23, 1980, were contacted and interviewed regarding their child’s recent immunization history. Fifty-three had received a DTP immunization. Of these 53, 27 had received a DTP immunization within 28 days of death. Six SI Ddeaths occurred within 24 hours and 17 occurred within 1 week of DTP immunization.”

    In recent years SIDS deaths have been called a number of different things including SUID or Sudden Unexplained Infant Deaths and suffocation. Many of the babies dying have been found to have a triad of bleeds in the brain. These bleeds are being put down to the parents or care givers abusing their children often under the guise of

    Shaken Baby Syndrome,Shaken Impact Syndrome,Abusive Head Trauma,Pediatric Traumatic Brain Injury,Shaken Brain Trauma,Whiplash Shaken Infant Syndrome,Non Accidental Head Injury.

    Many professionals believe that this is in a bid to cover up the true extent of the problem and hide the fact that vaccines are harming our children.

    These professionals include

    Dr Michael Innis MBBS, DTM&H, FRCPA and FRCPath
    Professor Gordon Stewart, M.D Emeritus professor of Public Health
    Dr Edward Yazbak M.D. F.A.A.P
    Dr Archie Kalokerinos M.D MBBS PhD FAPM
    Charles Pragnell Independent social care management consultant, a Child/Family Advocate, and an Expert Defence Witness – Child Protection
    Lisa Blakemore-Brown – Psychologist, Autism specialist, Expert Witness and Author
    Dr Viera Scheibner (PhD.) Principle Retired Scientist
    William C Torch, a retired pediatric neurologist
    Dr John Plunkett – Anatomic Pathology & Clinical Pathology, Forensic Pathology
    Dr Horace. Gardner – Ophthalmologist,
    Dr Harold Buttram – MD, FAACP.
    Dr Zachary Bravos – Legal Counsel,
    Neil Z Miller Medical research journalist
    Dr Kenneth Stoller M.D

    The list is endless. If there was not a substantial provable link then why would all these highly qualified professionals and many many more be writing papers claiming that they have evidence proving that vaccines are causing the death of many children?

    Neil Millers paper is as conclusive as it can be that vaccines can and do kill very young babies. When is the world going to wake up to this? Vaccines need to be considered as a differential diagnosis to SIDS and SBS and professionals have been saying this for years. On 20th July 2007 Lisa Blakemore-Brown made this comment Times Online

    “Professor Sir Roy Meadow also works in the area of vaccine research in which
    cot death is one of the adverse reactions.

    On 6th July 1988 in Room 1611/12 Market Towers, he sat with others including Professor Elizabeth Miller, epidemiologist for the vaccine programmer and Dr David Salisbury, with a similar remit at the Department of Health in the Joint Sub Committee on Adverse Reactions to vaccines and immunization.

    During these meetings held over many years, deaths of babies were
    routinely discussed.

    Leading medics have written to other medics about three and four children dying in one family within one area where the rate of cot death was much higher than in other parts of the country. At least two families reported how the deaths followed vaccines.

    So why is a vaccine reaction, clearly well known to the inner medical circle, NEVER mentioned as part of the differential diagnosis?

    Even now Hey and Bacon fail to even mention it.

    Its time the public knew about all this Lisa Blakemore-Brown, London, UK”

    How right she is, I wrote on VacTruth only a couple of week ago how Prof David Southall who is involved in aid work, sending vaccines to the third world, has known for nearly twenty years that children can die from breathing problems after a vaccine. How can parents ever trust that vaccines are safe, when evidence proves that giving multiple vaccines to young babies can be very dangerous? A full investigation needs to take place immediately investigating all vaccines. Unless governments around the world can disprove what these professionals are saying the take up for vaccines will continue on a downwards spiral.

  • Clemency Granted for Shirley Smith

  • Clemency Granted for Shirley Smith

  • Live Court – judgment Louise Woodward

    http://www.youtube.com/watch?v=7HeJoERUURA&feature=player_embedde

    • Louise Woodward Innocent? New Research Raises Reasonable Doubt

      Louise Woodward Innocent? New Research Raises Reasonable Doubt

      Shaken Baby Syndrome (SBS) is a medical theory that explains a form of child abuse when an infant is shaken violently by their caretaker, creating a whip-lash motion that results in severe brain injury, lifelong disability or death.  The concept of SBS was described in the early 1970’s by a neurosurgeon, Dr. Guthkelch.  His medical theory has sent dozens of women to jail and was used in the trial of the now infamous au pair, Louise Woodward.  She was prosecuted and found guilty of manslaughter for shaking an infant in her care while she was an au pair for Cultural Care.

      Gavel

      New scientific research published in the Paediatric Development Pathology Journal (United Kingdom, 2009) sheds new light on SBS.  Recent scientific findings may lend evidence to exonerate jailed “abusers” (who continue to protest their innocence) and could have a dramatic effect on future SBS and child abuse trials.

      Two British pathologists have found that a combination of injuries used to diagnose SBS abuse, known as the “triad” (swelling, bleeding and oxygen deprivation to the brain), can happen naturally.

      Dr Irene Scheimberg (London’s Bart’s Hospital) and Dr Marta Cohen (Sheffield Children’s Hospital) found that bleeding, swelling and oxygen deprivation to the brain can occur without violent shaking.  The study found that the symptoms of Shaken Baby Syndrome can happen in babies even before they are taken home from hospital.

      Dr. Scheimberg warns that when there “is no evidence of physical abuse (apart from the triad of SBS sypmtoms) we may be sending to jail parents who lost their children through no fault of their own.”  The doctor went on to state, “As scientists it is our duty to be cautious when we see the triad and to take each case on its merits. We owe it to children and their families.”

      The doctors looked at 25 babies who had died shortly before delivery and 30 newborns who had brain hemorrhages and found similar damage to the brains of all the babies.  The study concluded that the symptoms are common in infants and could be caused by a traumatic birth or other conditions.

      There were two groups of children who presented with symptoms similar to SBS – one group had bleeding in the brain caused by normal vaginal delivery and went on to lead normal lives and the other group who also presented with sign of SBS at birth, but did not get well, and whose bleeding continued and actually got worse.  Dr. Scheimberg said, “These are the children who the courts suspect have been harmed by their parents (or caregivers).”

      The evidence of their study could now be used in a number of appeals in cases where caregivers or parents were prosecuted and jailed for killing infants by shaking them (http://www.telegraph.co.uk/health/healthnews).

      The “triad” of symptoms known as Shaken Baby Syndrome was used by the prosecution in the 1998 U.S. trial of British au pair Louise Woodward, who was found guilty of the second-degree murder of eight-month-old Matthew Eappen in October 1997.  She was sentenced to a minimum of 15 years to life in prison but the judge overruled that decision and reduced her conviction to involuntary manslaughter.  Her sentence was then reduced to time served (279 days) and she was released as a free woman.

      In 2007,  Dr Patrick Barnes, the prosecution’s star medical witness, reversed his medical opinion that convicted Woodward: he concluded that death (of Matthew Eappen) could have been caused by an old injury, as argued by the defense.  In a scientific paper he states: “The science we have today could, in fact, have exonerated Louise. There is certainly, in retrospect, reasonable doubt.”

      There are about 200 cases of Shaken Baby Syndrome diagnosed in Britain every year and an estimated 1,200 to 1,400 cases diagnosed every year in the United States (data from the National Center on Shaken Baby Syndrome).  Many of the childcare givers and mothers who are accused in these cases protest their innocence and deny they did anything harmful to the babies left in their care.

      A U.S. physician, Harold E Buttram, notes that many cases of brain hemorrhages are dependent on the strength of the smallest blood vessels at birth, which can be affected by different conditions.  He also warns,  “Among the many adversities and difficulties facing the American family today, there is a relatively new and growing hazard in which a parent or caretaker may be falsely accused of murdering or injuring an infant by the shaken baby syndrome, when the true cause of death or injury arises from other sources. Very tragically, child abuse does occur and deserves appropriate punishment. However, it is equally tragic when a family, already grieving from the death of their infant, finds a father or mother unjustly accused, convicted, and imprisoned for murder of the infant, a murder of which he or she is innocent.”

      He explains, “In fact, an infant can die with extensive retinal hemorrhages, a blood clot under the capsule of the brain, extensive bruises, broken bones and sores that will not heal, due to Barlow’s disease, without having been subjected to anything but the tenderest of loving care.”  (Shaken Baby Syndrome – A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References, Icon Health Publication

      Louise Woodward Innocent? New Research Raises Reasonable Doubt

      Louise Woodward Innocent? New Research Raises Reasonable Doubt

      Shaken Baby Syndrome (SBS) is a medical theory that explains a form of child abuse when an infant is shaken violently by their caretaker, creating a whip-lash motion that results in severe brain injury, lifelong disability or death.  The concept of SBS was described in the early 1970’s by a neurosurgeon, Dr. Guthkelch.  His medical theory has sent dozens of women to jail and was used in the trial of the now infamous au pair, Louise Woodward.  She was prosecuted and found guilty of manslaughter for shaking an infant in her care while she was an au pair for Cultural Care.

      Gavel

      New scientific research published in the Paediatric Development Pathology Journal (United Kingdom, 2009) sheds new light on SBS.  Recent scientific findings may lend evidence to exonerate jailed “abusers” (who continue to protest their innocence) and could have a dramatic effect on future SBS and child abuse trials.

      Two British pathologists have found that a combination of injuries used to diagnose SBS abuse, known as the “triad” (swelling, bleeding and oxygen deprivation to the brain), can happen naturally.

      Dr Irene Scheimberg (London’s Bart’s Hospital) and Dr Marta Cohen (Sheffield Children’s Hospital) found that bleeding, swelling and oxygen deprivation to the brain can occur without violent shaking.  The study found that the symptoms of Shaken Baby Syndrome can happen in babies even before they are taken home from hospital.

      Dr. Scheimberg warns that when there “is no evidence of physical abuse (apart from the triad of SBS sypmtoms) we may be sending to jail parents who lost their children through no fault of their own.”  The doctor went on to state, “As scientists it is our duty to be cautious when we see the triad and to take each case on its merits. We owe it to children and their families.”

      The doctors looked at 25 babies who had died shortly before delivery and 30 newborns who had brain hemorrhages and found similar damage to the brains of all the babies.  The study concluded that the symptoms are common in infants and could be caused by a traumatic birth or other conditions.

      There were two groups of children who presented with symptoms similar to SBS – one group had bleeding in the brain caused by normal vaginal delivery and went on to lead normal lives and the other group who also presented with sign of SBS at birth, but did not get well, and whose bleeding continued and actually got worse.  Dr. Scheimberg said, “These are the children who the courts suspect have been harmed by their parents (or caregivers).”

      The evidence of their study could now be used in a number of appeals in cases where caregivers or parents were prosecuted and jailed for killing infants by shaking them (http://www.telegraph.co.uk/health/healthnews).

      The “triad” of symptoms known as Shaken Baby Syndrome was used by the prosecution in the 1998 U.S. trial of British au pair Louise Woodward, who was found guilty of the second-degree murder of eight-month-old Matthew Eappen in October 1997.  She was sentenced to a minimum of 15 years to life in prison but the judge overruled that decision and reduced her conviction to involuntary manslaughter.  Her sentence was then reduced to time served (279 days) and she was released as a free woman.

      In 2007,  Dr Patrick Barnes, the prosecution’s star medical witness, reversed his medical opinion that convicted Woodward: he concluded that death (of Matthew Eappen) could have been caused by an old injury, as argued by the defense.  In a scientific paper he states: “The science we have today could, in fact, have exonerated Louise. There is certainly, in retrospect, reasonable doubt.”

      There are about 200 cases of Shaken Baby Syndrome diagnosed in Britain every year and an estimated 1,200 to 1,400 cases diagnosed every year in the United States (data from the National Center on Shaken Baby Syndrome).  Many of the childcare givers and mothers who are accused in these cases protest their innocence and deny they did anything harmful to the babies left in their care.

      A U.S. physician, Harold E Buttram, notes that many cases of brain hemorrhages are dependent on the strength of the smallest blood vessels at birth, which can be affected by different conditions.  He also warns,  “Among the many adversities and difficulties facing the American family today, there is a relatively new and growing hazard in which a parent or caretaker may be falsely accused of murdering or injuring an infant by the shaken baby syndrome, when the true cause of death or injury arises from other sources. Very tragically, child abuse does occur and deserves appropriate punishment. However, it is equally tragic when a family, already grieving from the death of their infant, finds a father or mother unjustly accused, convicted, and imprisoned for murder of the infant, a murder of which he or she is innocent.”

      He explains, “In fact, an infant can die with extensive retinal hemorrhages, a blood clot under the capsule of the brain, extensive bruises, broken bones and sores that will not heal, due to Barlow’s disease, without having been subjected to anything but the tenderest of loving care.”  (Shaken Baby Syndrome – A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References, Icon Health Publications).

      Louise Woodward case

      http://en.wikipedia.org/wiki/Louise_Woodward_case#External_links

      The Agonizing, Complicated, Lingering Questions of Shaken Baby Syndrome

      The Agonizing, Complicated, Lingering Questions of Shaken Baby Syndrome
      Ten years after Matthew Eappen’s death – for which nanny Louise Woodward was convicted of involuntary manslaughter – a doctor who treated the infant has reversed his position on the case. Why is so much still unknown about shaken baby syndrome?

      By MARY CARMICHAEL | February 11, 2007

      On February 9, 1997, suffering from massive brain trauma after apparently being shaken and slammed against a hard surface, 8½-month-old Matthew Eappen died at Children’s Hospital Boston. It was the beginning of a story that would capture the nation’s attention and eventually see the dramatic release of au pair Louise Woodward, first convicted of second-degree murder, then let go on a lesser charge after 279 days in prison. Holed up in a Boston hotel after her sentence was commuted, a then 19-year-old Woodward sent out a statement saying she thought medical science would eventually clear her name. “I am confident that the future direction of this case, including the ongoing efforts by my lawyers to investigate further the science underlying the case, will further justify Judge [Hiller] Zobel’s decision,” the statement read. “I pray that further investigation into the scientific evidence convinces the Eappen family that I did their son no harm.”

      Ten years later, Sunil and Deborah Eappen are not convinced. Neither are most physicians. Dr. Robert Reece, a Tufts University pediatrician who is one of the nation’s most respected authorities on shaken baby syndrome, says, “The information that was presented at trial on the prosecution side was correct” – an opinion that lines up with those of the vast majority of doctors who study SBS.

      But Woodward was prescient in one respect: There has been a groundswell of scientific research since her trial, and some of it calls into question the facts of the syndrome. Deborah Eappen says the research can offer people an all-too-easy “defense mechanism,” a way to avoid contemplating the horror of child abuse by explaining it away as something else. It can be a literal defense mechanism, too; many of those who doubt the diagnosis regularly testify in court. The arguments, however, have persuaded a small but vocal minority of doctors, including a radiologist who testified against Woodward and some who have never testified at all. At times, their debates with mainstream pediatricians can devolve into outright fights, the sort seen often in court but less so in the usually placid prose of medical journals. The bickering can seem like little more than he-said-she-said. But it may be rooted in something more significant: an argument about what constitutes evidence, in both medicine and law; why those two standards sometimes differ; and, when they do, which should prevail.

      The debating experts, sadly, have plenty of victims to study. Among the most recent headlines: In September, a Framingham man was found guilty of involuntary manslaughter in a shaken baby case, and in late December, a potential case emerged after a 9-week-old boy from Dracut died. The National Center on Shaken Baby Syndrome estimates that US hospitals handle 1,300 cases of abuse-related head trauma in children every year, most of them diagnosed as SBS and many caused by parents or caregivers frustrated over incessant crying or fussiness. Research by Dr. Carole Jenny, director of the Child Protection Program at Hasbro Children’s Hospital in Rhode Island, suggests that many more cases go unnoticed by the legal system – and even by doctors trained to recognize them.

      Why can some perpetrators shake babies without being found out? Dr. Robert Block, who chairs the American Board of Pediatrics’ group on child abuse, explains that the syndrome is not always accompanied by obvious outward signs. “The symptoms can range from instant death to very minor things, and we’re not really clear on why there’s such a variety.” Some critically injured shaken babies have broken ribs from being squeezed, but others, even if shaken roughly and repeatedly, may enter emergency rooms with far fewer telltale symptoms – lethargy, decreased appetite, difficulty breathing, and bleeding and swelling under the scalp – that can mimic medical conditions unrelated to abuse. In less serious cases, which can initially manifest as vomiting and mild seizures, shaken baby syndrome is even easier to miss. “We have one [shaken baby] in the hospital right now who presented with a seizure thought at the time to be due to a fever and an apparent ear infection,” says Block, who sees cases as Oklahoma’s chief child abuse examiner. The infant improved a few days later. But when he had another seizure, the hospital referred him to specialists, who found injuries that suggested abuse.

      Without bruises, fractures, or accounts from witnesses, doctors must often rely on two clues to diagnose shaken baby syndrome, and both appear only under close examination. The first, a distinct type of retinal bleeding, is a sign that Deborah Eappen, an ophthalmologist, saw for herself while her son lay in intensive care. A baby’s eye muscles are weak, so the eyeballs rotate and rock back and forth when the body is shaken. The thick fluid inside the eyeballs pulls on the delicate, multilayered retinal tissue, causing it to pucker and bleed. More than 90 diseases can cause retinal bleeding, but the hemorrhages in SBS are scattered over the retina all the way to the edges. Though doctors must still look for rare disorders that might be implicated, the hemorrhages appear in “a specific pattern,” says Block, “that we just don’t see in other conditions.”

      Brain scans and autopsies provide doctors with the second clue in suspected shaken baby cases. They tell the story of what most doctors think happened under Matthew’s crown of black curls. In the brain, the syndrome is not a single injury, but a cataclysmic cascade of events that begins as the gelatinous gray matter bangs against the inside of the skull. The strain shears the fragile walls of tiny blood vessels crossing the brain’s surface, and the branches that connect the nerve cells are stretched to the breaking point. If cells in the brain stem are among those damaged, the body may quickly lose control over heart rate, respiration, blood pressure, and temperature. The baby’s breathing then falls off tempo, depriving the brain of oxygen – a stress the organ can bear only for several minutes before it starts to swell. Pressed against bone, the nerve cells now begin to implode, leaking chemicals into the brain tissue that are toxic outside the cell walls. Once this breakdown begins, the brain cannot resist, and it fails.

      Only a quarter of SBS cases have such tragic results. But of the patients who survive, very few make full recoveries. Had Matthew Eappen lived, he might have spent the rest of his life in a permanent vegetative state, blind, or plagued by massive learning disabilities and emotional disturbances. As it was, he died five days after he was admitted to the hospital. His death was not the end of his story, though; in some ways, it was the beginning.

      The Matthew Eappen/Louise Woodward trial changed society in ways that are still reverberating today. It pushed a little-known and poorly understood syndrome into the spotlight, ensuring that fewer people could plausibly claim ignorance of the dangers of violent shaking, as opposed to gentle bouncing – and that more of them would be prosecuted. Toni Blake, a top SBS defense lawyer based in San Diego, picked up her first case while the verdict in the Woodward trial was still pending. She says the prosecutions “exponentially increased” after that, growing from about 200 a year nationwide to more than 1,000 today. The trial, as Woodward had hoped, also set off a wave of new research. “That is the one good thing that came out of it,” says Reece, the Tufts pediatrician. “It made everybody aware that there were medical questions that needed further explanation.”

      One of those who set off in pursuit of explanations was Dr. Patrick Barnes, a radiologist who was working at Children’s Hospital Boston at the time. Barnes treated Matthew Eappen and testified in the Woodward case for the prosecution. In the following years, though, he made a turnaround in his views that left many of his colleagues astonished. He now regularly testifies for defendants in SBS cases, arguing that caregivers can be wrongly blamed and sometimes sent to prison when rare medical conditions and previous injuries cause bleeding in infants’ brains. Speaking about Barnes, Reece says, “I don’t know what’s going on in his brain – it’s a mystery to all of us.”

      Barnes says he had been indoctrinated throughout his career to believe that “there were certain features that were absolutely classic, that they were child abuse and could be nothing else.” He didn’t question those teachings, he says, until soon after the Woodward trial when he learned more details of the case, such as that Matthew had a weeks-old wrist fracture. “None of this was ever revealed to me by the prosecution,” he says. “I began to have real concerns about how a case like that was being handled.” He also began to wonder if previous injuries or genetic vulnerability could have caused the fatal insult to Matthew’s brain.

      Barnes delved into the medical literature on head trauma, neurosurgery, and biomechanics. At Children’s Hospital, he began to examine infants and images brought to his attention by defense attorneys in other cases. “I started seeing a number of cases and recommending that we do MRIs,” he says. “We saw other conditions – accidental trauma, infections, clotting, bleeding problems – that could be mimicking or causing these symptoms.” And suddenly, he says, he realized that “what people had been concluding about shaken baby syndrome, they were assuming.”

      Barnes, who is now at Stanford university, was not the only one undergoing a change of heart. Today, he is part of a small group of doctors who travel the country as witnesses and argue in journals that the shaken baby diagnosis needs an overhaul. Their names alone provoke hostility among many pediatricians, most of whom support the diagnosis. “These people are often pathologists who don’t have any clinical experience,” says Reece. “They see the dead tissue at the end of the process, and they have no information other than what they read and hear from colleagues. They’re speaking out of turn.” Yet many of the dissenters are well-credentialed doctors – and their work has shaped medical knowledge of the syndrome, even if only by challenging mainstream doctors to defend their ideas. Dissenters argue that:

      A person can’t shake a baby hard enough to cause the cardinal symptoms of SBS. Woodward’s defense team argued that she could not have shaken a baby as heavy as 25-pound Matthew with enough force to cause his injuries. The argument remains common in court and relies largely on biomechanical experiments. Dr. Jan Leestma, a Chicago forensic neuropathologist who has been one of the most visible SBS defense witnesses, says those experiments (and what he calls “the principles of physics”) were important in fueling his skepticism of the diagnosis. “When the biomechanics papers started coming out, I thought, ‘This is deep doo-doo,’ ” says Leestma. But Reece, who says the point “is specious,” contends that it’s impossible to measure how much force could kill a baby: “It’s not like we can say, ‘It takes 17 shakes at X many G-forces.’ That’s a fool’s errand.”

      SBS symptoms can result when the baby is struck against a hard surface, but shaking is not enough. In the summer of 2005, courts in the United Kingdom reexamined several shaken baby cases after British neuropathologist Dr. Jennian Geddes traced most child-abuse victims’ brain injuries to sudden, blunt impacts, not shaking. Whether shaking alone can mirror the effects of blunt trauma continues to be widely debated. Cases that clearly involve blunt trauma are now called “shaken impact syndrome.”

      The symptoms do not always manifest immediately after shaking, so the time of shaking cannot be pinpointed. Dr. John Plunkett, a Minnesota pathologist, wrote shortly after the Woodward trial that the symptoms of SBS might begin long after the initial injury. Other doctors have reported caring for shaken infants who experienced an extended “lucid interval” before succumbing. This argument is popular in court, because it throws doubt on who might be the perpetrator of the child abuse. But Reece, like most doctors, says the toxic cascade in the brain begins “very, very shortly” after the shaking, usually within minutes. “I think the claim that these things happen days or even weeks before is contrary to everything we understand in pediatric clinical medicine,” he says. “You can’t have a serious injury to a baby’s brain happening even a day before the child deteriorates and goes into a coma. It doesn’t work that way.”

      The symptoms of SBS can also be caused by falls from short distances. Plunkett has provided ammunition for this theory. In a 2001 paper, he described a girl, not quite 2, who died after falling off a 2-foot-high plastic jungle gym. Investigators accused her parents of shaking her – until they saw a videotape of the fatal fall. Biomechanics experts continue to examine whether trauma from short falls can cause injuries like those diagnosed as SBS.

      All of these arguments have played out against the background of “evidence-based” medicine, the movement to incorporate proven data as well as clinical tradition and individual observations into medical practices. Barnes argues that he and others are trying to bring that sort of scientific rigor to a field sorely lacking it. “The diagnosis and management of child abuse has escaped evidence-based medicine and a good methodology for 30 or 40 years,” he says. “It’s supposed to be founded in the scientific method and biostatistical analysis.”

      But Block calls this argument a “smoke screen.” Most evidence-based medicine, he argues, is founded on randomized trials, while child abuse studies can never be. “The main thing we don’t know is what happens inside a real brain, a real head – and we will never know,” he says. “How are you going to find out? Are you going to take 100 babies and shake half of them and see what happens?”

      Underneath the sharp words, both sides say they want the same thing: a solid diagnosis, the kind that will not be debatable in court. Therein lies the heart of the problem. When no one confesses to shaking a baby or witnesses the crime, doctors are often the only ones who can provide anything close to definitive insight. But in some shaken baby cases, depending on the injuries, the doctors’ detective work simply cannot be definitive. It’s a case of conflicting standards: Criminal justice calls for proof beyond a reasonable doubt, and medicine alone can’t always provide it.

      This mismatch is one of the few points on which both sides can agree. Reece, the pediatrician, says shaken baby syndrome is unique in its differing medical and legal standards of evidence – and he doesn’t know how to reconcile the two. “You can’t be black and white in medicine, and that’s the problem, because when it comes to court, you have to be black and white,” he says. “Should people be convicted on less than 100 percent foolproof evidence? There’s not always an absolute airtight case. I don’t know what you can do about that.”

      For Leestma, the forensic neuropathologist, the discrepancy leads to an inescapable conclusion. “There can’t be a relaxed standard for one branch and not the other,” he says. “We tend to be a little sloppy in medicine with diagnosis and treatment, but the law demands a more rigorous approach. If we don’t know what happened, it ends there.” Blake, the defense lawyer, is even more certain. She argues that in the rare cases that rely on medical evidence alone, that evidence “should not equate to ‘beyond a reasonable doubt.’ To me, that should not even pass probable cause.”

      Some courts are starting to lean toward Blake’s position. Judges in Kentucky and Florida recently banned the term “shaken baby syndrome,” and medical testimony has gotten a number of convictions overturned. In addition to the British cases, there have been several in America, most notably that of Ken Marsh, a San Diego man who was convicted in 1983 of killing his girlfriend’s young son – and exonerated in 2004 after an appeals judge concluded the child’s injuries came from falling off a sofa. Blake, who is close to the family, officiated at Marsh’s wedding to the girlfriend who stood by him during his 21 years in prison. Marsh is also suing for wrongful prosecution, with Blake’s help; experts will be chosen next month.

      Another case, making its way through the Wisconsin appeals system, eerily resembles that of Louise Woodward’s. Audrey Edmunds, a baby sitter imprisoned for almost a decade for fatally shaking a 7-month-old girl in her care, will have her second set of hearings this month. Her lawyers are expected to argue that the science used to convict her is now invalid and are tapping as the star witness Robert Huntington, a forensic pathologist who originally testified against her. He “now unequivocally rejects his prior opinion and its implications and will testify to that effect,” according to a brief filed on Edmunds’s behalf. He cites the “lucid interval” of the victim – or what Block skeptically calls the “somebody-else-did-it theory.”

      Although there are no prominent appeals on scientific grounds in Massachusetts, shaken baby cases continue to be a problem in the state. From 2001 to 2004, almost 80 Massachusetts children were diagnosed with SBS. The days just before Christmas saw a horrifying potential case: 9-week-old twins from Dracut were rushed to the hospital with injuries consistent with shaking. One of the children, Paige Garvey, is now in foster care. Her brother, Liam, died at the Floating Hospital for Children on December 22. At press time, no charges had been filed.

      For Jetta Bernier, the Dracut twins case was especially heartbreaking. Just weeks earlier, thanks in part to her lobbying efforts as director of Massachusetts Citizens for Children, the state had passed what she calls “the most comprehensive legislation in the country” regarding shaken baby syndrome. Late last year, Governor Mitt Romney signed a law calling for a statewide prevention plan intended to help researchers gather data and, says Bernier, provide training for new parents on how to cope with ceaseless crying. It’s unclear, however, whether the law will actually translate into action. Trying to raise funds for a similar plan several years ago, Bernier says potential donors told her there was no need, since the Woodward case had already publicized the dangers of shaking. A few others told her the defense had persuaded them the syndrome didn’t exist.

      Now Bernier finds herself struggling for funding again. There is no appropriations bill attached to the law. “At this point, there’s no funding at the [Massachusetts] Department of Public Health to carry this out,” she says. “We and others have been able to pilot efforts in a couple of counties, but there’s certainly not enough money to take this full scale.”

      Another person who watched the Dracut case with dismay was Paula Cashin, a longtime resident of the town. Well before Louise Woodward ever met the Eappens, Cashin was a sad and unwilling authority on shaken babies. Her 7-month-old daughter Laura began to show signs of SBS on August 30, 1990, while in the care of a baby sitter who lived down the road. That night, at the hospital, Cashin and her husband sat through separate interviews with the police while their daughter spiraled downward. By morning, Laura was brain-dead. It was then, Cashin says, that the police told her the baby sitter had “admitted to a state trooper to yanking Laura out of her high chair by one arm, and demonstrated how violently she shook her.” But in court, the baby sitter admitted only to shaking the baby gently and said she had never intended harm. She was found not guilty of manslaughter in 1992. “At least in the Eappen case they found [Woodward] responsible,” says Cashin, who was one of many supporters reaching out to the Eappen family during the Woodward trial. “All I ever wanted was for that woman to tell me, ‘I did this, and I’m sorry.’ And I will never know that.”

      The Eappens can understand the sentiment. Asked what an apology from Woodward would mean to her at this point, Deborah Eappen says she thinks “there’s a lot to be said for saying you’re sorry.” But, she adds, “I’m not holding my breath.” She does take some comfort in the original verdict of guilty of murder in the second degree against Woodward, despite the judge’s later reduction of the charge to involuntary manslaughter. “The really important thing,” she says, “is that we know the truth, and the jury saw it.”

      The other important thing to the Eappens now is preventing more cases. The family’s Matty Eappen Foundation cosponsors national conferences on shaken baby syndrome and has helped put together diagnosis-training workshops for physicians. It also recently started a scholarship for the siblings of shaken babies. As for Matthew’s own siblings, who are now 12, 8, and 6, they regularly field questions about their brother at school. “It just ripples through your life,” Deborah Eappen says. “I feel like we can’t run away from this. This is where we are. It’s not like our kids have a normal life, but we try.”

      Deborah Eappen does not keep tabs on Louise Woodward, but occasionally, she says, acquaintances will mention news reports to her. The last one she heard about was when Woodward famously began a career in law in 2004, declaring it a “crusade” inspired by her trial. It was not a long one, though; little more than a year later, Woodward left her firm to teach salsa dancing. Woodward did not respond to an interview request and has not commented publicly on any of the research from the last decade that she put her confidence in 10 years ago – or whether, as she hoped, it has bolstered her case.

      Gerard Leone Jr., the current Middlesex County district attorney, who helped prosecute Woodward, has a firm opinion on that matter: “I think there’s been a lot of good scientific work to try and enlighten us, but I don’t think any of it has shown in any way that what happened in that case was anything but child abuse.” Reece, the pediatrician – who was scheduled to testify against Woodward and was dismissed at the last minute – also says there’s nothing scientists have learned that would change his mind about the verdict. But, perhaps unsurprisingly, Leestma, the forensic neuropathologist who often works with the defense in SBS cases, is not so sure. And Barnes, the radiologist who changed sides on the syndrome, flat-out disagrees. “The science [we have today] could, in fact, have exonerated her,” he says. “There is certainly, in retrospect, reasonable doubt.”

      This, to Eappen, is precisely the defense mechanism that “needs to be overcome,” a “denial that takes in place in the courtroom by everyone who tries to think of another excuse for what happens.” She can understand, she says, the reason for that denial: “It’s too hard to imagine someone doing this to such an impossibly defenseless victim. You always wish it’s something else.” Cashin, who lost her daughter, has a similar take, but she describes herself as more “jaded.” Once a case reaches the courtroom, she says, “the truth really doesn’t matter. There are so many ways around it.”
      She may be right, but in a much less jaded sense than she intends. In the courtroom, after all, it is the jury that makes the decision. Ultimately, whether the doctors arguing over shaken baby syndrome can state their cases beyond a reasonable doubt may be irrelevant. The question is whether the jurors, hearing all of the evidence, can. In the Garvey case, in Wisconsin, and in courtrooms across the nation, they, and not the doctors, must come to a consensus. Justice is a matter of their opinion, and that’s one thing since the Woodward trial that hasn’t

 

Mom cleared in child abuse investigation; “bruises” are birth marks

http://kdvr.com/2012/04/05/mom-suspected-of-child-abuse-cleared-after-spots-found-to-be-birth-mark/

A Look Back at the Shaken Baby Case

http://abcnews.go.com/GMA/OnCall/Story?id=3794657&page=2#.T384CpJ1Z1E

Shaken Baby Syndrome: A Diagnosis Challenged

http://www.pbs.org/wgbh/pages/frontline/the-child-cases/shaken-baby-syndrome/

Interview Dr. Patrick Barnes

Interview Dr. Patrick Barnes

Patrick Barnes, M.D. He is a doctor and Stanford professor who specializes in pediatric radiology and neuroradiology, and also is a member of the Lucile Packard Children’s Hospital SCAN [Suspected Child Abuse and Neglect] team. Barnes was a key prosecution witness in the 1997 trial of Louise Woodward, the British nanny who was accused of shaking an 8-month-old baby to death, hitting his head and causing fatal bleeding. The trial was a turning point for Barnes — while it was clear something happened to the child, he now says, “Shaking was irrelevant in that case in retrospect.” This is the edited transcript of an interview conducted on May 26, 2011.

Tell me about Isis Vas. You looked at her medical records and her CT scans and X-rays. What did you think when you saw them?

First of all, when I looked at her brain CT and saw the diffuse injury to her brain, primarily swelling, the first thing that I thought of is she may have suffered from a lack of oxygen or blood flow to her brain if she wasn’t breathing properly or if her heart wasn’t getting blood to her brain. She did have a small amount of hemorrhage between the brain and her skull, but it’s not the type of hemorrhage that we would expect to see, for instance, with trauma. So even though it potentially could have been trauma, I was beginning to want to ask questions about other medical conditions that could produce this type of brain injury, including the swelling and the bleeding.

So from the scans, you said this does not look like enough bleeding to be a typical abuse case. Is that what you are saying?

That’s correct, and we started learning mid- to late ’90s, particularly after my experience being a prosecution expert witness in the nanny case, the [Louise Woodward] case in Boston, and then when we started using more advanced imaging techniques such as MRI, we started seeing findings that we had previously attributed to abuse or shaking. Yet we started realizing there were a number of medical conditions that can affect a baby’s brain and look like the findings that we used to attribute to shaken baby syndrome or child abuse.

And what kind of medical conditions are we talking about that seem to mimic child abuse?

Infection is a very important one, and when we started really looking at these cases more carefully, we started finding babies who may have had an ongoing illness. They may have had relatively nonspecific symptoms, because a baby can’t tell you, “I have a headache,” “I have got an earache” or whatever, so they may act with just maybe irritability, not eating well; they may not be sleeping well. And sometimes they can get worse if they don’t get immediate medical attention and diagnosis, and then at some point they may crash, like this child did. So infection is very important, and undiagnosed infection may be even a virus that maybe the majority of babies may get over in a few days.

“We started realizing there were a number of medical conditions that can affect a baby’s brain and look like the findings that we used to attribute to shaken baby syndrome or child abuse.”

There is a small percentage that can progress. They may stop eating, they may not have a normal fluid balance, they get dehydration, and then they collapse and stop breathing, which is a common crash-type symptom, or they may in fact have a epileptic-type seizure. So they may progress slowly, then crash, have brain-injury findings and have a little bleeding, and then the impression might be, “Well, this baby was abused,” was either shaken — and that had to have happened just before the baby collapsed. …

And so here we have a baby that’s handed off from one caretaker — let’s say the mother, as in this case [of Isis Vas] — to another caretaker. And then the last person standing, the last caretaker when the baby crashes, it was pretty much traditional for 30 or more years that that baby had to be abused by the last caretaker. And automatically the caretaker, who could not otherwise explain the baby’s injuries, would be charged — murder, for instance, when we lose a child, such as we did in this case — and be indicted and convicted, for instance, for shaken baby syndrome, just because the baby has what at one time was thought to be the characteristic findings, what we call the “triad,” and that is the hemorrhages in the brain, subdural hemorrhages between the brain and the skull; hemorrhages in the eye; and then the brain injury.

The brain swelling.

Yeah, the brain swelling. And that could carry the case all the way through the child protection process, all the way through the criminal justice system process, and result in convictions with significant prison sentences with little investigation into what was really going on with the baby in terms of days, sometimes maybe a week or so before this happened.

So we have learned our lesson with that, particularly since we started doing more advanced imaging with magnetic resonance imaging [MRI], which is 100 to 1,000 times more powerful than CT scanning, and then we started seeing other findings that we go, you know, that’s not what we used to think we saw with trauma. We saw no traumatic brain injury, no tearing or bruising of the brain. It just looked like it didn’t get enough oxygen or blood flow.

So why did the baby stop breathing? Why did the baby’s heart stop? Maybe the baby had an infection that became sepsis. The baby bled because of that, and then the baby stopped breathing or had a seizure. So as a result of MRI showing these findings and then correlating in our research the MRI findings with postmortem much more carefully than we did, and particularly correlating the MRI findings with the laboratory testing, which in this particular child also showed the child had a bleeding and clotting problem — previously we would have blamed that on extensive shaking or a shaking-impact injury to the baby’s brain that would secondarily trigger this bleeding or clotting problem. …

When Isis came into the hospital, she had bruising on her body, she had bleeding from her vagina, she had bleeding on her brain, and the doctors at the hospital said, “This looks like abuse.” The forensic pathologist who did the autopsy said, “This child was a victim of blunt-force injuries; this child was violated; this was an attack by adults.” What’s wrong with that analysis?

… We had always assumed using the Sherlock Holmes approach that when we saw these findings that this had to be child abuse. We stopped there. We made that medical diagnosis, and then it carried over into child protection and into the criminal justice system without doing an adequate evaluation of what is going on, and then bring it forward and put it together. So once we put the details of this illness in this baby together and come from the beginning to forward, which is the logical way to analyze these cases and the proper way, it does explain all the injuries of the baby based upon a complicated medical condition.

What are the symptoms of the child [Isis Vas] and the medical history that suggests to you this wasn’t abuse? What stuck out to you that said, “Hey, this might not be child abuse”?

For instance, the pattern of the brain injury made us think something other than abuse. The pattern of the bleeding in the baby’s brain made us think of something other than abuse. We found no evidence on the brain imaging, the CT scan, for instance. And as I recall, on the postmortem imaging, [there was] no impact-type injury to this baby’s brain, tearing, bruising of the brain itself. So those were the types of things that we pay attention to. Of course, a baby that presents with bruises or bleeding, we pay attention to that. And yes, that certainly could be due to impact like trauma, but there ought to be other physical signs of impact trauma or imaging signs of impact trauma.

So that’s, in my mind, what was really lacking in this case, both on the imaging as well as on the postmortem examination, and even though the baby did have an old healing clavicle fracture, that was much older than what could be attributed to this more acute presentation, where most people thought that the beating had to have happened by the second caretaker as opposed to the first caretaker, and trying to split that by a matter of hours or parts of a day between the two. Also, any potential rib deformities that were old or new or acute. So it didn’t all come together as a single acute assault-type of injury pattern. So that’s when we start looking at the other aspects of the case.

This was a child who had a PTT [partial thromboplastin time] score that was off the scale. What does that say to you?

Well, that’s when we start looking into bleeding and clotting problems. That is telling us we have a severe problem, or the baby did, with normal clotting, and she is bleeding because that particular measure of clotting was so far off the scale. And correlating with these multiple areas of breathing or bruising, if we had trauma causing that, there should have been extensive traumatic injury to this child’s brain, tearing of the brain, bruising of the brain, because if you are going to get a secondary bleeding or clotting problem from trauma to the brain, it is that tearing and bruising of the brain that incites that type of bleeding. This baby had none of those findings on the imaging or the postmortem.

If that’s true, you have to start considering other causes of bleeding. Infection, particularly if it spreads, is a cause of bleeding in babies, and we know that particularly if that’s progressing and going on for a while. And if the baby also then stops breathing or the heart stops and there is not getting any oxygen in the brain and you get injury from that, that can contribute to the bleeding. So that particular parameter in itself was quite suspicious for a process going on that was really a medical condition or a natural condition, not a traumatic condition.

Now, the forensic pathologist who did the autopsy shall say: “Dr. Barnes, you got it wrong. Children can get blood-clotting disorders after they have had head trauma. This blood-clotting disorder could have come from the child being abused.” What do you say to that?

What I say to that is if that’s true, then you have to show that there is traumatic injury associated with the abuse, OK? And there was no traumatic injury, direct traumatic injury to this baby’s brain on the imaging or the postmortem. …

Can you get a PTT score of 212 [as was the case with Isis Vas] within an hour of sustaining a head injury, in your experience?

I think you could, but it would have to be massive brain injury that we have seen in some children with high-impact brain injuries — diffuse tearing, extensive tearing of the brain, extensive bruising of the brain — and then the release from that injury of those chemical factors that can be associated with this type of bleeding, particularly what we call multiple-trauma victims, not just brain injury but those that particularly have multiple injuries elsewhere — acute bone injuries; acute muscle injury; acute injury, for instance, to the heart or chest. And now you have much more extensive trauma that can trigger to have bleeding parameters that [are] out of normal range. This child had none of those.

So we would be talking about car crash-type injuries.

Yes, and potentially a massive assault by an individual on a child, which would usually be a beating. That would be the classic situation — usually a beating and breaking of bones, impact to the abdomen, injury to the organs, extensive injury that releases these chemicals that then trigger that type of bleeding or a problem. We had none of that in this particular case.

So you just didn’t see the type of injuries that would trigger a clotting disorder of that magnitude?

Correct. And none of those factors supported a secondary bleeding or a clotting problem due to trauma, because we did not have findings of that type of trauma in this case. And that’s true of many other cases that we see of alleged or suspected shaken baby syndrome. So we have gotten smarter in the last decade or so about these.

So our new approaches to this, my part of [it] as being a co-founder of [a] child abuse task force the last 10 years, coming from Boston, and now working with multiple specialists in addition to our child abuse pediatrician and a much more careful approach to these cases, a proper medical workup. While we are also using our very good social workers and our child protection professionals to help us sort out caretaker issues, at-risk potential family members, other caretakers who are protecting the child and the family, and the caretaker is on one side, a simultaneous process [is occurring] while we are also doing the medical workup and getting detailed historical data having to get the records, and maybe even talk directly with prior caretakers to sort out the story and not just automatically turn the case over to police investigators, for instance. So we have really changed our approach to this to a much more thoughtful and compassionate approach.

That was something I wanted to ask you about. As we have been looking at these cases around the country, one thing that seems to come up repeatedly is whether the hospital doctors and whether the forensic pathologists are delving into the child’s past, whether they are looking at lab reports in great detail, whether they are looking at medical history. How important do you think it is to go into a child’s past when you have a possible abuse case?

It’s absolutely critical, because number one, we no longer want to make the mistake of the misdiagnosis, and it really can’t be a medical diagnosis any longer, a misdiagnosis of child abuse when it really doesn’t exist because of what it means to that child, that caretaker or that family. …

Number two, we want to protect that child, particularly a child that may have had a previously undiagnosed condition. Now that we have the advanced laboratory techniques and the advanced imaging to do that, we no longer do what we did in past decades, and that is just because a child presents with a triad, we assume child abuse, and we don’t do the medical workup, and then we find at a postmortem exam when we have lost the child that there was a different diagnosis. Now we have made a huge error.

It is critically important, particularly for children and babies six months and younger, because at that age they could actually have conditions that have yet been diagnosed that stem from birth process, that are delayed effects of trauma at birth or other conditions passed from the mother to the baby and so forth. Plus, for the babies that we lose, or even if they survive, number one, we need to diagnose those conditions, because even if the baby survived, that baby may suffer another episode due to that medical condition. We didn’t diagnose it, we didn’t treat it, or we lost the baby, let’s say, and the mother and father who may have been thinking that the caretaker did this to the baby want to have other children. And if we didn’t diagnose that condition that maybe the next child may have, then we have done a disservice to family planning for that family.

Plus, even in the case that I have seen and others have seen that we cannot 100 percent say that there has not been some neglect or abuse, yet we have diagnosed a predisposing condition, those children need to be protected, but they need to be treated. We have found that many of our physicians were not going back and doing those adequate evaluations of past history, even back to birth and pregnancy. We found that adequate tests were often not being done, and what’s even more unethical, if you want to put it that way, is we had children who we assumed were abused, and then we turned our backs on them. We didn’t follow them up. There were pediatricians and other doctors who did not want to see children that had been abused or parents that may have been accused [of] abuse, so they were being discriminated against.

We have a 100-year history of discrimination regarding mothers, their babies and young children that we’re just now getting around to realizing. There are conditions there that can predispose children to brain and bone findings that look just like abuse, particularly under six months, and actually stem from conditions in the mother passed on to the baby. So the important thing here is a much more compassionate, thoughtful, comprehensive approach in these cases, particularly if we have an injured child that maybe is not too severely injured but did have injuries, and that’s to do our best to help bring the families back together if we can with that child ultimately — reunification — look after that child and family with regard to their follow-up care and diagnosis for any of these predisposing or complicating conditions.

And because in this particular era of American [medicine], with all of our cultural challenges, the lack of adequate education, people being sent home from the hospital with sick preemies, not adequately being educated on how to take care of them — and, for instance, sick preemies become babies who are thought to be abused when in fact that they were premature was part of why they had these type of injuries.

So our approach has changed from working at the back end, calling [it] child abuse — breaking up the family, sending the other children elsewhere, maybe they go to foster care, and then they are adopted out of state, never seen again, send one or both parents to prison — breaking up that family to now really working hard with our professionals to try to hold these families together better. …

What was it exactly about the Louise Woodward case that made you rethink your approach to child abuse?

It was a very painful case. … The baby had a skull fracture, and even though we were talking about shaking in that instance, we couldn’t really time the skull fracture [so] that it had happened within a few hours of when the baby came to Children’s [Hospital Boston], and that would implicate the nanny as opposed to anyone else. That could have been an older skull fracture.

The collection between the brain and the skull on that baby’s head and the bleeding in it, that may have all happened during that period of time, but the imaging didn’t exclude that there was an older collection with a new bleed in it. Plus, the baby had a much older fracture of the wrist that was up to four weeks old, and there were rumors that maybe there had been some prior, maybe accidental traumatic event in that baby.

So I was really affected by all of that and began to question my role as a pediatric radiologist and a neuroradiologist as part of the child abuse team in these particular cases and [decided] that I needed to be more proactive in these cases and insist that we do more thorough investigations in these particular cases. …

Do you think Louise Woodward was wrongly convicted?

I think it’s possible. I think looking back on the case — and subsequently I was contacted by writers about that case. Looking back on it, and [taking] a second look and [thinking] about some other individuals that had come forward, witnesses about other things that may have been going on in that home or elsewhere, I was forwarding this information on. And I knew from that point on that I just have to be more careful with these cases. I do believe it was a trauma case; it wasn’t a medical condition. It could have been potentially abuse. I am not sure Louise Woodward was the one who abused the child. …

[Editor’s Note: In October 1997, British au pair Louise Woodward was convicted of second-degree murder in the death of 8-month-old Matthew Eappen, who was in her care. Less than a month later, the judge in the case reduced her sentence to involuntary manslaughter and sentenced her to time served.]

… Do you think the child in that case was shaken to death?

No, the child had an impact injury. You can’t get a skull fracture from shaking. You can’t get a wrist fracture from shaking. The child had a traumatic impact injury. Shaking was irrelevant in that case in retrospect.

But the prosecution’s theory was this child was shaken.

That’s correct. And at that time, that was my theory going into that case, based on my previous 20 years of experience in child abuse and accepting shaken baby syndrome without ever questioning it. And that case changed my entire approach. …

If you were called to testify in the Woodward case today, what would you say?

I would say that this is most likely a traumatic impact injury, that I would not be considering shaking, that this could be accidental just as it could be non-accidental or abusive. And I would say that from the imaging findings, my area of expertise, you cannot select out, accuse, indict or convict any particular caretaker based on the medical evidence that we have.

Do you believe it is possible to shake a small child to death?

I believe in a situation, that the current state of research and science shows, and particularly for babies under six months of age, [what] I am concerned [about] particularly with a violent shake, and maybe not so much violent shaking but a baby that [is] maybe shaken. But there is an impact associated with it, is [there] the possibility that for these particularly young infants that don’t have good head control and they have very weak necks. It would be the neck that would, with severe shaking, potentially, that could be injured, and a neck injury particularly involving the spinal cord and the upper neck where it attaches to the brain stem at the skull base where the breathing center is, for instance, could potentially be lethal.

So that’s the one scenario that I would worry about with a potentially violent shaking, or what may not be a shake at all, but an assault that would involve impact.

We spoke to a shaken baby theory proponent the other day, and this person said to us: “We have never said that these children were only shaken. We have always said that there had to be some impact along the way, that they were shaken and their small heads hit something as well.” Is that true?

No, that’s not true. For 20 years prior to the nanny case in the mid- to late-’90s, we were implicating shaking for just about every injury that we are seeing, particularly in the young infants. …

And looking back on it, does it seem strange to you that you would see these children presenting with bleeding on the brain but no bruising on their heads, no sign that their head had hit anything?

Yes, that was very important. Probably the next case that opened my eyes was the baby [Mariah] Scoon case in New York that I was, after the nanny case, asked by the defense to review. And that was a very sick young baby girl, former preemie, who had meningitis and strokes in the brain and the imaging supported that, and the postmortem, yet the father was convicted of shaken baby syndrome.

Do you believe people have been wrongly convicted of shaking their children to death?

I do, yes.

Is it a big number? Is it a small number? I mean, what’s your guess?

I don’t know for sure. What I am worried about and concerned about in terms of my role in the past and even what continues to this day [is] that there is more than we think that have been convicted because of shaken baby syndrome. …

So there is a whole range of cases in which people may have been wrongly convicted of killing children. Is that correct?

Yes. And that’s why it’s so important for the pediatricians who are training in child abuse pediatrics, now that it’s board-certified, is to make sure they have the adequate training outside of child abuse and keep up on the conditions and the environmental conditions and the safety factors out there that can hurt children that have nothing to do with abuse.

That’s just in the environment and the safety issues at home, that accidental injuries can happen at home that can hurt and kill children that are not abused. … There is a lot of factors going on that really have to be looked at more carefully and in fact are being looked at more carefully: the lack of good nutrition in this country — I’ve talked about vitamin D deficiency, but deficiencies in other nutrients that can be passed on from mother to baby; toxic factors in the environment; child safety factors with regard to child seats and child swings and child toys. And this means we need to be better with educating our new parents about those potential safety issues, things that can happen in the home that are accidental but get called child abuse. …

I want to run a scenario by you. A child dies in the hospital after having three probes inserted into his head. When the child is autopsied, the forensic pathologist says, “These three bruises on the child’s head were caused by abuse.” What does that say about the forensic pathologist?

Yes, we have seen other cases like that, where some of the pathologists — there is a total disconnect with the process of a postmortem examination in isolation, [where it’s] separate from the medical record, completely dissociated, out of context, and that’s, believe it or not, still happening in some cases that we see. We just can’t allow that to continue to happen, particularly once it gets into the justice system. Then here come the experts who go back through and look at everything that they should look at everything in a proper CSI way, right, crime scene investigation way, you know? So that’s a big problem. …

But you have seen that in other cases, where it seems like there is a disconnect between the doctor and the morgue and the doctor and the hospital.

Yes. For instance, a situation where I looked at a postmortem exam and a pathologist reported a laceration in the right frontal lobe, and I looked at the imaging, and there was a probe put there, a catheter by the surgeon to try to help reduce the pressure in the baby’s brain, and I go, “You know, that’s not really a penetrating traumatic abusive brain injury; that was a medical intervention.” …

The stance you have taken is not popular with a lot of people. A lot of people who have similar views in the medical field to you did not want to go on camera with us. Tell me about that.

Well, I didn’t either. And I have really tried to stay away from this. I didn’t want to do The New York Times Magazine article recently. But after participating in a number [of cases] for [the] Innocence Project in this country, and the Innocence’s cases convicted individuals getting new trials and everything and looking at the entire environment on all of this, I just felt that it was important to be more involved and hopefully, possibly become maybe not so much a leader, but [a] modeler in this particular area, and for us to develop these types of model programs, because I see abused children as part of our child abuse team.

We see neglected children; we see abused children, physically abused, and we see sexually abused children. But we make sure that those cases that are alleged cases get — we are doing our best to get a thorough workup, and we get the right specialists involved and come to determination that maybe this is not abuse.

So instead of splitting up the family, sending someone to jail, let’s do our best, and it takes a lot more work to do that, to protect this child and the other children in the family, and see if there is a process working with our very good social workers and child protection workers, that we can bring these individuals back together, because what we have found in the past, talking with public defender[s], colleagues of mine, that children who have been separated from parents, for instance, say, on alleged child abuse and maybe they have gone in a foster home, or maybe have been adopted, something like over 50 percent of those children when they get older want to go back and find their original parents and try to reunify [sic]. I was struck by that, and those are cases that in retrospect you look at and go, “This may not have been abuse at all.” .

Doctor queries shaken baby symptoms

http://m.smh.com.au/national/health/doctor-queries-shaken-baby-symptoms-20120315-1v86t.html

Two Cases of Incontinentia Pigmenti Simulating Child Abuse

Two Cases of Incontinentia Pigmenti Simulating Child Abuse

http://pediatrics.aappublications.org/content/100/4/e6.full

Parents Are Being Wrongly Accused Of Child Abuse Because Of Rise In.undiagnosed cases of rickets.

Parents Are Being Wrongly Accused Of Child Abuse Because Of Rise In.undiagnosed cases of rickets.

Sheffield Children’s Hospital

Scientists are claiming that parents are being wrongly accused of child abuse because of an undiagnosed epidemic of rickets among very young children.

Rickets is caused by a lack of vitamin D. In very young children, the condition can lead to breakage of bones, and can trigger fatal bleeds in the brain. Cases of the illness have soured in the past decade due poor lifestyle and diet.

It has been shockingly claimed that parents are being accused of abusing their young children, when the children are in fact suffering from rickets.

These new claims are originating from scientists from Sheffield Children’s Hospital and London’s Barts hospital. They are suggesting that in many cases parents are mistakenly being accused of hurting or shaking babies whose injuries were actually caused by rickets.

A case of this was seen recently when a couple were originally accused of murdering their son, Jayden Wray, who died at four months from head injuries. Last month the parents were cleared of murder at the Old Bailey when it was discovered that the child actually had the severe vitamin D deficiency that was passed onto him by his mother, causing him the injuries that led to his death.

Dr Irene Scheimberg, of Barts hospital, believes that the rise of rickets is leading to parents being wrongly accused of abuse.

Dr Marta Cohen, of Sheffield Children’s Hospital, said that due to this confusion, it was likely that many children suffering from rickets had wrongly been placed into foster homes because their parents had been suspected of abuse. When speaking to BBC Radio 4 she said:

“If you have bones that fracture easily they will fracture with any normal movement. Like trying to put a babygrow on a baby, you will twist the arm. ‘In a child whose bones are weakened, it’s easier for them to get these very tiny fractures or big fractures. There should be a commission that studies all of these cases, taking into account the age of these children, their gender, the race, the way in which these families live.”

Dr Cohen also believes that rickets could also be responsible for many cases of cot death, or sudden infant death syndrome, because it can cause the heart to stop beating.

The Doctor recently carried out a study involving 24 babies who had died of cot death. She interestingly found that three quarters were found to have moderate or severe vitamin D deficiency.

The Government estimates that as many as 40 per cent of Britons are deficient in vitamin D. The increase in rickets in young children has been blamed on the children spending considerably more time inside, rather than outside in the sun.

Shaken Baby Syndrome: Pitfalls in Diagnosis and Demographics

http://www.whale.to/vaccine/yazbak_sbs.html#The_medical_and_child_p

BLOOD VISCOSITY AS A FACTOR IN ALL METABOLIC DISEASES

BLOOD VISCOSITY AS A FACTOR
IN ALL METABOLIC DISEASES

It’s said that blood is thicker than water (sometimes more so than it oughta!)

Blood is a wonderful and complex substance containing many chemical compounds to perform many functions. It constantly changes and adapts to meet the body’s requirements. Healthy blood varies in viscosity as it flows normally and becomes much “thinner” by the time it reaches the capillaries. It can even change viscosity locally at a given point in order to pass through a constriction.

As described in Chapter 8, the viscosity of blood is quickly increased by stress, and continuous stress will maintain the condition. Severely affecting blood viscosity too is a diet containing fat, cholesterol, refined carbohydrates, coffee, alcohol and excessive amounts of animal protein. Removal of these foods from the diet enables the blood to clear in several days, but because most people consume these foods constantly, their blood is always polluted and viscous.

Since 1852 when Dr A. Coccius published data on microscope observations of agglutinated blood in living human patients, many other studies have been made but unfortunately their significance has not been appreciated. Dr Leopold Dintenfas of Sydney Hospital has studied blood viscosity for over 20 years and is just beginning to convince the medical profession that high blood viscosity is a disease factor. Dr Dintenfas is the Director of Hemorhology and Biorheology Department, University of Sydney. He is the author of Blood Micro-rheology Viscosity Factors in Blood Flow, Ischemia and Thrombosis (1971 Butterworth Press), Rheology of Blood in Diagnostic and Preventive Medicine, (1976 Butterworth Press), Hyperactivity and Hypertension and Blood Viscosity in Heart Disease and Cancer (1981 Pergamon Press) plus numerous medical papers published throughout the world.

High blood viscosity invariably accompanies degenerative diseases. The factors that effect blood viscosity are: plasma viscosity, aggregation of red cells, internal viscosity of red cells, hemoconcentration, aggregation of platelets, and concentration of white cells.

Quoting Dr Dintenfas:

“The high viscosity syndrome can contain one, two, or more of these elements. Capillary occlusion, stasis hypoxia, acidosis, necrosis and infarction are inevitable, although not necessarily irreversible steps in this process.

“It would be worthwhile to note that osteoarthritis and rheumatoid arthritis are associated with an elevation of plasma viscosity (Houston et al 1949–Gasen et al 1970) and an elevation of the degree of aggregation of red cells (Laine and Zilliacus 1950, Redioch et al 1970). High blood viscosity always leads to a slow down of circulation and to reduced oxygenation of tissues.

“Wardle in 1967 suggested that it is the increased blood viscosity in the small digital arteries which is responsible for the common symptom of malignancy. Red cell aggregation, platelet aggregation and hypercoagulability can contribute to this syndrome. Crenated red cells, raised fibrinogen, increased platelet stickiness, are all a common feature of malignancy.”

The full implication of high blood viscosity in cancer is described in Chapter 20 and in arthritis, MS etc, in Chapter 21.

On the subject of blood as a disease indicator, here is a quotation from the book Hunza Land by Dr Allen E. Bank from Nebraska, USA (1960):

“One of my major reasons for wanting to visit Hunza was to find out whether their robust health would be corroborated by evidence of superior circulatory function as revealed by a study of the arteries and veins within their eyes, also to learn if their eyesight was superior, in general to that of our population.

“Although optometrists do not practise medicine, their knowledge of pathology enables them to refer patients with abnormalities to proper medical authority. In my opinion, comparison of the diameters of the arteries and veins of the eye indicates whether the circulatory system is ‘in balance’ or ‘out of balance’–whether a person’s blood pressure is normal or abnormal. Determination of the color relationship between arteries and veins is also indicative of an individual’s condition. For example, if the color ratio between an artery and corresponding vein is 1:1, a person is healthy (i.e. The artery is rich red and the vein has a color intensity of equal degree). If the color ratio is 1:2 (the vein is two shades darker than the artery), health is somewhat below normal. The average American–including many children falls into this category. A ratio of 1:3 indicates illness; at approaching death the ratio is 1:4.

“Interesting evidence of this theory is supplied by studies made by Dr Melvin Knisely of the University of Chicago. Dr Knisely made an exhaustive study of the color changes in the circulatory systems of dying frogs, monkeys and humans, and was able to predict the progression of diseases. As death approached, the toxin-laden corpuscles were unable to pass through the capillaries. Their progress was stopped and their oxygen content discharged. As a sticky substance in the blood covered the dying cells, they formed into clusters which the doctor called ‘blood sludge’–a condition common in 50 diseases. Gradually, the blood flowed more slowly, and the tissues died of asphyxia. ‘Understanding sludge’, Dr Knisely says, ‘will make possible a new attack on a whole panorama of human diseases’. Photomicrographs of the circulatory systems of frogs, monkeys and humans substantiated the theory. An account of this remarkable discovery appeared in Life magazine, May 31, 1948.

“The examinations I made in Hunza of the eyes of people in all age groups indicated that the Hunzakuts have healthy circulatory systems. Their artery-to-vein circumference ratios were, in most cases, perfect or near perfect, and the color ratios could generally be classified at 1:1.

“In all respects the Hunzakuts’ eyes were notable. I found them unusually clear; there were few signs of astigmatism; even the oldest men had excellent far and near vision–an indication that their crystalline lenses had retained elasticity. Most of our crystalline lenses lose their elasticity in our early forties, and we require bifocal lenses for the remainder of our lives.

“Here, I believe, is confirmation of the fact that bodily health can be ‘read’ by a study of the eyes, and that general health promotes eye health. For our own benefit and that of our children, we should resolve that, starting now, we will make the necessary adjustments in our diet to promote the radiant health to which we are all entitled.”
Blood Sedimenatation Rate (ESR)*
*Red cells are called erythrocytes.

There are many components of blood chemistry which can be checked by complex tests.

A simple test of the blood sedimentation rate is one which indicates the degree of red cell aggregation. Again quoting from Blood, the Paramount Humour, by Dr Earle Hackett:

“The sedimentation test consists simply in watching a column of blood, which has been prevented from clotting, standing in a vertical tube. The red cells settle down to the bottom. The faster they settle, the sicker the patient (with a few exceptions, such as pregnancy).

“Absurd? No–more or less true.

“The explanation is that normal red cells are coin-shaped flakes of jelly and are slightly heavier than the plasma in which they are suspended. When blood stands still they will very gently settle to the lowest part of the container. They settle slowly because each individual one falls like a light disc on syrup, and there is a maximum resistance to its fall because of its large surface area.

“When red cells stick together they do so like piles of coins or dinner plates.

“These adhering collections offer less surface resistance when falling through plasma, and therefore in the test they settle more quickly. Rapid sedimentation accompanies all diseases which involve tissues or the entry of foreign or abnormal proteins into the blood. This will include a wide variety of chronic inflammations, toxic infections, operations, fractures, blockages of blood vessels, and disorders of the cell system which normally manufactures the plasma proteins.”
Platelet Adhesiveness Index (PAT)

Another factor which affects blood viscosity and by which the condition of the blood can be assessed is the stickiness of the blood platelets.

Dr Paul Owren, Hematologist at the Oslo University Hospital, devised a method of measuring platelet stickiness by means of observing the percentage of platelets which adhered to glass beads. The percentage is the index number.

Healthy young women have an average index number of 20, whereas cardiovascular-prone males have an index of between 50 and 70.

The effect of trauma on blood viscosity is reflected in the fact that after a major wound, all people, regardless of their starting PAI, have it increased to 90 for a period of 15 days.

Anti-coagutants have no effect on the PAI but reductions have been observed after the intake of Vitamin E, flaxseed oil, garlic, codliver oil, lecithin and aspirin. Alcohol, although it elevated triglycerides, had the effect of temporarily reducing platelet aggregation.

Dr Mark Patterson, hematologist at the National Heart Hospital, London, in a paper titled Study of Action of Flaxseed Oil, Flax-phosphatides and Tocopherals on Platelet Adhesion (July 1975) said that these substances, even when used in pastry., reduced the PAI by an average 20%. He said that deep vein thrombosis was absent after operations, and that protection was afforded to coronary heart patients. In an experimental group of 18, the PAI reduced from 59 to 29 and no deaths occurred compared to six deaths in the control group of eighteen.

Although aspirin lowered the PAI, it was an irritant and did not prevent deep vein thrombosis.

Recent research has revealed how dietary fats, in the amount consumed in the Western diet, cause platelet stickiness. Hormone-like substances called prostaglandins, derived from fatty acids in the blood, are used by the cells in the blood vessel walls to produce prostacyclin, and by the platelets to produce thromboxane. Prostacyclin controls the muscular contraction of the vessels and presents platelets adhering to the vessel walls. Thromboxane determines the stickiness of the platelets and tends to cause the vessels to contract.

Prostaglandins differ in type depending on the type of fatty acids available. If fatty acids either from animal protein, dairy foods, eggs, or from vegetable sources such as nuts, are in abundance, then Prostaglandin H2 (PGH2) is formed and the resultant thomboxane (TXA2) makes the platelets sticky. If blood fats are normal (which they never are on the Western diet) of if they are abundant from fish sources, then PGH3 and TXA3 are formed , and the platelets will be normal. (This is the effect of garlic etc.) The fatty acid in fish is called eicosapentaenoic acid or EPA.

Dr William Connor, professor of medicine, University of Oregon Clinical Nutrition Section, found that on a 10-day diet of salmon, patients’ elevated cholesterol levels fell by 20% and triglycerides by 40-67%. These results are not entirely surprising because it has often been observed, but not before explained, that fishing communities in various parts of the world suffer a lower rate of heart attacks than elsewhere.

Because EPA has the effect of reducing platelet stickiness, towering elevated cholesterol and triglycerides, and reducing blood viscosity, it is being researched for medical use* and is now available in extract form. This is well and good, but it should be first of all realized that better results are obtainable simply by eliminating both animal fats and concentrated vegetable fats from the diet.

*Medical authorities have stated low fat diets to be ineffectual in the treatment of disease, although they now recommend that fat should be limited to 30% of the diet. This recommendation is indeed ineffectual. The reduction of fat in the diet to 25% of total calories is helpful but achieves only a 10% reduction of elevated blood pressure, indicating the blood is still sticky. Total fat should be reduced below 10%. It has been proven that hypertension (high blood pressure) is directly related to high blood viscosity and that the removal of fat from the diet effectively reduces blood pressure in a few days whether there is salt in the diet or not. Drinking beer, and to a lesser extent other alcohol, increases blood fats and blood pressure. Three pints of light ale per day are sufficient to cause big increases in blood pressure over a three-day period, the increase in viscosity being sufficient to present risk of heart attacks in coronary prone patients. This information was reported recently by Dr John Potter and Dr Gareth Beevers at Birmingham Hospital, England.

It should also be noted that even on a high fat diet, athletes in training have low blood viscosity with no red cell or platelet stickiness, and consequently lower blood pressure, simply because in a physically fit body the metabolism of fat is more efficient.

That the effect of high EPA intake can be harmful and prevent blood coagulation altogether, is shown by the fact that primitive Eskimos whose diet consists mainly of fish, although not prone to heart attacks or cancer, are very prone to hemorrhaging, young and old alike, and often suffer nose bleeding lasting several days which sometimes reduces them to a state of collapse.

Improvement of circulation by the injection of snake venom serum has been demonstrated in Europe and the USA in the treatment of various complaints such as angina, claudication, arthritis and MS. The research shows that the marked relief of symptoms of these complaints is achieved by way of lowered blood viscosity. A recent television documentary on this topic showed graphically how a sample of treated blood flowed faster than untreated blood when both samples were released simultaneously in an inclined dish.

In Chapter 20 it is described how the incidence of both primary and secondary cancer is dramatically reduced among patients with circulatory problems who for long periods have been on anti-coagulant drugs to prevent blood clotting.

Thus it is abundantly clear that the state of health of an individual is directly related, not only to the nutrients contained in the bloodstream, but inversely to the harmful substances present and the degree of blood viscosity.
Other disease indicators

It is axiomatic that lipotoxemia and high blood viscosity must eventuate in disease and premature death. The state of health always correlates inversely with the readings of blood pressure, pulse-rate, se dimentation rate, platelet adhesion index and blood viscosity. High readings of any of these related parameters is an indication of disease whether symptoms are evident or not.
Summary on blood viscosity

This chapter can he summarized in the brief statements of three eminent medical researchers–

Dr Melvin H. Knisely, University of Chicago:

“Thus far, completely unagglutinated blood has been found only in strictly healthy animals and men. No severely ill person has yet been seen who did not have intravascular agglutination of the blood and visibly pathologic vessel walls.”

Dr Leopold Dintenfas, University of Sydney:

“Studies of athletes, normal individuals and patients with cardiac and renal diseases show a progression from a low blood viscosity with a high flow velocity among athletes to an elevated viscosity and low flow velocity amongst patients. Furthermore, my colleagues and I have found time and again an elevation of blood viscosity among apparently healthy individuals who later displayed obvious symptoms of heart disease and cancer.”

Dr Meyer Friedman, San Francisco:

“A meal rich either in animal or vegetable fat can lead to sludging of the blood and blocked capillaries for most of a 24 hour period, and one fatty meal follows another. At this writing (1965), 1 know of no single phenomenon that has been so consistently neglected, in the study of heart disease, as this one. Later we may rue this inexcusable oversight.”

Annie Li: Shaken Baby Case Highlights Difficult Diagnoses

Annie Li: Shaken Baby Case Highlights Difficult Diagnoses

PHOTO: Annie Li, a 2-month-old infant, died of shaken baby syndrome.

Annie Li, a 2-month-old infant, died of shaken baby syndrome. (Courtesy of Michael Chu)
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Jan. 17, 2012

The death of Annie Li, a 2-month-old infant born to Chinese immigrants living in Queens, N.Y., has highlighted the hard-to-spot signs of shaken baby syndrome and the role of doctors in deciphering them.

Li died in 2007 five days after her parents brought her to emergency room with a fractured skull, brain and eye injuries, two broken legs and a fractured rib, as first reported by the New York Times. Investigators ruled her death “homicide by shaking and blunt impact of the head,” landing her parents, 27-year-old Li Hangbin and 26-year-old Li Ying, in prison.

But some experts say the signs of shaken baby syndrome are far from clear-cut, and that other conditions can mimic the bruising, bleeding and fractures typical of abuse. For the doctors charged with uncovering what happened, the fear of falsely accusing parents or missing signs of true abuse weighs heavily.

“In most cases — maybe 80 to 90 percent — somebody hurt the child intentionally. The trouble is, most is not good enough,” said Dr. Michael Laposata, pathologist-in-chief at Vanderbilt University Medical Center in Nashville. “You’ve got to get it right. Either way — underdiagnosis or overdiagnosis — there’s no room for error.”

Li’s parents maintain their innocence. They say their daughter lost consciousness while feeding, and they tried to save her with chest compressions and mouth-to-mouth. Pressed to provide an explanation for her head injuries, the father Li said her head might have hit the nightstand during the commotion, the New York Times reported.

Laposata, an expert on bleeding disorders, said some doctors can be quick to suspect abuse without ruling out other possibilities.

“They look at a bruised child and say, ‘Somebody’s going to pay.’ But if a bruise occurs because of bleeding disorder, you must differentiate that from an intentional injury.”

An infant with a bleeding disorder, Laposata said, could develop a brain bleed from a minor bump to the head. In the case of Annie Li, friends of the parents suspect she might have had osteogenesis imperfecta, a rare and sometimes hereditary condition that causes extremely fragile bones.

“It would be important to understand other inherited conditions in Annie’s family that might have created a situation that looked like shaken baby syndrome but was, in fact, attributable to something else,” said Dr. Sessions Cole, director of newborn medicine at St. Louis Children’s Hospital. “Babies with osteogenesis imperfecta may have bleeding in the brain, especially if the condition was not recognized prior to birth and the babe was delivered vaginally.”

The three most cited signs of shaken baby syndrome are bleeding in between the brain and skull, bleeding in the retina and brain swelling.

“The difficulty is that shaking a baby may result in that triad. But there are other conditions that mimic that triad, and may therefore be confused with shaken baby syndrome,” Cole said. “I’d like to be able to say it’s a crisp diagnosis but that’s just not true.”

Instead, Cole said there is an unresolved debate over the so-called unambiguous characteristics of shaken baby syndrome.

A 2011 investigation by ProPublica, PBS “Frontline” and NPR identified 23 cases in the United States and Canada in which parents or caregivers were accused of killing children based on medical investigations and later cleared.

“People think an autopsy is the definitive test, but may be too late,” said Vanderbilt’s Laposata, who has reviewed cases falsely labeled as shaken baby syndrome when the child actually had a bleeding disorder. “If the child is dead, you can’t do any blood-clotting tests.”

Related articles

Pioneering a Way to Distinguish Blood Disorders From Child Abuse

Pioneering a Way to Distinguish Blood Disorders From Child Abuse

by Gretchen Gavett, Special to ProPublica Feb. 21, 2012, 3:16 p.m.

.Dr. Michael Laposata, chief pathologist at Vanderbilt University Medical Center (Photo courtesy of PBS Frontline)

Last year, as part of our ongoing investigation into the troubled state of death investigation in America, PBS “Frontline,” ProPublica and NPR took a closer look at what can be the most troubling and difficult cases — suspicious deaths of young children.

We discovered a growing awareness in the medical community of a variety of diseases that can mimic the symptoms of child abuse, including hereditary blood disorders, leukemia and vitamin K deficiency.

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PBS 'Frontline'

NPR

In collaboration with the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism

One doctor we spoke to — Dr. Michael Laposata, a pathologist and blood-clotting expert at Vanderbilt University who co-published a 2005 study on diseases that can mimic abuse — is pioneering a new blood testing regimen to rule out these types of disorders.

“If you’re lucky, most places … do the three routine tests: PT, PTT [both blood-clotting tests] and a platelet count, and that’s it,” Dr. Laposata told FRONTLINE in a phone interview. “It turns out most of the kids that have a bleeding problem have something other than that.”

Laposata and his colleagues have devised a system to make blood testing as foolproof as possible for doctors in cases of potential abuse: They created a tiered series of blood tests, known as a “Non-Accidental Injury Coagulation Panel,” which can identify underlying disorders that are more common in children. The panel can be performed with a small amount of blood, which is key when the patient is a baby.

“I think it’s the most comprehensive evaluation for a bleeding disorder that anybody has put forth to date,” Laposata said.

The panel is expected to be introduced soon at Vanderbilt and Dr. Laposata hopes to study its efficacy and to follow cases through the system over the years.

Because blood tests like these can only be performed on living patients whose blood is still flowing, a gap remains in diagnosing underlying conditions from autopsies. Laposata hopes that advances in genome testing could someday help close it, allowing for hereditary disorders to be better identified.

He said he also hopes his coagulation panel “will spur doctors to invent similar panels to evaluate bone injuries and skin changes that are also misdiagnosed as child abuse.”

Laposata was one of a number of doctors and other experts to offer testimony during the appeals process of Ernie Lopez, a Texas man convicted in 2003 of sexually assaulting 6-month-old Isis Vas. Isis, who had bruising and bleeding in the brain and vagina, later died. Lopez was sentenced to 60 years in prison. After reviewing lab tests performed on Isis before her death, Laposata concluded that they contained “clear abnormalities” and suggested that Vas suffered from a bleeding disorder known as disseminated intravascular coagulation (DIC). He gave an affidavit in the case in 2010.

Last month, the Texas Criminal Court of Appeals voided Ernie Lopez’s conviction, saying Lopez received ineffective counsel because his attorneys did not adequately challenge the prosecution’s medical evidence. Potter County District Attorney Randall Sims says he will retry Lopez.

Take a look at Dr. Laposata’s PowerPoint presentation highlighting the difficulty in diagnosing abuse cases. On one side is a photo of a child with bruises from a bleeding disorder; on the other, a photo of a child who was abused.

“I’ve been looking at patients with bleeding problems for years, more than two decades,” he said. “And if you show me the two children with the bruises on their legs, I couldn’t tell you that that one is the bleeding disorder. I’d have to do the blood test to find out.”

Gretchen Gavett is a digital associate producer for Frontline. “The Child Cases,” our film on questionable convictions in child death cases, rebroadcasts tonight on PBS (check your local listings). You can also watch it anytime online.

Muscle Exertion and Physiological Fatigue Associated with Vigorous Shaking

http://www.drergonomics.com/SBS-EMG.html

SHAKEN BABY SYNDROME/ EVIDENCE: R v Arshad [2012] EWCA Crim 18

SHAKEN BABY SYNDROME/ EVIDENCE: R v Arshad [2012] EWCA Crim 18

http://www.familylaw.co.uk/articles/2012EWCACrim18?CC=Newswatch&utm_source=Newswatch&utm_medium=email&utm_campaign=HL+-+Newswatch+17.02.2012&utm_term=Newswatch%3a+Councils+fined+for+serious+data+breaches+relating+to+children&utm_content=41933&gator_td=nv7ddqbfepKS5MCdXxviHylfp%2fo6Pl0XIZMSKTJx3Pouxz3S1cxAFbOaYvkBE

Bio mechanics of Retinal Hemorrhages (RH)

Bio mechanics of Retinal Hemorrhages (RH)

http://www.drergonomics.com/RetinalHemorrhages.html

subdural bleeding, cerebral edema/brain swelling,

subdural bleeding, cerebral edema/brain swelling,
Dear PAIN,
The following is excerpted from an important new scientific article, published in the Journal of Forensic Biomechanics, which challenges the unsubstantiated basis of alleged shaken baby syndrome. Would you please make this article available to your audience. Thank you for the important work that you do.
Sincerely,
John Lloyd
www.DrErgonomics.com
———————————————————-

New biomechanics research demonstrates that shaking is no more likely to cause brain injury than an infant merrily playing — which demands reexamination of the many cases where persons may have been wrongfully convicted on the basis of now disproven science.

Abstract

Abusive shaking of infants has been asserted as a primary cause of subdural bleeding, cerebral edema/brain swelling, and retinal hemorrhages. Manual shaking of biofidelicmannequins, however, has failed to generate the rotational accelerations believed necessary to cause these intracranial symptoms in the human infant. This study examines the apparent contradiction between the accepted model and reportedbiomechanical results.

Researchers collected linear and angular motion data from an infant anthropomorphic test device during shaking and during various activities of daily life, as well as from a 7-month old boy at play in a commercial jumping toy. Results were compared among the experimental conditions and against accepted injury thresholds.

Rotational accelerations during shaking of a biofidelic mannequin were consistent with previous published studies and also statistically undifferentiated from the accelerations endured by a normal 7-month-old at play. The rotational accelerations during non-contact shaking appear to be tolerated by normal infants, even when repetitive.

Conclusions

This study demonstrates that angular acceleration of the head during aggressive shaking of the CRABI biofidelic mannequin (1068.3 rad/sec2) is statistically undifferentiated (p≤0.05) from angular head kinematics experienced by a 7-month-old infant fervently playing in his Jumparoo™ (954.4 rad/sec2). Other pediatric ADLs, such as being burped or bounced on a knee, are clearly negligible. Furthermore, measured angular accelerations fall 84% below the scientifically accepted biomechanical threshold for bridging-vein rupture of 10,000 rad/s2.

Although shaking an infant or toddler in anger is clearly ill advised and potentially unsafe, our data indicate that neither aggressive nor resuscitative shaking is likely to be a primary cause of diffuse axonal injury; primary retinal hemorrhage, schisis or folds; or subdural hematoma in a previously healthy infant.

Future research will investigate a systematic protocol for evaluating biomechanical indices associated with falls from different heights and orientations onto various surfaces.

The article is available open-source from the Journal of Forensic Biomechanics: http://www.ashdin.com/journals/JFB/F110601.pdf

BIO MECHANICS OF INFANT SHAKING.

SKULL FRACTURE CHILD ABUSE OR ACCIDENT

SKULL FRACTURE CHILD ABUSE OR ACCIDENT

http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2805%2974515-3/fulltext

Genetic and Congenital Defect Conditions that Mimic Child Abuse

http://www.ednf.org/medical-professionals/genetic-and-congenital-de…

 

 

Epidemic of Infantile Rickets May Have Put Thousands of Innocent Parents in Jail for Child Abuse