Shaken Baby Syndrome: Doctors' Forensic Response to the Boston Au Pair Case



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<http://child.cornell.edu/sbsletter.html>


Posted: February 28, 1998.


THIS LETTER was provided to us by the group of physicians who developed it. The letter was widely published by the media, appearing in most major and national daily newspapers, and picked up by many major television morning and news shows. The process that lead to the letter involved one of the best examples of the power of the internet to guide and to inform issues of significant concern. Here is the story:

The Child Abuse Prevention Network co-hosts an Internet Mailing List ("listserv") for physicians in the field of child abuse and neglect. Since early 1997, this list has explored a number of clinical topics, providing physicians and other professionals with ready access to hard-to-find expertise.

In the fall of 1997, national attention was riveted on the murder trial of an English Au Pair, Louise Woodward, in the case of an infant who apparently died of what is popularly known as Shaken Baby Syndrome (SBS.) The attention was especially great, because the trial was televised, and the daily progress was reported often on the national network and cable news outlets.

Physicians on our Mailing List followed the case closely. As matters unfolded, the list discussion turned to the question of how physicians could best assure that scientific expertise could be brought to bear in an effective and responsible way in future cases. The letter below was the result of those discussions.

Larry Ricci
11/16/97

THIS LETTER IS FOR IMMEDIATE RELEASE. FOR
FURTHER INFORMATION, CONTACT DR. ROBERT REECE (617-587-1500 or
e-mail:breece%mspcc@notes.worldcom.com), DR.
LAWRENCE RICCI (207-879-6160 or e-mail:riccil@aol.com) OR DR. ROBERT
KIRSCHNER (312-891-5983 or e-mail:kir5@midway.uchicago.edu)

Shaken Baby Syndrome - A Forensic Pediatric Response

To the Editor:

As physicians who specialize in the diagnosis and treatment of victims
of child abuse, we feel compelled to speak out regarding the scientific
evidence as portrayed in the trial of Louise Woodward for the murder of eight
month old Matthew Eappen. Both in the United States and in England, media
publicity surrounding the case has led to considerable sentiment that she
was convicted despite allegedly irrefutable scientific evidence presented
by the defense that the infant's injuries had occurred days to weeks
earlier. Many in the media and the public have failed to credit the jury
in this case with having had the intelligence to understand that the
prosecution put forward well established medical evidence that
overwhelmingly supported  a violent shaking/impact episode on the day in 
question, when Matthew was in the sole custody of Ms. Woodward. The 
hypothesis put forward by the defense that minor trauma caused a 
"re-bleed" of an earlier head injury can best be characterized as 
inaccurate, contrary to vast clinical experience and unsupported by 
any published literature. The "re-bleed" theory in infants is a 
courtroom "diagnosis", not a medical diagnosis, and the 
jury properly rejected it. 

Infants simply do not suffer massive head injury, show no significant
symptoms
for days, then suddenly collapse and die. Whatever injuries Matthew
Eappen may or may not have suffered at some earlier date, when he
presented to the hospital in extremis he was suffering from proximately
inflicted head injuries that were incompatible with any period of normal
behavior subsequent to the injury. Such an injury would and did produce
rapidly progressive, if not immediate, loss of consciousness.

The shaken baby syndrome (with or without evidence of impact) is now a
well characterized clinical and pathological entity with diagnostic
features in severe cases virtually unique to this type of injury -
swelling of the brain (cerebral edema) secondary to severe brain injury,
bleeding within the head (subdural hemorrhage), and bleeding in the
interior linings of the eyes (retinal hemorrhages). Let those who would
challenge
the specificity of these diagnostic features first do so in the
peer-reviewed literature, before speculating on other causes in court.
Indeed, the courtroom is not the forum for scientific speculation, but
rather the place where only, according the the U.S. Supreme Court in
Daubert vs. Merrill Dow, peer reviewed, generally accepted, and
appropriately tested scientific evidence should be presented.

We endorse a panel of medical experts to offer a 
scientifically based analysis of the medical testimony 
offered in this case and others so that some guidelines can be 
established for the courts on future admissibility of scientifically 
supportable medical testimony.


Randall Alexander, MD
University of Iowa

Mia Amaya, MD, MPH 
University of Alabama
Birmingham, Alabama

Jan Bays, M.D.
Emmanuel Children's Hospital
Portland, OR

Kirsten Bechtel, M.D.
St. Christopher's Hospital
Philadelphia, PA		

Rebecca Beltran-Coker, M.D.
East Carolina University School of Medicine
Greenville, NC

Carol D. Berkowitz, M.D.
Harbor/UCLA Medical Center
Torrance, California

Steven D. Blatt, M.D.
SUNY Health Science Center at Syracuse
Syracuse, NY

Ann S. Botash, M.D.
SUNY Health Science Center at Syracuse
Syracuse, NY

Jocelyn Brown, M.D., M.P.H
College of Physicicans & Surgeons of Columbia University
New York

Mary Carrasco, MD
Children's Hospital of Pittsburgh
Pittsburgh, PA

David L. Chadwick, M.D.
Children's Hospital and Health Center
San Diego, CA

Cindy Christian, MD	
Children's Hospital of Philadelphia
Philadelphia, PA

Patrick Clyne, M.D.
Santa Clara Valley Medical Center
San Jose, CA

Daniel L. Coury, MD				
Children's Hospital
Columbus, OH

James Crawford, MD
Children's Hospital Oakland
Oakland, CA

Nicholas Cunningham, MD, DrPH
Columbia University
New York, NY

Michael D. DeBellis, M.D
University of Pittsburgh Medical Center
Pittsburgh, PA

Chris Derauf, M.D.
Kapi'olani Child Protection Center
Honolulu, HA

John de Triquet, MD
Children's Hospital
Norfolk, VA

Benard P. Dreyer, M.D.
NYU School of Medicine
New York, NY

Howard Dubowitz, M.D.
University of Maryland
Baltimore, MD

Kenneth W. Feldman, M.D.
University of Washington
Seattle, WA

Martin A. Finkel, D.O.
Univ. Medicine & Dentistry of New Jersey
Camden, NJ

Emalee G. Flaherty, M.D.
Children's Memorial Hospital
Chicago, IL

Lori Frasier, M.D.
University of Missouri Hospitals & Clinics
Columbia, MO

Lorraine Gari, MD
Wolfson Children's Hospital
Jacksonville, FL

Jill Glick, M.D.
University of Chicago Children's Hospital
Chicago, IL

Penny Grant, MD
Broward County Child Protection team
Fort Lauderdale Florida

Gilles Fortin MD
Chief of Clinique de Pediatrie Socio-Juridique
Hopital Sainte-Justine
Montreal, Qubec, Canada

Scott Halpert, M.D.
Lane County Child Advocacy Center
Eugene, OR

Ralph A. Hicks, M.D.
The Children's Medical Center
Dayton, Ohio

Dirk Huyer, MD
Hospital for Sick Children, University of Toronto
Toronto, Ontario

Carol Jenny, M.D.
Hasbro Children's Hospital
Providence, RI

Mark Joffe, MD
Children's Hospital of Philadelphia
Philadelphia, PA

Steven W. Kairys, MD,MPH
Dartmouth Medical School	
Lebanon, NH

Karen M. Kaplan, MD
Penn State Geisenger Health System
Hershey, PA

Marilyn Kaufhold, M.D. 
Children's Hospital-San Diego
San Deige, CA

Kathi J. Kemper, MD,MPH
Swedish Family Medicine
Seattle, WA

Robert H. Kirschner, M.D.
University of Chicago
Chicago, IL

Elliot J. Krane, M.D.
Stanford University
Stanford, CA

Henry Krous, MD
Children's Hospital-San Diego
San Diego, CA

Michelle Lorand, M.D.
Cook County Hospital
Chicago, IL

John McCann, M.D.
University of California, Davis Medical Center
Sacramento, CA

Marcellina Mian, M.D.
Hospital for Sick Children, University of Toronto
Toronto, Ontario

Kieran Moran, MD
Sydney Children's Hospital
Sydney, Australia

Lucy M. Osborn, MD,MSPH
University of Utah Health Sciences Center
Salt Lake City, UT

Vincent Palusci, MD
DeVos Children's Hospital
Grand Rapids, MI

Robert M. Reece, M.D.
Institute for Professional Education, MSPCC			
Boston, MA

Lawrence R. Ricci, M.D.
The Spurwink Child Abuse Program
Portland, ME

Mary Ann Radkowski, M.D.
Children's Memorial Hospital
Chicago, IL

Mary E. Rimsza, M.D.
Maricopa Medical Center
Phoenix, AZ

Des Runyan, MD,DrPH
University of North Carolina
Chapel Hill, NC

Michael Ryan, M.D.
The New Children's Hospital
Sydney, Australia

Matthew D. Sadof, M.D.
General Pediatrician
Temple University Health System
Philadelphia, PA

Charles Schubert, MD
Children's Hospital Medical Center
Cincinnati Ohio

Robert Sege, MD,PhD
The Floating Hospital
Boston, MA

Robert A. Shapiro, M.D.
Children's Hospital Medical Center		
Cincinnati, OH

Benjamin Siegel, MD
Boston Medical Center
Boston, MA

Andrew Sirotnak, MD
Denver, Colorado

Wilbur Smith, MD
University of Iowa

Rebecca Socolar, M.D.
University of North Carolina
Chapel Hill, NC

Demetra Soter, M.D.
Cook County Hospital
Chicago, IL

Suzanne P. Starling, MD
Vanderbilt University Medical Center
Nashville, TN

Carol Stashwick, MD,PhD
Children's Hospital at Dartmouth  
Lebanon, NH

R. Daryl Steiner, D.O.
Children's Hospital Medical Center of Akron
Akron, Ohio

John Stirling, MD
Clark County Child Abuse Intervention Center
Vancouver, WA

Naomi Sugar, MD 
University of Washington

Thomas Truman, M.D.
Tallahassee Memorial Regional Medical Center
Tallahassee, FL

David Turkewitz, M.D.
York Hospital
York, PA			 

Claudia Wang, M.D.
UCLA Children's Hospital
Los Angeles, CA

J.M. Whitworth, M.D.
Children's Crisis Center
Jacksonville, FL

Joseph A. Zenel, Jr., MD
Doernbecher Children's Hospital
Portland, Oregon