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Posted: February 28, 1998.
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:email@example.com), DR. LAWRENCE RICCI (207-879-6160 or e-mail:firstname.lastname@example.org) OR DR. ROBERT KIRSCHNER (312-891-5983 or e-mail:email@example.com) 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