Medical examiner Dr. Jon Thogmartin stresses the need for better investigations of child deaths.

Medical examiner Dr. Jon Thogmartin, another expert we interviewed in The Child Cases, says that when a child dies, people presume it's murder. A prosecutorial mindset sets in. Do you agree?

No, that's not true. When a child collapses unexpectedly, child protective services and law enforcement do get involved. Somebody has to do a scene investigation, and it's not going to be the doctors. I'm not going to go to the house to look for toxins or poisons. No one presumes that child injury is abuse. Abuse is a diagnosis we make after we rule out a long, extensive list of physical and accidental ideologies that would explain the degree and severity of the injuries we see.

Is there a problem with the standards for those who testify as experts?

People are for sale. Obviously not all. Some who testify are extremely ethical and professionally responsible.

There's no quality control. Some of the experts who give the most outrageous testimony are in very high demand. They are making very large amounts of money.

It's an area where there seems to be no downside to irresponsible expert witness testimony. Most of the folks who do it are retired, doing it as a hobby. State medical societies won't take it on for fear of liability or litigation. State medical boards in most states don't consider expert testimony to be "the practice of medicine," so they don't take it on. And most prosecutors are very hesitant to charge anyone with perjury because this is, in fact, their opinion. If you have an opinion, it may be false. But it's not necessarily a lie.

Is there a solution to this?

I think the medical societies should take a more proactive stance. In the OBGYN societies, they've taken on the issue of malpractice testimony—people going around the country, providing false testimony, causing ethical, competent doctors to be sued.

I know the American Academy of Pediatrics won't touch this. It has lots of missions to promote child health. If they had to tie up millions in child lawsuits, it would decrease their resources for other core missions.

The American Academy of Emergency Medicine has taken an interesting stance on this. If their members feel that other members have testified irresponsibly, they will put the transcripts online so that others can read it and comment. It's kind of like a public shaming.


http://www.propublica.org/article/q-a-a-prominent-advocate-presses-for-better-investigations-of-child-deaths