Medill Innocence Project questions an 18-year-old shaken-baby syndrome investigation.

At the center of this case is convicted murderer Pamela Jacobazzi, a petite 57-year-old former babysitter who taught Catechism class at her local Catholic church before she was accused of shaking Matthew Czapski, leading to his death more than a year later, in 1995.

Back then, shaken-baby syndrome was a largely uncontested diagnosis associated with a triad of symptoms: brain bleeding, brain swelling and bleeding within the eyes. When all three signs are detected in an infant, authorities often accuse the last caregiver of abusing that child, believing the symptoms surface instantly and catastrophically.

But a slew of medical studies have emerged in recent years, challenging the very foundation of shaken-baby syndrome. These studies show that the triad of symptoms associated with this form of child abuse can be attributed to other, less sinister causes, including when a child falls. As medical experts increasingly mount a challenge to the traditional understanding of shaken-baby syndrome, the inevitable question arises: Are mothers, fathers, nannies, babysitters, day care workers and others in prisons for crimes they did not commit based on outdated medical science?

Advances in the medical science behind shaken-baby syndrome in recent years have led some appeals courts to overturn convictions. For instance, a Wisconsin former day care worker, Audrey Edmunds, spent more than a decade in prison when she was released in 2008. In her case, an expert from the original trial came forward and reversed himself, saying the infant could have experienced a lucid interval, or period when she seemed well, before falling ill again. Earlier this year, an Arizona man, Drayton Witt, was set free after serving time for allegedly shaking his infant son in 2000.

For this article, the Medill Innocence Project consulted with numerous medical experts and studies conducted over the past several years, interviewed Jacobazzi family members, neighbors and former clients, submitted five Freedom of Information Act requests and obtained thousands of pages of court records, police reports as well as hospital, pediatric, medical examiner, children and family services and property documents. The Medill Innocence Project found that:

Eye injuries that used to be considered proof of child abuse at the time of Jacobazzi’s trial are known today to result from accidental trauma and certain medical conditions. The ophthalmologist who diagnosed Matthew in 1994 with “shaken injury” is one of several experts interviewed who now acknowledge that such symptoms may arise from non-abusive causes.

Research into the onset of symptoms after brain trauma has raised doubts about how accurately doctors can pinpoint when trauma was inflicted. Recent studies have shown infants can experience a lucid interval–a temporary period of well-being–after suffering a fatal head injury. Experts say Matthew may have developed slow bleeding in his brain that did not become apparent until hours or days later when he lost consciousness and was rushed to the hospital. As a result, experts interviewed for this article say they cannot pinpoint Matthew’s trauma to the time he was under Jacobazzi’s care.

Biomechanical studies have called into question whether it is physically possible for a person to shake an infant to death. Experts say it was not possible for Jacobazzi, at 115 pounds, to physically shake Matthew, who was 21 pounds, to death, especially given that his neck and spine were undamaged.

Some experts question how Jacobazzi could have been convicted, given what they view as the uncertainty of Matthew’s condition. Experts say the child’s pediatric records, which were only mentioned in passing at Jacobazzi’s trial, indicated he appeared to have suffered from internal bleeding, while CT scans and a slide of brain tissue may have revealed a slow bleed from an old head injury that remained undetected until he was rushed to the hospital on the day he was under Jacobazzi’s care.

The majority of experts interviewed agree that Matthew’s death was the result of some kind of trauma but they disagree about what caused that trauma, when the trauma occurred and to what degree preexisting medical conditions contributed to his death.

“This lady is probably sitting in jail for no reason,” said Darinka Mileusnic-Polchan, an associate professor of pathology at the University of Tennessee Medical Center and the medical examiner for Knox and Anderson counties in Tennessee who reviewed Matthew’s medical records at the request of the Medill Innocence Project. “Why anyone focused on the babysitter, I don’t understand.”
Matthew’s family declined to comment for this article, as did Joseph Ruggiero, chief of the criminal division of the DuPage County State’s Attorney’s Office. Authorities at the Bartlett Police Department did not respond to multiple interview requests.

Over the 13 years since the trial, increasing numbers of researchers have documented cases of children exhibiting the same patterns of eye damage not from abuse but as a result of accidents. What used to be attributed only to abuse is now recognized to occur from other severe forms of trauma, including car crashes, crush-head injuries and high-altitude falls. These retinal injuries also have been documented in cases of leukemia, meningitis and in rare instances of spontaneous blood vessel abnormalities.

After bringing her attention to some of these research papers, Leonard acknowledged in an interview with the Medill Innocence Project that the science behind her diagnosis in 1994 was not as ironclad as she had believed. “That’s very compelling stuff,” she said of the research papers. “It certainly opens up the differential diagnosis beyond shaken injury.”

Among those research papers was a 2004 study led by Patrick Lantz, a forensic pathologist at Wake Forest Baptist Medical Center, which documented the case of a 14-month-old boy who exhibited retinal hemorrhaging and folds after a television fell on his head. The damages were considered so indicative of abuse that child protective services removed a sibling from the home, though the trauma proved accidental.

When Lantz reviewed Matthew’s medical records for this article, he said, “There’s no way you can look at these [folds] and automatically say it was abuse.” He added, “Any of the eye findings could have come about from a number of different factors. You need to consider the case as a whole.” Lantz said he is working as a consultant to Jacobazzi’s defense.

In 2006, Saint Louis University pathologist Jane Turner co-wrote a paper in the Archives of Ophthalmology in which the retinal hallmarks of shaken-baby syndrome—retinal hemorrhaging, schisis and folds—were found in a 4-month-old boy accidentally crushed by his 12-year-old sibling. Turner told the Medill Innocence Project that retinal symptoms alone cannot conclusively determine that a child was a victim of abuse.

“It takes the whole picture, and retinal folds are only one brush stroke in the painting,” Turner said.
In 2007, Ebube Obi and Patrick Watts in the United Kingdom wrote an article for the Journal of AAPOS, the American Association for Pediatric Ophthalmologists and Strabismus, comparing two cases, one an abusive injury and the other accidental. They found similar retinal damage in both children: retinal hemorrhages, schisis and folds.

Other studies conducted over the past 10 years have shown diagnosing shaken-baby syndrome based on specific eye patterns is not as precise as once believed. A 2007 study in Ophthalmology, a publication of the American Academy of Ophthalmology, looked at 118 autopsy cases of known or suspected child abuse, revealing that fewer than a quarter showed retinal folds and schisis.
In the United States, the largest ophthalmologist association, the American Academy of Ophthalmology, relies on the classic combination of symptoms—the retinal hemorrhages, schisis and folds—to indicate whether a child is a victim of shaken-baby syndrome.

Alex Levin, a pediatric ophthalmologist who co-authored the association’s statement on abusive head trauma/shaken-baby syndrome, said in an email for this article, “There is no individual sign that is pathognomonic for [shaken-baby syndrome]. But that’s not how the system works. Every child should have a detailed evaluation including a reasonable and relevant assessment for medical conditions.”

Andrea Vincent, a lecturer in ophthalmology at New Zealand’s University of Auckland who has testified in numerous child abuse cases, agrees no single symptom points automatically to child abuse.

“You’d be a heretic for saying that 10 years ago, but it’s been documented,” Vincent said.

Read more:
http://mip.medill.northwestern.edu/blog/2012/12/11/medill-innocence-project-probes-18-year-old-child-abuse-case-examining-medical-advances-that-challenge-chicago-area-day-care-owners-murder-conviction-2/

(Videos) Shaken Baby Syndrome?

It's a scenario as horrifying as it is heartbreaking: a frustrated parent ... a baby that just won't stop crying ... and suddenly, what were tender, cradling arms become instruments of death. At least this is how Shaken Baby Syndrome has been characterized in countless court cases in recent years. But what are the scientific foundations of this diagnosis?

Gillian Findlay examines the conventional wisdom around Shaken Baby Syndrome, discovering that those who question it often feel targeted by those who believe passionately in it.  And yet new science suggests the so-called syndrome may be a physical impossibility.

"Diagnosis Murder" tells the story of several Canadian parents who say they were wrongfully accused--and the leading-edge medical researchers who believe they're telling the truth. The stakes are high: Some have gone to jail. All have had their other children taken away from them.

One couple recently had their children returned after a four-year battle. Even though the courts in B.C. cleared Zabeth and Paul Baynes of charges they had shaken their baby, the couple feel they will carry the stigma for life. Another man in Ontario has now had his case put up for judicial review, giving him hope that his name may too be cleared.

Is Shaken Baby Syndrome conclusive evidence of murder? Or is it a scientific hypothesis that has convicted an untold number of parents as killers -- when their children actually died from other causes?
http://www.cbc.ca/fifth/2011-2012/diagnosismurder/news.html