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Forensic Pathology page 2 of 2
Forensic Pathology
SIDS
Dr. Roy Meadow
On June 11, 2007, BBC News reported the findings of a cot death study by Dr. Christopher Bacon and Dr. Edmund Hey that had been published in the Archives of Disease in Childhood. After reviewing a 2005 study in the Lancet involving 6,373 SIDS cases dating back to 1970 in which researchers had reported relative risks of a second cot death recurring in the range of 1.7 to 10.1 times that of the general population, Drs. Bacon and Hey found that a second cot death in the family is much rarer than that. Flaws in research had resulted in the above statistical estimate. It was the notion that a second cot death was not nearly as unusual as Dr. Roy Meadow said it was that led to the overturning of murder convictions in the Sally Clark and other SIDS cases. Now Dr. Bacon was saying that perhaps Dr. Meadow was not completely off base in arguing that a second cot death was rare enough to raise suspicions of foul play. Dr. Bacon did say that Dr. Meadow’s placing the chance of losing two children to cot death at 1 in 73 million was “extreme.” “But,” he said, “there are extremes at the other end, too. Quite simply, there is no evidence to back up the 1 in 200 assertion.”
SIDS
Dr. David Southall
In October 2007, Dr. David Southall, a once prominent SIDS researcher and pediatrician in Great Britain, was the object of a government inquiry (he was also being investigated by England’s General Medical Council) into medical experiments he had conducted in the 1980s and 1990s involving infants who had been hospitalized for nighttime breathing disorders. Parents of many of these children were accusing Dr. Southall of getting control of their children for his so-called “sleep studies” by falsely accusing them of child abuse. They allege the Dr. Southall had forced their babies to breathe noxious gases such as carbon monoxide. They also claimed, as part of the doctor’s experiments, that he deprived his tiny patients of oxygen. Government investigators were asking to see Dr. Southall’s medical files to determine if the infants had been suffering from illness rather than child abuse as he claimed. The General Medical Council had scheduled a hearing to determine if Dr. Southall was fit to practice medicine.
Dr. Southall’s professional problems began following the infamous Sally Clark trial in November 1999. Sally Clark was convicted of murdering two of her boys on the strength of Dr. Roy Meadow’s testimony that the statistical likelihood of two SIDS babies in one family was one in seventy-three million. That figure was later discredited by statisticians. This led to the overturning of Sally Clark’s conviction.
In April 2000, following a television documentary about the Clark case, Dr. Southall, a consultant pediatrician at North Staffordshire Hospital in Stoke-on-Trent, reported to the police that based on what he had learned from the TV program, he believed it was Sally Clark’s husband Stephen who had committed the murders. In Dr. Southall’s opinion the wrong person had been convicted. Dr. Southall had become well-known for his statement that one-third of all SIDS cases were criminal homicides. Dr. Southall’s public accusation against Stephen Clark shocked his colleagues. Mr. Clark filed a complaint with the General Medical Council accusing the doctor of professional misconduct. In the fall of 2004, the Council found Dr. Southall guilty of professional misconduct and barred him from child protection work for three years. In August 2007 the Council extended the prohibition another year. Sally Clark, in poor health and suffering from depression, died in March of 2007. She was forty-two.
Dr. David Southall:
Denied Emeritus Status
Along with Dr. Southall’s pediatric position at the University Hospital of North Staffordshire, came the honorary status of professor at Keele University. Upon Dr. Southall’s retirement from the hospital in November 2004, professor Peter Crone, head of postgraduate medicine, recommended emeritus status for the retired honorary professor. This created a feud between a group of child protection advocates who believe that Dr. Southall had wrongfully accused parents of murdering their children (and having performed harmful research on children without parental consent), and doctors who consider Dr. Southall one of the pioneers in cot death research and the Munchausen Syndrome by Proxy disorder.
In November 2007, the university, fearing the public relations impact of continuing a relationship with Dr. Southall through the emeritus status, denied him that honor. University officials insisted that the decision was not a judgment on the quality of Dr. Southall’s medical work. The University was merely avoiding the adverse publicity the emeritus status would bring. (Based on reportage in the Guardian Unlimited, November 8, 2007.)
In December 2007, the fitness to practice panel of the General Medical Council, sitting in London, were deciding if the fifty-nine-year old pediatrician should be removed from the medical register for serious professional misconduct. In January 1998, based upon Dr. Southall’s recommendation, social workers took a boy away from his mother on the grounds that the woman, in June 1996, had murdered the son’s older brother. In April 1998 Dr. Southall accused the mother of drugging and hanging the ten-year-old to death. The allegation turned out to be false. Panel chairperson Dr. Jacqueline Milton, in addressing Dr. Southall said, “Although Mrs. M [the designation for the woman in question] was not your patient, your action in accusing her of drugging and murdering [her child] by hanging him was inappropriate, added to her distress and was in the circumstances an abuse of your professional position.”
Several pediatricians spoke before the panel on Dr. Southall’s behalf. Dr. Simon Parke, who worked with Dr. Southall at North Staffordshire Hospital, said he had complete confidence in his clinical care.
On December 4, 2007, the panel voted to strike Dr. Southall off the medical register on grounds of serious professional misconduct in connection with his false accusations of murder in 1998. Chairperson Dr. Jacqueline Milton, speaking to Dr. Southall, said, “The panel has concluded that you have deep-seated attitudinal problems and that your misconduct is so serious that it is fundamentally incompatible with your continuing to be a registered medical practitioner. The panel is particularly concerned by your lack of insight into the multiplicity of your failings over a long period.” The panel pointed out that Dr. Southall has never apologized to the Clark family or to the mother he falsely accused of murdering her son.
Dr. Patricia Hamilton, the president of the Royal College of Pediatrics and Child Health (RCPCH) defended Southall’s reputation, stating that the institution was concerned that “pediatricians and social workers will be deterred from undertaking child protection work. The RCPCH is saddened and disappointed to learn of this judgment. David Southall has made a major contribution to child health both nationally and internationally and has been a strong advocate for children during a distinguished career. Sadly there are circumstances where parents may have harmed their children and in these situations health professionals have a statutory duty to act on their concerns and look after the best interests of the child.” (Based on reportage in the Guardian Unlimited, BBC News, and The London Times.)
SIDS
New Research
Pediatric Anesthesiologist Daniel Rubens, in a paper published in the July 2007 journal, Early Human Development (and reported in USA Today, September 30, 2007), theorizes SIDS is causes by an injury to the inner ear and the brain created by a high-pressure surge of blood from the placenta during delivery. Dr. Rubens, with the Children’s Hospital and Regional Medical Center in Seattle, believes that delicate vestibular hairs in the right inner ear are damaged during birth. He hypothesizes that these hairs, known for their role in maintaining balance, are actually responsible for transmitting information that regulate breathing.
Pediatric cardiologist Warren Guntheroth of the University of Washington in Seattle dismisses Dr. Ruben’s theory as “not biologically plausible.” Dr. J. Bruce Beckwith, the cot death researcher who created the acronym SIDS in 1969, doubts infants who suffer from this form of birth injury would live more than a month. SIDS babies generally live beyond that.
SIDS
Statistics Showing SIDS Decline False
In the early 1990s, a campaign to reduce the number of SIDS cases called “Back to Sleep” urged parents to have their newborns sleep on their backs. In 2004 SIDS prevention advocates were reporting that the “Back to Sleep” program had reduced the rate of SIDS by half.
In October 2007, as reported in The Cincinnati Post, Scripps Howard journalists Thomas Hargrove and Lee Bowan found that the SIDS decline has been seriously overstated as a result of sloppy record keeping, manipulation of statistics, and lack of uniformity in reporting. Perhaps the biggest reason for the misleading rate of decline involves the fact that in many jurisdictions the SIDS designation on death certificates has been replaced by vaguer cause of death descriptions such as “threats to breathing” or just “undetermined.” According to the reporters, SIDS deaths since the early 1990s have decreased only slightly. (An example of what the Scripps Howard journalists would consider false reporting: In an article published on October 12, 2007 in the Daytona Beach News-Journal, Deborah Circelli wrote: “Nationally and statewide, the number of babies dying from SIDS has dropped by more than 50 percent since the early 1990s, to more that 2,500 a year nationwide.)
SIDS Investigations:
A Mixed Bag
In 2007, the Scripps Howard News Service studied, nationwide, 40,000 infant death cases to determine how much criminal investigation went into SIDS fatalities. The study revealed that in states where SIDS cases were aggressively looked into, twice as many SIDS fatalities lead to homicide investigations. According to the study, geography largely determines what chance a parent or babysitter has in getting caught suffocating or shaking a baby to death. There are no national guidelines requiring governmental review of sudden infant death cases. Some jurisdictions have them but most don’t. In places that do, more SIDS cases lead to homicide convictions.
Arizona, with a network of child death review teams overseen by a statewide Child Fatality Review program, leads the nation in the determination of infant homicide. In Arizona, from 2000-2004, one out of six SIDS cases was ruled a criminal homicide. Idaho, with no formal review process for the sudden death of children, has a SIDS to criminal homicide ratio of one in fourteen. If the entire country had a program like the one in Arizona, there would be 700 infanticide cases a year instead of the 200 investigated annually by the police.
One can only hope that in Arizona there are enough qualified forensic pathologists to ensure that parents and babysitters are not being falsely prosecuted. While criminal homicide in a SIDS case can be difficult to prove, these cases can also lend themselves to false accusations. Without a solid foundation of forensic science, SIDS review board inquiries can easily turn to governmental witch-hunts. It’s all about reliable cause and manner of death determinations. (To see the effects of an over-aggressive child protection operation, see “Cutting out the Forensic Pathologist: The San Diego Experiment” that follows the “Forensic Pathology” section.)
Shaken Baby Syndrome (SBS)
The Debate Goes On
A growing number of scientists are coming to the conclusion that shaking alone does not produce the physical symptoms commonly associated with SBS. More and more researchers believe that without other physical signs of abuse, brain hemorrhaging and swelling and retinal bleeding reflect symptoms of other causes of death which can be natural or accidental.
But according to the National Institute of Neurological Disorders and Stroke, SBS bears a “classic triad” of symptoms that include brain hemorrhaging, retinal bleeding, and brain swelling. In 2006 there were an estimated 1,500 cases of SBS reported to the authorities. But Dr. John Plunkett, a Minnesota pathologist who became interested in SBS after the Louise Woodward British nanny conviction in 1997, has said, “You can’t cause the injuries said to be caused by shaking.” Dr. Plunkett believes that symptoms of SBS can be caused from ordinary accidents such as falls out of bed.
A 2005 study conducted at the University of Pennsylvania used dummies simulating eighteen-month-old babies to determine how falls from various heights to various surfaces such as concrete and carpet, injured an infant. They found that a fall from three feet produced forces nearly forty times greater than a violent shaking. Other studies have shown that symptoms of SBS can be caused by a variety of diseases and birth defects.
A study by Dr. Suzanne Starling, Director of forensic pediatrics at Children’s Hospital in Norfolk, Virginia showed that children who have been shaken have a 2.39 times greater chance of retinal bleeding than those who have been struck in the head. Dr. Starling’s study, involving eighty-one cases in which an adult confessed to either hitting or striking a baby, supports the traditional SBS triad of symptoms. (The above material is from an Associated Press article that appeared April 29, 2007 in the Youngstown Vindicator.)
The New York City Medical Examiner’s Office:
Independent and Prestigious
The nation’s largest and first (1918) medical examiner’s office, under Chief Medical Examiner Dr. Charles S. Hirsch, was not always efficient and beyond the reach of political influence. By 1989, the year Dr. Hirsch took charge, the office was in bad shape. The facility was a mess physically, it took months to get an autopsy completed, and autopsy results, particularly when it came to the death of men in police custody, had no credibility. In the 1980s, mayor Ed Koch, looking for a politically independent forensic pathologist, appointed Dr. Michael Baden as Chief Medical Examiner. A year later Koch fired Dr. Baden because, according to Manhattan District Attorney Robert Morgenthau, Baden was too independent to the point of being uncooperative with law enforcement authorities. Koch replaced Dr. Baden with Dr. Elliot M. Gross, a high-profile practitioner who was dismissed by the mayor after accusations (of which he was later cleared) that he made rulings in favor of the police in cases involving men who died while in police custody. Shortly after replacing Dr. Gross in 1989, Dr. Hirsch had to render a politically controversial opinion in the case of a 25-year-old man arrested by officers of the New York Police Department. According to many, the police had choked Richard Earl Luke to death while taking him into custody. Dr. Hirsch reported that the autopsy and accompanying toxicological tests showed that Mr. Luke had died of “acute cocaine intoxication.” That finding led to protests and street demonstrations but Dr. Hirsch stuck to his guns.
Dr. Hirsch, unlike most of his predecessors, avoided the limelight. Shortly after taking office he eliminated the backlog problem by hiring competent forensic pathologists and using private laboratories to handle the more complicated tests. During the next sixteen years Dr. Hirsch turned New York City’s medical examiner’s office into a model of competence and political independence. His professionalism and credibility allowed him to render highly unpopular opinions without risk of being removed from office by the mayor. For example, on October 20, 2007 Dr. Hirsch ruled that a 911 ground zero police officer’s death was not related to the inhalation of toxic dust. A New Jersey forensic pathologist, Dr. Gerard Breton, had previously ruled that the officer had in fact died from breathing the World Trade Center debris. The officer’s family had asked Dr. Hirsch to review the New Jersey autopsy report in hopes that he would add his prestige to the finding. He did not. Dr. Hirsch had made a similar ruling in four other ground zero cases.
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