Sign the Imschweiler Petition!
In 2018, tragedy came to the Imschweiler family.
Tom and Laura’s four-month-old baby Franklin contracted a severe case of hand food and mouth disease, which caused him to exhibit a 104° fever. The baby was also experiencing issues keeping food down. A doctor however, reassured the Imschweiler family that the virus would run its course.
On the night of July 17 2018, however, the situation deteriorated into the worst possible outcome. Baby Franklin woke up several times requiring care, and Tom got up again to comfort and feed the baby. While Tom was preparing a bottle for Franklin, his baby slumped over on the couch he had been propped up on, and was found by Tom face down in a pillow, not breathing and unresponsive.
Tom performed CPR and called for help, but it was too late. Investigators then discovered the classic “shaken baby syndrome triad” of subdural bleeding, retinal bleeding, and brain swelling. Tom was arrested and charged with murder. Despite the evidence debunking the shaken baby syndrome diagnosis, investigators assumed the triad proved a crime had taken place. They postulated that Tom must have lost his temper with the fussy baby repeatedly waking up, and violently abused his child in response.
Meanwhile, the multiple alternative explanations for the triad were left uninvestigated. According to retired pathologist Dr. Douglas Smith, other possible explanations include the viral illness baby Franklin contracted. Such viral illness can cause “cerebral sinus venous thrombosis,” a clot that prevents blood from properly circulating in the brain and could lead to damage such as a subdural hemorrhage.
Dr. Smith also questions the age of the subdural bleeding. The bleed may have occurred many days before the incident with Tom on July 17th, which could open up other possibilities as to different accidents that could have caused the bleeds. Yet another of Franklin’s conditions, “macrocephaly” or enlarged head circumference and the resulting build up of fluid in the skull that results is a known risk factor for subdural hemorrhage.
Despite copious testimony from Tom’s friends, family, and employers supporting and praising his character, the case was not dropped. Today, Tom Imschweiler is serving 5 years in prison per the Alford plea deal he accepted to maintain his innocence. His wife Laura continues to champion his cause, and is requesting help signing this petition to commute Tom’s unjust sentence for a crime that never took place.
You can sign the petition here, or learn more at the Imschweiler’s website.
Michigan Innocence Clinic Wins New Trials For Tonia Miller
Some good news today: The Michigan Innocence Clinic successfully petition and won a new trial for Tonia Miller in the Michigan Court of Appeals. Miller has spent 18 years in prison after being falsely accused and convicted of second-degree murder in the death of her two month old daughter. She was accused of “shaken baby syndrome”. Our own board member Jeremy Praay has been active in advocating for Ms. Miller. The prosecution has already announced their intention to appeal this decision. Visit our Facebook page for future decisions on this important case.
New Podcast: Do No Harm
From Apple Podcasts:
"Melissa Bright thinks she's living every parent's worst nightmare when her five-month-old baby tumbles from a lawn chair and hits his head on the driveway. But after she rushes him to the hospital, a new nightmare begins.
The Brights are thrust into a medical and legal system so focused on protecting children from abuse, it has targeted innocent parents. With exclusive audio captured as the events unfolded, this harrowing six-episode series takes you inside the Brights' fight to hold their family together, against a system that can sometimes do more harm than good. Hosted by NBC News National Investigative Reporter Mike Hixenbaugh, Do No Harm is a co-production of NBC News and Wondery."
Click here to listen to the podcast now wherever you get your podcasts.
ER Pediatrician Accused of Abuse
This excellent article highlights the insanity and devastation of Lynn Sheets’ work, a doctor using unscientific research to create dangerous federal legislation that will fund exhaustive screening of any infant with a bruise. Interestingly, accidental injury of the infant in this case is being blamed on a pediatrician, Dr. John Cox. It is encouraging to see doctors’ own eyes opening to the aggression of CPS.
Highlights of the true abuse in this case: medical records edited to bolster prosecution of alleged abuse, birthmarks misreported as bruises, photographic evidence removed from a child’s medical record, a bruise caused by a medical procedure blamed as parental “abuse,” an abnormal blood test falsely reported as coming back negative, and more.
Read the full story here:
Shawn Brown's Conviction Overturned
By Torn Family Board Member Jeremy Praay
I first read about Shawn Brown's case shortly after his conviction in 2010. As I learned more about it, I was struck by how similar it was to so many other "shaken-baby" cases. It was, in essence, a "triad only" case. For all intents and purposes, there were no other outward or internal signs of abuse, just the internal findings of subdural and retinal hemorrhaging. These have often been described as the most dangerous cases to prosecute, since the possibility of other causes (other than abuse) are often overlooked. Recently, I have become uncomfortable with the phrase "triad only," and feel that it's essentially a "diagnosis only" case. If not for the shaken-baby diagnosis itself, the prosecution would have no case for abuse. None. The entire case rested on a diagnosis.
The day that Shawn Jr. lost consciousness, Shawn had been hurrying down the stairs with his son in a car seat. He lost his balance, and Shawn and his son fell down several steps. The baby was not crying, so Shawn didn't spend a lot of time thinking about it. Later that morning, others had spent time playing with the baby, and no one noticed anything out of the ordinary. That afternoon, Shawn was bottle-feeding him when his son began to choke, then became unresponsive. Shawn panicked and patted the baby on the back, but when that didn't help, he got a family friend to come over. She tried doing infant CPR, but soon realized it was not helping. They drove the baby to the hospital.
At the hospital, initially Shawn was told that the baby was choking, and they needed to get him breathing again. But when the first hospital was unable to properly care for the infant, he was transported to another hospital. Once there, the "shaken baby" allegations began. Shawn was told that his son had "old and new" bleeding on the brain.
At sentencing, Shawn made the following statement, which has continued to have an impact on me to this day:
I'd just like the courts and both of the families know that I am truly suffering just as much as loss and grief as them. This was my only son, my only biological son, a spitting image of myself. Every day that I wake up, I mean, it tears me apart to know that my son isn't here by me, you know what I'm saying, still here in the presence. I think that - that it's truly a hard situation to cope with yourself when, you know, I'm sitting here being charged for killing my son when I didn't. I mean, there's no other words to say that but I'm truly, truly hurt and just as in much in pain as anyone in this courtroom.
In late 2013, I mentioned Shawn's case to the Michigan Innocence Clinic, and they began an investigation, later deciding to pick up his case. The Claim of Appeal was filed in April of 2017. The case was remanded back to the trial courts for an evidentiary hearing, where appellants, in Michigan, are allowed to present new evidence. In July of 2018, the trial court finally rendered its decision, denying Shawn a new trial.
In July of this year, the Michigan appeals court finally overturned Shawn’s conviction, agreeing with the Michigan Innocence Clinic that Shawn had ineffective trial assistance in failing to get an expert witness to present the opposing viewpoint. While it is good to see an injustice righted, nothing can overturn the pain that Shawn expressed in court that day.
More on Shawn's overturned conviction can be found here:
https://nbc25news.com/news/local/manslaughter-conviction-overturned-in-shaken-baby-case
When is a bruise on an infant a “sentinel injury”?
Child Abuse Pediatrician Dr. Lynn Sheets of the University of Wisconsin is working with U.S. Senator Tammy Baldwin to enact a bill that would use taxpayer dollars to develop an “early detection” program for child abuse. Sheets proposes examining infants under the age of 7 months for child abuse if they have a bruise. Such an action would increase the already high rates of potential false abuse accusations.
This legislation is based on the belief that pre-mobile infants never get bruises, a belief that has not been proven by science. This legislation, supported by the American Academy of Pediatrics, would serve to get more and more children referred to child abuse pediatricians, thus increasing the importance of that sub-specialty.
Our justice system must protect the innocent, and maintain the principle of innocent until proven guilty. Allowing child abuse pediatricians – with their demonstrated bias towards over-diagnosis of abuse – to examine every child with a bruise is a threat to that principle of justice. Read the paper by Dr. Douglas Smith below to understand more of why this legislation is so dangerous.
Call or write Senator Baldwin, as well as your own U.S. senator to ask them to stop this legislation.
When is a bruise on an infant a “sentinel injury”?
Douglas M. Smith MD, PhD
There is a mantra among child abuse pediatricians, that “if they’re not cruisin’ they’re not bruisin’.” Because infants under 7-8 months of age cannot move on their own, pediatricians believe bruises on an infant are rare and raise a red flag for abuse.
Dr. Lynn Sheets, a child abuse pediatrician at the University of Wisconsin, now wants to spend 10 million federal dollars to try to prove that mantra.
Dr. Sheets claims[1] “One of the things we realized is if you just call it a bruise, everyone has bruises," Sheets said. "Everyone thinks about it as a minor injury including the doctors, including child welfare. So we needed to change the way people are thinking about these minor injuries in young infants." She continues by recommending, "Think about them differently. They’re warning injuries or important injuries. They’re sentinel injuries. That’s why I coined the term and it has caught on nationally and even internationally."
Dr. Sheets has now gone so far as to propose a bill, which has been entered by Tammy Baldwin, US Senate. The doctor states the legislation “...will be helpful by creating a demonstration program to show how detecting these sentinel injuries can reduce physical abuse.” The legislation requires Secretary of Health and Human Services to award grants for the program.
However the “no cruising no bruising” dogma has little basis in science, making such legislation not only a misuse of taxpayer dollars, but also dangerously unethical. I want to explore the scientific basis and the implications of Dr. Sheets proposal.
Dr. Sheets bases her opinion on a study that she published in 2014.[2] When creating a study however, it is important to correctly word the hypothesis or question you are setting out to prove. Dr. Sheets designed her study to ask, “do abused babies have more sentinel injuries than non-abused babies?” This is different however, than asking “how many babies with a sentinel injury are being abused?” This distinction in wording may seem trivial, but it actually reveals a critical flaw in Sheets’ conclusion. Finding a correlation between bruising and abuse only aids in creating a rate of correlation. The predictive value of that correlation rate will vary with the prevalence of abuse in the population. The prevalence of abuse would be much higher in babies referred to a child abuse team than in a pediatrician’s office practice, which is where Sheets wishes this dogma to be utilized.
To better understand, one can consider some hypothetical numbers. If a study finds that 30% of 100 abused infants have a bruise, but only 5% of 100 non-abused infants have a bruise, this may seem like dramatic evidence that bruising signals abuse.
A very different picture emerges however, when one applies these same percentages to a more realistic population ratio. In real life, a general pediatrician will probably see far less cases of abuse than a child abuse pediatrician. If a child abuse pediatrician finds abuse in 50 of 100 patients, 15 of those babies (30%) will have a bruise and 2.5 (5%) of the non-abused children will have a bruise. In comparison, if a general pediatrician finds abuse in 1 of 100 patients, only .3 abused babies will have a bruise. But at the same time, the general pediatrician will also find 5 non abused babies with a bruise. One can calculate the positive predictive value of a general pediatrician declaring a baby abused on the basis of a bruise by dividing the rate of true positives by the rate of false positives plus the true positives: 0.3/0.3+5 = 6%. In other words, if a general pediatrician assumes a bruise means abuse, he or she will only be correct 6% of the time. In comparison, a child abuse pediatrician assuming a bruise meant abuse would see a positive predictive value of 15/15+2.5 = 86%
This is why Dr. Sheets should have focused on how many bruised children are abused, instead of comparing bruise rates among abused and non abused children, especially if she wishes to justify examining all babies with bruises for child abuse.
Even if the correlations Dr. Sheets discovered were of value however, there are additional issues with the study. In her paper, Dr. Sheets stated that bruises were discovered on 0-2.2% of “non-cruising” infants in well child physical examinations. She cited three references to support that conclusion. One was not an actual study but an opinion piece. The second study included 246 infants less than 9 months old, and only 3 had bruises (1.2%).[3] The third study found 11 bruises in 511 infants (2.2%) that were not yet cruising.[4]
These studies reached these numbers by excluding suspected abuse. There are two problems with this however. First, child abuse pediatricians often claim any lesion that doesn’t blanch when pressed is a bruise. Lesions such as petechial rashes and eczema can be misdiagnosed as bruises, thus inflating the number of bruises. Secondly, there is no objective, scientific way to determine whether or not a child has been abused. Dr. Sheets categorized cases as “abuse” cases if the case was determined to be abuse by a Child Protection Team. But since Child Protection Teams already believe in the mantra that non-cruising infants don’t bruise, they are already biased towards the conclusion Dr. Sheets is trying to prove. Children who received a bruise in a simple accident could have been placed into the “abused” category in Dr. Sheets’ study.
Dr. Sheets’ study essentially says, “Bruises prove the child was abused. Therefore, children with bruises should be placed in the ‘abused’ category of the study, and since many children in the abused category have bruises, therefore bruises prove the child was abused.” This circular reasoning self destructs because one cannot prove an assumption with the assumption itself.
One could object that the assumption is simply common sense. How could a pre-mobile baby get a bruise unless through abuse? This however, overlooks innocent accidents and medical conditions that can cause susceptibility to easy bruising. To assume bruises indicate abuse is dangerous, because it biases doctors to assume accidents don’t happen, or to ignore natural medical conditions for bruising.
One might also object that it is “better to be safe than sorry,” and that it is worth examining bruised children more carefully for abuse, even if is expensive. However, there are medical risks to examining for child abuse. A child abuse work-up includes taking x-rays of every bone in the body and in many hospitals, a CT scan of the head. The medical risk of skeletal x-rays is small, but the medical risk of CT scans is not insignificant. A radiologist from the University of Oregon put the lifetime cancer risk from CT scan at 1 in 1,000.[5] That may seem small, but imagine being a parent and knowing your child had not been abused. Would you be willing to take that risk? Many parents in these situations do not have the luxury of that choice however. They are often coerced by the doctor or by Child Protective Services to allow the tests. Dr. Sheets’ study may actually have ethical issues, since research projects involving human subjects require informed consent.
There are 4 million babies born in the United States each year. If 1.2-2.2% of them have a bruise at any given point in time, that represents 48,000 to 88,000 babies. If all of those babies get a bone survey and a CT scan, that represents 10’s of millions of dollars for the costs of the tests, untold expenses to the families falsely accused because of false positive tests, and up to 88 excess cases of cancers per year.
In addition to the medical risk, requesting a work-up for child abuse creates the risk of a false accusation of abuse. The scans produced in child abuse work-up may lead to a doctor mis-diagnosing a fracture, or perhaps, discovering an old fracture and making biased assumptions as to their cause. As mentioned before there is also the problem that skin lesions such as petechial rashes and eczema can be misdiagnosed as bruises. The legal battles from false accusations of abuse are devastating to their victims. They lead to loss of finances, careers, reputations, friends, children, family, and even freedom. It is crucial that there is solid evidence to warrant such a serious investigation.
Another study by Dr. Harper and colleagues[6] asked the question in a different way. They took a database that was collected to study siblings of children who had been referred to the Child Protective Team for evaluation of physical abuse. The Harper study extracted data from the original cohort of children examined for abuse, specifically babies less than 6 months old who had been referred for isolated bruising. They then asked how many of them had been abused. There were only 50 children with a single bruise and only 14 of those (28%) had a final diagnosis of physical abuse. One should keep in mind that these were not all children that had a single bruise, but only children who were referred by another doctor to the Child Protection Team because they suspected abuse. In other words, this study fails to take a sample that reflects the population at large. There may have been many babies with a bruise, but were never sent to a child abuse pediatrician. A properly designed study would have covered a random sampling from the general population to get an accurate picture of how frequently bruises are from abuse.
Even with these limitations, I think what these studies actually show is that not every bruise is a sentinel injury. Instead of rushing to dangerous and costly assumptions, one must listen to the parent’s explanation, investigate, run non-invasive blood tests, and use the common sense of referring physicians before blindly doing bone surveys and CT scans. Hopefully, this approach will avoid some of the false allegations that can be so devastating to families.
Citations:
[1] Glauber, B. (2019, April 03). Children's Hospital research aids Congressional push to help prevent infant abuse. Retrieved from https://www.jsonline.com/story/news/2019/04/03/childrens-hospital-research-aids-push-help-prevent-infant-abuse/3357387002/
[2] Sheets LK, et al “Sentinel Injuries in Infants Evaluated for Child Physical Abuse” Pediatr Clin North Am. 2014 Oct;61(5):923-35
[3] Sugar NF, Taylor JA, Feldman KW; Puget Sound Pediatric Research Network. Bruises in infants and toddlers: those who don’t cruise rarely bruise. Arch Pediatr Adolesc Med. 1999;153(4):399–403
[4] Labbé J, Caouette G. Recent skin injuries in normal children. Pediatrics. 2001;108(2):271–276
[5] Frequently Asked Questions. (n.d.). Retrieved June 16, 2019, from https://www.imagegently.org/Portals/6/FAQs-Medical Professionals.pdf
[6] Harper NS, et al “Additional Injuries in Young Infants with Concern for Abuse and Apparently Isolated Bruises” J Pediatr. 2014 Aug;165(2):383-388
Support The Burns!
WHAT: Oral Arguments for Josh Burns’ Appeal
WHEN: Monday April 15th, 2:00pm
WHERE: Theodore Levin U.S. Courthouse 231 W. Lafayette Detroit, Michigan 48226 - Room 212
We have some good news in the original case that inspired the creation of Torn Family. Josh Burns, who was falsely accused of Shaken Baby Syndrome, continues his appeal at a Federal level. A judge has requested to hear oral arguments for the appeal, which will be presented by the Innocence Clinic from the University of Michigan. This hearing is open to the public, and we encourage you to come to show your support.
The Burns family have been doing well - Josh and Brenda Burns now reside in Arizona, where Josh works as a flight simulator instructor. Naomi, still healthy and strong, is growing up fast. She is already in pre-school, and loves to read!
WE NEED YOUR HELP
Right now, there is a proposal before the U.S. House of Representatives to revise a law that currently provides immunity to those reporting suspected child abuse. The revision will broaden that immunity to cover child abuse professionals even when they assist investigators or testify against defendants in court. Doctors who give false, negligent, or unscientific testimony will be free from any repercussions.
Common sense should tell us no one should be free from accountability, and the suffering of the thousands of families torn apart by false accusations tell us just how important that accountability is.
We need your help to call or write your representative to vote NO on H.R.5955 - Victims of Child Abuse Act Reauthorization Act of 2018.
FIND YOUR REPRESENTATIVE:
https://www.house.gov/representatives/find-your-representative
CALL OR WRITE:
If you need help writing, below is a pre-written letter for your convenience.
Dear____,
I am writing in regards to H.R.5955 - Victims of Child Abuse Act Reauthorization Act of 2018. Please vote NO on this dangerous legislation.
Currently this law provides legal immunity to individuals who report cases of suspected child abuse. This reauthorization act expands that immunity to cover those who assist investigators or testify against a suspected child abuser.
Protecting heroes who fight child abuse is a wonderful idea. But speaking as someone who has seen the devastation that can be caused by the inaccurate testimony of child abuse pediatricians, I find this law deeply concerning.
There are many doctors who promote ideas no longer supported by science, and these doctors wield incredible power in court. In cases where a child has not actually been abused but is suffering a medical condition, the unscientific testimony of a child abuse pediatrician is often the only “evidence” the prosecution can find against the defendant. The testimony of such well educated experts is often enough to sway a jury into convicting an innocent person.
If this law is passed, such doctors will face no consequences for their negligence and unscientific claims. They will be free to continue tearing apart family after family. No one should be above accountability, not even someone claiming to do something as noble as fight child abuse.
Thank you for considering my viewpoint. It is my sincere hope that you will protect justice and vote NO on the H.R.5955 - Victims of Child Abuse Act Reauthorization Act of 2018.
Visit TornFamily.com to learn more of families effected by false accusations of abuse.
Sincerely,
________
The "Bruise"
This year Torn Family board member and former University of Michigan Professor of Pathology Dr. Douglas Smith was able to assist in a case involving a child with “bruising” on the abdomen. His findings provided multiple non-abusive explanations for the bruising, ultimately helping the parents get their child back from CPS custody. The following is a paper written by him detailing the case.
When a “Bruise” Is the Beginning of a Family’s Nightmare
The Nightmare Begins
The Parker family’s nightmare began with a diaper change. Their son Dylan was 6 weeks old. Jimmy, Dylan’s dad, noticed an area on the left side of Dylan’s belly covered in a series of small red marks. His wife, Allie had changed Dylan’s diaper earlier that morning, so he asked if she had seen the markings earlier. She hadn’t. They didn’t understand what caused the marks, so they were concerned.
In addition, Dylan had not had a bowel movement in two days, so they had made an appointment with his pediatrician. Dylan ended up having a large bowel movement before the appointment, but they kept the appoint anyway, to address the marks on his belly.
The Parkers showed the markings to the nurse practitioner. What the Parkers didn’t know was that pediatricians and other medical personnel are routinely taught that non-crawling babies do not get bruises on their own, and therefore bruises can only result from abuse. Because of this, the pediatrician’s office suspected someone was abusing Dylan and filed a report with the Department of Human Services. The Parkers were told that they must go to the emergency room of the University at Michigan Mott Children’s Hospital immediately.
In the mean time, their pediatrician called Dr. Bethany Mohr, the head of the Child Protection Team at Mott’s, and told Mohr to expect the Parkers’ arrival. The pediatrician had received her residency training at Mott’s from Mohr herself.
Mott Children’s Hospital
At the emergency room a child abuse protocol went into “autopilot.” Dylan had X-Rays of every bone in his body, as well as a CT scan of his head. He had a series of blood tests and an ultrasound scan of his belly to look for internal bleeding. Then came the big surprise: Dylan had four healing rib fractures.
Dylan was admitted to the hospital and Child Protective Services took steps to take custody of Dylan and his older sister. The next day they met with Mohr, who separated James and Allie into different rooms in order to question them about Dylan’s injuries and take a medical history. This is not typical for a sick child but is an investigative technique similar to the methods used by police. Mohr then examined Dylan and took photographs.
Dylan required no medical treatment and was discharged into the custody of Allie’s parents along with his older sister. Allie and James were ordered to have no contact with either child until their first court hearing.
“Bruises”
Dr. Mohr said she saw several “bruises” on Dylan in addition to the marks on this stomach. However, no other doctors identified these additional marks as “bruises.” Instead, the photos taken show a rash that had been previously diagnosed as eczema by Dylan’s pediatrician.
Furthermore, the “bruises” on Dylan’s stomach turned out to not be bruises at all. Allie’s description of the markings when they were fresh match the description of another type of bleeding into the skin: a petechial rash. Petechial rashes are superficial bleeding from capillaries just under the surface of the skin. A common example of a petechial rash is what is called a “hickey.” In the case of a hickey, the rash is caused by sucking on the skin. Petechial rashes can also be caused by pressure on the skin. It differs from a bruise in that it takes less force to cause one. A bruise is the result of deeper tissue injury. A bruise will be tender while a petechial rash will not be, since it is just superficial capillary bleeding.
Nevertheless, Mohr concluded the following:
“Based upon Dylan's developmental level, the location of the bruising, the patterned nature of his left abdominal bruising, and no history reported which provides a mechanism for his bruising, Dylan's bruising is diagnostic of physical abuse.”
“Due to Dylan's age and developmental level, as well as the location of his rib fractures, his rib fractures are diagnostic of physical abuse. Posterior rib fractures in infants are highly specific for physical abuse due to squeezing.”
Genetic Explanations For the Bruises:
Missing from Mohr’s report was any mention of Dylan’s mother’s medical history, which turned out to be very important. Allie Parker has a genetic condition called Ehlers-Danlos syndrome. This syndrome is characterized by very loose joints and capillary fragility, which leads to easy bruising and petechial rashes. Mohr’s report does not address the possibility that Dylan could have inherited this condition, providing a non-abusive explanation for the marks.
Allie described how she gets a bruise from the blood pressure cuff whenever she gets her blood pressure taken. Allie was examined by a clinical geneticist and he performed a test for joint hypermobility called a Beighton score. Allie had a score of 8 or 9 (see photographs). Any score of 5 or above indicates joint hypermobility. Allie can also dislocate her hips at will and she is developing some hip pain, which is common in Ehlers-Danlos patients as they get older.
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Allie Parker testing for joint hypermobility -
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Ehlers-Danlos syndrome is inherited as a dominant trait, meaning that if only one parent has the condition, one can predict that half of their children would inherit the disorder. Dylan has a 50% chance of having inherited Ehlers-Danlos syndrome.
Origin of the Bruise
Dr. Mohr was later asked in court if she had ever investigated whether the pattern of the “bruise” matched anything in the Parker’s home. She responded that was not her job.
It turns out the “bruise” does match something in the Parker’s home. In fact, there are two swings and a car seat that have similar harness with horizontal and vertical straps joined by a plastic buckle (see photographs). Dylan had spent time in the swing on the day the bruise appeared. Since the markings were on the left side of Dylan’s belly it seems that he must have gotten twisted a little to his right side in the swing, causing the straps and buckle to tighten against his skin.
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Dylan's "bruise" -
Dylan's swing harness
Causes of Dylan’s Rib Fractures
In addition to the Ehlers-Danlos syndrome, Allie has a skin condition known as polymorphic light eruption. This condition can cause her to develop rashes from exposure to sunlight. This was important because it led to her and Dylan being severely vitamin D deficient. Vitamin D is essential for bone health, and lack of it can lead to fragile bone diseases such as rickets, thus providing a non-abusive explanation for Dylan’s broken ribs.
Sure enough, when Dylan was tested for vitamin D at 6 weeks of age, his level was 12 ng/ml. He had been receiving vitamin D drops since birth so his level was undoubtedly much higher than when he was born. When his mother was tested several months after Dylan was born, her level was 8 ng/ml. The baby’s vitamin D level is always less than that of the mother's at birth.
There is considerable controversy in the medical literature about what level of vitamin D is normal and what level will cause a bone disease such as rickets. It is generally accepted that levels above 30 ng/ml are optimal for bone health. The majority of the medical literature sets the level for “deficiency” as anything less than 20 ng/ml - but some have recommended thresholds for deficiency as low as 10 or 12 ng/ml.
Mohr testified that the vitamin D level was “insufficient” but not “deficient” and that without signs of rickets on the x-rays Dylan’s vitamin D levels would not explain the fractures. However, autopsy studies show that about 30% of children with Vitamin D levels between 10 and 20 ng/ml have conditions consistent with rickets. These conditions can only be viewed under a microscope, and are not visible with an x-ray.
In addition to the low vitamin D level, Dylan had a very elevated level of alkaline phosphatase, a symptom of rickets. Other blood tests that are often abnormal in rickets were normal but it needs to be kept in mind that these blood tests were performed a month or more after the fractures occurred. Dylan was receiving vitamin D drops since birth and these blood tests can return to normal long before the bone strength returns to normal.
Ehlers-Danlos syndrome alone probably does not cause fractures but some experts have reported that in combination with vitamin D deficiency, it can cause fragility fractures in infants. Since the frequency of Ehlers-Danlos syndrome is only 1 in 5,000 births, one would expect that if the association was random it would be very rare. In reviewing a few dozen fracture cases, this author has already seen two cases where the mother clearly had both Ehlers Danlos syndrome and vitamin D deficiency, and the baby had multiple fractures. Other defense experts have reported similar cases. No studies have been reported that contradict that association. Thus, although not proven, it seems likely that Ehlers-Danlos syndrome makes bone fragility worse in cases of vitamin D deficiency.
Determining the Age of the Fractures
The doctors would later testify that the fractures were “at least” 10 to 14 days old. This is misleading however, because the fractures could have dated back as far as 4-6 weeks, which was when Dylan was born. This makes it very plausible that the rib fractures could have occurred as a result of Dylan’s C-section delivery. Though rare, fractures can occur when the doctor pulls the baby out of the womb during a C-section, even in babies with normal bone strength.
Analysis of two full body bone surveys on Dylan, one at 6 weeks and one at 12, reveals that the older estimate of 4-6 weeks is actually more likely. Dylan’s first bone survey at 6 seeks showed rib fractures, which displayed their peak amount of healing tissue (callus). The second at 12 weeks, showed near complete healing of the fractures. Peak callus occurs at about 5 to 7 weeks. Complete healing doesn’t occur before 9 to 11 weeks. Although dating fractures is not a precise science, the best estimate is that Dylan’s rib fractures occurred sometime between his birth and two weeks of age.
Conclusion
Child Protective Services petitioned the court to terminate the parental rights of both parents. The trial was spread out over three months. The parents ran out of money to hire defense experts, so they petitioned the court to pay for an expert on vitamin D deficiency. The chief judge agreed in an ex-parte motion, but the prosecutor motioned that the approval be rescinded. In a hearing on the motion, the chief judge admonished the prosecutor severely for attempting to deprive the parents of due process. The Parkers were allowed to hire an expert, and they were found not responsible for the injuries. Regarding the Parkers lawyer, Lisa Kirsch Satawa, the judge stated "You need to thank Ms. Satawa because she did a job I rarely see in this courtroom.” Thanks to all of this, the case was dismissed. The judge even tearfully apologized that the parents had to go through this difficult and expensive process.
“Confusing Juries with Science”
Dr. Waney Squier presents a TED talk about what she experienced when she dared to challenge the paper thin foundations of Shaken Baby Syndrome. When the English doctor’s research led her to testify against Shaken Baby Syndrome in court, officials revoked her medical license as punishment.
Police, striving to achieve a certain number of convictions instead of seeking the truth, accused her of “confusing juries with science.” Now, Squier shares her plea to institutions of medicine and law around the world to let the objective truth of science speak:
https://www.youtube.com/watch?v=O5FyTFs7P7U&feature=youtu.be