SHAKEN BABY SYNDROME – Sometimes the Doctors Get it Wrong

Shaken Baby Syndrome or Abusive Head Trauma is a severe condition that can cause death or serious bodily injury in very young children. The condition causes blood to flow under the skull and creates bruising, swelling and bleeding. We handled a case for a client who was accused of harming a child in her care and was facing the possibility of prison. She needed to consult with an Austin Criminal Defense Lawyer and another attorney referred her family to us.

In this case, a toddler was brought to the Dell Children’s Medical Center with retinal hemorrhaging, bilateral brain bleed, and brain swelling. Emergency surgery saved the child’s life. My client had been providing daycare for the child at her home. She was not a native speaker of English. When the EMTs arrived they found the child eyes open and not breathing. The medical team determined that the injury occurred while my client was caring for the child.

A Sheriff’s Deputy took my client to an interrogation room and questioned her for three hours. No break, No translator, No lawyer present. After the interrogation was completed the Deputy reported to the medical team that my client had confessed to the abuse. The doctors took the Deputy’s report into account agreeing that this was a case of non-accidental injury — this was done knowingly and with the intent to cause serious bodily injury to the child. The prosecutors offered five years in prison.

Despite the confession and the serious injuries, something didn’t feel right. My client was an extremely soft-spoken and demure woman. She was a mother and had raised her own children to adulthood. She had taken care of many toddlers over the years and there was never a suspicion that she mistreated children — quite to the contrary, parents lined up waiting for an opening to have her watch their kids because of her excellent reputation. Referrals came by word-of-mouth. She prepared warm meals and delighted in playing affectionately. She had lots of experience and could soothe an infant with a kiss and a whisper.

I met with four different prosecutors and each was absolutely convinced she was guilty. Their doctors explained that subdural hematoma, retinal hemorrhage, and brain swelling make up together what is known as “the triad theory” which in an infant can mean only one thing – the baby was violently shaken or thrown against a hard object.

It took six months to get the medical records and there were thousands of pages to review. The records came from six different pediatrician’s offices plus the records from Dell Children’s Hospital. This was going to be a formidable challenge. Then, some good fortune arrived.  The very first page of the first document I read contained a reference to this child having a condition known as von Willebrand Disease.  Von Willebrand Disease is a congenital blood disorder that affects 1% of the population.  It is a condition that inhibits blood clotting. Children with von Willebrand Disease need to take special precautions against accidents because bleeding can occur after minor bumps and scrapes.  In some cases, subdural hematoma, retinal hemorrhaging, and brain swelling can occur.  Since the blood has difficulty clotting, blood can flow continuously into the skull and cause the triad of symptoms.  In a person with von Willebrand Disease, there is nothing to slow the blood from continuing to flow causing the subdural hematoma.

I consulted with the Chair of the Department of Pathology at the University of Texas. He agreed to review the records and get back to me. A week went by and we continued our conversation. More good news for my client! His conclusion is that von Willebrand Disease placed the child at risk of bleeding without the need to invoke child abuse to explain the injury. The medical evidence simply didn’t support a claim of intentional injury.

I had the confession transcribed. As I said, my client is not a native speaker and is not entirely comfortable with English. After scouring the transcript, it becomes clear that the Deputy misreported what my client said. She never confessed, her three-hour statement was a forceful denial of ever harming the child. She said she didn’t know what happened. She found the child at the foot of the stairs not responding. She called the child’s parents. She tried resuscitating the child but nothing worked. When the Deputy threatened her with jail she became hysterical and started pacing and crying. The Deputy told her that she needed to admit that she hurt the child and that she was lying. She begged to have her husband brought into the room. Finally, she said she played rough with the child showing how she would pinch the child’s cheek. That’s all he wanted to hear. The Deputy inferred guilt and reported to the medical team that she had confessed.

The records show that the medical team incorporated this false report into their medical findings.  The Deputy had contaminated the medical investigation with confirmation bias.  Instead of relying solely on their medical findings, the medical team relied on the Deputy’s report that this was a case of child abuse.

The prosecutors refused to listen.  Their doctors stood by their initial diagnosis.  They disputed the von Willebrand Disease levels and said that the child did not have a deficiency such as to cause this injury. I presented recent articles from established medical journals.  The new research showed that the triad theory could not accurately predict non-accidental abuse.  We had a conference call with all of the doctors but they refused to change their opinions.

I witnessed a disturbing dynamic. Remember, these doctors worked at Dell Children’s Medical Center – “the premier health care provider for children and adolescents in Central Texas.”  It seemed to me that the doctors were locked into their conclusion.  They cared about the child but they were more concerned with being seen as right.  They were not going to discard the triad theory.  Even in the face of more recent and accepted research, even when confronted by more knowledgeable experts, even when presented with an alternate and more credible medical explanation — the Dell physicians would not budge.  There was also the inevitable question in my mind of how many other kids had been misdiagnosed.  If von Willebrand Disease afflicts 1 percent of the population, how many accused individuals had been falsely convicted based on their diagnosis.  How hard would it be for doctors to face that liability?

After countless court settings, I scheduled a meeting with the District Attorney and asked him to intervene. He encouraged some further discussion and with his guidance, the ADAs agreed to reject their own doctors’ conclusions.  The case is pending dismissal. Had she gone to trial my client would have faced up to twenty years in prison. We got the right result. Hopefully, these types of false charges can be avoided with solid preparation and perseverance.