Shaken Baby Syndrome: Medical Mimics and Alternate Explanations
Finding the Right Expert
Defense teams are seldom faced with a legal animal like a shaken baby syndrome case. Seldom are our clients the one who called 911 after someone arrested or died in their arms. Seldom is the person who finds another in respiratory distress and tries to save him, the one accused of his murder. Seldom do our clients give endless hours of statements searching for what they “might” have possibly done wrong to cause the death of another.
It is also rare when a defense team is faced with the question of “cause of death” of the “victim”. The “what is it” question (accident, homicide, or natural cause) is usually pretty obvious by the crime scene. If a person is found dead, with a gunshot wound to the head, and there are no guns found near the body, it is assumed the cause of death is homicide and the manner of death, is gunshot wound. The only other question remains is “who done it”.
Shaken Baby cases are a different than most of the cases seen by defense attorneys. They require a great deal of medical expertise on the part of the attorney and a careful review by qualified medical specialists, trained specifically in the area of medical mimics and alternate explanations to SBS. Recent studies have shown that the causes of subdural hematomas and retinal hemorrhages are varied and are not always the result of child abuse. The list of medical mimics and alternate explanations include: child birth, short falls, infectious processes, hydrocephalus, bleeding disorders, anemias, and metabolic disorders. A good expert will first ask the “what is it” question (is it abuse or a mimic?) and then, if it is abuse, he or she will ask the “who done it” (timing) question. Much of the success in these cases comes from choosing the right type of expert for your particular fact pattern and medical history. Not every defense expert is right for every case.
General Tips for Hiring an Expert
◦ If your case involves a short fall or impact of some kind to the head, you may need a short fall expert or a biomechanician.
◦ If your case involves a coagulation disorder or anemia, you may want to consult with a pediatrician, a hematologist or an osteopath.
◦ If your case involves a rebleeding subdural, you may want a neurosurgeon, a neurologist, radiologist, neuropathologist or an ER doctor.
If the baby lived, you may want to consult with a(an):
◦ Pediatric Radiologist – To read CT scans, MRI’s, X-rays and bone scans.
◦ Pediatrician – Difficult to find objective experts in this area.
◦ Neurologist – If you want to discuss treatment or progress post injury.
◦ ER Physician – If you want to discuss hospital procedures and findings.
If the baby dies, you will need a/an:
◦ Pathologist- Generally a medical examiner. Looks at the injuries, explains the origin of the injuries, and the cause of death.
◦ Forensic Neuropathologist- Checks the timing and dating of injuries, screens for other disorders of the brain.
◦ Ophthalmologist- if you want to discuss the various causes of retinal hemorrhages.
Litmus Test for Finding a New Expert
Question #1: Ask them if they believe that retinal hemorrhages are generally an indicator of non-accidental trauma. If the answer is yes, move on to another expert.
Question #2: Ask them if they believe that short falls can kill children or cause subdural hematomas and retinal hemorrhages. If they say no, and you have a short fall case, move on to another expert.
Question #3: Ask them if they believe subdural hematomas can be asymptomatic. If they say no, and you have an asymptomatic/lucid interval case, move on to another expert.
Question #4: Ask them if they believe that subdural hematomas can rebleed with little to no force at a later date. If they say no, and you have a rebleed case, move on to another