To the Editor:
As physicians who specialize in the diagnosis and treatment of victims of child abuse, we feel compelled to speak out regarding the scientific evidence as portrayed in the trial of Louise Woodward for the murder of eight month old Matthew Eappen. Both in the United States and in England, media publicity surrounding the case has led to considerable sentiment that she was convicted despite allegedly irrefutable scientific evidence presented by the defense that the infant's injuries had occurred days to weeks earlier. Many in the media and the public have failed to credit the jury in this case with having had the intelligence to understand that the prosecution put forward well established medical evidence that overwhelmingly supported a violent shaking/impact episode on the day in question, when Matthew was in the sole custody of Ms. Woodward. The hypothesis put forward by the defense that minor trauma caused a "re-bleed" of an earlier head injury can best be characterized as inaccurate, contrary to vast clinical experience and unsupported by any published literature. The "re-bleed" theory in infants is a courtroom diagnosis, not a medical diagnosis, and the jury properly rejected it.
Infants simply do not suffer massive head injury, show no significant symptoms for days, then suddenly collapse and die. Whatever injuries Matthew Eappen may or may not have suffered at some earlier date, when he presented to the hospital in extremis he was suffering from proximately inflicted head injuries that were incompatible with any period of normal behavior subsequent to the injury. Such an injury would and did produce rapidly progressive, if not immediate, loss of consciousness.
The shaken baby syndrome (with or without evidence of impact) is now a well characterized clinical and pathological entity with diagnostic features in severe cases virtually unique to this type of injury - swelling of the brain (cerebral edema) secondary to severe brain injury, bleeding within the head (subdural hemorrhage), and bleeding in the interior linings of the eyes (retinal hemorrhages). Let those who would challenge the specificity of these diagnostic features first do so in the peer-reviewed literature, before speculating on other causes in court. Indeed, the courtroom is not the forum for scientific speculation, but rather the place where only, according the the U.S. Supreme Court in Daubert vs. Merrill Dow, peer reviewed, generally accepted, and appropriately tested scientific evidence should be presented.
We wholeheartedly endorse a panel of medical experts to offer a scientifically based analysis of the Shaken Baby Syndrome and would suggest that this panel also review the medical testimony offered in this case and others so that some guidelines can be established for the courts on future admissibility of scientifically supportable medical testimony.
Mia Amaya, MD, MPH
University of Alabama
Birmingham, AL
Kirsten Bechtel, MD
St. Christopher's Hospital
Philadelphia, PA
Steven D. Blatt, MD
SUNY, Syracuse Health Science Center
Syracuse, NY
Ann S. Botash, MD
Syracuse University Health Care Center
Syracuse, NY
Mary Carrasco, MD
David L. Chadwick, MD
Children's Hospital and Health Center
San Diego, CA
Cindy Christian, MD
Children's Hospital of Philadelphia
Philadelphia, PA
Daniel L. Coury, MD
Children's Hospital
Columbus, OH
Michael D. DeBellis, MD
University of Pittsburgh Medical Center
Pittsburgh, PA
John deTriquet, MD
Children's Hospital
Norfolk, VA
Howard Dubowitz, MD
University of Maryland
Baltimore, MD
Kenneth W. Feldman, MD
University of Washington
Seattle, WA
Emalee G. Flaherty, MD
Children's Memorial Hospital
Chicago, IL
Martin A. Finkel, DO
Univ. Medicine & Dentistry of New Jersey
Camden, NJ
Lori Frasier, MD
University of Missouri Hospitals & Clinics
Columbia, MO
Lorraine Gari, MD
Wolfson Children's Hospital
Jacksonville, FL
Jill Glick, MD
University of Chicago Children's Hospital
Chicago, IL
Penny Grant, MD
Broward County Child Protection team
Fort Lauderdale FL
Gilles Fortin MD
Chief of Clinique de Pediatrie Socio-Juridique
Hopital Sainte-Justine
Montreal, Quebec
Lorraine Gari MD
Wolfson Childrens Hospital
Jacksonville, FL
Scott Halpert, MD
Lane County Child Advocacy Center
Eugene, OR
Ralph A. Hicks, MD
The Children's Medical Center
Dayton, OH
Dirk Huyer, MD
Hospital for Sick Children, University of Toronto
Toronto, Ontario
Carol Jenny, MD
Hasbro Children's Hospital
Providence, RI
Mark Joffe, MD
Children's Hospital of Philadelphia
Philadelphia, PA
Steven W. Kairys, MD, MPH
Dartmouth Medical School
Lebanon, NH
Karen M. Kaplan, MD
Penn State Geisenger Health System
Hershey, PA
Robert H. Kirschner, MD
University of Chicago
Chicago, IL
Kathi J. Kemper, MD, MPH
Swedish Family Medicine
Seattle, WA
Henry Krous, MD
Children's Hospital-San Diego
San Diego, CA
Alex V. Levin, MD
Hospital for Sick Children, University of Toronto
Toronto, Ontario
John McCann, MD
University of California, Davis Medical Center
Sacramento, CA
Marcellina Mian, MD
Hospital for Sick Children, University of Toronto
Toronto, Ontario
Kieran Moran, MD
Sydney Children's Hospital
Sydney, Australia
Lucy M. Osborn, MD, MPH
University of Utah Health Sciences Center
Salt Lake City, UT
Vincent Palucci, MD
DeVos Children's Hospital
Grand Rapids, MI
Robert M. Reece, MD
Institute for Professional Education, MSPCC
Boston, MA
Lawrence R. Ricci, MD
The Spurwink Child Abuse Program
Portland, ME
Des Runyan, MD, DrPH
University of North Carolina
Chapel Hill, NC
Michael Ryan, MD
The New Children's Hospital
Sydney, Australia
Matthew D. Sadof, MD
General Pediatrician
Temple University Health System
Philadelphia, PA
Matthew D. Sadof, MD
Temple University Health System
Philadelphia, PA
Robert Sege, MD, PhD
The Floating Hospital
Boston, MA
Benjamin Siegel, MD
Boston Medical Center
Boston, MA
Robert A. Shapiro, MD
Children's Hospital Medical Center
Cincinnati, OH
Suzanne P. Starling, MD
Vanderbilt University Medical Center
Nashville, TN
Carol Stashwick, MD, PhD
Children's Hospital at Dartmouth
Lebanon, NH
John Stirling, MD
Clark County Child Abuse Intervention Center
Vancouver, WA
David Turkewitz, MD
York Hospital
York, PA
J.M. Whitworth, MD
Children's Crisis Center
Jacksonville, FL