Reeling from shock, Sameer Sabir and his wife Nada Siddiqui stared blankly at the district attorney for Cambridge, Massachusetts. She had just told them she was dropping charges against their Irish nanny, Aisling Brady McCarthy, accused of shaking their infant daughter Rehma to death on her 1st birthday. After nearly three years of waiting for the trial Sameer and Nada believed would tell the world how Rehma was harmed, McCarthy was being set free. “Rehma did not have her day in court,” Sameer told CNN Chief Medical Correspondent Dr. Sanjay Gupta. “She did not have her chance at justice.” In 2013, Boston medical examiner Dr. Katherine Lindstrom had ruled Rehma’s death a homicide by blunt force trauma, in what child abuse specialists called a classic case of shaken baby syndrome, also known as abusive head trauma, or AHT. Now, just weeks before attorneys would try Rehma’s case, Lindstrom had changed her mind. Instead of blunt force Rehma may have died from a brain bleed of unknown cause. In the United States on an expired visa, McCarthy was quickly deported to her native Ireland. CNN reached out to McCarthy through family members in the United States, her former lawyer, even a family priest in Ireland. The requests for an interview went unanswered. In a 2016 interview with a Boston Globe columnist McCarthy maintained her innocence and said she grieves for Rehma. “I looked after Rehma 10 hours a day, five days a week,” she told the Globe at the time. “I stayed over to help her sleep train. I’ve been looking after kids since I was 13.” In a separate story, McCarthy’s lawyers told the Globe the case was a rush to judgment, calling it a “Shaken Baby Syndrome (SBS) prosecution … based on a scientific hypothesis that has crumbled over the last decade.” In her official announcement, Lindstrom said she based her turnabout on a range of materials not available at the time of the original autopsy. The reversal came after she was provided opinions by the nine medical experts hired by McCarthy’s defense team. Some of those experts have testified in hundreds of cases across the country or played key roles in obtaining acquittals or appeals for people accused of shaking a baby. Several question methods used by specialists to diagnose abusive head trauma, while others are severe critics of the science behind shaking, calling it flawed and disproven. All have presented alternative theories they say can “mimic” the symptoms of shaking — including theories which mainstream practitioners say are speculative or unproven in particular cases. “While I do not agree with all of the conclusions that are drawn by the various experts they do present a significant amount of additional information,” wrote Lindstrom in her announcement. CNN asked the medical examiner’s office on four occasions for an interview with Lindstrom to discuss the reasons for her change of opinion. The office declined each time, and provided a statement saying Lindstrom could not comment because “medical information relating to a specifically named individual, including information drawn from autopsy reports, is by statute private and confidential.” CNN also reached out directly to Lindstrom twice. She did not respond. Fueled by grief and anger, Sameer became a driven man. He filed a Freedom of Information Act request and obtained all of Rehma’s medical records and legal filings, including statements created for the defense by the nine doctors. He shared those files with CNN; we verified the documents and obtained additional records from the district attorney’s office. In those nine opinions, there were dozens of competing explanations for Rehma’s brain injuries: cardiac arrest, choking, vomiting, a blood clot from infection in her middle ear, stroke, a short fall from a bed, metabolic disorders, bleeding disorders, various rare inflammatory diseases, and more. None of the medical defense witnesses felt Rehma’s injuries were caused by inflicted trauma. Sameer and Nada were bewildered. These defense witnesses were provided with the same medical facts as the doctors who cared for Rehma, yet they had failed to provide any unifying theory to explain her injuries. It was, Sameer said, as if “they threw spaghetti at the wall, hoping one theory sticks.” In his opinion, Wake Forest pathologist Dr. Patrick Lantz said it was “probable” that Rehma died of an extraordinarily rare inflammatory disease called acute necrotizing encephalopathy, or ANE. Two other defense witnesses, British pathologist Dr. Waney Squier and Dayton Children’s Hospital of Ohio geneticist Dr. Marvin Miller, reached the same conclusion. Yet the symptoms of ANE did not match the facts in Rehma’s case, experts told CNN. Children with ANE develop fever, vomiting and diarrhea for several days, followed by neurological problems such as seizures, hallucinations and abnormal muscle tone. Family and friends saw none of those symptoms in the days before Rehma’s death. “We spent time with her and she was perfectly healthy and happy,” said Silvia Gomes, Nada’s sister-in-law. “A sick baby doesn’t go around with never-ending energy, doesn’t play and laugh and enjoy company the way she did.” Another key point: Neurologists say anyone stricken with ANE will have distinctive lesions in their brain, in an area called the thalamus. Those markings would be visible on an MRI. Rehma’s brain scans, provided to the defense and reviewed by Lantz and Squier, showed no such telltale lesions, said Dr. Alice Newton, the child abuse pediatrician who investigated Rehma’s case. “This image doesn’t support the defense witness allegation,” Newton said, pointing to the unscathed thalamus on Rehma’s MRI she would have submitted as evidence if the case had gone to trial. Miller declined an interview and said he stood by his report. Squier and Lantz explained their reasoning in separate phone interviews with CNN. Rehma’s brain had “widespread inflammatory cuffing around the blood vessels,” and “blood clotting in the small vessels,” which was not a “typical pattern” one would see in brain swelling after trauma, Squier said. However, Newton referenced studies which show otherwise, explaining that trauma produces inflammation “as a generalized reaction when cells are dying.” Lantz also pointed to elevated signs of inflammation, specifically tumor necrosis factor alpha and Interleukin 6 and 13, “which you would not typically see in a case of trauma to the brain.” Yet an internet search of peer-reviewed studies quickly found all are key responses to brain trauma, typically as the body’s way of reducing inflammation. Lantz, who told CNN he frequently works for the prosecution in abuse cases, believes shaking is often misdiagnosed by pediatricians on the basis of retinal bleeding “when in fact it may be some other disease process.” Defense witness Dr. Michael Laposata, who chairs the pathology department at the University of Texas Medical Branch in Galveston, suggested Rehma died from a bleeding disorder called von Willebrand disease. It’s a genetic disorder caused by low levels of a clotting protein called von Willebrand factor. Laposata declined an interview, saying he was “confident of my conclusions and do not want to be involved in a public debate.” He told the Houston Chronicle in 2019 he leads a team of doctors which conducts pro bono evaluations of medical records for parents accused of child abuse. Sometimes the team agrees with the abuse diagnosis but at other times they find mistakes or missed medical problems. In Laposata’s report for McCarthy’s defense, he said “daily handling” of Rehma could produce “bruising (and) bleeding,” and suggested her brain injury began when Rehma “repeatedly ‘plopped’ down on her bottom during her birthday party on January 12.” Rehma’s medical records show von Willebrand disease had been ruled out by a hematologist when Rehma was 10 months old, then ruled out again by a blood specialist at Boston Children’s Hospital just before her death. Despite that, Lindstrom appeared to be heavily swayed by Laposata’s theory: “I believe that enough evidence has been presented to raise the possibility that the bleeding could have been related to an accidental injury in a child with a bleeding risk,” she wrote. Could that be true? No one in the family had a bleeding disorder, Sameer said, which is one of the diagnostic requirements for von Willebrand disease. With Sameer and Nada’s permission, CNN asked pediatric hematologist-oncologist Dr. Shannon Carpenter to review Rehma’s medical records. Carpenter heads the Hemophilia Treatment Center at Children’s Mercy Kansas City and co-wrote the American Academy of Pediatrics policy for evaluating bleeding disorders in suspected child abuse cases. Carpenter said Rehma did not appear to have von Willebrand disease, only a mild deficiency in von Willebrand factor. “The operative word in this is ‘mild,’ ” Carpenter said, adding that the more pertinent question is whether a “mild bleeding like von Willebrand’s or a platelet function defect, even in combination” would be fatal. It would not, she said. Rehma’s death, Carpenter added, “is not the result of a bleeding disorder any more than multiple fractures are. I think whether or not she had von Willebrand or another mild bleeding disorder is a red herring.” As Nada and Sameer read the legal files, their sense of injustice grew. It was as if Rehma had been victimized twice: first by the person they believed shook her to death, then by defense experts they felt ignored key facts in the case. “No rare disease on earth would enable a gash in a wall or bloody wipes to end up in a pail by themselves,” Sameer said, voice rising. “If two people are left in an apartment in the morning, and at the end of the day, one of them is dead,” he continued, “there’s no way that there would not be a trial in that situation.” In news reports, McCarthy has consistently denied harming Rehma. Sameer dug deeper, reading studies and calling experts. He wanted to understand how such diverse explanations of Rehma’s death by defense witnesses could cause Lindstrom to change her mind. “I expected to find that the science had crumbled and changed, and this [shaken baby syndrome] was debunked theory,” Sameer told Gupta. “To my huge surprise, there was actually very little debate.” No less than 24 domestic and international medical organizations acknowledge abusive head trauma as an accepted diagnosis. A survey of the specialists who do the detective work to diagnose AHT — from pediatric neurosurgery, pathology, radiology, critical care and pediatrics — found the vast majority believe in the science. “There really is not a controversy in medicine about the existence of abusive head trauma," American Academy of Pediatrics President Dr. Lee Savio Beers told CNN. “The science behind it is really quite clear.” “It’s a happy day when the child abuse team finds a medical condition that has confounded other clinicians and has led them to think the child is being abused,” said Penn State child abuse pediatrician Dr. Lori Frasier. In a 2015 analysis of 936 suspected child victims of physical abuse at four children’s hospitals, pediatricians trained to diagnose child abuse decided 49% of those cases were actually the result of an accident or medical condition. Only 33%, or 306 cases, were classified as abuse, with another 18% declared questionable or unknown. “Of these 306 cases of abuse, 93 (or 30%) were AHT,” study author Dr. John Leventhal told CNN in an email. Leventhal is the former medical director of the Yale-New Haven Children’s Hospital Child Abuse program and a Professor Emeritus of Pediatrics at Yale School of Medicine. He pointed to another 2015 study that focused specifically on diagnosing abusive head trauma. It was conducted at one children’s hospital, UPMC Children’s Hospital of Pittsburgh, by child abuse pediatrician Dr. Rachel Berger. “In Berger’s study over almost 6 years there were 223 suspected cases of AHT, and a consultation by a child abuse expert was conducted for each. Of the 223 cases, 117 cases or 52.5% were classified as abuse, and the others were classified as non-abuse,” Leventhal wrote. Yet in court, pediatricians say defense teams reject that mainstream scientific knowledge and instead offer judges, juries, medical examiners and the national media speculative theories that may hold little to no scientific validity. “Diagnosing abusive head trauma places child abuse pediatricians in the crosshairs of defense attorneys who have increasingly pushed pseudoscientific theories that have no basis in medical research,” said the chair of the AAP Council on Child Abuse and Neglect, Dr. Suzanne Haney, in a powerful op-ed published in May. In addition, defense witnesses often tell juries that child abuse specialists only use a “triad” of symptoms — brain swelling, bleeding in a part of the brain called the subdural and bleeding in the retina of the eye – to diagnose shaking. That’s a “clever” defense tactic, said former New York prosecutor Leigh Bishop, who trains investigators on shaken baby cases: “The term ‘triad’ is not a medical term. It’s a courtroom term,” Bishop said. “It implies a rush to judgment and a checklist to judgment, and these cases are the absolute opposite of that.” In fact, child abuse specialists say they rule out a long list of possible “mimics” for abuse, such as metabolic diseases, genetic syndromes, tumors, clotting disorders, infections and vitamin deficiencies, to name a few, before they decide a child could be a victim of abuse. In an ideal world, they say, defense witnesses would do the same. Instead, child abuse specialists say defense experts often “cherry pick” a symptom and claim it’s a sign of a rare disease or a speculative, unproven syndrome — or they suggest causes of death that do not match all the facts about a baby’s injuries — just as occured in the Rehma Sabir case. How did this “battle of the experts” begin? The answer can be traced to another Boston child abuse case that riveted the nation over 24 years ago. On a frigid February afternoon in 1997, an ambulance screeched to a halt outside the Newton, Massachusetts, home of 8 1/2-month-old Matthew Eappen. Paramedics were responding to a call from 19-year-old British au pair, Louise Woodward, who said she found Matthew unresponsive in his crib while his parents were at work. Rushed to the hospital, Matthew was immediately put on life support. Doctors discovered signs of abuse: a large skull fracture, severe swelling and bleeding in his brain and hemorrhages in the retinas of his eyes. Matthew’s mom, Debbie Eappen, was an ophthalmologist who had consulted on abuse cases. Fearful Matthew was the victim of shaken baby syndrome, she decided to look for herself. “When I looked into Matty's fixed dilated pupils, I saw so much blood in the retina that it was difficult for me to identify the normal landmarks,” Eappen recently told CNN. “I looked into his left eye and found similar findings … “I knew what this meant,” she continued. “Matty had been violated and he might die.” Despite medical intervention, Matthew continued to decline. When life support was removed five days later, Woodward was arrested and charged with second-degree murder, accused of violently shaking the baby and slamming his head against a hard surface, causing his death. Broadcast on Court TV, the so-called “Nanny Trial” became an international sensation. Viewers in the United States and England were fascinated by the defense strategy orchestrated by attorney Barry Scheck, a member of the “Dream Team” that successfully defended O.J. Simpson in his 1995 murder trial. Scheck told the jury both the skull fracture and bleeding in Matthew’s brain were the result of an older injury, perhaps from a short fall. Defense medical witnesses he called to the stand suggested a pre-existing blood clot in Matthew’s brain had begun to “rebleed,” leading to the baby’s collapse. “Rebleeding” is a controversial hypothesis used by defense witnesses to explain a subdural hemorrhage – the bleeding between the brain and its tough outer lining — that’s frequently seen in cases of shaken baby syndrome. The rebleed theory maintains some babies have pre-existing blood clots in the subdural area. Some could be from a former injury, but most are from a small bleed caused by the trauma of birth. The clot could sit in the brain for months, the theory says, with new bleeding triggered by a burp or sneeze or even when a baby suddenly plops on its bottom. The fresh bleeding, defense witnesses maintained, could be severe enough to cause the injuries seen in shaking, including coma and death. Even in 1997, child abuse specialists believed the rebleeding defense to be unfounded. Research since the Woodward trial has continued to validate the mainstream medical view. “If you did have a rebleed of a subdural hematoma, it would be just a minor kind of leak,” said Boston pediatrician Dr. Robert Reece, who was to be the prosecution’s rebuttal witness in the Woodward trial. Scheck’s defense strategy didn’t convince the jury. On October 30, 1997, jurors convicted Woodward of murder in the second degree. But at a hearing nearly two weeks later, Judge Hiller Zobel shocked observers by reducing the charge to manslaughter and sentencing the nanny to time served. Zobel said he based his decision on his belief that Woodward had injured Matthew in a state of "confusion, inexperience, frustration, immaturity and some anger, but not malice (in the legal sense)." For Matthew’s parents, the judge’s decision was “appalling.” “I could imagine him trying to reduce the number of years in jail,” Debbie Eappen said. “I could imagine that. I absolutely could not imagine that he would set her free.” Scheck had previously co-founded the Innocence Project, a nonprofit legal organization dedicated to using DNA evidence to exonerate the falsely imprisoned. The Woodward trial was not an Innocence Project case, yet it wasn’t long before justice projects in a number of states — today part of the Innocence Network — began taking on appeals for shaken baby convictions. “Many innocence organizations after the Woodward case observed — I think correctly — that a lot of that science was not evidence-based and that something really had to be done to defend people in these kinds of instances where there could be false accusations based on unvalidated science,” Scheck told Gupta in an interview. According to the Innocence Network’s website, the shaken baby diagnosis is dangerously flawed and “has been used in courts to send untold numbers of innocent people to prison in what may be the largest cause of wrongful convictions to date.” “The Network's position on SBS/AHT derives from its long-standing concern about the unreliability of the scientific evidence presented in such cases,” said Meredith Kennedy, director of the Innocence Network’s support unit, in an email. Wisconsin Innocence Project co-founder Keith Findley, a vocal critic of the science behind shaken baby syndrome, points to a 2016 report by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, or SBU. The controversial analysis found “insufficient” evidence of “very low quality” to support shaken baby syndrome. Major medical associations have criticized the SBU report as flawed “to the extent that children’s lives may be put at risk,” and maintain the science behind AHT has never been stronger. Don’t “kill the messenger,” the SBU authors responded, and defended their reasoning for only including two studies out of thousands in their analysis. But major medical groups, domestic and international, say the Swedish report flies in the face of widespread consensus over the validity of the AHT diagnosis. “The diagnosis of abusive head trauma can be made with the same medical certainty as any diagnosis in medicine,” said Dr. Christopher Greeley, who directs the child abuse pediatrics program at Texas Children’s Hospital and specializes in the critical evaluation of medical literature. What doctors can’t decide, Greeley added, is who harmed a child. It wasn’t long before the appeals mounted by the Innocence Network caught the attention of national media. News outlets published riveting tales of parents or caretakers claiming to be unjustly imprisoned by overzealous authorities. Reporters quoted doctors frequently hired by defense teams to denounce the diagnosis of shaken baby syndrome. To mount the appeals, Innocence Network lawyers relied on a small group of doctors who denied the validity of widely held medical beliefs about abusive head trauma. Mainstream practitioners soon began calling them “denialists.” One of the defense witnesses in Rehma’s case, Stanford neurologist Patrick Barnes, was an early convert. Interestingly, Barnes had testified for the prosecution during the 1997 Louise Woodward trial. At that time, he said baby Matthew’s injuries were the result of shaking. Barnes told CNN arguments presented by Scheck during the trial caused him to question the validity of shaken baby syndrome. After further research he began to testify for the defense in shaken baby cases across the country. He says he does not rule out abuse, but believes there are alternate medical reasons for the injuries. Barnes was a key witness in a 2008 victory for the Wisconsin Innocence Project — a new trial for Audrey Edmunds, convicted in 1996 of shaking 7-month-old Natalie Beard to death while babysitting. Barnes relied heavily on the controversial rebleed theory, telling the court something as common as coughing or vomiting could have caused an old blood clot in baby Natalie’s brain to begin to bleed again. When the Wisconsin Court of Appeals ruled in Edmunds’ favor the judges made it clear they considered the science behind shaken baby syndrome to be in dispute: “There has been a shift in mainstream medical opinion,” the Wisconsin Court of Appeals said in 2008 as it sent Edmund’s case back for a new trial. It was a decision that would influence judges in shaken baby cases for years to come, including a justice on the nation’s highest court. “Doubt has increased in the medical community ‘over whether infants can be fatally injured through shaking alone,’” the late Supreme Court Justice Ruth Bader Ginsburg wrote in a 2011 minority dissent on a shaken baby case. In the majority decision, the high court refused to overturn the jury’s conviction. As for Edmunds, local prosecutors declined to retry her case and she was set free after serving 12 years of her 18-year sentence. Maintaining her innocence, Edmunds would go on to write a book about her experience. Why would a small group of defense witnesses regularly testify against mainstream medical opinion in shaken baby cases? Critics suggest money is a motive: testifying as an expert witness for the defense or prosecution has become a lucrative cottage industry. “For the few doctors who speak out against it, I think it’s important to consider where their motivations lie, and what other conflicts of interest they may have when assessing their statements,” the AAP’s Beers said. However, Barnes, one of the witnesses in Rehma’s case, told CNN he stopped “charging long ago,” and considers his testimony to be part of his “child protection advocacy.” Another defense witness in Rehma’s case, retired British neuropathologist Dr. Waney Squier, told CNN she too no longer charges a fee. All of the defense witnesses CNN spoke to said they were concerned about parents being accused and convicted of shaking their babies based on science they discount. “I’m absolutely appalled there is no scientific evidence whatsoever to support the shaken baby hypothesis,” Squier told CNN. “And yet it’s put before the courts again and again and is used to take children away from loving parents and put people in prison.” In April of 2016, the Innocence Network gave Squier their Champion of Justice award for her “relentless and courageous” work in more than 160 shaken baby cases worldwide. However, just weeks before receiving the award, the UK Medical Practitioners Tribunal Service had “struck off” Squier’s medical license for providing “deliberately misleading and dishonest evidence” while testifying in shaken baby cases. “Struck off” is the British term for revoking a medical license. “From day one I’ve disagreed with all of the things they said about me,” Squier told CNN. On appeal, Squier’s license to practice pathology was restored that fall. But the judge banned her from testifying as a medical expert in shaken baby cases in the UK for three years, calling her conduct in court deliberately “misleading and irresponsible." Squier recently told CNN she has not changed her opinion: “I am if anything even more certain that the proponents of the shaking hypothesis are mistaken,” she wrote in an email. Child abuse specialists said they found the attack on mainstream science in the courts and the national media deeply disturbing. Concern over the growing success of denialism triggered 17 domestic and international medical organizations to issue a strongly worded admonishment in 2018: “Defense attorneys and the medical witnesses who testify for them have been disseminating inaccurate and dangerous messages that are often repeated by the news media,” the organizations warned in a consensus statement: “The accompanying defense message — that shaking an infant cannot cause serious injury — will create the additional risk of encouraging dangerous or even life-threatening caregiver behavior.” It’s exactly the kind of message that Rehma’s parents – and child abuse specialists everywhere – are trying to counteract. “We’re trying to educate parents that shaking a baby is dangerous — these people are sending the wrong message,” said Dias, one of the consensus paper’s authors. “They’re gaining traction. That’s the disturbing thing,” Dias added. “It’s time for people in medicine … to stand up and say, ‘No, what you’re saying is wrong.’”
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