Bloomberg Law
Sept. 21, 2023, 8:00 AM UTC

Law Needs to Keep Up With Science in Shaken Baby Syndrome Cases

Patrick D. Barnes
Patrick D. Barnes
Stanford University Medical Center

In 1997, I was an expert medical witness for the prosecution in the high-profile case of Louise Woodward, a British nanny prosecuted for allegedly causing the death of a baby in her care by violent shaking. For many Americans, this was the first time they had ever heard of shaken baby syndrome. Woodward was convicted of second-degree murder under the SBS hypothesis. Based on my own subsequent research and significant developments in scientific understanding, I would not give the same testimony again.

Over the past two decades, there has been a revolution in the understanding of internal pediatric head conditions, which has shown that numerous naturally occurring illnesses can affect a child in the manner previously attributed to SBS. My own extensive research was key to the evolution of the science and to discrediting SBS.

According to the National Registry of Exonerations, at least 30 people served years or decades in prison after convictions involving the SBS theory before being exonerated. But the law, in many cases, has not kept up with the science.

Many experts who originally supported the SBS hypothesis, including me, believe we have a duty to help vacate convictions that are based on old and false assumptions. In one case, Robert Roberson, an innocent father, is facing execution in Texas for a crime that never occurred.

This is why, together with 15 other leading physicians and scientists, I signed a friend-of-the-court brief urging the US Supreme Court to review or vacate Roberson’s conviction and death sentence. The high court will review the Roberson petition at its conference on Sept. 26.

In 2002, Roberson’s daughter, Nikki, a chronically ill 2-year-old, had a high fever and undiagnosed pneumonia; she then suffered a short fall out of bed and Roberson brought her to the emergency room.

Unaware that Roberson had autism, hospital staff judged his reaction to his daughter’s dire condition as indicating guilt. A doctor’s preliminary suspicion of SBS led to Roberson’s arrest for murder before Nikki’s autopsy was even performed. He was tried long before the evidence of pneumonia in her lung tissues was ever identified.

As we explained in our brief, when Roberson was tried in 2003, SBS diagnoses were almost always based on the same triad of symptoms observed in Nikki: bleeding over the brain, brain swelling, and bleeding in the eyes.

Unless the child’s parent or caretaker could explain the injuries by recourse to a major trauma like a car accident or fall from a multistory building, the medical consensus was that this triad could only mean that the baby had been shaken hard enough to produce whiplash forces.

When Roberson was tried, we also believed that the child would become immediately unconscious upon the infliction of these injuries. Therefore, it was assumed that whoever was with the child at the time of her collapse must have harmed the child. When the condition resulted in the child’s death, the triad was accepted as proof beyond a reasonable doubt of murder. The medical presumption of child abuse was so strong that defense attorneys, including Roberson’s, did not challenge the SBS theory in those days.

Since Roberson’s trial, my research and research by others have established that the presence of the triad is not presumptive proof of abuse. We now know that many illnesses, like Nikki’s pneumonia, medical disorders, and accidents, including short falls like the one Nikki experienced, can cause the same constellation of symptoms.

In Nikki’s case, the combination of her undiagnosed pneumonia, the medications she was prescribed, and her accidental fall fully explain her condition and death. Although the foundations of SBS have been debunked, parents and caregivers who were wrongfully convicted remain in prison or, in Roberson’s case, even face the prospect of execution.

Notably, A. Norman Guthkelch, a British pediatric neurosurgeon whose 1971 paper first posited the SBS hypothesis, later reviewed a number of cases where defendants claimed their innocence. Guthkelch was struck by the high proportion of cases in which the child had a history of illnesses, indicating their injuries were the result of natural causes, not abuse. In 2015, shortly before his death, Guthkelch told the Washington Post, “I am doing what I can so long as I have a breath to correct a grossly unjust situation.”

Over the last two decades, courts in at least 12 states, including Alaska, Nevada, North Carolina, Ohio, and Wisconsin, have overturned SBA-based convictions or rejected the outdated science.

The Texas courts reviewing Roberson’s case did not follow this trend. Even though the Texas legislature passed a statute to allow courts to revisit flawed convictions based on false or misleading scientific evidence, the courts in Roberson’s case disregarded unrebutted scientific evidence showing that the SBS premises conveyed to his jury as scientific “fact” have since been debunked. The courts also disregarded compelling evidence that Nikki died of natural and accidental causes.

When the lower courts refuse to consider the current state of the science, the Supreme Court must intervene, especially when the life of an innocent man is at stake.

The case is Roberson v. Texas, US, No. 22-7546, (conference scheduled 9/26/23).

This article does not necessarily reflect the opinion of Bloomberg Industry Group, Inc., the publisher of Bloomberg Law and Bloomberg Tax, or its owners.

Author Information

Patrick D. Barnes is professor of radiology, emeritus, in Pediatric Radiology & Neuroradiology at the Lucile Packard Children’s Hospital at Stanford University Medical Center.

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