Pediatric Forensic Pathology Expert Witness: Infant death at daycare

FOCUS

Infant death at daycare: SIDS or strangulation?  A case requiring PEDIATRIC FORENSIC PATHOLOGY expert witness review.

BACKGROUND

Sudden Infant Death Syndrome (SIDS) is a leading cause of death in infants aged less than 1 year. There is little know about the cause of SIDS, though it does frequently occur when the infant is sleeping. In an autopsy, the cause of death is only identified to be SIDS when all other possible diagnoses are ruled out using medical history, history of accidents, abuse, or neglect, and any previously undiagnosed conditions.

CASE

A 6-month old girl is taken to a daycare center where she is left unobserved for a period of time, whereupon she was found to be apneic. Despite full resuscitative efforts, she was pronounced dead. The autopsy identified Tardieu’s spots, an observation found in tissues of persons who have been strangled, or otherwise asphyxiated. The cause of death was listed as “Unexpected Infant Death” (SIDS). The family of the child alleges neglect against the daycare center.

ELITE’S ROLE

ELITE’s physician-led team was asked to secure a top-tier PEDIATRIC FORENSIC PATHOLOGIST expert witness to independently review the case and to determine if the objective data supports death due to neglect, rather than SIDS.

THE MEDICAL EXPERTS

ELITE MEDICAL EXPERTS secured a top-tier professor of PEDIATRIC FORENSIC PATHOLOGY at a major east coast US medical school with experience identifying SIDS and negligent death, having both extensively researched and published on the topic, as well as serving as a medical expert witness in prior cases regarding SIDS.

OUTCOME

The PEDIATRIC FORENSIC PATHOLOGIST expert witness opined that the autopsy and objective findings supported the plaintiff’s theory, necessitating a further investigation into the specific events at the daycare surrounding the infants death.

E-CASE STUDIES are brief clinical vignettes based upon actual cases handled by ELITE. Identifying information has been redacted or altered to protect case confidentiality.

Child Abuse Pediatrics Experts

Child abuse pediatrics is a specialty devoted to the issues involved in alleged child abuse. Expert witnesses in this specialty may report and testify regarding non-accidental trauma, shaken baby syndrome, fatal neglect, as well as other criminal cases involving injured infants and children. To better understand how medical experts define reasonable medical certainty in the context of these cases, Dr. Mark S. Dias, Professor of Neurosurgery and Pediatrics, along with investigators at Penn State Hershey Medical Center and Penn State Dickinson School of Law, surveyed medical specialists who testify in cases of suspected abusive head trauma. The results are described in The Penn State Journal Child Abuse and Neglect article, Better definition needed for reasonable medical certainty in child abuse cases.

Physicians use different definitions of “reasonable medical certainty” when testifying as expert witnesses in child abuse cases. The variability is troubling because it could result in flawed rulings, according to researchers at Penn State College of Medicine.

In court cases involving alleged child abuse, expert medical witnesses are asked to testify if abuse has occurred and when. Attorneys commonly ask expert witnesses to express their opinions in terms of reasonable medical certainty. However, there is no clear legal definition for the term.

In many cases, the threshold of probability that constitutes reasonable medical certainty is left to the discretion of the experts. And despite the court’s reliance on this opinion in reaching a verdict, experts are seldom asked to share this probability with the court during their testimony.

Other investigators on this project were Susan Boehmer, Department of Public Health Sciences, Penn State College of Medicine; Lucy Johnston-Walsh, Penn State Dickinson School of Law; and Dr. Benjamin H. Levi, Department of Pediatrics, Penn State Hershey Medical Center and Department of Humanities, Penn State College of Medicine. Read more at EurekAlert.org.