ebola

Questionable convictions in “shaken baby” cases

Shaken BabyThe term “shaken baby syndrome” (SBS) was developed to explain those instances in which severe intracranial trauma occurred in the absence of signs of external head trauma. SBS is the severe intentional application of violent force (shaking) in one or more episodes, resulting in intracranial injuries to the child. Physical abuse of children by shaking usually is not an isolated event. Many shaken infants show evidence of previous trauma.

Frequently, the shaking has been preceded by other types of abuse.

Mechanism of Injury

The mechanism of injury in SBS is thought to result from a combination of physical factors, including the proportionately large cranial size of infants, the laxity of their neck muscles, and the vulnerability of their intracranial bridging veins, which is due to the fact that the subarachnoid space (the space between the arachnoid membrane and the pia mater, which are the inner two of the three membranes that cover the brain) are somewhat larger in infants. However, the primary factor is the proportionately large size of the adult relative to the child. Shaking by admitted assailants has produced remarkably similar injury patterns:

  • The infant is held by the chest, facing the assailant, and is shaken violently back and forth.
  • The shaking causes the infant’s head to whip forward and backward from the chest to the back.
  • The infant’s chest is compressed, and the arms and legs move about with a whiplash action.
  • At the completion of the assault, the infant may be limp and either not breathing or breathing shallowly.
  • During the assault, the infant’s head may strike a solid object.
  • After the shaking, the infant may be dropped, thrown, or slammed onto a solid surface.
  • The last two events likely explain the many cases of blunt injury, including skull fractures, found in shaken infants. However, although blunt injury may be seen at autopsy in shaken infants, research data suggest that shaking in and of itself is often sufficient to cause serious intracranial injury or death.

 

 

Questionable convictions in “shaken baby” cases?

Deborah Tuerkheimer is a Professor of Law at Northwestern University and the author of “Flawed Convictions: ‘Shaken Baby Syndrome’ and the Inertia of Injustice.” She also appears onSaturday’s “48 Hours” investigation into the case of Melissa Calusinski, a former day care provider who says she is wrongfully convicted in a toddler’s death. Here, Tuerkheimer weighs in on questionable convictions in child death cases. Her opinions do not necessarily reflect those of CBS News.

A few months ago, a 55-year-old Florida day care provider became yet another caregiver accused of shaking a toddler to death. The woman, who had worked with children for decades, denied harming the boy. But pediatricians concluded that this was a case of Shaken Baby Syndrome (SBS).

Even before an autopsy was performed, the state charged the woman with murder. She is being held in jail without bond and if convicted, she faces mandatory life in prison without the possibility of parole.

Based on the press reports, this case resembles many that I have written about in my book, Flawed Convictions: “Shaken Baby Syndrome” and the Inertia of Injustice. Without witnesses or external signs of abuse, the classic diagnosis of Shaken Baby Syndrome rests on three neurological symptoms, otherwise known as the “triad”: bleeding beneath the outermost layer of the brain, retinal bleeding, and brain swelling.

These symptoms are said to prove that a baby was violently shaken and, what’s more, to identify the abuser– whoever was present when the child was last lucid. Shaken Baby Syndrome is, in essence, a medical diagnosis of murder. In order to convict, prosecutors must rely entirely on the claims of science.

But the science has shifted. In recent years, there has been a growing consensus among experts that the neurological symptoms once viewed as conclusive evidence of abuse may well have natural causes, and that old brain injuries can re-bleed upon little or no impact.

In short, current science raises significant questions about the guilt of many caregivers convicted of shaking babies.

Reflecting real movement in the direction of doubt, this past spring, a federal judge in Chicago issued a ruling of “actual innocence” in the case of Jennifer Del Prete, a caregiver accused of shaking a baby in her care. (My book describes this trial in detail.) Del Prete was able to show that, based on what doctors now know about alternative causes of the triad, no reasonable jury could possibly find Del Prete guilty of murder. Indeed, according to the reviewing judge, a lack of evidentiary support for the theory of Shaken Baby Syndrome means that the diagnosis is arguably “more an article of faith than a proposition of science.”

Our legal system has been slow to absorb this new reality. As a consequence, innocent parents and caregivers remain incarcerated and, perhaps more inexplicably, prosecutions based solely on the “triad” symptoms continue even to this day. The cautionary tale of Shaken Baby Syndrome shows that our system is too inclined to stay the course, and awful injustices can result.

Pt 2 The Suicide Plan – Investigating Planned Suicides

SuicideThe assisted suicide movement is, if anything, indefatigable. Not only is it undeterred by its failures, but it is now more energized than any other time in recent years. By the end of March of 2015, bills were introduced in twenty-five state legislatures to legalize assisted suicide.

Defining the Subject

Many people remain confused about the exact nature of assisted suicide advocacy, sometimes confusing it with other medical issues involving end-of-life care. Thus, to fully understand the subject, we must distinguish between ethical choices at the end of life that may lead to death and the poison of euthanasia/assisted suicide.

1.      Refusing unwanted medical treatment is not assisted suicide: Fear of being “hooked up to machines” when one wishes to die at home has traditionally been a driving force behind the assisted suicide movement. But we all have the right to refuse medical interventions—even if the choice is likely to lead to death. Thus, a cancer patient can reject chemotherapy and a patient dying of Lou Gehrig’s disease can say no to a respirator.  Indeed, in 1997, the U.S. Supreme Court ruled unanimously that the right to refuse medical treatment is completely different from assisted suicide.[9]

2.      Assisted suicide/euthanasia is not the same as medical treatment for pain control: Because pain control may require strong drugs, which can cause death, assisted suicide advocates often claim that palliation and euthanasia are ethically the same under the “principle of double effect.” But this is all wrong:

  • Any legitimate medical treatment can unintentionally lead to death, including pain alleviation. In assisted suicide death is the intended effect.
  • We would never say that a patient who died during open heart surgery was euthanized. Similarly, a patient who dies from the unintended side effects of pain control has not been assisted in suicide or euthanized.
  • Pain control experts state that aggressive pain control generally does not shorten life.

3.      Assisted suicide/euthanasia is antithetical to hospice: Hospice was founded by the great medical humanitarian Dame Cicely Saunders in the late 1960s as a reform movement to bring the care of the dying out of isolated hospitals and into patients’ homes or non-institutional local care facilities. Its purpose is to provide dying people with proper treatment of pain and other disturbing symptoms as well as to render spiritual, psychological, and social support toward the end that life be lived as fully as possible until natural death.

In contrast, assisted suicide is about rushing death, making it happen sooner rather than later through lethal actions. Or to put it another way: Hospice is about living. Assisted suicide/euthanasia is about dying. As the noted palliative care expert and assisted suicide opponent Dr. Ira Byock has written, “There’s a distinction between alleviating suffering and eliminating the sufferer — between enabling someone to die gently of their disease and ending that person’s life with a lethal pill or injection.”

4.      Assisted suicide/euthanasia are acts that intentionally end life: In contrast to the above, the intended purpose of assisted suicide and euthanasia is to end life, e.g., to kill. In assisted suicide, the last act causing death is taken by the person who dies, for example, ingesting a lethal prescription of barbiturates. In euthanasia, the death is a homicide, an act of killing taken by a third person, such as a doctor injecting a patient with poisonous drugs.

From an Investigators Standpoint 

With the above statements we can see that the topic of assisted suicide is at best conversional.  As a death investigator, our job is simple; to report the facts and the facts only.  However, it is well understood that our own emotions and bias on the topic can and will play a role in how we approached these scenes. The investigators must guard against allowing these personal feelings to interfere with the proper reporting and interpretation of  the scene.

Conversation with Prosecuting Attorney 

It is  a good suggestion to have a conversation with your  prosecuting attorney and a review of your agency policy to see how best to proceed in these cases. You should always report all facts in the case, but having a better understanding of how you are expected to proceed may well help in your overall review of the case.

With Family

No matter what decision  your Prosecuting Attorney goes, some members of the deceased family will invariably not agree with the decision.  This is why it best to do a proper and complete investigation, report all and only, the facts – and let those responsible for making these critical decision do their job. You, as the investigator , can rest in the knowledge that you have done your job and can properly explain to the family exactly what took place and why decision  are made based upon these facts.  Many family members may still not agree with the outcome, but it is much better for them to have the facts than them come up with their own set of “facts’ as they see it.

Anita Brook-corner talk-secondary stressAnita Brooks    anitabrooks.com

Dr. Judy Melinek – Working Stiff

Melinek-Slide_0A   forensic pathologist can not work in a vacuum, they must have critical information gathered at the scene by qualified investigators. It is only with this information and the results of the autopsy that a ruling can be made.  It is often that a ruling will be delayed, or no determination made at all, without this information and investigation by the medicolegal investigators.

In this episode I talk with Dr. Judy Melinek, and forensic pathologist working with the Alameda County Coroners Office and and private consultant at  Pathology Expert .com.   We discuss what investigators need to provide to a pathologist to help in the determination of cause and manner of death.  We also discuss her role in the 9/11 attacks as she was working in New York City at the time and witnessed the first plane hit.

Dr. Melinek, along with her husband TJ – wrote the book Working Stiff that chronicle her first two years as a forensic pathologist  and her work in New York City Medical Examiners Office during the 9/11 attacks.

 

Working-stiffThe fearless memoir of a young forensic pathologist’s “rookie season” as a NYC medical examiner, and the cases—hair-raising and heartbreaking and impossibly complex—that shaped her as both a physician and a mother.

Just two months before the September 11 terrorist attacks, Dr. Judy Melinek began her training as a New York City forensic pathologist. With her husband T.J. and their toddler Daniel holding down the home front, Judy threw herself into the fascinating world of death investigation—performing autopsies, investigating death scenes, counseling grieving relatives. Working Stiff chronicles Judy’s two years of training, taking readers behind the police tape of some of the most harrowing deaths in the Big Apple, including a firsthand account of the events of September 11, the subsequent anthrax bio-terrorism attack, and the disastrous crash of American Airlines flight 587.

Lively, action-packed, and loaded with mordant wit, Working Stiff offers a firsthand account of daily life in one of America’s most arduous professions, and the unexpected challenges of shuttling between the domains of the living and the dead. The body never lies—and through the murders, accidents, and suicides that land on her table, Dr. Melinek lays bare the truth behind the glamorized depictions of autopsy work on shows like CSI and Law & Order to reveal the secret story of the real morgue.

About the Authors

tj-mitchell-dr-judy-melinekJudy Melinek, M.D. is a graduate of Harvard University. She trained at UCLA in medicine and pathology, graduating in 1996. Her training at the Office of the Chief Medical Examiner in New York is the subject of her memoir, Working Stiff, which she co-wrote with her husband. Currently, Dr. Melinek is an Associate Clinical Professor at UCSF, and works as a forensic pathologist in Oakland. She also travels nationally and internationally to lecture on anatomic and forensic pathology and she has been consulted as a forensic expert in many high-profile legal cases, as well as for the television shows E.R. and Mythbusters.

T.J. Mitchell, her husband, graduated with an English degree from Harvard and has worked as a screenwriter’s assistant and script editor since 1991. He is a writer and stay-at-home Dad raising their three children in San Francisco. Working Stiff is his first book.

Money Plan S.O.S | Financial Coaching

Money Plan sosWe all, at times,  need to take a step back and look at our personal lives.  We are always in the mix of other people’s mess and we often neglect our own.  As public servants none of us are paid what would be considered an amazing wage. However, we can take steps to live better, live smarter, and plan for tomorrow.  In this episode I talk with Steve Stewart of Money Plan S.O.S. We talk about how to come out of financial crisis mode and into a secure financial state free from fear and worry and how Financial Coaching   can help you too.

Steve Stewart is a financial coach and podcaster and can be found at the links below.  I invite you to check out his show – subscribe to his podcast and leave a review after three shows.  His down to earth advice and information is invaluable to our financial  success.  Steve’s website has tons of resources and information free to download and use.  You can find more about Money Plan SOS and Steve Stewart at:

 

http://moneyplansos.com

Podcast Link 

Death Notifications | CT14

death notificationDeath notification is acknowledged to be one of the most difficult tasks faced by law enforcement officers and other professionals, because learning of the death of a loved one often is the most traumatic event in a person’s life. The moment of notification is one that most people remember very vividly for the rest of their life — sometimes with pain and anger.

Basic Death Notification Procedures

These are some of the cardinal principles of death notification. Some of the points overlap, and all will be refined by the notifier’s experience and judgment.

“In Person”

  • Always make death notification in person — not by telephone.
  • It is very important to provide the survivor with a human presence or “presence of compassion” during an extremely stressful time. Notifiers who are present can help if the survivor has a dangerous shock reaction — which is not at all       uncommon — and they can help the survivor move through this most difficult moment.
  • Arrange notification in person even if the survivor lives far away.
  • Contact a medical examiner or law enforcement department in the survivor’s home area to deliver the notification in person.
  • Never take death information over the police radio.
  • Get the information over the telephone, or it might leak out to family through the media or private parties listening to police radio. If radio dispatchers start to give information over the radio, stop them and call in.

“In Time” — and with certainty

  • Provide notification as soon as possible — but be absolutely sure, first, that there is positive identification of the victim. Notify next of kin and others who live in the same household, including roommates and unmarried partners.
  • Too many survivors are devastated by learning of the death of a loved one from the media. Mistaken death notifications also have caused enormous trauma.
  • Before the notification, move quickly to gather information.
  • Be sure of the victim’s identity. Determine the deceased person’s next of kin and gather critical information — obtain as much detail as possible about the circumstances of the death, about health considerations concerning the survivors to be notified, and whether other people are likely to be present at the notification.

“In Pairs”

  • Always try to have two people present to make the notification.
  • Ideally, the persons would be a law enforcement officer, in uniform, and the medical examiner or other civilian such as a chaplain, victim service counselor, family doctor, clergy person, or close friend. A female/male team often is advantageous.
  • lt is important to have two notifiers. Survivors may experience severe emotional or physical reactions. (Some even strike out at notifiers.) There may be several survivors present. Notifiers can also support one another before and after the notification.
  • Take separate vehicles if possible.
  • The team never knows what they will encounter at the location. One might need to take a survivor in shock to a hospital while the other remains with others.
  • (Shock is a medical emergency.) One notifier may be able to stay longer to help contact other family or friends for support. Having two vehicles gives notifiers maximum flexibility.
  • Plan the notification procedure.
  • Before they arrive, the notifier team should decide who will speak, what will be said, how much can be said.

“In Plain Language”

  • Notifiers should clearly identify themselves, present their credentials and ask to come in.
  • Do not make the notification at the doorstep. Ask to move inside, and get the survivor seated in the privacy of the home. Be sure you are speaking to the right person. You may offer to tell children separately if that is desired by adult survivors.
  • Relate the message directly and in plain language.
  • Survivors usually are served best by telling them directly what happened. The presence of the team already has alerted them of a problem.
  • Inform the survivor of the death, speaking slowly and carefully giving any details that are available. Then, calmly answer any questions the survivor may have.

Begin by saying, “I have some very bad news to tell you,” or a similar statement. This gives the survivor an important moment to prepare for the shock.

Then, avoid vague expressions such as “Sally was lost” or “passed away.” Examples of plain language include: “Your daughter was in a car crash and she was killed.” “Your husband was shot today and he died.” “Your father had a heart

attack at his work place and he died.”

Call the victim by name — rather than “the body.”

Patiently answer any questions about the cause of death, the location of the deceased’s body, how the deceased’s body will be released and transported to a funeral home, and whether an autopsy will be performed. If you don’t know the answer to a question, don’t be afraid to say so. Offer to get back to the survivor when more information is available, and be sure to follow through.

There are few consoling words that survivors find helpful — but it is always appropriate to say, “I am sorry this happened.”

“With Compassion”

  • Remember: Your presence and compassion are the most important resources you bring to death notification.
  • Accept the survivor’s emotions and your own. It is better to let a tear fall than to appear cold and unfeeling. Never try to “talk survivors out of their grief” or offer false hope. Be careful not to impose your own religious beliefs.
  • Many survivors have reported later that statements like these were not helpful to them: “It was God’s will,” “She led a full life,” and “I understand what you are going through” (unless the notifier indeed had a similar experience.)
  • Plan to take time to provide information, support, and direction. Never simply notify and leave.
  • Do not take a victim’s personal items with you at the time of notification.
  • Survivors often need time, even days, before accepting the victim’s belongings. Eventually, survivors will want all items, however. (A victim’s belongings should never be delivered in a trash bag.) Tell survivors how to recover items if they are in the custody of law enforcement officials.
  • Give survivors helpful guidance and direction
  • Survivors bear the burden of inevitable responsibilities. You can help them begin to move through the mourning and grieving process by providing immediate direction in dealing with the death.
  • Offer to call a friend or family member who will come to support the survivor — and stay until the support person arrives.
  • Offer to help contact others who must be notified (until a support person arrives to help with this duty.)
  • Survivors may have a hard time remembering what is done and said, so write down for them the names of all who are contacted.
  • Inform the survivor of any chance to view the deceased’s body.
  • Be available to transport the survivor or representative for identification of the victim, if necessary. Explain the condition of the deceased’s body and any restrictions on contact that may apply if there are forensic concerns. If appropriate, explain that an autopsy will be done.
  • Viewing the deceased’s body should be the survivor’s choice. Providing accurate information in advance will help a survivor make that decision. Some survivors will choose to see the body immediately, and this should be allowed if possible.
  • (Denying access to see the body is not an act of kindness.)
    Provide other specific information. Take a copy of the “Community Resource Information”
  • form, fill it out, and leave it with the survivor. [See copy of form at end of this booklet.] Fill out and keep the “Survivor Intake Form.” [See copy of form at end of this booklet.]
  • This form records basic information about survivors and their wishes. Complete the form, sign it, and keep it with the report or investigation file.

Follow up.

  • Always leave a name and phone number with survivors.
    Plan to make a follow-up contact with the survivor the next day.
  • If the death occurred in another county or state, leave the name and phone number of a contact person at that location.
  • Most survivors are confused and some might feel abandoned after the initial notification. Many will want clarifications or may need more direction on arrangements that are necessary.
  • Following up can be the last step in completing a “person-centered” and sensitive death notification that is truly helpful to survivors.
  • The notification team should be sure they are clear on any follow-up assignments they need to carry out. (See also the discussion of “debriefing” notifiers, on page 8.)
  • Death Notification in the Work Place
  • Survivors often must be notified at their work place. Here are several tips to help apply the basic principles described above to a work place notification.
  • Ask to speak to the manager or supervisor, and ask if the person to be notified is available. It is not necessary to divulge any details regarding the purpose of your visit.
  • Ask the manager or supervisor to arrange for a private room in which to make the notification.
  • Follow the basic notification procedures described above: in person, in time, in pairs, in plain language, with compassion.
  • Allow the survivor time to react and offer your support.
  • Transport the survivor to his or her home, or to identify the body, if necessary.
  • Let the survivor determine what he or she wishes to tell the manager or supervisor regarding the death. Offer to notify the supervisor, if that is what the survivor prefers.
 Special Credit for this show given to:

‘In Person, In Time”

Recommended Procedures for Death Notification

The principles of death notification: In person

in time,
in pairs,
in plain language,
and with compassion.

Dr.Thomas L. Bennett, State Medical Examiner, the Iowa Organization for Victim Assistance (IOVA), MADD/Polk County Chapter, and

Polk County Victim Services

Crime Victim Assistance Division Iowa Department of Justice

Bonnie J. Campbell Attorney General of Iowa

Blood Pattern – Bare Bones Forensics| CT13

Karen SmithKaren L. Smith earned her undergraduate degree in Criminal Justice from the University of North Florida (Magna Cum Laude) and her Master’s Degree in Pharmacy with a concentration in Forensic Science from the University of Florida.

Karen spent nearly 14 years as a police officer and detective at the Jacksonville Sheriff’s Office in Florida. She served as both a major case detective for nearly 11 years and as training coordinator for 3 years, conducting nearly 500 death investigations and 20,000 cases during her term with JSO. She designed and instructed courses in all aspects of crime scene field work including basic crime scene response, casting techniques, latent print development and recovery, bloodstain pattern analysis, alternate light source applications, laser trajectory reconstruction, chemical blood enhancement, photography, laser mapping techniques and scientific methodology.
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Ebola-Guidance for Handling Human Remains | CT11

ebolaThese recommendations give guidance on the safe handling of human remains that may contain Ebola virus and are for use by personnel who perform postmortem care in U.S. hospitals and mortuaries. In patients who die of Ebola virus infection, virus can be detected throughout the body. Ebola virus can be transmitted in postmortem care settings by laceration and puncture with contaminated instruments used during postmortem care, through direct handling of human remains without appropriate personal protective equipment, and through splashes of blood or other body fluids (e.g. urine, saliva, feces) to unprotected mucosa (e.g., eyes, nose, or mouth) which occur during postmortem care.

  • Only personnel trained in handling infected human remains, and wearing PPE, should touch, or move, any Ebola-infected remains.
  • Handling of human remains should be kept to a minimum.
  • Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.

 

Important Links

http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html

http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf