getting through what you can’t get over

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

The Suicide Plan – Investigating Planned Suicides Pt1

SuicideThe Centers for Disease Control and Prevention (CDC) collects data about mortality in the U.S., including deaths by suicide. In 2013 (the most recent year for which full data are available), 41,149 suicides were reported, making suicide the 10th leading cause of death for Americans. In that year, someone in the country died by suicide every 12.8 minutes.   With those totals, we are all bound to be involved in investigating suicides.  Suicides can be acute, meaning short term or spur of the moment final decision, or a well planned and risk assessed  action.  In this episode of Coroner Talk™ we are going to look at the pros, if there be any, and the cons of planned suicide.

Featured in this weeks show is a PBS production of  Frontline that deals with the topic of a well planned suicide and the legal and moral implication that accompany such a decision.  Regardless of where you stand on the topic, this episode will start you thinking of the other side.

The Assisted Suicide Debate

Since Oregon legalized physician-assisted suicide for the terminally ill in 1997, more than 700 people have taken their lives with prescribed medication — including Brittany Maynard, a 29-year-old with an incurable brain tumor, who ended her life earlier this month.

Advocates of assisted-suicide laws believe that mentally competent people who are suffering and have no chance of long-term survival, should have the right to die if and when they choose. If people are have the right to refuse life-saving treatments, they argue, they should also have the freedom to choose to end their own lives.

Opponents say that such laws devalue human life. Medical prognoses are often inaccurate, they note — meaning people who have been told they will soon die sometimes live for many months or even years longer. They also argue that seriously ill people often suffer from undiagnosed depression or other mental illnesses that can impair their ability to make an informed decision.

At the latest event from Intelligence Squared U.S., two teams addressed these questions while debating the motion, “Legalize Assisted Suicide.”

Before the debate, the audience at the Kaufman Music Center in New York was 65 percent in favor of the motion and 10 percent against, with 25 percent undecided. After the debate, 67 percent favored the motion, with 22 percent against, making the team arguing against the motion the winner of this debate.

http://www.npr.org/2014/11/20/365509889/debate-should-physician-assisted-suicide-be-legal

The Suicide Plan – Investigating Planned Suicide

Investigators are offered a hard road when it comes to investigating a planned suicide when it is found that family or friends may have assisted in some manner, regardless of the extent of the that assistance.  Even providing a cool drink of water to wash down the pills that will end life can be enough in some states to charge a person with assistance.  But where, as investigators, do we stand on the issue.  Some investigators are only providing cause and manner of death determinations, which can be clouded by the assistance issue. While other investigators are charged with the task  of deciding the criminal aspect of the assistance rendered.

In part two of this issue we will take a deep dive into the debate that will most assuredly muddy up the waters a bit.  That is next episode on Coroner Talk™..

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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.

Workplace Bullying

workplace_bullying

 

Workplace Bullying is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct that is :

This definition was used in the 2014 WBI U.S. Workplace Bullying Survey. Its national prevalence was assessed. Read the Survey results.

Workplace Bullying…

  • Is driven by perpetrators’ need to control the targeted individual(s).
  • Is initiated by bullies who choose their targets, timing, location, and methods.
  • Is a set of acts of commission (doing things to others) or omission (withholding resources from others)
  • Requires consequences for the targeted individual
  • Escalates to involve others who side with the bully, either voluntarily or through coercion.
  • Undermines legitimate business interests when bullies’ personal agendas take precedence over work itself.
  • Is akin to domestic violence at work, where the abuser is on the payroll.

Please know two things:

Bullying is a systematic campaign of interpersonal destruction that jeopardizes your health, your career, the job you once loved. Bullying is a non-physical, non-homicidal form of violence and, because it is violence and abusive, emotional harm frequently results. You may not be the first person to have noticed that you were bullied. Check to see how many of these indicators match yours.

Remember, you did not cause bullying to happen. We’ve broken down the major reasons why bullies bully. The primary reason bullying occurs so frequently in workplaces is that bullying is not yet illegal. Bullying is four times more common than either sexual harassment or racial discrimination on the job.

Should you confront the bully? If you could have, you would have. Instead, use the WBI-suggested 3-Step Method. Remember, put your health first. Don’t believe the lies told about you. Spend time with loved ones and friends. At times of debilitating stress like this, you must not be isolated. Isolation will only make the stress worse.

As we said, to date, no U.S. state has passed an anti-bullying law for the workplace.

* This article is a re-print if excerpts from  Workplace Bullying Institute   To read full article and see many more resources click over to there site.Anita Brook-corner talk-secondary stress

Todays guest is Anita Brooks  of anitabrooks.com 

 


anita brooks asphyxia aurora auto-erotic auto-erotica batmanburnout child abuse colorado Colorado Coroners communication compassion  compassion fatigue corone rcrime scene crime scene photography csidarren dake death death investigation denver deputy detective ebola emergency care field fire firefighterfire fighter fire fighter training  getting through what you can’t get overmedical examiner murderparamedic  police police training PTSD scene command sheriffshooting sids suicidesymptoms of compassion fatiguetheater trauma victims who is at risk for compassion fatigue

Blood Pattern Analysis

Blood_SpatterBecause blood behaves according to certain scientific principles, trained bloodstain pattern analysts can examine the blood evidence left behind and draw conclusions as to how the blood may have been shed. From what may appear to be a random distribution of bloodstains at a crime scene, analysts can categorize the stains by gathering information from spatter patterns, transfers, voids and other marks that assist investigators in recreating the sequence of events that occurred after bloodshed. This form of physical evidence requires the analyst to recognize and interpret patterns to determine how those patterns were created.

Bloodstain pattern analysis (BPA) is the interpretation of bloodstains at a crime scene in order to recreate the actions that caused the bloodshed. Analysts examine the size, shape, distribution and location of the bloodstains to form opinions about what did or did not happen.

BPA uses principles of biology (behavior of blood), physics (cohesion, capillary action and velocity) and mathematics (geometry, distance, and angle) to assist investigators in answering questions such as:

  • Where did the blood come from?
  • What caused the wounds?
  • From what direction was the victim wounded?
  • How were the victim(s) and perpetrator(s) positioned?
  • What movements were made after the bloodshed?
  • How many potential perpetrators were present?
  • Does the bloodstain evidence support or refute witness statements?

Why and when is bloodstain pattern analysis used?

Bloodstain evidence is most often associated with violent acts such as assault, homicide, abduction, suicide or even vehicular accidents. Analyzing the size, shape, distribution, overall appearance and location of bloodstains at a crime scene helps investigators by answering basic questions including:

  • What occurred?
  • Where did the events occur?
  • Approximately when and in what sequence?
  • Who was there? Where were they in relation to each other?
  • What did not occur?

    One of the most important functions of bloodstain pattern analysis is to support or corroborate witness statements and laboratory and post-mortem findings. For example, if the medical examiner determines the cause of death is blunt force trauma to the victim’s head, the pattern and volume of blood spatter should be consistent with a blunt instrument striking the victim one or more times on the head. Conversely, if the spatter resembles that seen in expirated blood spray, the analyst will check the medical examiner or pathologist reports for injuries that can cause the presence of blood in the nose, throat or respiratory system of the victim. If blood is not reported in these locations, the analyst may be able to exclude expiration as the possible cause of that spatter pattern..

READ MORE AND GET YOU FREE EBOOK DOWNLOAD

Free eBook –  Download here: 

A Simplified Guide To Bloodstain Pattern Analysis

 

 

 

Practical Cultural Guidelines For Death Investigators

globe [Converted]Culture includes the beliefs, customs, and arts of a particular society, group, or place. How people respond to issues of death or dying is directly related to their cultural backgrounds. Anyone who works with families should be sensitive to their culture, ethnic, religious, and language diversity.

10 Practical Guidelines

  1. » Allow families to grieve the loss of their loved one in their customary ways.
  2. » Recognize that grief and loss may be expressed differently across cultures.
  3. » Use an interpreter when necessary to avoid miscommunication.
  4. » Identify important ethnic or faith leaders in the community and ask them about what support is available for families.
  5. » Avoid personal contact such as hugging or touching unless invited.
  6. » Carefully consider the words you use when speaking with family members about their loss.
  7. » Respond to family requests in a respectful and sensitive manner.
  8. » Avoid answering questions such as “why?”
  9. » Be conscious of the volume of your voice.
  10. » If you are entering a home, be conscious of your shoes.

 

Full Downloadable Guideline

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Secondary Traumatic Stress – Getting Through What You Can’t Get Over

Anita Brook-corner talk-secondary stressSecondary Traumatic Stress (STS), also known as Compassion Fatigue , is a condition characterized by a gradual lessening of compassion over time. It is common among individuals that work directly with trauma victims such as coroners, police, nurses, psychologists, and first responders.  Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt. This self-doubt can cause problems at work and home, and over time will effect all relationships.

Several personal attributes place a person at risk for developing compassion fatigue. Persons who are overly conscientious, perfectionists, and self-giving are more likely to suffer from secondary traumatic stress. Those who have low levels of social support or high levels of stress in personal life or job are also more likely to develop STS. In addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, increase the risk for developing STS.

Many organizational attributes in the fields where STS is most common, such as the healthcare field and death investigators, contribute to compassion fatigue among the workers. For example, a “culture of silence” where stressful events such as deaths in an intensive-care unit are not discussed after the event is linked to compassion fatigue. Lack of awareness of symptoms and poor training in the risks associated with high-stress jobs can also contribute to high rates of STS.

There are no known clinical treatment options for compassion trauma, but there are a number of recommended preventative measures

Personal self-care

Stress reduction practices have been shown to be effective in preventing and treating STS. Taking a break from work, participating in breathing exercises, exercising, and other recreational activities all help reduce the stress associated with STS. In addition, establishing clear, professional boundaries and accepting the fact that successful outcomes are not always achievable can limit the effects of STS.

Social self-care

Social support can help practitioners maintain a balance in their worldview. Maintaining a diverse network of social support, from colleagues to pets, promotes a positive psychological state and can protect against STS.

 


 

Screen Shot 2014-07-18 at 7.49.33Many thanks to  Anita Agers-Brooks  for her contribution  to our community and her research on this topic.  You can find more about Anita from the link in her name.  Her knew book can be found on Amazon.  

 

 

 

 

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 

Sandbox Wars – End of Life Battles

Stephanie PayneStephanie Payne, author of The Sandbox Wars, talks about the battles that can occur when end of life planning is not completed. As Coroners, Medical Examiners, and death investigators we can be faced with families unprepared for a death of a loved one.  You may also be faced with the “long lost” family member that suddenly appears and wants to control the investigation and the family.    

For thirty years Stephanie Payne has been a practicing RN with special interest in Home Health and Hospice.  Her education is varied and diverse:  St. Louis Community College, Webster University and Landmark Education.  As a talented artist Stephanie has stretched her skills by writing about her passion: Helping people.  Next Stephanie Payne and Michael Keune have produced a documentary:   Legacy Decisions.  Stephanie has been presenting this for radio, Senior Groups, Community Organizations, Business Forums, Attorneys and Financial Planners. 

The Sandbox Wars

End of Life Decisions The Most Important Gift to Your Family

Learn about the end of your life with real life stories about how families behave during your last days.  There is a solution to our lives and The Sandbox Wars address some of the most important aspects of achieving a successful resolution to a life well lived.  There is wonderful artwork in the book by Chuck Ridler which adds humor and character to the stories.  Leland’s Road song, Whispers in My Ear, augments the experience of the book.

Visit www.TheSandBoxWars.com to listen to the music and enjoy more stories by Stephanie Payne.