Reporting Highlights
- Wrongful Accusations: Mother and father are being charged with abusive head trauma, a more recent title for shaken child syndrome, as mounting exonerations and new science elevate questions in regards to the prognosis.
- Findings of Abuse: Youngster abuse pediatricians defend their diagnostic course of, saying they do rigorous examinations to rule out different prospects earlier than they make a dedication of abuse.
- Mother and father Left Weak: Critics argue that the title change helped protect a flawed prognosis, leaving mother and father weak to felony fees and baby welfare investigations.
These highlights have been written by the reporters and editors who labored on this story.
On the 911 name, Nick Flannery’s voice was frantic as he tried to revive his toddler son. “Come on, buddy,” he pleaded with the 2-month-old, who had gone limp. “Come on, buddy. Breathe.”
Nick, who was on paternity depart from his IT job, had been caring for his two boys whereas his spouse, Felecia, was at a health care provider’s appointment. Not lengthy earlier than he known as 911, on Sept. 7, 2023, his child, Arlo, vomited whereas being given a bottle. Nick, who was cradling him, turned him over to make sure that he didn’t choke, then modified him into recent garments and put him in his bouncy seat. Immediately, Arlo’s eyes rolled again and his physique stiffened. Then he went nonetheless.
Paramedics rushed to the Flannerys’ home in Blue Ash, Ohio, a suburb of Cincinnati. They revived the toddler, however his respiration remained shallow. Felecia, who returned house to seek out emergency medical employees swarming her driveway, staggered throughout the entrance yard towards her household, uncomprehending.
Within the emergency room at Cincinnati Kids’s Hospital Medical Middle, the Flannerys appeared on as docs labored to save lots of their son. Quickly, a social employee took them apart. She defined {that a} CT scan revealed the presence of subdural hematomas, or bleeding between the mind and the cranium: a symptom, she mentioned, generally seen in abuse instances. Nick and Felecia have been dumbfounded.
Extra checks nonetheless wanted to be run, she informed the Flannerys, however necessary reporting legal guidelines required that the police and baby welfare officers be alerted. Nick and Felecia, upset however sure that any issues can be allayed as soon as docs gathered extra info, mentioned they understood.
Detectives arrived, and the attending doctor informed them that subdural hematomas may point out an underlying medical situation — or that the newborn had been shaken. It was the latter state of affairs that Felecia remembers the physician mentioning to her that night. “I’ll always remember him telling me, ‘You’ll in all probability know this as shaken child syndrome,’” she says. Felecia, having as soon as listened to a podcast that characterised the prognosis as controversial, grew alarmed.
No outward indicators instructed Arlo had endured hurt. (Arlo is a nickname his mother and father requested that I take advantage of to guard his privateness.) He had no bruises, scratches or cuts. No exterior proof of head trauma, like a scalp harm or a cranium fracture. No damaged bones. No signs of neglect or malnutrition. Nick and Felecia have been his sole caregivers, and neither of them had any prior interplay with baby protecting providers or a felony historical past.
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The following day, as they sat at their son’s bedside within the pediatric ICU, they have been visited by two docs with the hospital’s baby abuse workforce. Dr. Steven Pham, who was midway by way of a three-year fellowship in childhood pediatrics, and Dr. Pratima Shanbhag, a baby abuse pediatrician, every examined Arlo. Youngster abuse pediatrics is a comparatively new subspecialty whose practitioners work carefully with cops and social employees to research potential instances of intentional hurt. These physicians are entrusted with a profound duty: deciding whether or not a baby’s signs point out abuse or are resulting from an unrelated medical situation. Their findings usually decide whether or not mother and father face felony fees and whether or not youngsters are separated from their households.
Pham requested the Flannerys whether or not something had occurred to their son — a fall? a automotive accident? — which may account for the bleeding on his mind. Extra checks nonetheless wanted to be carried out, he mentioned, however the absence of any affordable rationalization for Arlo’s signs instructed that the toddler had suffered abusive head trauma.
Pham was utilizing the time period that the American Academy of Pediatrics has beneficial physicians make use of since 2009 as an alternative of “shaken child syndrome.” That 12 months, the AAP endorsed using the extra complete time period “abusive head trauma” to explain not solely mind, cranium and spinal accidents that end result from shaking but in addition these ensuing from blunt impression or a mix of the 2.
The title change got here amid controversy over whether or not shaken child syndrome’s signature signs — mind swelling and bleeding across the mind and from the retina — have been at all times proof of abuse. As soon as believed to be proof of shaking, the signs had by then been proven to produce other causes, together with unintended falls, sickness, an infection and congenital issues. The courts took discover, and in 2008, a Wisconsin appeals court docket held that “a shift in mainstream medical opinion” raised questions in regards to the prognosis’s core assumptions.
It was within the wake of the Wisconsin resolution that the AAP’s Committee on Youngster Abuse and Neglect, a small group of kid abuse specialists, spearheaded the title change. The committee’s work got here at a time when confidence was eroding in a prognosis that the kid safety neighborhood noticed as important to safeguarding youngsters. The brand new title, abusive head trauma, was not solely extra exact, in line with its 2009 consensus assertion on the matter, it might additionally shore up credibility within the courts. “Authorized challenges to the time period ‘shaken child syndrome’ can distract from the extra vital questions of accountability of the perpetrator and the security of the sufferer,” the assertion learn.
Fifteen years later, the prognosis remains to be shaping felony prosecutions and baby welfare investigations. Youngster abuse pediatricians say they do rigorous workups to rule out the chances of each pure and unintended causes earlier than they choose the prognosis. However docs — and the police, prosecutors and judges who look to them for steerage — don’t at all times get it proper. Thirty-five folks whose convictions rested on the prognosis are at present listed on the Nationwide Registry of Exonerations. Not but counted is Joshua Burns, whose wrongful conviction was vacated by a Michigan court docket in November.
This 12 months, convictions that hinged on the prognosis have been overturned in California, Minnesota and Kentucky. In Texas, doubts in regards to the guilt of a dying row inmate, Robert Roberson, galvanized a bipartisan group of lawmakers to name for a wholesale reappraisal of the proof; the authorized battle that adopted succeeded in suspending his scheduled execution in October. In the same case in Arkansas, one other father, Cody Webb, was acquitted of capital homicide. Some judges, in the meantime, have began wanting on the prognosis with extra skepticism. Final 12 months, a New Jersey appellate court docket backed a lower-court choose who pronounced the prognosis “akin to junk science.”
That stress — between baby abuse pediatricians who stand by their potential to establish abuse from telltale signs and a mounting variety of felony instances that time to the fallability of the prognosis — leaves households just like the Flannerys weak. “The rebranding of shaken child syndrome preserved the prognosis and allowed it to dwell on with much less scrutiny,” says Randy Papetti, an Arizona trial lawyer and writer of the 2018 guide “The Forensic Unreliability of the Shaken Child Syndrome.” “Shaken child syndrome is alive and nicely however principally operates beneath an alias.”
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Anne Vetter
Nick and Felecia had been collectively ever since they have been juniors in highschool in Troy, Ohio — he, earnest and mild-mannered, with chunky black glasses that channeled Buddy Holly; she, heat and unguarded, with a mane of pink hair. They have been strivers, intent on muscling their manner out of what Nick known as “the underside finish of the decrease center class.” He enlisted within the Military to pay for faculty, serving a fight deployment to Afghanistan, and Felecia labored her manner into administration at a nationwide retail chain. They have been intentional about beginning a household, ready till they have been financially safe sufficient, of their late 20s, for Felecia to remain at house once they had their first baby, Arlo’s older brother, in 2021. They constructed a home in college district, with room for a giant household, and painted it a cheerful lavender.
The Flannerys didn’t rent a lawyer when the specter of abuse was first raised by docs. They remained singularly targeted on their toddler son, who lay intubated within the pediatric ICU, his tiny physique dwarfed by medical equipment. Earlier than his hospitalization, that they had informed his pediatrician how he slept a lot that Felecia usually needed to wake him for feedings, however their pediatrician had not been overly involved; Arlo was assembly all his milestones and seemed to be thriving. Three days after he arrived on the hospital, he underwent surgical procedure to alleviate the surplus fluid that had been increase inside his head. Nick and Felecia have been relieved to see that he step by step improved with every day that adopted.
In a report that Pham forwarded to the Blue Ash Police Division every week after the operation, he wrote that Arlo’s signs — which a current examination had proven included retinal hemorrhages — raised a “concern” for abusive head trauma. Additional testing, he famous, had not turned up any proof of a genetic situation or a bleeding dysfunction that might clarify his signs. Although it was not a definitive prognosis, it was sufficient to set in movement a series of occasions that will upend the Flannerys’ lives.
Two days later, on Sept. 20, 2023, a social employee got here to their house to tell them that Hamilton County Job and Household Providers, which oversees baby protecting providers for the realm, was submitting for short-term custody of their youngsters. Moments later, Blue Ash police detectives served a search warrant, demanding that the Flannerys enable them entry and switch over their telephones.
Police physique cameras captured the Flannerys’ anguish: Nick buckled, almost falling to his knees. Felecia, wide-eyed, stared again on the officers’ hardened expressions.
What adopted was a grinding bureaucratic journey that stripped them of every part that they had labored so exhausting to construct. They have been forbidden from bringing Arlo house when he was launched after a two-week keep on the hospital; a court docket order mandated that he and his brother dwell with Felecia’s aunt. Restricted to supervised interactions with their youngsters, Nick and Felecia did every part they may to keep up a way of normalcy, arriving on the aunt’s home every morning earlier than daybreak, in order that they could possibly be there when the boys awoke, and caring for them all through the day, till Felecia nursed Arlo to sleep. Barred from spending the night time, they returned house every night to an empty home.
Determined to be a household once more, and hoping that voluntarily submitting to an additional diploma of scrutiny would possibly persuade the authorities that they had nothing to cover, the Flannerys had cameras put in in each room of their home. At a listening to in Hamilton County Juvenile Court docket that October, Justice of the Peace Nicholas Varney supplied a tentative path ahead: The kids may return house, however beneath strict circumstances. Nick and Felecia have been barred from being alone with them, and the boys’ grandmothers, who had come to court docket and volunteered to assist, agreed to take turns and keep a relentless presence.
The specter of dropping their youngsters by no means went away. A caseworker would seem unannounced, coming into their house and probing whether or not the Flannerys had deviated in any manner from the court docket order. Their authentic caseworker, after which her substitute, usually sought to get Felecia alone, urgent her to simply accept that her husband was an abuser. “I used to be not seen as protecting of my youngsters as a result of I didn’t imagine that Nick damage our son,” she informed me. In a November listening to, a prosecuting lawyer put the county’s targets plainly: “We keep that the Flannery youngsters can be at imminent threat of hurt have been they to proceed to reside of their mother and father’ house at this time and have been custody to not be granted to Job and Household Providers.”
Then, on Jan. 3, Blue Ash police detectives made an unannounced go to, arresting Nick on assault and baby endangerment fees. Nick, who was handcuffed in entrance of his older son, was cautious to not react. “I knew they wished to see me as this horrible, violent particular person with a hairpin set off,” he says. From that second onward, the Flannerys discovered themselves in parallel authorized battles: one in juvenile court docket over custody of their youngsters, and one other in felony court docket, the place Nick confronted prosecution.
Two days after his arrest, when he was set to be launched on bond, the Flannerys’ caseworker arrived on the home with out warning. Although Nick was inside his rights to return house — the court docket had not imposed a no-contact order — the caseworker eliminated the toddler and toddler that afternoon.
Felecia hurriedly nursed Arlo earlier than he was taken away. “I used to be sitting on the steps, simply crying and crying,” Felecia informed me. “My toddler began wiping my tears away, and I keep in mind considering, ‘I’ve to get it collectively, as a result of this is likely to be the final time I ever see them.’”
The boys weren’t positioned in foster care, as she had been informed was a chance — they went to her aunt — and so they have been returned house the next week on the route of the juvenile court docket. However the information that her youngsters could possibly be taken from her at any second left her unmoored. Stalked by the concern of what would possibly occur if one of many boys fell or damage themselves, she not often left house, trusting the cameras she had put in to doc her each interplay along with her youngsters. She and Nick scrupulously adopted the court docket’s order to have an authorized member of the family current across the clock, however she started dropping sleep over any doable breach — even imagined — that might value them custody. “I began having nightmares,” she says, “the place the nightmare was that I used to be discovered alone with my youngsters.”
The Flannerys felt sure there was a logical rationalization for Arlo’s signs, and so they started to piece collectively what they knew, beginning together with his troublesome supply, which had resulted in an emergency cesarean part. Greater than 24 hours of labor — augmented with Pitocin, to make contractions stronger — had left a deep hole above his brow. The Flannerys had been assured that this was a standard consequence of a difficult supply, and the indentation, although conspicuous, had ultimately gone away. Looking back, they puzzled if this had something to do with the bleeding on his mind.
Additionally notable, wanting again, was the dramatic improve in Arlo’s head circumference within the weeks after his start. By one month, his medical information confirmed, he had leapt from the 81st percentile for head measurement to the 99th, which was a doable trigger for concern. The Flannerys had been informed that his head progress must be monitored, and that if it continued to increase on the similar charge, that he can be referred to a specialist for analysis. (His subsequent head measurement was scheduled to be taken the day after Nick known as 911.)
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Courtesy of Flannery Household
As their questions multiplied, the Flannerys consulted three docs: a pediatrician who was certified to testify in court docket as a baby abuse skilled, a pediatric neurologist and a radiologist. After learning Arlo’s medical information and imaging, they every concluded that he had not suffered a sudden trauma simply earlier than he was rushed to the ER. In written stories, and later testimony given in juvenile court docket by two of the specialists, they laid out their findings. Arlo, they decided, had a preexisting well being situation: the bleeding on his mind was continual, possible originating at start. Fluid had then collected between his mind and cranium, and strain constructed, ultimately triggering seizures. This defined Arlo’s speedy head progress and the extreme sleepiness that the Flannerys had reported to their pediatrician.
In his report, Pham dismissed the concept that Arlo’s start was accountable, pointing to the newborn’s sudden collapse a full two months after he was born. Pham made no point out of the main points in Arlo’s medical information that famous the newborn’s head circumference at one month or the weird charge of progress that his pediatrician had flagged for additional monitoring.
However a number of details within the medical document instructed an ongoing situation: Along with his rapidly increasing head circumference, there was his pronounced sleepiness — presumably a symptom of seizures associated to fluid across the mind. There have been additionally the post-operative notes of Arlo’s neurosurgeon, which described the subdural hematomas as “continual,” suggesting that they had been current for an indeterminate time frame. The blood on the toddler’s mind was straw-colored, the surgeon had noticed, not the pink or pink sometimes related to acute trauma. Throughout a 2023 juvenile court docket listening to, Pham acknowledged talking with the neurosurgeon and reviewing the surgical notes, however he mentioned he didn’t embody them in his report as a result of he targeted on different indicators, similar to Arlo’s speedy decline. “The factor that I targeted on is his acute presentation,” Pham mentioned.
I wished to raised perceive Pham’s perspective and that of the pediatrician who had examined Arlo with him, Shanbhag. The Flannerys agreed to supply a letter authorizing the docs to speak to me about their son’s protected well being info, however a spokesperson for Cincinnati Kids’s declined to make them obtainable for an interview. The hospital additionally didn’t reply to an in depth record of questions.
The Flannerys believed the brand new skilled opinions offered by the three docs would exonerate Nick. “I assumed investigators would seek the advice of the docs we have been speaking to, and this complete misunderstanding can be swept away,” Felecia says.
However the suspicion of abusive head trauma, as soon as raised, is difficult to undo. Kristina Kerlus, a Las Vegas mom I spoke with, whose 2-month-old, Jocai Davis, was rushed to the hospital in 2018 in cardiac arrest, informed me that docs developed “tunnel imaginative and prescient” after discovering that her son had the prognosis’s signature signs. Jocai died three days later, and she or he was charged with homicide. It took years of authorized wrangling — throughout which her three different youngsters have been faraway from her custody — for Kerlus to be vindicated. Prosecutors dropped fees in 2022 after the protection’s medical specialists decided that Jocai had died from problems of sickle cell trait, an inherited blood dysfunction.
Even when accused mother and father problem an abusive head trauma prognosis with medical specialists of their very own, prosecutors are likely to view these witnesses cynically. Their mistrust stems from a core perception amongst some baby advocates that physicians who query the prognosis — whom some dismiss as “denialists” — are dangerous actors. “Denialists persist in producing false controversy in opposition to the prognosis of AHT and unwarranted skepticism about shaking being an vital mechanism of AHT,” states an opinion piece co-authored by three outstanding baby abuse specialists that appeared final 12 months in JAMA Pediatrics, a journal of the American Medical Affiliation. “Misinformation generated by science denialists could hurt youngsters.”
Dr. Cindy Christian, a lead writer of the American Academy of Pediatrics’s 2009 assertion, known as it “cynical” to recommend that the shift to abusive head trauma was made to evade scrutiny of the prognosis. Reasonably, she wrote in an electronic mail, the title change ensured “that physicians have been utilizing appropriate terminology in medical information and in courts.” The controversy round shaken child syndrome, she added, is essentially contained to the authorized enviornment. “The prognosis isn’t controversial in youngsters’s hospitals around the globe,” she wrote. “The courtroom isn’t designed to be the arbiter of scientific fact.”
In its most up-to-date coverage assertion in regards to the prognosis, the AAP mentioned in 2020 that the title change to abusive head trauma “was misinterpreted by some within the authorized and medical communities as a sign of some doubt in or invalidation of the prognosis and the mechanism of shaking as a explanation for harm.” The AAP “continues to embrace the ‘shaken child syndrome’ prognosis as a legitimate subset of the AHT prognosis.”
The antipathy for physicians who problem the prognosis was exhausting to overlook on the Worldwide Convention on Shaken Child Syndrome/Abusive Head Trauma, held in Salt Lake Metropolis this September. The convention — which pulls baby abuse pediatricians, social employees, police and prosecutors — featured a number of shows that forged docs who testify for the protection as each ill-informed and mercenary. Throughout a keynote presentation, a Milwaukee prosecutor, Deputy District Legal professional Matthew Torbenson, questioned whether or not docs function in good religion once they rebut an abusive head trauma prognosis. “Is that training drugs,” he requested a sympathetic crowd, “or is that offering affordable doubt on the market?”
The skilled opinions of docs from exterior the sector of kid abuse pediatrics who weigh in on these instances — together with radiologists, neurologists and pathologists — are not often given the identical deference by the courts, one cause most authorized efforts to counter the prognosis fail. In July, I chronicled the efforts of prosecutors on the Nashville DA’s workplace to overturn the 2004 shaken-baby conviction of Russell Maze; although seven medical specialists concluded that his son’s dying was the results of pure causes, the presiding choose refused to grant a brand new trial.
For the Flannerys, having three physicians who offered an alternate rationalization for Arlo’s signs didn’t show to be sufficient. Throughout a listening to in juvenile court docket in March, Shanbhag took the stand to dismiss the notion {that a} start harm may clarify the toddler’s presentation on the ER, emphasizing that abusive head trauma was the one doable trigger. “There was no different medical situation that might account for these accidents,” she mentioned.
After listening to from either side, Varney, the Justice of the Peace, handed down a ruling late this summer time wherein he leaned closely on Shanbhag’s testimony, discovering that the toddler had been abused. Nonetheless, the Justice of the Peace was cautious to state that resulting from docs’ differing opinions, each “the origin and explanation for the accidents” remained “unknown.” The attorneys whom the Flannerys retained to characterize them in juvenile court docket, James Whitfield and Aaron Rapier, criticized this conclusion as logically inconsistent with a discovering of abuse and the equal of claiming there “could also be ‘abuse’ with none ‘abuser.’” The guardian advert litem — the lawyer appointed by the court docket to characterize Arlo’s pursuits — opposed the Justice of the Peace’s ruling that abuse had occurred, noting that such a conclusion was “not supported by the manifest weight of the proof.”
Protecting orders stay in place, requiring the Flannerys to maintain dwelling beneath the watchful eyes of members of the family, cameras and caseworkers. They’ve finished every part the court docket has requested — taking parenting courses, submitting to psychological well being evaluations, complying with the security plan — however greater than a 12 months after their boys have been returned house, they’re nonetheless dwelling in limbo. “We’ve requested our caseworker, ‘So what comes subsequent?’” Felecia says. “And the reply is that they’re nonetheless pursuing custody. They provide us no plan — simply that we have to say that Nick harmed Arlo.” (A spokesperson for Hamilton County Job and Household Providers declined to touch upon pending litigation.)
Felecia longs for his or her previous life, unencumbered by the quiet terror of an abuse investigation. She appears at different moms on the grocery retailer — moms who’re unaware that their lives may be turned the wrong way up right away — and she or he feels “like a special species, like an alien,” she informed me. Nick speaks of what appears like a primal wound: “the disgrace and stigma of being known as an unfit guardian.”
Nonetheless, the Flannerys know they’re fortunate. Not like different mother and father who’ve confronted the identical sorts of accusations, that they had the means to publish bond and get Nick out of jail. They’d members of the family who have been in a position to function caregivers, which prevented Arlo and his brother from being put in foster care. Their buddies caught by them. Nick didn’t lose his job. And they didn’t undergo the worst doable end result: Their child lived. Arlo, now a wholesome 1 1/2-year-old, has loved a full restoration; ever because the surgical procedure that relieved the surplus fluid on his mind, he has not wanted any medical interventions.
But the long run is full of uncertainty. Nick, who is predicted to face trial subsequent 12 months, faces as much as 12 years in jail if convicted. Felecia as soon as wished to fill their lavender home with youngsters, however she now not thinks past the current. “We used to have plans and desires,” she informed me. “And now our future is a large query mark.”
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Anne Vetter