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Allegheny County medical examiner disagrees on child's injury cause

| Monday, July 13, 2015, 10:48 p.m.

The team of doctors at Children's Hospital of Pittsburgh didn't expect the boy to survive when paramedics brought him in a few days shy of his second birthday in October 2013.

An injury to his head caused bleeding on the back of his eyes and the top of his brain, the latter of which required doctors to remove part of his skull to relieve pressure.

Four doctors from UPMC Children's Hospital told an Allegheny County jury hearing the case of the man accused of causing the injuries that they were clear signs of abusive head trauma — formerly known as shaken baby syndrome — absent some other reason such as a blood disease or a car accident.

Allegheny County's medical examiner, Dr. Karl Williams, disagrees, and his testimony in the case Monday for the defense could help determine whether Douglas Hines goes to jail.

Allegheny County police in January 2014 charged Hines, 31, of Homestead with aggravated assault and endangering the welfare of a child.

Hines, who was a friend of the baby's mother, was watching the boy Oct. 21, 2013. He told investigators he had his back turned when he heard a thud. He believed the boy fell five to seven feet off the side of the stairs at his home and landed on the carpeted floor below. Hines said he immediately called 911.

The boy remains partially paralyzed on the left side of his body and is continuing to receive physical and occupational therapy, according to testimony.

Hines' trial before Common Pleas Judge Donna Jo McDaniel began July 7. The defense is expected to rest its case and the jury will begin deliberations Tuesday.

Williams is the defense's key witness. He disagreed during his testimony with each of the prosecution's experts, all of whom concluded that the child's injuries, coupled with the fact that he had no bruises or fractures, were too severe to have been caused by the fall alone.

“The question is: Can a fall cause this type of bleeding (on the brain)? I believe it can,” said Williams, the head of the county's medical examiner's office since 2006.

The case is one example of the prosecution's trouble of proving beyond a reasonable doubt shaken baby syndrome, also known as shaken impact syndrome and abusive head trauma. While the majority of doctors recognize it as a medical diagnosis, a small fraction in the medical community fervently dispute it.

Even Williams conceded that it's the “most controversial and complex issue facing forensic pathologists.”

Doctors who question shaken baby syndrome often point to a 1987 study that showed that the University of Pennsylvania football team couldn't shake a doll hard enough to mimic the injuries caused in real life.

But to the Children's Hospital experts, the controversy is only with those who say it doesn't happen.

Dr. Jennifer Wolford compared doctors who don't believe in diagnoses of abusive head trauma to parents who don't believe in getting their children vaccinated. Dr. Rachel Berger acknowledged that while it may be a point of contention for some pathologists, the vast majority of doctors who specialize in working with children agree that it's possible.

In this case, Berger testified, “Unequivocally, this is abusive head trauma.”

The Centers for Disease Control and Prevention, American Academy of Pediatrics, National Center for Biotechnology Information, among several others, all recognize it, they said.

“I think we're all on the same page as to whether shaken baby syndrome is a viable diagnosis,” Dr. Mandeep Tamber, a pediatric neurosurgeon at Children's testified last week. “We all believe it exists.”

Williams testifying for the defense in a courthouse where he primarily testifies for the prosecution is “unusual,” said Richard Long, executive director of the Pennsylvania District Attorney's Association, though Long said he could not comment on any details.

Williams said he was testifying in his capacity as medical examiner.

“This is not a case over which I have jurisdiction, so I don't have a conflict of interest,” he said. “I don't serve as an expert only for the police or only the district attorney's office.”

This is the second time in two years Williams was called to testify for the defense in a shaken baby case.

A jury in January 2014 acquitted Jason Gmuer of Castle Shannon in the death of his infant son, Nathan. Medical experts for the prosecution said Gmuer violently shook his son and caused his death.

Experts for the defense, including Williams, said the boy was born with a disease that cause blood clots.

Adam Brandolph is a staff writer for Trib Total Media.

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