Shaken baby syndrome disputed

By Sue Yanagisawa
Local News - Saturday, September 25, 2004 @ 07:00

Defence lawyer Peter Kemp continued to suggest yesterday, during his questioning of the Crown’s second expert medical witness, that “shaken baby syndrome” is unprovable.

The diagnosis, he said, is accepted more by pediatric specialists than the scientific world as a whole.

But Dr. Richard van Wylick, a pediatric specialist and medical director of the child protection team at Kingston General and Hotel Dieu hospitals, stood by his finding.

The doctor told Superior Court Justice Helen MacLeod that he arrived at his diagnosis based on the brain injury sustained by 22-month-old Brody Albert, a pattern of bleeding and damage in the deep structures of the child’s eyes and his assessment that an accidental fall down stairs was inconsistent with the damage he was seeing.

The toddler’s babysitter, Cheryl Ann Larsen, 33, is on trial for manslaughter in his December 2002 death. She has pleaded not guilty.

Crown attorney Bruce Griffith and assistant Crown attorney Laurie Lecelle are prosecuting the case. They contend that Brody was shaken so violently it caused bleeding between the membranes lining his skull and a subsequent cascade of medical problems that claimed his life.

Court has been told that, in his post-operative report, the surgeon who removed part of the right side of Brody’s skull on Dec. 6, 2002, described the combination of pooled and clotted blood he found underneath as an “extremely high-pressure subdural hematoma.”

Reciting at length from articles published in medical and other scientific journals, Kemp asked Van Wylick about different fall scenarios. The pediatrician agreed he’d expect significantly more injury in a child who fell four feet straight down than one who fell down stairs a distance of four feet. But he told Kemp that that’s part of the assessment – determining whether the injuries match the story of how they occurred.

In Brody’s case, Larsen told paramedics and the toddler’s parents that he fell down part of a flight of 11 to 13 carpeted stairs, depending on whether the landing and floor were counted.

Griffith, in his opening statement to the court, said Larsen subsequently told police the boy was potty training and she’d put him in the main floor bathroom and gone to check the e-mail on her computer in the basement. She looked up, according to that account, and saw Brody at the top of the stairs holding his pants in one hand just before he stumbled and fell.

Brody’s mother, Julie Albert, recalled in testimony earlier this week that when she asked Larsen at the hospital what had happened, she “indicated she should not have started potty training so early.”

Julie Albert told the court the timing of toilet training Brody was Larsen’s idea. Brody being her first and at that time only child, she said she deferred to Larsen’s experience, since her baby-sitter was the mother of three boys.

One of the paramedics who worked on the unconscious toddler at Larsen’s Pembridge Drive home that morning testified that they found him on the main floor of the house, lying on the carpet wearing only a diaper. The boy’s father, Steve Albert, also recalled seeing him wheeled into hospital on a gurney wearing only his diaper.

William Hay, a former identification officer with Kingston Police, now working for Fire and Rescue Services, testified that he seized a number of items from the Larsen home four days after Brody’s death, among them a pair of light-blue corduroy pants he found folded in a portable crib in the master bedroom. Brody’s mother testified that she’d dressed her son in blue corduroy pants and a green and white sweater with a truck on the front that last morning before she dropped him off at Larsen’s house.

Under questioning by Kemp, van Wylick estimated he’s had 20 to 25 cases of suspected shaken baby syndrome referred to him in the time he’s worked with the child protection team. He diagnosed the syndrome “in the range of six or seven” of those cases, including this one. In at least two of those cases – “I think there was a third” – the child died, he said.

Doctors who examined Brody found no bruising or broken bones, but van Wylick told the court there wouldn’t have to be bruising or broken bones if the boy had been injured during a violent shaking.

Kemp pressed the pediatric specialist, pointing out that some non-medical researchers contend it’s impossible to cause the brain injuries attributed to shaken baby syndrome by shaking alone.

Citing published articles, he asked the doctor about the position some have taken that there would have to be an included high-impact event, such as the child being thrown against an unyielding surface.

The doctor agreed there are researchers in biomechanics “who are questioning this diagnosis.” He told Kemp, “I can’t speak to the biomechanics,” and added, “It certainly is a serious question.”

But van Wylick said that for obvious moral reasons, it’s impossible to conduct the kind of empirical research that would end the scientific debate.