Stephanie’s story—my first case

The article below summarizes the story of a friend’s adult niece, convicted of shaking a baby in her care just before the Boston nanny trial made national news. These words reflect my conclusions a decade ago. As of May 2011, the fundamental arguments remain the same.
-Sue

October 2001

How an unproven model of shaken baby syndrome is sending innocent people to prison

If you had asked her five years ago, Stephanie Olsa would have told you our justice system works. If anything, she says, she figured the courts were too careful about protecting the rights of criminals. She never imagined that at age 30 she’d be serving five to fifteen at a women’s prison in Coldwater, Michigan, convicted of a violent crime she still denies while her husband raises their son without her.

In the spring of 1996, Stephanie was caring for 6-month-old Dinah Nelson when the child developed breathing problems and seizures that led quickly to hospitalization. The doctors said it was Shaken Baby Syndrome, and Dinah must have been assaulted at the sitter’s. Stephanie said the doctors were wrong, but she couldn’t prove it in court.

Shaken Baby Syndrome, or SBS, is the child-abuse phenomenon of the moment. Proposed in the early 70s to account for a few extreme cases, the term is now commonly applied to all forms of what doctors prefer to call “abusive head trauma,” probably the single leading source of infant death from abuse. Various experts estimate that 600 to 3,000 babies a year in the U.S. are shaken and slammed violently enough to cause death or permanent, profound injury. Statisticians are scrambling to put a mechanism in place to track the true incidence.

Researchers are still arguing the medical details, but the presumed scenario is this: Someone, usually in a moment of exhaustion and exasperation, shakes a crying baby, most likely throwing the child down afterwards, possibly onto a soft surface like a crib or sofa. With its large head and weak neck muscles, the infant suffers mild to fatal brain damage. There might be no other signs of abuse—no bruises, no scratches, no broken bones. Witnesses are rare. And the survivors, even those who eventually learn to talk, can never tell us what really happened.

Shaken Baby Syndrome has a particular appeal in the law-enforcement community, where a belief that the symptoms are immediate and obvious streamlines investigation and carries tremendous weight with a jury. A prosecutor who believes there can be no delay between the shaking and the symptoms is routinely left with one suspect—the caretaker—whose guilt is easy to argue.

Presumably because Dinah Nelson didn’t die, Stephanie’s story received only a few inches in the local paper, even though she was sentenced during the first wave of media fascination with Louise Woodward, the British au pair convicted of shaking 8-month-old Matthew Eappen to death in Massachusetts. Both Woodward and Olsa were prosecuted on the theory of immediate symptoms—but in Olsa’s case, even the prosecution agrees the baby had a prior brain injury, already days old on the day she was rushed to the emergency room.

And Stephanie was not a teenage nanny. She was a suburban wife and mother, with a long and spotless babysitting record, taking a break from her career as a golf pro to be home with her own son Eamon. A compact woman with the short hair of an athlete and an upbeat, pixie-like charm, she was well liked in her neighborhood and well respected at Catholic Central High School, her alma mater, where she coached the golf team. “I can’t imagine that she did it,” says her pastor, Father Louis Stasker, one of the scores of friends and neighbors who still say they believe Stephanie is innocent.

A number of prominent child-abuse specialists—like pathologist Dr. Robert Kirschner at the University of Chicago Children’s Hospital—insist that the symptoms of a serious shaking are indeed immediate and obvious. In the 1994 text Child Abuse: Medical Diagnosis and Management, edited by Dr. Robert Reece of the Tufts University School of Medicine, Kirschner argues that the immature brain of an infant reacts differently to trauma, so differently that babies simply cannot experience the  “lucid interval”—the well-recognized period after a head injury when a patient might appear perfectly normal, only to collapse hours or even days later when bleeding or swelling inside the skull reaches a critical point.

Kirschner’s arguments are endorsed by most child-abuse experts, like Dr. Randell Alexander, who estimates he’s testified in 150 SBS cases. Alexander says research on infant victims of accidental injury supports his conviction that a serious shaking injury will be immediately apparent.

Not everyone agrees.

“SBS symptoms can emerge over time,” says Dr. Lorry Frankel, chief of critical care services at the Louise Salter Packard Children’s Hospital at Stanford University. “We’ve seen it, and you find cases in the literature.”

Frankel says that SBS can appear to be cumulative. In a typical autopsy, he explains, “you find these lesions of different ages. You assume that it’s additive, that the injuries are exacerbated in subsequent shakings.” Then, too, a diagnostic feature of SBS is brain swelling, which itself causes secondary damage.  Hard facts on the syndrome are scarce, Frankel says. “First, it’s always uncertain exactly what happened. Second, you’ve got these compounding injuries.”

In a 1993 Pediatrics article that gave the official stamp of approval to a diagnosis of SBS, the American Academy of Pediatrics noted:

“Shaken baby syndrome is characterized as much by what is obscure or subtle as by what is immediately clinically identifiable. A shaken infant… may have a history of poor feeding, vomiting, lethargy, and/or irritability occurring intermittently for days or weeks prior to the time of initial health care contact.”

Stephanie had been watching Dinah Nelson for about five hours on Saturday, March 30, 1996. The baby had been cranky, Stephanie says, and had thrown up her midday bottle, but she looked normal—both to Stephanie and to Jeffrey Metz, an exterminator who was in Stephanie’s home that afternoon setting squirrel traps in the walls.

Metz testified that shortly after he arrived that day he saw Stephanie pick up and soothe a crying baby. The baby quit crying: normal baby behavior. Over the next half hour, Metz saw Stephanie and the infant in the kitchen two or three times, as he came through to ask questions and examine the walls. He didn’t notice anything unusual about either of them; he doesn’t think the baby was crying.

Then, maybe 15 minutes before Dinah’s mother was due to pick her up, something went wrong. Stephanie says she was feeding Dinah a bottle when the baby seemed to choke. Trained in infant first aid, Stephanie turned Dinah head-down over her arm and patted her back to dislodge the obstruction. She says Dinah threw up some formula; when she heard the baby breathing again, she gave thanks to God and to her own mother, who had insisted on the first aid classes years before.

After the choking, though, Dinah seemed sleepy, lethargic. Stephanie tried to wake her up by talking to her. It didn’t work. Then the baby’s breathing seemed wrong—Stephanie was realizing there was a problem just about the time Dinah’s mother arrived. While Stephanie continued to hold Dinah, Mary Beth Nelson called 911. The dispatcher asked if the child had a history of breathing problems, and the baby’s mother replied, “No. This is something that’s happened within the last two days.”

By the time Dinah reached the emergency room, she had started mild, periodic “posturing,” arching her back and jerking her arms. Her eyes were deviating to the right. She was fitted with a breathing tube and given sedatives and anti-seizure medication. X-rays revealed both fresh and healing bone injuries. A computed tomography (CT) scan showed possible brain swelling. She was transferred to nearby Butterworth Hospital, where pediatric critical-care specialist Dr. Dominic Sanfilippo ordered Mannitol to fight the brain swelling.

Medical social worker Jerry Bonnema was assigned to the case. According to Bonnema’s notes, Sanfilippo requested his services that night “as injuries are suspected to have been caused by shaken baby by babysitter.”  Bonnema counseled the parents, called Child Protective Services, and then called the police. He wrote at that point, “Mom appeared extremely hyper & tense. She was hyperverbal and overly focused on prosecuting babysitter. Mom needs to relax, allow herself to focus on baby.”

Police officers drove to Butterworth at 3 o’clock Sunday morning to take the complaint—the doctor wasn’t available, but Bonnema and the victim’s mother agreed about what he’d said. Recommended procedure in a child-abuse investigation is to interview family members separately, preferably before they’re aware of the abuse diagnosis. These officers were receiving a complaint, though, not questioning suspects. Asked about previous incidents with that sitter, Mary Beth Nelson reported that Dinah had supposedly rolled off Olsa’s couch a few weeks earlier, during a diaper change.

A fall from a low height is the single most common lie offered to explain child-abuse injuries—police training materials use the term “killer couches.” Reported chokings, as well as attempted resuscitations, are also on the list of stories investigators are trained to doubt. Such insights and the medical evidence might be all a child-abuse prosecutor has to work with. The doctor in this case was sure about the timing of Dinah’s injuries. The police looked as carefully as they thought they needed to. They saw what they expected to see.

Unaware of her presumed guilt, Stephanie tried to visit Dinah Sunday afternoon at the hospital. The nurses wouldn’t confirm that the child was on the premises, wouldn’t accept the balloon and teddy bear she’d brought. “I figured it was intensive care, of course they wouldn’t let me in,” Stephanie recalls, “but I thought it was strange they wouldn’t tell me if she was even there.” Still, she says, it didn’t occur to her to start looking for a lawyer.

Detective Rex Marks received the incident report on Monday morning. His first stop after lunch was the hospital, where, according to his notes, Sanfilippo “offered his professional opinion… that if the care provider was alleging a choking, then that was the time the injuries were inflicted.” By this time, there was no physical evidence left that might have proved or disproved the choking:  The bottle and the kitchen floor had been cleaned and dried, and Stephanie’s trash had been picked up. The soiled baby clothes would be turned over to the police already washed and folded.

Stephanie heard about the child-abuse diagnosis on Monday afternoon. She was heading up the street with a pair of 2-year-olds—one of them her own son Eamon—when her neighbor Sue Troke came outside, newspaper in hand. The Grand Rapids Press reported that police were investigating injuries to the infant Dinah Nelson as a possible case of child abuse by shaking. “They must have got it wrong,” Stephanie told her, “Nobody’s talked to me about it.”

But then a car pulled up, John Smith from Child Protective Services. Stephanie told him about the choking, the resuscitation, the sleepiness, the breathing. He thanked her and left. Ten minutes later, he was back, this time with a pair of police officers.

In an untaped interview, Detective Marx asked Stephanie to demonstrate how she had reacted to the choking. She showed him. “Then they were at me,” she recalls, “over and over, how hard I shook her, how long before we called the ambulance.” For the first time, she says, it occurred to her that maybe she had caused Hannah’s injuries—perhaps she’d panicked and been rougher than she thought. She started crying. Officer Chris Postma later testified that Stephanie’s tears had come at the wrong time—inappropriate emotional response, another cue that you’ve identified the perpetrator. Marx wrote in his report that Stephanie had told them “it was a panic reaction when the shaking began.”

The warrant was issued the next day. Bail was set at $100,000 cash, no bond accepted. No one at either hospital had met Stephanie or talked with her about the incident. Detective Marks waited a week before taking a statement from the exterminator.

If anyone had asked, Stephanie’s neighbors would have described her as warm, playful, sensible, and, always, good with children. She was the one who stayed by the play structure and kept an eye on the toddlers during the block party. “If you knew Stephanie, you’d know she’s just not capable of a crime like this,” says Patty Clifford, who lives around the corner and used to leave her sons with Stephanie one morning a week while she met with her Bible study group. “When she watched the kids, she didn’t just turn on the TV and make the snacks,” Clifford explains. “She got down on the floor and played with them. It’s who she was.” Full-body x-rays of Stephanie’s son Eamon revealed no fractures, fresh or healing.

Medical testimony dominated the four-week trial. Dinah’s injuries were described again and again, with special attention to the violence required to cause them. One doctor compared SBS to putting a baby’s brain in a blender. The following week Sanfilippo said no, not a blender, more like a paint mixer at the hardware store.

A diagnosis of shaken baby is based on a distinctive cluster of symptoms:

• bleeding between the dura and the arachnoid membrane, the two outer layers of a three-ply lining around the brain and spinal cord,
• diffuse brain swelling, or cerebral edema, and
• bleeding within the lining of the eye, known as retinal hemorrhage.

Dinah Nelson had all these and more.

She had a broken rib, estimated to be at least 10 days old, and a fractured ankle bone no more than 72 hours old. She had a skull fracture of indeterminate age, and evidence of old bruising on the surface of the brain. She had blood of at least two different ages in her spinal fluid—the “chronic” bleed was estimated to be no less than 14 to 21 days old, the “acute” bleed no more than 24 hours old. Doctors concluded that Dinah had been abused more than once, over a period of weeks. The last assault left her with permanent brain damage.

None of the laboratory tests or medical images could narrow the window for Dinah’s fresh injuries to anything less than 24 hours before she reached the hospital—but the doctors testified that Dinah’s brain injury was so severe that the symptoms must have been immediate. “Without intervention, the interventions we did,” Sanfilippo said, “she would have died in hours.”

Two forensic pathologists and one pediatrician with a specialty in neurologic disorders testified for the defense, arguing that Dinah’s injuries were chronic and complex, that brain swelling can start slowly and then accelerate, that the culminating event could have occurred a full day before the serious symptoms emerged.

Prosecutor Helen Brinkman attacked their credentials. The forensic pathologists, she said, “cut open dead people… they don’t judge symptoms.” The pediatrician didn’t treat patients, she charged, “he dispenses Ritalin six times an hour, that’s what he does.” She pleaded with the jury not to be duped by the people being paid “ungodly amounts of money” to confuse them.

The pediatrician, Dr. Robert Lerer, was donating his fee from the Olsa case to an international medical relief fund. A few years earlier, he’d written a journal article calling for a peer review process to discourage doctors from stretching the medical facts on the witness stand. “He’s trying to deceive you,” Brinkman told the jury, whose members saw the article only from across the courtroom. “This man is arrogant enough to write an article on how to deceive jurors. He writes an article about how doctors can do that, and then he turns around and comes in here and does the very same thing.”

Stephanie’s sister Alison Price said she was there the day Hannah rolled off the couch. Price testified that she’d seen the fall and that Hannah’s only injury was a red nose, like a rug burn. Brinkman told the jury that Price was making it up: “She didn’t see what happened; she wasn’t there.” That was the day, Brinkman argued, that Olsa had inflicted the broken rib and the old brain injuries.

Stephanie’s neighbor Renee Parks confirms that two of her daughters, then 8 and 6, were at  Stphenie’s the afternoon Hannah rolled off the couch—both Stephanie and Alison say the girls were in the room at the time. Investigators never questioned Parks or her daughters. The prosecution successfully petitioned the court to prohibit the children’s testimony at trial.

Dinah usually stayed with Stephanie two days a week. That month it was less—the baby and her mother had been out of state, visiting relatives. Defense attorney David Dodge asked the jury if it made sense to assume that a series of injuries was inflicted during a few brief visits with Olsa, when the child had spent most of the month with a variety of other caretakers, none of whom reported any bruising or tenderness. Brinkman attacked his credibility: “Only Mr. Dodge could make a visit to grandma’s sound sinister.”

Presented in court with the tape of the 911 call, Hannah’s mother explained that she’d meant to say Dinah had been throwing up for two days, not that she’d had breathing problems for two days. Mary Beth herself had stayed home from a party the night before the incident, in part because the baby had been sick. Dinah’s father—who had been caring for the child at home that day, after working graveyard shift the night before—went to the party alone. He also threw up that night.

None of this was in the police report. The day Dinah was hospitalized, Mary Beth Nelson told the police and doctors at both hospitals that Dinah had been fine when she dropped her off at Stephanie’s in the morning. In court, she agreed she’d warned Stephanie that the child had been throwing up—a classic sign of head injury. A story that changes as the facts emerge is also a cue for identifying the perpetrator, but police didn’t request the 911 tape until after Stephanie was arraigned. By that time they were building their case, not investigating.

The medical records are peppered with references to Mary Beth Nelson’s tendency to hysteria. On April 2, three days after her daughter was hospitalized, Mary Beth began shouting at nurses and her husband, ultimately ordering them all to leave the room. The medical social worker who was summoned in the aftermath wrote, “Mom appers to be upset and has difficulty in expression of her anger without becoming hysterical… Family appears to need continuous and ongoing support from all [Butterworth Hospital] staff.” On April 3: “Mom’s mood tends to be somewhat labile with potential for escalation very quickly. Appears mom is able to be diffused with intervention.”

In the winter of 1996 Mary Beth Nelson was working part-time at a bank and taking classes toward a teaching credential. One Monday about a month before the incident, she returned to Stephanie’s unexpectedly mid-morning, to take Dinah home instead of going on to work after class. Both women agree that Mary Beth was upset and that she told Stephanie she needed to find a cheaper babysitter—she wouldn’t be bringing Dinah back.

Then, the following Sunday evening, Mary Beth called and apologized. Stephanie claims that Mary Beth told her the real reason she’d been upset the previous week was that her professor had said she wasn’t cut out to be a teacher. At Stephanie’s first trial, Mary Beth confirmed that she’d had an unpleasant talk with her teacher. At Stephanie’s second trial, Mary Beth said her only concern that morning had been the money—she didn’t remember any problems at school. She was unable to find a cheaper sitter, so she returned to Stephanie’s.

But one of Mary Beth’s fellow students, Tina Richmond, remembers the winter morning when Mary Beth got “really upset” and “stormed out” during a class discussion of their student teaching experiences. Mary Beth had been complaining about her placement, Richmond recalls. “The professor didn’t say it right out, you should never do that, but she told her maybe she should consider a different field.” The teacher denies criticizing Mary Beth in front of the class, but says she did have a private talk with her about the importance of a positive attitude.

Whatever else Mary Beth and Stephanie did or didn’t talk about that Sunday evening, Stephanie agreed to watch Dinah the next day. She’d already planned a neighborhood outing, though, to an indoor playground called the Discovery Zone, and Dinah would have to come along. Stephanie’s neighbors later testified that Dinah was cranky that day, as usual. She screamed when put on her back for diaper changes, and she fussed even when being held.

A few friends and neighbors were allowed on the stand as character witnesses. By that time the investigation was long over, and the prosecution’s job was to refute their testimony. “Yep, all the children adored her, and she adored them,” Brinkman told the jury, “But one child didn’t adore her. One child really didn’t adore her, and she couldn’t handle it.”

The prosecution maintained that there had never been a choking, that Stephanie had simply “lost it” and attacked the crying baby, 15 minutes before the mother was due to pick her up. “There was no feeding, there’s no formula, and she’s lying,” Brinkman told the jury. “We’re talking a rage attack, simple—this woman hated that child.  She finally got—not finally, she would repeatedly get to the point that she would take it out on this child. But I can prove that on March 30th, she did it, based on these injuries.”

There was never any other evidence against Stephanie—no tell-tale threads or skin cells or blood samples, no witness to any assault on any child at any time. The exterminator saw and heard nothing alarming while he moved freely through the house. Stephanie says she expected his presence to prove her innocence, or at least to cast reasonable doubt. The prosecution saw it as proof that Hannah’s injuries had been inflicted in the few minutes after the workman saw the baby apparently normal and before the child’s mother arrived.

Stephanie’s first trial ended in a hung jury, her second in a conviction. She turned down a number of plea bargains along the way because, she says, “I didn’t do anything.” Now her appeals have been rejected, her son is growing up without her, and her parents are paying off a second mortgage taken to pay legal fees. Stephanie’s husband and son have moved in with the Price family—everyone agrees it gets tense, but they think it’s the best arrangement for Eamon, who thrives on the flow of uncles, aunts, and neighbors.

Stephanie still maintains her innocence, and so the court sees no remorse. That went against her at sentencing, and it’s on the list of factors the parole board is obliged to consider.

Stephanie is only one in a throng of unrepentant babysitters. In a 1995 study of perpetrators in shaken baby cases, Dr. Suzanne Starling noted that not a single babysitter in her sample population had confessed, even though non-relative care providers accounted for an extraordinary 17 percent of the crimes—in most statistical profiles, excluding sexual abuse, babysitters from outside the family account for no more than 2 or 3 percent of child physical abuse.

Starling speculates that babysitters have less motivation to confess—family members come clean, she suggests, because they think the truth might help save the baby’s life.

In Iowa, babysitter Mary Weaver maintained her innocence for four years before she was released in 1997 on new evidence. Weaver had been caring for a cousin’s 11-month-old daughter for less than an hour on the day the baby developed breathing problems. At the hospital, the girl was found to have a skull fracture some 7 to 10 days old and, like Dinah Nelson, both new and old subdural bleeding. Based on the theory of immediate symptoms, the prosecution targeted Weaver.

Her first trial ended with a hung jury, her second with a conviction and a life sentence. She was granted a third trial after new witnesses came forward to report that the child had been knocked unconscious in a fall before being placed in Weaver’s care on the critical day.

In Los Angeles, single mother Maurania Gonzales spent 7 months in jail after she was charged in the shaking death of her 18-month old son, Andre. After a series of defense doctors submitted exonerating reports, the prosecution sought out its own second opinion—a total of five outside doctors concluded that the boy could indeed have died from an accidental fall onto concrete, as Gonzales had insisted all long. Andre had seemed fine after the fall, Gonzales reported, but fell unconscious 4 hours later.

Back in Michigan, child care provider Steven Church remains in prison for the shaking death of 6-month-old DeShon Green. DeShon’s mother worked night shift. She had dropped the boy off, apparently asleep, at 9 pm. Church says he heard the child crying between 3 and 4 am, and went in to check on him. He claims he found DeShon in distress; the state says he shook and slammed the boy into unconsciousness. DeShon died 36 hours later, with old brain injuries revealed at autopsy.

Like virtually all SBS defendants, Church was represented by a lawyer with no previous SBS experience. Like Stephanie, he was prosecuted by Helen Brinkman.

Brinkman says she has no second thoughts about any of her cases: “I never prosecute unless I’m convinced the person was guilty.” In the shaken baby cases, she says, “I depend entirely on my experts. The doctors can tell.”

Dr. Vincent DiMaio, the chief medical examiner of Bexar County, Texas, and the editor of the American Journal of Forensic Medicine and Pathology, calls shaken baby an unproven hypothesis. “I’m not saying these deaths are from natural causes,” he clarifies, “I’m saying that these children are not just being shaken. They are also being hit on the head or thrown against something. It’s an impact injury.”

Until a couple of years ago, he says, he would have agreed that the symptoms of a fatal infant head injury must be immediately obvious, but then he was asked to review the medical records of Melissa Mathes, the baby in Mary Weaver’s case—the child had been seen by her family doctor three times for the flu in the week before she quit breathing at Weaver’s house. “That case is very disturbing,” DiMaio says, “because everybody agrees that the skull fracture is seven days old, and everybody agrees that the doctor saw this child and thought she looked normal… But we know she already had cortical necrosis [dead brain tissue] and thrombosis [clots inside the vessels]… Whether or not you believe the babysitter killed the kid, you know a serious brain injury went unnoticed by a professional observer.”

DiMaio is also clear on this point: “If the child has old injuries that have not completely healed, the child will be more susceptible to fresh injuries. That’s standard pathology.”

Stephanie Olsa, Mary Weaver, Stephen Church, Louise Woodward—all four sitters were convicted of shaking babies on the basis of medical testimony that the attacks must have been violent and the symptoms immediate. All four of the infants had prior injuries, three of them prior brain injuries undisputed by the prosecution. Still, the presumption of immediate symptoms prevailed in court.

The defense in the Woodward case argued that Matthew Eappen’s fatal collapse was caused by the rebleeding of an old brain injury. After the trial, child-abuse doctors Kirschner and Reece, with Dr. David Chadwick of the San Diego Children’s Hospital, collected 70 signatures on an open letter that dismissed the rebleed theory and decried media coverage that treated it as credible.

Then CBS’s 60 Minutes interviewed new experts, doctors who’d agreed to review Matthew Eappen’s medical images pro bono. Neuropathologist Floyd Gilles and radiologist Marvin Nelson at the Children’s Hospital of Los Angeles concluded the child’s problems were triggered by oxygen deprivation, possibly as long as 48 hours before the serious symptoms emerged—and they noted evidence of an old brain injury. Reece and Kirschner gathered 120 signatures on a second letter that rejected the new diagnosis and reiterated that a child can’t look normal after a fatal head injury.

Still, experts outside the child-abuse community tend to accept evolving symptoms of SBS, even in fatal cases. “Is it common? No. Does it happen? Yes,” shrugs Brad Alpert, a pediatric intensivist at the University of Texas at Houston, “Timing has to be only one part of the puzzle.”

When Stephanie was tried, the medical journals contained one paper on the timing of SBS injuries, a 1994 literature review. Pathologists Marcus Nashelsky and Jay Dix from the University of Missouri–Columbia University Hospital found only three cases that met their criteria (death from shaking, with no evidence of impact). In two, the symptoms were immediate; in the third, a caretaker had confessed to shaking the child four days before seizures started. Clinging to the common knowledge, the authors speculated, “One wonders whether the infant was reshaken shortly before onset of seizure activity.” The prosecution cited the paper as further proof of Stephanie’s guilt.

Since Stephanie’s trial, forensic pathologist M.G.F. Gilliland has published a larger study, based on data she and colleagues collected over eight years at the Southwestern Institute of Forensic Sciences in Dallas, Texas. In 54 of Gilliland’s 76 fatal shaking and slamming cases, serious symptoms emerged within 24 hours; in 22 cases, the interval was longer. “Certainly the symptoms can be immediate, and they often are,” Gilliland says, “but the common knowledge that they must be is not uniformly correct.”

The medical social worker who counseled Dinah’s parents was part of a child protection team, one of the tools that hospitals have developed to meet their moral and legal responsibilities in the era of child-abuse awareness. Doctors and other professionals are required by law to report any suspicion of child abuse; the penalties for not doing so include time in jail. Nevertheless, studies still find that children who die from abuse have often been treated for injuries in the past and returned to the same caretakers. Everyone is looking for ways that caring professionals can work together against a terrible and elusive enemy.

Into this era was born Shaken Baby Syndrome, a diagnosis that eliminates all doubt about how to proceed. Experts like Kirschner and Alexander travel the country to train other doctors and testify in court, explaining what they see as the simple truth:

•     the syndrome can result only from an intentional, violent assault, not from an accident in the home

•     the symptoms will be immediate and obvious, even to an untrained observer.

There is no room in this model for people who slip in the shower or fall down the stairs; there’s no room for evolving symptoms. And as long as the justice system applies the model without question to any SBS-like death or injury, there’s little chance of gathering evidence to the contrary.

The people who prosecute child abuse are only doing their jobs when they embrace a medical model that’s proving so potent in the courtroom. Doctors who find their opinions confirmed by legal outcome seldom wonder if the police are looking as closely as they should, especially when the suspect is an unknown babysitter, not the parent who’s been seen grieving at the victim’s bedside. Meanwhile, people are in prison on the basis of sincere but unproven medical opinion, and the convictions are feeding back into the system, distorting what little is known about a subtle but emotionally charged medical condition.

“I have no doubt that the people who targeted Stephanie believe in what they’re doing, but I believe they’re wrong,” says Father Stasker, still the pastor at St. Paul the Apostle Church, where the congregation in 1996 included not only the Olsas and the Nelsons but also parishioners in and out of the legal system. “It was an emotional time,” he recalls. “So many people rose to Stephanie’s defense, you couldn’t stay out of it.” After the verdict, the Nelsons wrote a letter of complaint to the bishop and switched to a second, and then a third, parish. Does Stasker know who injured Dinah Nelson? “I have a fear, but I have no opinion based on facts,” he says. “I’ve tried to approach all parties in a spirit of healing.”

Although he’s still sure she’s innocent, Stasker declines to condemn the system that put Stephanie prison. “We probably have a better legal system than most,” he says, “but the search for vengeance rarely brings out the best in us.”

Note:  Some names have been changed for privacy, but not Stephanie’s or the professionals’.

(c) 2011 Sue Luttner