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Prominent Advocate Presses for Better Investigations of Child Deaths

Dr. Carole Jenny says the quality of scientific practice has to be very high to avoid putting innocent parents and caregivers in jail.

ProPublica, in collaboration with Frontline and NPR, recently published "The Hardest Cases," a report about how medical examiners and coroners have mishandled child death investigations. In some cases, their errors helped put innocent people behind bars.

Recently, we interviewed Dr. Carole Jenny, a pediatrician at Hasbro Children's Hospital and a leading figure at the National Center on Shaken Baby Syndrome. She is a high-profile advocate for putting more resources toward investigating suspect child deaths.

According to the National Child Abuse and Neglect Data System, there were 1,700 child maltreatment deaths last year. Yet, according to the FBI, there were 500 child homicides. Why is there such a big discrepancy?

The FBI data comes from medical examiners and state health departments. The NCANS [data] is from child protection agencies. Child death review team data is yet another source. Different agencies have different ways of collecting data. I don't think any of them are all that good. The techniques people use to obtain that data are very, very different from jurisdiction to jurisdiction.

Last week you told the House Ways and Means Committee that progress has been made in tracking pediatric maltreatment, and now the field needs federal money. Could you elaborate on what you meant?

There is now a board-certified sub-specialty called child abuse pediatrics. Physicians who are already board-certified pediatricians take three extra years of training, learning about all aspects of child maltreatment. Most of the folks who go through this—there's 187 in the U.S.—will work at children's hospitals, doing child protection full time. Here we have three physicians and three fellows in training who do child abuse cases. We keep very busy. It's not cheap.

ProPublica's partner NPR recently reported on how scientists are rethinking Shaken Baby Syndrome. Years ago you credited Dr. Norman Guthkelch, the pediatric neurosurgeon, for first observing the condition in children in a 1971 paper for the British Medical Journal. What's your reaction to his recent statements that doctors are over-diagnosing SBS?

I've talked with him. He has the same position as many of us. We do know that kids' heads don't spontaneously explode. But sometimes we don't know if [they've] been shaken, hit or both. The Shaken Baby Syndrome diagnosis presumes a mechanism—major traumatic injury to the head that has absolutely no accidental explanation. Sometimes it's obviously [that]. Sometimes it's not.

Medical examiner Dr. Jon Thogmartin, another expert we interviewed in The Child Cases, says that when a child dies, people presume it's murder. A prosecutorial mindset sets in. Do you agree?

No, that's not true. When a child collapses unexpectedly, child protective services and law enforcement do get involved. Somebody has to do a scene investigation, and it's not going to be the doctors. I'm not going to go to the house to look for toxins or poisons. No one presumes that child injury is abuse. Abuse is a diagnosis we make after we rule out a long, extensive list of physical and accidental ideologies that would explain the degree and severity of the injuries we see.

You testify in child abuse criminal cases monthly and in cases involving child death four or five times a year. Are you more concerned about innocent parents and caregivers being convicted or guilty ones walking free?

Obviously both are not good outcomes. When people who've hurt children aren't held accountable, it puts other children at risk. No one would advocate putting innocent parents in jail. That's why the quality of scientific practice has to be very high.

We work with the medical examiners in Rhode Island, who are board-certified forensic pathologists. None [of the three] are board-certified in pediatric pathology. It's not a very well-developed field. In general, many jurisdictions underfund it. There's not a lot of people that go into the specialty [of forensic pathology]. It doesn't make a lot of money. It's not like being a plastic surgeon or dermatologist.