Verdict Renews Scrutiny Of Expert Witnesses In Shaken Baby Cases

BURLINGTON, MA — The former Massachusetts medical examiner who changed the cause of death in the 2014 death of a six-month-old girl from "homicide" to "undetermined" now works for a pathologist who routinely testifies for defendants in shaken baby cases. While a Middlesex County Superior jury found Pallavi Macharla, 44, of Burlington, guilty of second degree murder last week, the case has renewed scrutiny on a handful of specialists who testify as expert witnesses for the defense in shaken baby cases.

Anna McDonald was performing her first autopsy involving suspected fatal baby shaken syndrome on Ridhima Dhekane after the child died from injuries sustained in Macharla's care in 2014. McDonald initially ruled the death a homicide. But more than a year after her initially ruling, and after she had left for a job in North Carolina, McDonald changed the cause of death to "undetermined."

During Macharla's trial, McDonald testified she changed the cause of death after reading medical articles that contradicted her previous beliefs on the case. McDonald left her job in Massachusetts for her current position working under Dr. Patrick Lantz of Wake Forest University. Lantz has been a defense witness and has been paid for his testimony as an expert witness in numerous shaken baby cases throughout the U.S.

Lantz A Fixture In Shaken Baby Cases

Macharla, who was sentenced to life in prison and will not be eligible for parole for 15 years, maintained that the child became unresponsive after a feeding on March 27, 2014. Ridhima died three days later. Former chief medical examiner Dr. Harry Nields also testified at Macharla's trial. He supervised McDonald's autopsy and said he had "no doubt" the child had been shaken.

Diagnostic tests of Ridhima revealed the baby was suffering from diffuse subdural hemorrhaging, diffuse subarachnoid hemorrhaging, diffuse and multilayered bilateral retinal hemorrhages and retinoschisis. While the American Academy of Pediatrics says bleeding inside the skull with brain injury and bleeding behind the eyes are "hallmarks" of abusive head trauma, it cautions doctors to consider a child’s medical history, other signs of injury and other factors when making a cause of death determination.

But Lantz has frequently testified those conditions could manifest in cases where the child was accidentally dropped or has an infection or disease.

"People who tell me you can be really sure it’s abuse based on the number, location and type of retinal hemorrhages and the presence of blood and swelling in the skull to me are probably about as scientific as a fortune teller reading tea leaves," Lantz told the Orange County Register in 2016.

Another Victim's Father Speaks Out

In Monday's editions of the Boston Globe, Sameer Sabir wrote an opinion piece detailing the time he spent at Macharla's trial. There, he listened to many of the same expert witnesses that opined in the criminal case stemming from his 1-year-old daughter's 2013 death testify for Macharla.

Criminal charges against Aisling Brady McCarthy, the nanny indicted in the death of Sabir's daughter, were eventually dropped after the state medical examiner changed the cause of death to "undetermined" from "homicide."

Sabir and Nada Siddiqui, Rehma's mother, were eventually awarded $4 million in a wrongful death lawsuit against McCarthy. The sum is only payable if McCarthy tries to profit from her story. "The goal of the suit was to prevent exactly that situation - we never planned to, or ever hope to collect a dime from her," Sabir said in an email to Patch.

"Media coverage around this, ours, and similar cases tends to focus on the supposed controversy surrounding shaken baby syndrome," Sabir wrote. "I say 'supposed' because controversy implies a real and substantial disagreement. In fact, within the medical community, there is a high degree of consensus about the validity of abusive head trauma (AHT) as a medical diagnosis."

Lantz was instrumental in getting the criminal charges against McCarthy dropped. While eight other expert witnesses offered reports suggesting other reasons why Rehma may have died without making a determination, Lantz was far more direct. "Rehma Sabir did not die from abusive head trauma or complications from blunt force head injuries," he wrote, saying the girl likely died of brain swelling caused by complications from an infection.

A month later, Dr. Katherine Lindstrom, the medical examiner assigned to the case, changed her finding to "undetermined."In 2016, Lantz told the Boston Globe he did not influence McDonald's decision in the Macharla case and she only learned of his involvement in Rehma's case after she changed her ruling.

In his op/ed, Sabir questioned the motives of witnesses who make most of their income as expert witnesses. He noted that one witness in Macharla's trial, a pediatrician, testified he was "self taught" in child abuse medicine, while another expert witness called by the defense said he was qualified to offer an opinion because he was "six months away from being board-certified in pathology." Another implied a "key piece of information in her review of the case was peer-reviewed." But the information had only been reviewed for inclusion at a conference and had not undergone the more rigorous peer review required for medical journals.

"Unfortunately, a tiny group of self-professed experts have had and will continue to have disproportionate influence in shaping the narrative around cases involving shaken baby syndrome because of their willingness to create hypothetical medical scenarios in the courtroom that can fit the symptoms after the fact," Samir, who works in the life sciences industry, wrote. "In doing so they are ignoring evidence-based medicine. They peddle their own brand of science much as anti-vaxxers put children and other vulnerable populations at risk through their efforts to prevent vaccination, and climate change denialists put our planet at risk."

Dave Copeland can be reached at dave.copeland@patch.com or by calling 617-433-7851. Follow him on Twitter (@CopeWrites) and Facebook (/copewrites).