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Defense’s Expert Testifies in Infant Death Case

Yolo-Count-Court-Room-600by Marya Alloo and Antoinette Borbon

In the ongoing emotionally sensitive trial of a man accused of shaking his three-month-old baby to an end result of death, the defense’s expert radiologist could not honestly rule out the possibility of child abuse.

In fact, the doctor agreed with a lot of the substance in the medical reports written by the other doctors who performed the baby’s autopsy. However, some of his findings stemmed from what he called “his red flags,” which he claimed he found in the x-rays and reports.

Quentin Stone has been charged with causing his infant’s death in October of 2012. Quentin Stone is the father accused of “shaking” his baby, which potentially may have caused the baby’s death. The trial involves the contention that three-month-old Samuel Stone died from injuries that included bleeding in his brain, retinal hemorrhages and fractured ribs, and has left many questioning the charges at hand.

The Stone case continued with the defense’s witness, Doctor Patrick Barnes.

Dr. Barnes is a physician specialized in pediatric neuroradiology. He is also a professor at the Stanford School of Medicine, where he specializes in pediatric radiology and neuroradiology, and he also is a member of the Lucile Packard Children’s Hospital SCAN [Suspected Child Abuse and Neglect] team. Barnes was a key prosecution witness in the 1997 trial of Louise Woodward, the British nanny who was accused of shaking an eight-month-old baby to death, hitting his head and causing fatal bleeding.

Barnes, who has been in practice for over forty years, stated that in the past doctors lived in an authoritarian era. He stated “Whatever the doctor said, we had to oblige.” It wasn’t until the 60s and 70s that the authoritative era of medicine actually began. The authoritative era dawned in the necessity of scientific evidence, in assessing an illness or medical situation. Barnes stated that he was almost embarrassed to say that at one point in time he had “embraced the myth of shaken baby syndrome to exist.”

With the prosecution doggedly holding on to the idea that shaken baby syndrome was the cause behind baby Samuel’s death, Barnes is an advocate of recent scientific evidence and believes that shaking alone, without impact or injury, cannot possibly lead to the types of severe traumatic injury seen in the infant’s scans.

Barnes, who was asked to assess the scans of both twins, Samuel and Henry, had prepared a PowerPoint slide presentation that he went through in detail with the jury. It is important to note that the jury has had multiple theories and medical jargon thrown at them, but Barnes eloquently showed the jury step by step what he saw in each of the scans of the infants, and how he would go about assessing them.

The first scan shown by Dr. Barnes was of the CT scan done in October of 2012 on baby Samuel. Barnes stated that first it is important to rule out all causes behind the presence of the edema and swelling, because “there are a number of conditions that can mimic abuse.”

An important factor noted by Dr. Barnes is that this scan showed a large amount of gray matter on the right side of the brain, which emphasizes that this infant had edema. Edema is excess fluid and swelling in the brain tissue. An animated Dr. Barnes emphasized that “the number one cause for edema in a baby’s brain is that at some point this baby had stopped breathing.” Barnes, through reading medical record and reports, noted that the infant did suffer multiple episodes of seizures, and he informed that jury that “babies who have seizures often do stop breathing.”

Another important fact pointed out by Dr. Barnes pertained to the gaps in the skulls that were shown in the CT scan of the infant. He stated that these gaps were “abnormal, and can lead to swelling in the brain.” He also stated that between the hemispheres there was thrombosis, which may be due to a term referred to as venous thrombosis. “Venous thrombosis is one of the most common reasons behind seizures in babies under six months.”

When further asked to discuss what venous thrombosis was and how it can be caused, an informative Dr. Barnes stated, “Some of the main causes of venous thrombosis are: Number one, a baby has stopped breathing. Number two, the baby has experienced some form of trauma. Number three: The baby has experienced some form of recent infection. Number 4: The baby has had recent vaccinations.”

When asked by defense attorney Monica Brushia how vaccinations can have an effect on this form of thrombosis, Dr. Barnes replied, “Vaccinations can trigger venous thrombosis to take place in infants, also vaccinations can cause bleeding in chronic subdural hematomas.”

It is also important to note that, later on in his testimony, Dr. Barnes stated, “Venous thrombosis is more common to lead to brain injury then child abuse is.”

Dr. Barnes then showed MRI scans of baby Samuel’s brain, as well as his body. A disappointed Barnes told the jury that “an MRI should have been done the moment the baby first came to the hospital, but it was not done till later by the doctors.” “An MRI,” an adamant Barnes stated, “is 100-1000 times more powerful and precise about the type of injury and time that the injury may have taken place.” He explained that baby Samuel’s death may have been a result of a cascade of events that may have been present at birth.

Previously, expert witness Dr. Omalu had informed the jury that “an infant’s neck is not fully developed, and is also more susceptible to rotational movement.” Dr. Barnes, on the other hand, underlined that a recent protocol added to assessing abuse in an infant, was abnormalities to the spinal cord and the tissue of the neck to show that some form of shaking had taken place.

In the MRI scan presented by Dr. Barnes, there were no signs of abnormality. Doctor Barnes informed the jury that recent and current literature indicates that “shaking would require impact; shaking would lead to the breaking of the neck or injury to the bottom of the brain stem.”

When showing another slide of three-month-old Samuel Stone’s brain MRI, Dr. Barnes raised his voice and became very animated. Pointing his finger he showed that this infant “was continuing to hemorrhage, even when in the hospital, as you can see with the coloring of the MRI.” He also stated that there were clots inside of the veins of baby Sam’s head, but there were no venograms (exam to further study clots) done on baby Sam.

After studying scans of both Samuel and Henry, Dr. Barnes indicated that “both the twins have some form of bone fragility because the long bones in the babies show that there is some form of abnormality.” Sam had very low Vitamin D levels, which may have also been a sign of the bone fragility. He stated that “twins exert force on each other in the womb, and Sam was born breached which could also have impacted the formation of fractures on his ribs.”

When Dr. Barnes presented images of Samuel’s twin, Henry, he stated that “Henry had a normal brain. He did have some dark fluid in the brain scan which may indicate that he was pre-disposed to injury during birth.” He reassured that baby Henry’s brain “was a normal brain for an infant.”

When cross-examined by DDA Steve Mount, Dr. Barnes said he read all the reports and found things he disagreed with, but admitted to DDA Mount that he never actually saw the brain itself or ran any of his own tests.

He stated, over and over, “I disagree with the American Board of Pediatrics, I have read a lot of literature and have been asked to look over the reports in cases like this to give my opinion.” He said he looked at the x-rays taken on baby Stone and did not agree. He also stated that, in many cases, “abuse seems to be the default diagnosis, but I also agree that it can’t be ruled in or out as a cause.”

Mr. Mount, pressing the issues of expertise, asked him if he were qualified to answer questions about neurology; he danced around the question by saying “no,” but said he had read literature to back up the facts. It seemed Dr. Barnes was dancing around most of Mount’s questions, by allowing his voice to get louder, laughing, and avoiding direct questions by Mr. Mount.

Mount then asked “Do you think it’s possible that a three-month-old baby, placed in middle of a king size bed, could seize and fall out of bed.” Barnes responded hesitantly, “Um…it’s possible.” Mr. Mount chuckled a bit to himself at the doctor’s response.

In conclusion, Mr. Mount emphasized by asking if abuse could be ruled out, and Barnes responded that “abuse can neither be ruled out or in.”

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4 comments

  1. I cannot fathom why an MRI or CT scan was not performed immediately.

    • Even with good insurance to cover the cost of procedures, we haven’t found Kaiser, or Woodland Hospital, or UCDavis Neurology to be up to par.

      It seems that medicine requires a lot more expertise than it used to, and too many doctors aren’t able to make the grade, so to speak. That is, the level of expertise required for full competence is beyond many doctors’ reach. We see that in prior testimony.

      In days gone by, the baby would simply have died, cause unknown. Now we have advanced technology but sometimes, often times, it’s not used in time to save someone.

      Too bad the DA didn’t have good info when the case was filed. The family has suffered so much.

  2. If on the jury, today, I would have a reasonable doubt.

  3. Jane Fitzsimmons

    Great article, Marya and Antoinette. Animated is exactly how I would describe Dr. Barnes. I, myself, was blown away by Barnes’ hypothesis of what might’ve happened to poor baby Sam — the progressive events leading to a “crash.” It’s nice to hear alternative perspectives, along with the recognition that child abuse is sometimes a “default diagnosis.” I have no stance in this case and try to keep an open mind, but one thing I can say is that the conflicting testimonies by countless doctors makes me question the reliability of medical diagnosis. It seems to be more speculation and guesswork than calculated elimination based on objective, modern research.

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