1. Investigation of Child Abuse National Conference on Science, Technology, and the Law September 13, 2005

2. Robert W. Block, M.D. Professor and Daniel C. Plunket Chair

3. Child Abuse 2003: 906,000 child victims 2003: 906,000 child victims Average across states of 12.4 per 1000 Average across states of 12.4 per 1000 About 1500 deaths from abuse or neglect About 1500 deaths from abuse or neglect –2000 deaths per 100,000 children –79% younger than 4 years of age

4. Science: the debate Topic: Abusive Head Trauma Topic: Abusive Head Trauma –Issue: Evidence-based Medicine –Issue: Daubert hearings

5. The Shaken Baby Syndrome Is it real? Is it real? Why is there a “controversy?” Why is there a “controversy?” –Why can’t the media get it “right?” –What does the scientific literature say? What do we know about the Science? What do we know about the Science? –Intracranial bleeding –Hemorrhages in the retina –Other injuries, sometimes (rib fractures) –Brain cell injury!!!!!

6. Technology: Advances Old model, still in play; Duhaime et al, 1987 Old model, still in play; Duhaime et al, 1987 New models: New models: –Carole Jenny, MD –Cory & Jones, 2003, Can shaking alone cause fatal brain injury? Medicine, Science and the Law, 43:317-333 Why don’t you march an army across a bridge in cadence? Why don’t you march an army across a bridge in cadence?

7. Science AND Technology Back to the question of evidence-based medicine: Ethics and human experimentation!

8. The Law Law Enforcement Law Enforcement –SIDS, SUDC, Homicide and the Importance of:  A complete death scene investigation  A complete and competent autopsy

9. The Law Expert Witnesses from Medical Fields Expert Witnesses from Medical Fields Suggestions from the Royal Court of Justice, London, England; July 21, 2005 Suggestions from the Royal Court of Justice, London, England; July 21, 2005

10. Experts and Evidence Expert evidence should be the independent product of the expert uninfluenced by the exigencies of litigation Expert evidence should be the independent product of the expert uninfluenced by the exigencies of litigation An expert witness should provide independent assistance to the court by way of objective unbiased opinion…should never assume the role of advocate An expert witness should provide independent assistance to the court by way of objective unbiased opinion…should never assume the role of advocate

11. And……… …should state the facts or assumptions on which his opinion is based. He should not omit to consider material facts which detract from his concluded opinions …should state the facts or assumptions on which his opinion is based. He should not omit to consider material facts which detract from his concluded opinions …should make it clear when a question or issue falls outside his expertise …should make it clear when a question or issue falls outside his expertise

12. And… If insufficient data is available then the opinion must be identified as no more than a provisional one If insufficient data is available then the opinion must be identified as no more than a provisional one If after an exchange of reports, an expert witness changes his view on material matters, such change of view should be communicated to the other side without delay and when appropriate to the court. If after an exchange of reports, an expert witness changes his view on material matters, such change of view should be communicated to the other side without delay and when appropriate to the court.