Guilty Until Proven Innocent
Two families suffer from a
doctor's best intentions.
By Denise Grollmus
Published: April 18, 2007
It was around 10 p.m., and Trenton was getting fussy. The
three-month-old was convulsing like a worm in his father's arms.
|
Photo by
Walter Novak
Nathan Humrighouse with son Trenton. Nathan was accused of child abuse
when Trenton suffered a brain injury in a fall.
"The ramifications of my diagnosis are huge," says Dr. Steiner.
Photo by
Walter Novak
Monica and Trenton were separated from Nathan for seven months.
Photo by
Walter Novak
"Everyone kept telling us Dr. Steiner is never wrong," says LeAnn.
Photo by
Walter Novak
Becca worried she'd be taken from her parents too.
Photo by
Walter Novak
Rachel was separated from her father, Dan, for four months.
Photo by
Walter Novak
Bill Whitaker twice proved Steiner was wrong.
|
Nathan Humrighouse
held him with outstretched arms, raising him just above his head. "Ssh,
ssh, ssh," Nathan chanted to his son.
But Trenton wasn't having it. He wiggled out of Nathan's grip and dove
directly into his face. The fall startled both father and son.
Nathan, a 31-year-old nurse, carefully examined Trenton. Though he
appeared to be fine, he called his wife, Monica. She too was a nurse,
working the night shift at Canton's Aultman Hospital, having just
returned from maternity leave.
A doctor told her to bring the baby in, just to be safe.
That's when a CAT scan revealed that Trenton had suffered a subdural
hematoma -- bleeding within the Saran-wrap-like lining of the brain.
"We knew what it was immediately," Monica says. "We knew how serious it
was, what kind of brain damage it could cause, and we were shocked and
upset."
Since Aultman didn't specialize in working with infants, Trenton was
transferred to Akron Children's Hospital.
Doctors and nurses did their best to console the visibly shaken
parents. "The ER physician told us that children recover easily from
this," Nathan says. "He even said that his son had suffered a subdural
hematoma from birth."
But they were also warned that whenever infants arrive with head
injuries, it's required that the hospital investigate the possibility
of child abuse.
As Trenton underwent more tests, his parents met with social workers
and nurses, telling their story again and again. "They all told us it
was nothing out of the ordinary," Nathan says. "And we were fine with
it. We were glad they were being so thorough."
Trenton was kept overnight for observation. His parents never left his
side.
The following day, the couple met with Dr. Daryl Steiner, a lean man
whose salt-and-pepper beard creates an air of physician's distinction.
Steiner pulled the couple into a separate room. He didn't ask
questions, didn't offer consolation. Instead, he stared coldly at
Nathan and accused him of abuse.
Nathan's story didn't jibe with Trenton's injury, Steiner said. The
only thing that could cause a brain to bleed like that was if Nathan
violently shook his son. This was, 100 percent, a case of shaken-baby
syndrome, he informed the couple.
Steiner ordered Nathan to leave the hospital
immediately and to
have no further contact with Trenton. The couple would have to meet
with Stark County Child Protective Services.
Monica burst into hysterical tears. "It was bad enough that our son had
a serious injury," she says. "But to be accused of causing it?"
Dr. Steiner
has seen some horrific things in his 31 years at Children's
Hospital. He's treated kids burned beyond recognition, bloodied babies
who've been slammed against walls, infants who've been squeezed so
tight, their ribs were crushed into shards of irreparable bones. So he
dedicated his life to protecting defenseless children.
He began his career at Children's, a fat slab of concrete that
dominates Akron's skyline. By 1991, he was appointed director of the
hospital's Children at Risk Evaluation Center, better known as the
C.A.R.E Center.
At the time, it was just a small part of Children's emergency-room
operations. But in Steiner's hands, it quickly became one of the most
respected child-abuse centers in the country. He built his own staff
and perfected its evaluation process.
At the same time, a newly discovered phenomenon was drawing much
attention in the field.
For decades, infants had been turning up in emergency rooms with brain
injuries -- but without any visible signs of trauma. In the late '60s,
doctors determined that this condition could be caused by the simple
act of shaking a baby. It wasn't until 30 years later, however, that
medicine christened this mysterious malady with a name: shaken-baby
syndrome.
Soon, hospitals nationwide were launching public awareness campaigns,
warning anyone in reach of a baby about the deadly effects of shaking
an infant. In Akron, there was a time when you couldn't drive down
Market Street without seeing a billboard showing a smiling child next
to the slogan "Never, Never, Never Shake a Baby." Steiner was behind it
all.
Among the movement's most vociferous advocates, he devised a special
evaluation process for suspected cases.
First, the child is given a CAT scan for brain trauma. If bleeding
under the brain lining is discovered, Steiner then looks for bleeding
behind the eyes. If both conditions are present, he then interviews the
parents.
There are few causes for a brain injury of this kind, he believes -- a
bad car crash, a serious fall -- or, most likely, violent shaking by a
perturbed parent. "I think it's an extremely violent event -- nothing
approaching the normal handling of a child," Steiner says.
If the parents' story doesn't match up -- or they simply don't have a
story to tell -- Steiner's diagnosis is abuse. "I have never had a
caregiver come to me and say, 'Well, I threw the baby up against the
wall,'" he says. "And the child can't tell me either. It's only after
the investigation that the confessions come."
In the past 25 years, he's diagnosed at
least 275 infants with the syndrome.
"It's a very agonizing decision," he says. "I have to be 100 percent
correct, because if I diagnose a child as abused and it's not, it's as
damaging to the child and the family as if I return a child to an
abusive environment. The ramifications of my diagnosis are huge."
Unfortunately, Steiner has been wrong -- on more than one occasion.
LeAnn Dunkle sits at her dining-room table, surrounded by her husband,
parents, sister, and two daughters.
She's wrapped in a cozy beige cardigan, her youngest daughter tight at
her chest. "I wish I never knew how easy it is to lose your children,"
she says. "And it is so easy."
LeAnn and her husband Dan stumbled across this unfortunate truth last
July. The family was preparing for a camping trip. As LeAnn packed the
hot dogs and diapers, Dan strapped their three-month-old daughter
Rachel into a mobile car seat and placed her on a table.
He went about his preparations, then suddenly heard a loud thump and
crying. He ran to find his three-year-old daughter, Becca, standing
over her little sister, who was now laying face first on the floor, the
car seat on top of her.
Dan quickly looked Rachel over. Nothing was bleeding or broken. "After
about five minutes, she calmed down," Dan says. "She was scared more
than anything."
Still, the Dunkles wanted to be safe. They called Rachel's
pediatrician, who said she was more than likely fine, but if they
wanted, they could take her to the emergency room.
The couple made the 30-minute drive from Wadsworth to Children's
Hospital. A CAT scan revealed a subdural hematoma. "We had no idea what
that meant," LeAnn says. "So when they said her brain was bleeding --
that feeling, it was terrifying. The whole room got long and narrow
quickly."
Rachel was kept for observation. LeAnn spent the night with her, while
Dan went home to watch Becca.
The next day they switched places. That's when Dan met Dr. Steiner. "He
said, '100 percent shaken baby,'" Dan says. "He said the only other
things that could cause it were a 35-mph crash or a three-story fall."
Steiner ordered more tests. For the next two days, the family waited
patiently through numerous MRIs, eye exams, and the scrutiny of social
workers.
Steiner finally returned with his diagnosis: 100 percent shaken-baby
syndrome.
"But that's impossible!" LeAnn shouted. She threatened to leave with
Rachel, but was told she'd be arrested. It would be best if she left
the hospital voluntarily. She collapsed in grief, but helplessly agreed
to go. "We thought that if we just cooperated, it'd all be over
quickly," she says.
Dan called LeAnn's parents, who arrived at the hospital to watch over
Rachel.
A few hours later, Medina Children Services arrived at the room, where
the infant lay asleep in her grandmother's arms. "You're not taking
this baby," Maureen Sega told them.
But it was no use. They were armed with a court
order. The
social worker pried Rachel from Sega's arms and disappeared. "It was
one of the most horrible days of my life," Sega says.
The following week was a nightmare. Rachel was placed in foster care,
her family clueless as to her whereabouts. LeAnn and Dan endured harsh
questioning from social workers, who parsed their every word. "I asked
them if we needed a lawyer," LeAnn says. "And the social worker says,
'Do you think you need a lawyer?' It was always guilty until you could
prove yourself innocent."
Finally, Sega and her husband, who live next door to LeAnn and Dan, got
temporary custody of Rachel.
Over the next four months, the Dunkles could
only have
supervised visits with their daughter. LeAnn often found herself
peering through the window into her parents' house, pained that she
wasn't the one rocking her little girl to sleep.
Three-year-old Becca suffered pangs of guilt, worried she'd be taken
away too. "She was so scared," LeAnn says. "She'd say, 'Sorry I hurt
Rachel. Will I have to go away too?'"
|
For the first time in their lives, the Dunkles had to hire a lawyer.
They enlisted Bill Whitaker and his daughter Andrea. As the Whitakers
built their case, LeAnn and Dan's lives were thrown into total flux.
"They split us apart," says Sega. "It felt vindictive. It was like how
much pressure could they put on you until you snap?"
Finally, last October, their hearing in Medina County Juvenile Court
took place. The Whitakers arrived with an arsenal of doctors, medical
journals, and character witnesses to battle Steiner. It worked.
Dan plays the voice mail that LeAnn left for him on November 2 -- the
day they got their daughter back. "She's not abused!" LeAnn exclaims
over the phone.
As the Dunkles celebrated the return of their baby girl, the
Humrighouses prepared for the worst.
Steiner had accused both couples of abuse within weeks of each other,
but the Humrighouse case stretched on for twice as long.
After Nathan was ordered to leave Children's Hospital, Stark County
Child Protective Services placed him under a no-contact order. Monica
and Trenton moved into her mother's house.
For the next seven months, Nathan wasn't allowed to see his son without
a social worker present. He missed most of Trenton's firsts, from
sitting up to crawling. The joy of Thanksgiving and Christmas was
replaced by separation and loss. "For those seven months, he didn't
know me," Nathan says. "He was completely uprooted from what he knew
and where he lived."
Then, a day after Christmas, things took a turn for the worse. Nathan
was indicted for child endangerment, a second-degree felony. Steiner
was the prosecution's only witness. "Steiner had told them that it was,
absolutely, abuse," Nathan says. "He said it needed to be prosecuted in
criminal court."
For the first time in his life, Nathan found himself in jail. He was
placed on leave at Aultman Hospital and faced a prison sentence of two
to eight years. "I was terrified," he says. "I felt like we had to
prove our innocence, rather than the other way around."
As his hearing approached, Nathan and Monica remembered reading about
the Dunkles' case. They contacted Bill and Andrea Whitaker.
By this time, Bill Whitaker had become something of an expert on
shaken-baby syndrome as well as Dr. Steiner's methods. "Frankly, Dr.
Steiner is not up-to-date on the research that's been done as to the
cause of subdural hematomas," the lawyer says.
Whitaker took Trenton's medical records to Dr. Ronald Uscinski, a
pediatric neurosurgeon at Georgetown University and an expert on
subdural hematomas.
Uscinski concluded that Trenton's bleeding wasn't a result of
shaken-baby syndrome. It wasn't even caused by the accident. It had
been there since the day he was born. [A recent study at the
University of North Carolina at Chapel Hill found that 26% of newborns
have intracranial bleeding.]
Uscinski points to the way an infant's soft skull adjusts to the shape
of the mother's birth canal. In the case of traumatic births, many
babies' skulls will shift severely enough to cause cranial bleeding.
It's a common side effect of the birth process that can sometimes cause
severe brain damage, but usually results in little more than a
cone-shaped head, just like Trenton's.
Medical records also showed that Monica had been in labor for 22 hours
before Trenton was free of the birth canal. "It's more likely than not
that he got it from birth," Uscinski says. "It's not unusual. Surgeons
have known this is common for a century or more."
Trenton's CAT scan from June -- the same scan Steiner used to make his
charges -- cemented Uscinski's thesis.
The scan shows a mixture of new blood and old, distinguished by varying
color and density. "Often time, children will suffer a rebleed in the
months after their birth," Uscinski says. "It can be caused by
literally nothing. A baby can simply cry and have a rebleed."
On February 1, Uscinski said as much at Nathan's criminal hearing. His
claims were backed by Dr. Geneiso Serri, the Aultman emergency-room
doctor who saw Trenton on June 29.
"We didn't suspect abuse," Serri said. "Any child under the age of one
gets a CAT scan, because we're finding more and more brain injuries
resulting from minor trauma. You'd be shocked by how the most trivial
trauma causes subdural hematomas."
The only voice of protest was Steiner's.
He said he knew of Trenton's difficulties at birth, but ruled them out
as a cause. He insisted that the only possible cause of Trenton's
injury was abuse. "The father says they bumped heads," he said. "That's
nothing, that's trivial. The mere fact that he had a bleed showed this
was serious."
But the court didn't find his argument convincing.
A few days later, Judge Lee Sinclair threw out Nathan's case. The
Humrighouses were finally reunited.
Two months after their reunion, the couple is getting used to normal
life again. "Trenton's just now starting to sleep through the night,"
Monica says. "It was a rough adjustment." These days, he's an active
toddler, insistent upon walking by himself, even though he falls every
few feet.
The couple has no bitterness toward Steiner or Children's Hospital.
They're simply relieved to be together again. "It made us realize that
family is all that's important," Monica says. "I just thank God that
[Trenton] will never remember this."
But when they share their tale with others, they're not greeted with
the same forgive-and-forget resolve.
"A lot of people tell us that they're afraid of taking their own kids
to the hospital when they have accidents," Monica says. "It's scary for
people to think how much power they can lose and how much power one
person can have over their lives. I hate to say it, but I probably
wouldn't take [Trenton] to Children's ever again."
The Dunkles say their story elicits the same reaction. After a friend's
kid took a spill, he started heading to Children's -- until he thought
of the Dunkles' story. He turned around, afraid of being accused of
abuse.
"Everyone kept telling us, 'Dr. Steiner is never wrong,'" LeAnn says.
"But he has been wrong -- at least twice. It's scary to think of how
much authority these doctors have. One person shouldn't be allowed to
decide the fate of our child."
Steiner can't comment on specific cases. He acknowledges a legitimate
debate over the causes of bleeding on the brain. But he continues to
stick by his methods.
"The idea that somebody can make a definitive diagnosis on very minimal
evidence -- it's of great concern," Bill Whitaker says. "If parents are
going to be misdiagnosed and accused of abuse, it's a huge concern."
|
