For the Defense - Vol. 7, Issue 2 - 7

In light of the Nieves decision, this Article revisits
Pennsylvania's treatment of AHT testimony under
the Frye test, and explores different ways to preclude
the admission of such testimony at trial. This Article
begins with a brief overview of AHT and summarizes
the current state of Pennsylvania law on expert
testimony and AHT. This Article then examines
the Pennsylvania Rules of Evidence and proposes
possible ways to exclude expert testimony on AHT
from criminal prosecutions.
Brief Overview of Abusive Head Trauma (AHT)
In 1971, Dr. Guthkelch identified a number of
cases where children suffered subdural hemorrhages
without visible external head injuries, and he
suggested that parents " shaking " their children
might have been the cause.15
Over the next few years,
American radiologist John Caffey expanded on Dr.
Guthkelch's theory and concluded, based largely on
the child-abuse cases of Virginia Jaspers, the allegedly
serial killer nanny,16
was a common term in pediatric medicine,18
that shaking was a leading cause
of cases of children with unexplained subdural
hematoma, retinal hemorrhaging, and cerebral
edema.17
By the 1980s, " shaken baby syndrome "
and
the triad symptoms-subdural hematoma, retinal
hemorrhage, and cerebral edema-was considered
uniquely indicative of vigorous shaking and child
abuse.19
However, a paradigm shift in medical research
occurred during the late 1990s that weakened the
scientific relationship between child abuse and the
triad symptoms by requiring that doctors " derive
their research from methods that are scientific
and statistically rigorous. " 20
According to Professor
Deborah Tuerkheimer:
The application of the evidence-based
framework to the SBS literature resulted
in
a
remarkable
determination:
the
medical literature published prior to 1998
contained " inadequate scientific evidence
to come to a firm conclusion on most
aspects of causation, diagnosis, treatment,
or any other matters pertaining to SBS. "
More
specifically,
" [s]erious
data
gaps,
flaws of logic, [and] inconsistency of case
definition " meant that " the commonly held
opinion that the finding of SHD [subdural
hematoma] and RH [retinal hemorrhage] in
an infant was strong evidence of SBS was
unsustainable. " 21
In addition to scrutinizing these methodological
issues, medical researchers drew upon insight from
neuroscience, biomechanical engineering, and
pathology to analyze the triad symptoms.22
This
multi-disciplinary approach, along with revolutionary
influence of magnetic resonance imaging (MRI) in
the field of radiology, eviscerated the scientific basis
for the " shaken baby syndrome " diagnosis.23
Nonetheless, pediatricians continued to use " shaken
baby syndrome " to diagnose the unexplained
existence of the classic triad until 2009, when " the
American Academy of Pediatrics broadened the
terminology to include all mechanism of injury, not
just shaking, officially calling it 'abusive head trauma'
in a policy statement to include inflicted injury to the
head caused by shaking, a combination of shaking
and inflicted injury, and crushing injury. " 24
However,
as with SBS, " there are no specific diagnostic criteria
to define AHT: there are only symptoms a child may
exhibit when looking to see whether to diagnose
AHT. " 25
Ultimately, the diagnostic determination
If the child's parent or caregiver cannot
hinges on whether the child's injuries have no other
explanation.26
offer a credible explanation, then the pediatrician
may diagnose the child with AHT.27
State v. Nieves
Recognizing the problems with AHT testimony,
Judge Pedro J. Jimenez, Jr., of the New Jersey
Superior Court (Middlesex) ruled in State v. Nieves
that AHT testimony was inadmissible as unreliable
under the Frye test and as highly prejudicial.28
The
State brought criminal child-abuse charges against
the stay-at-home father of an 11-month-old infant,
who had a complex neonatal medical history, after
a child-abuse pediatrician diagnosed the child with
AHT.29
child had suffered any accidental injuries,30
The mother and father both denied that the
and the
State had no evidence that the father had inflicted
any force or abuse on the child.31
The State's only
evidence of child abuse was the AHT diagnosis.32
The defense moved to preclude the AHT diagnosis
from being introduced at trial, arguing that such
diagnoses " have been seriously undermined over the
past two (2) decades by multiple studies showing that
adult humans cannot produce the requisite physical
force necessary to produce the symptoms associated
with AHT. " 33
The defense contended that the
diagnosis was unreliable because the prominent AHT
studies relied on flawed scientific methodologies,
and, most importantly, " no biomechanical study has
validated the hypothesis that shaking a child can
cause the triad of symptoms associated with AHT. " 34
A Frye hearing was requested to determine the
reliability of AHT.35
Vol. 7, Issue 2 l For The Defense 7
For the Defense - Vol. 7, Issue 2

Table of Contents for the Digital Edition of For the Defense - Vol. 7, Issue 2
