For the third time in just over a year, the state medical examiner’s office has stepped back from a finding of shaken baby syndrome in a Middlesex County murder case, leading to the release on bail of a woman accused of killing a neighbor’s baby girl last year.
Last week, the medical examiner who performed the autopsy on the 6-month-old Burlington girl revised her conclusion that the infant died from shaking, citing her “experience and review of medical literature on an ongoing basis,” according to court records. In light of the revised ruling, the defendant, Pallavi Macharla, was granted $25,000 bail on Monday.
Despite the shift, the medical examiner maintains that the baby died from blunt force trauma, and prosecutors are still pursing murder charges against Macharla.
The ruling comes amid growing legal challenges to diagnoses of abusive head trauma, also known as shaken baby syndrome.
A strong majority of specialists accept the scientific underpinnings of shaken baby syndrome. But others say the brain and eye injuries that are strong indicators of shaken baby abuse can also be caused by accidents and other medical conditions, including metabolic disorders and blood-clotting problems. That ambiguity is raising new questions about the usefulness of the shaken baby syndrome label.
In an earlier high-profile case, Aisling Brady McCarthy, a nanny from Ireland, was released on bail in May after the medical examiner’s office agreed to review the cause of death of 1-year-old Rehma Sabir, of Cambridge. She was found unresponsive in her crib in January 2013 while under McCarthy’s care.
Middlesex prosecutors dropped murder charges against McCarthy after the medical examiner’s office said the child’s injuries were not necessarily the result of abuse. The medical examiner’s office concluded that Rehma’s medical history, which made her prone to bleeding with relatively minor trauma, raised doubts that she was intentionally harmed.
In a similar case, prosecutors dropped a murder charge against a Malden man, Geoffrey Wilson, in September 2014 after the medical examiner’s office said the cause of death for his 6-month-old son in 2010 could not be determined.
The decision to drop the charges against Wilson, a former MIT employee, came after new information about the family’s medical history raised doubts about the initial homicide ruling.
In this latest case, Macharla, 41, had been held without bail since March, when she was arraigned after medical tests found that the infant’s injuries were consistent with abusive head trauma. Macharla, a neighbor of the girl’s family, regularly looked after the child.
Macharla’s lawyer, J.W. Carney Jr., said a specialist who has reviewed the medical records in that case concluded that the infant died of cardiac arrest. Macharla, who is married with two young children, has maintained her innocence, he said.
“She is a meek, gentle, compassionate person,” Carney said.
Middlesex Assistant District Attorney Katharine Folger said the medical examiner stands by the ruling that the infant was killed. The office “remains firm that the infant died of blunt force trauma,’’ Folger said.
Prosecutors and Carney agreed to the bail terms just before Monday’s hearing presided over by Supreme Judicial Court Justice Margot Botsford. A spokeswoman for the Middlesex district attorney’s office said the bail agreement stemmed from “the change of circumstances” in the case.
Carney praised District Attorney Marian Ryan for agreeing to Macharla’s bail, saying she had learned “from the experiences her office went through in the Wilson and McCarthy cases.”
“I think the courts are catching up to the science,” Carney added.
On March 27, 2014, Macharla called the child’s mother to say the girl was not breathing. The mother drove to Macharla’s home and saw her performing mouth-to-mouth resuscitation on the infant, who was limp and nonresponsive. The child was pronounced dead three days later.
Macharla said the child became unresponsive after vomiting following a feeding. But tests found that the child suffered from bleeding in the brain and eyes and had sustained multiple spine fractures.
The cause of death was ruled “blunt force and shaking injuries of head.”
Jetta Bernier, executive director of Massachusetts Citizens for Children, said the revised ruling did not mean that the child was not abused.
“Whether the baby was shaken in the air or slammed down on a hard surface, the situation is the same,” Bernier said. “These determinations are made by teams of child protection specialists.”
Bernier said that most victims of abusive head trauma are under 2 years old, and that caregivers who lash out at children are often unable to cope with their crying.
“It’s usually the result of moments of frustration that build to anger, which results in a violent act,” she said.John R. Ellement of the Globe staff contributed to this report. Peter Schworm can be reached at email@example.com. Follow him on Twitter @globepete.