A group representing 1,800 pediatricians in Massachusetts is calling on Governor Charlie Baker to launch a review of the state medical examiner’s office, after it changed its determination on three infant deaths in the past two years.
The letter from the Massachusetts chapter of the American Academy of Pediatrics suggests the medical examiner’s office is allowing defense medical experts to have outsized influence, prior to trial, in cases involving “shaken-baby” death investigations. In the three cases, child fatalities originally deemed to be homicides were later changed to be of “undetermined” cause.
“Publicly available information questions whether individual examiners may have been influenced by participating attorneys and paid reports from defense medical experts,” according to the letter obtained by the Globe. “Sadly, these extraordinary and alarming events call into question both the capacity and independence of our medical examiner’s office.”
A spokesman for the governor, whose secretary of public safety oversees the medical examiner’s office, did not comment on whether Baker would undertake a review of the office but noted the office had received a $1 million boost from the governor.
“The administration values the feedback of members of the medical community and appreciates the extremely difficult work the Office of the Chief Medical Examiner performs to ensure justice and closure for families and victims, especially in the tragic case of a child death,” spokesman Billy Pitman said.
The changed rulings from the medical examiner’s office — involving three separate state pathologists — caused prosecutors to halt two of the three murder prosecutions. They dropped charges in 2014 against Geoffrey Wilson, a Malden father who had been accused of killing his infant son, Nathan. They also dropped charges against Aisling Brady McCarthy, a nanny from Ireland accused of murdering 1-year-old Rehma Sabir of Cambridge.
Prosecutors are still pursuing murder charges against a Burlington child care provider, Pallavi Macharla, who is accused of killing a baby girl from Burlington, Ridhima Dhekane. Middlesex District Attorney Marian Ryan said even though the state pathologist this year backed off her initial homicide ruling, prosecutors have enough evidence to go forward. This evidence includes the medical testimony of chief medical examiner Dr. Henry Nields, who Ryan said supervised the autopsy of that baby and will support the original assessment that the death was a homicide.
When prosecutors initially went forward with murder indictments, they largely based them on the medical examiner’s original reports, based on autopsies and other forensic information, that the child’s death was caused by inflicted injuries. Testimony from the medical examiners included findings about brain swelling and bleeding, eye damage, and bruising in the head area.
The letter to the governor appears to represent growing frustration by the pediatricians’ organization, which had originally sought a behind-the-scenes solution to their concerns that fatalities from abusive head trauma — also known as “shaken baby syndrome” — were potentially being wrongfully labeled as deaths caused by rare medical events.
The letter is signed by Dr. Michael McManus, president of the Massachusetts chapter of the American Academy of Pediatrics and head of critical care anesthesiology at Boston Children’s Hospital, and Dr. Stephen Boos, chairman of the chapter’s abuse and neglect panel and a child abuse pediatrician affiliated with Bay State Medical Center in Springfield.
McManus has not responded to the Globe’s efforts to reach him, and Boos told the Globe that he wanted the letter to the governor to remain confidential; he had no comment.
In early March, top members of the pediatricians’ group met privately with state public safety secretary Daniel Bennett and Nields, the chief medical examiner, hoping they would agree to launch a comprehensive review of the handling of these child fatalities.
Instead, Bennett later suggested to the pediatricians’ group that they “prepare a presentation” for the pathologists at the medical examiner’s office. In response, in a letter dated April 29, the pediatricians’ group went directly to the governor demanding a review. Copies of the letter were sent to Bennett and Nields, as well as Attorney General Maura Healey, among others.
“While we welcome the opportunity to assist any state agency, we do not believe that the ME’s Office or the children of Massachusetts are adequately served by a single information session,” the letter states. “Rather, we ask that you consider these recent cases as warnings that systemic weaknesses may be undermining the reliability of our medical examiners.”
The doctors’ group is asking the governor to “initiate a review to determine the root causes of recent events and begin a longitudinal process for supporting, improving and maintaining the ME Office’s ability to reliably and accurately assess questions of fatal child abuse.”
In an interview last week, Bennett declined to talk about his conversations with the pediatricians’ group but defended the office’s handling of these three cases.
“Those are independent situations where three different medical examiners made decisions with regard to three different cases,” he said. “I’m satisfied that it’s not something about the medical examiner’s office itself that has caused those three cases to be changed from homicide to undetermined.”
Bennett also said that the office has about 12 full-time pathologists, and that the chief medical examiner, Nields, gives each of them autonomy to come to their own decisions, including changing their minds and accepting input from defense experts prior to trial. Bennett, a seasoned homicide prosecutor, acknowledged that it is highly rare to see three pathologists change their rulings from homicide to undetermined in less than two years.
In the case of the Malden infant, the defense provided a medical report suggesting the child’s death might be related to Ehlers-Danlos syndrome, a connective-tissue disorder that can cause easy bleeding and bruising; in the death of the Cambridge girl, the defense provided evidence that she might have had some signs of von Willebrand disease, which affects blood clotting; and in the case of the Burlington baby, the defense suggested the child had an undetected cardiac problem.
Defense attorneys in the three cases have previously maintained that their medical investigations showed child abuse was not the cause of death, and they emphasized the importance of taking a thorough look at all possible causes of such tragedies. They have previously argued in court that their clients were innocent and ended up victims of prosecutors and child abuse physicians who too quickly see murder behind some fatalities that have unusual medical explanations.
In the letter to the governor, the pediatricians’ group raised concerns that recent controversy over shaken-baby cases is leading the public to potentially believe that “well established science is in question.”
A study last year found the national conviction rate in shaken-baby cases remains high, though more vigorous challenges to these child-abuse allegations have led to cases being dropped.
The study, conducted jointly by the Washington Post and Northwestern University’s Medill Justice Project, found that out of some 1,800 cases going as far back as 2001, about 1,600, or 89 percent, led to convictions, a rate higher than for other violent crimes. Still, there were 200 other cases over that time period that did not lead to convictions, including cases where charges were dropped or dismissed, or the defendant was acquitted or the convictions overturned.
In its letter to Baker, the pediatricians’ group said the latest decisions out of the medical examiner’s office makes them concerned that Massachusetts will become a state that doesn’t see clearly the tragic regularity of “shaken-baby” deaths. It called on the governor to make sure that the medical examiner’s office has “sufficient expertise in child abuse injuries to reject controversial and unscientific alternate cause theories.”
Patricia Wen can be reached at firstname.lastname@example.org.