Six-month-old Ridhima Dhekane arrived at her baby sitter’s home on a March morning in 2014 in the arms of her father, with a container of her mother’s homemade applesauce for lunch. Six hours later, the infant from Burlington was near death — not breathing and comatose.
A team of doctors worked furiously to save her, but the severe swelling and bleeding in her brain were too great. Ridhima was pronounced dead three days later.
The question of how little Ridhima died is at the crux of the case against the girl’s baby sitter, who is scheduled to go on trial for murder Monday in Middlesex Superior Court.
The case may hinge on dueling accounts from two state medical examiners who were involved in the infant’s autopsy and who disagree on whether shaken-baby syndrome — now often called abusive head trauma — was the cause of death.
Their showdown is expected to echo a battle that has played out in dozens of courtrooms across the country, pitting medical experts who disagree on the validity of long-accepted science about shaken baby deaths.
That debate has also roiled the Massachusetts medical examiner’s office in two earlier cases. One involved MIT employee Geoffrey Wilson, accused of killing his infant son. The other involved Irish nanny, Aisling Brady McCarthy , charged with murdering a Cambridge baby in her care. Prosecutors dropped charges in both cases after medical examiners backed away from their earlier findings that the babies died from being shaken violently.
One of the two medical examiners in the latest case, Dr. Anna McDonald, was a doctor in training at the time of Ridhima’s death. She initially ruled the infant was killed by blunt force and injuries to her head caused by shaking. The baby sitter, Pallavi Macharla, who was caring for Ridhima and a few other children in her home, is charged with murder.
Macharla, who worked as a medical doctor in her native India before moving to the United States, insisted she was innocent. She said Ridhima had vomited while she was feeding her applesauce and then stopped breathing.
Months later, McDonald changed her mind. She had left the medical examiner’s office by then but wrote a letter to prosecutors saying she wanted to revise her findings. She wanted to change the manner of Ridhima’s death to “undetermined,” concluding the infant died of cardiac arrest and that her other injuries could have been linked to doctors’ efforts to save her.
McDonald’s new thinking mirrored that of an expert hired by the baby sitter’s attorney.
That expert had suggested the infant died of cardiac arrest after choking on applesauce and the extensive brain injuries might have been caused by doctors aggressively trying to revive her.
But McDonald’s boss, Dr. Henry Nields, who was the chief medical examiner and who had supervised McDonald’s autopsy of Ridhima, disagreed. He believed the death was a homicide and the infant died of severe head injuries. The original death certificate stood, and prosecutors pushed forward with a murder charge.
Nields, who has since retired, did not return a phone call. McDonald, who now works in North Carolina, declined to comment. Both are expected to testify.
Child abuse specialists have long contended that bleeding in the brain and behind the eyes, together with spine or rib fractures, typically are signs a baby has been brutally shaken. But experts for those accused of shaking a baby to death have offered alternative theories, suggesting instead that the babies were victims of blood-clotting disorders, connective tissue and bone diseases, or accidents.
Alarmed about alternative theories leading to overturned convictions, the American Academy of Pediatrics last year issued a report, “Combating misinformation about abusive head trauma.” It contained the best evidence-based medical literature on the topic, the academy said.
“There is healthy debate about the details of abusive head trauma, but there are also people trying to create illegitimate debate and taking something and inflating it for purpose of the courts,” said Dr. Stephen Boos, who chairs the child abuse and neglect committee of the Massachusetts chapter of the American Academy of Pediatrics.
But Dr. Jonathan Arden, a pathologist who worked in medical examiners’ offices in Washington, D.C., New York, Delaware, and West Virginia, said he has seen some plausible alternative explanations for these deaths. He now works as a consultant and expert witness for defense attorneys, and he said in the vast majority of these cases, he finds child abuse and advises the attorneys to have their clients plead guilty rather than go to trial. But not all.
“I understand people don’t want experts coming in from the outside and offering bad explanations for things, but some of those competing theories are valid and in some cases they turn out to be right,” said Arden, who is also the president of the National Association of Medical Examiners.
Both the defense and prosecutors list multiple expert witnesses they expect to call in the upcoming trial in Middlesex Superior Court, which is expected to last at least a month, according to court filings.
The controversy in the Massachusetts medical examiner’s office over Ridhima’s death follows the McCarthy and Wilson cases, in which prosecutors dropped the charges after defense attorneys presented medical records that suggested alternative theories of how the children died.
Now, the father of the infant in the McCarthy case is urging state lawmakers to tighten scrutiny of child deaths in the medical examiner’s office. Sameer Sabir, whose 1-year-old daughter, Rehma, died in 2013, is backing legislation that would require the chief medical examiner to review and approve all findings and reports involving deaths of children under age 2.
“For parents to lose a child under any circumstances is excruciating,” Sabir said. “Given the sensitivity of these cases, it benefits everyone to have a clearly defined and transparent process to ensure that the correct cause of death is determined and has been officially double-checked by the chief medical examiner.”
The state’s Office of the Chief Medical Examiner, which investigates violent and unexplained deaths, has been plagued by problems and backlogs. As of early April, results on some 15 of 56 infant deaths were still pending from 2017, as were 15 of 57 from last year, according to a spokesman. He declined to comment on the proposed legislation and how it might affect the current backlog.
But several child advocates endorsed the legislation, pointing to similar practice in other states. They said child deaths are relatively rare and most medical examiners don’t encounter enough cases to develop an expertise, so extra scrutiny from the chief examiner is welcome.
“We have seen cases in which individual examiners had opinions that may have been influenced by defense experts who had access to them without any checks and balances,’’ said Dr. Robert Sege, a pediatrician and researcher at Floating Hospital for Children at Tufts Medical Center. “It makes sense to havethe chief medical examiner check these autopsies to make sure conclusions are drawn on the literature, and not vague suppositions.”