Guilty Until Proven Innocent

April 18, 2007 permalink

Dr Daryl Steiner of Cleveland diagnoses cases of subdural hematoma as shaken baby syndrome, even among newborns who got the injury during natural childbirth.

expand

collapse

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.

photos 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.

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."

Source: Cleveland Scene website