by Jane Fitzsimmons and Justine Joya
On the morning of May 7, the Stone trial slowed its stride to allow direct examination of character witnesses called by the defense. From neighbors to babysitters to the grandfather of Samuel Stone, testimonies aligned – “Quentin was [and is] a hands-on dad.” These same witnesses would further contend that Mr. Stone has never displayed a violent temper, and he could not possibly have caused the death of his infant son. Of course, nobody can know what goes on behind closed doors.
The first witness, questioned by Deputy Public Defender Martha Sequiera, was a close family friend who often looked after Quentin and Sara Stone’s sons. She testified that “Quentin was a hands-on dad. He was a caretaker and Sara never had to ask him to help with the boys. They were very in tune with each other.” She then acknowledged how the Stones struggled to become parents. “They had difficulties conceiving Jack, and the twins, but there was no anxiety with having a multiple birth since Sara grew up with twins.”
Following gentle prodding by Ms. Sequiera, the witness continued her testimony, defining Quentin’s “gentle and soft-spoken” demeanor as well as his approach to parenting Jack – “He is kind, thoughtful, reserved, very loving… always puts others before himself. I never saw him discipline Jack, except to calmly ask him to not do something.” To drive the point home about Mr. Stone’s mild temperament, the witness boldly announced, “If I had any reservations, I would not be sitting here today.”
Ms. Sequiera changed the subject to ask the witness about her experience with Sam’s vomiting in early September of 2012. After confirming that she was well aware of Sam’s falling incident prior to being sick, she said, “On one occasion, I was holding Sam and he was projectile vomiting. I’ve seen it before in my kids, but I was shocked by the volume and it was more clear than normal.” In response to how Sam’s behavior seemed post-vomiting, the witness recalled, “Sam became limp. His arms and legs were weak like after an athlete runs a marathon. He did not pass out, but he began crying, agitatedly.”
With no further questions, Ms. Sequiera handed the witness over for cross-examination, which established solely that the witness “only saw Sam Stone projectile vomit once.”
The second witness to take the stand this morning was a Public Guardian in Yolo County. She has worked as a conservator for 15 years, and eight of which she has known Mr. Stone, ever since he married into the Yudin family. She knew the Stones had trouble conceiving, and when asked by Deputy Public Defender Monica Brushia if the Stones were happy about the birth of their first son, she confirmed, “Yes. They were thrilled. Very ready for their first child. Life was good.” Regarding Mr. Stone’s character, she could not help smiling. “Quentin is a bit of a gentle giant. He’s mellow.”
Ms. Brushia altered her line of questioning to a later date, querying, “What was ‘Q’s’ demeanor at the funeral?” The witness hung her head and mumbled, “Broken.” In the somber silence that followed, she sighed, “When you have such a loss, you don’t wake up the next morning and you’re okay. Quentin was devastated.”
In cross-examination, Deputy District Attorney Steve Mount asked the Public Guardian if her opinion was biased. She gave a resounding, “Yes,” followed by affirmation that it would be unlikely for anything to change her mind about Mr. Stone’s innocence. DDA Mount shocked the courtroom by asking a question that led the witness to exercise her 5th Amendment right. As a result, her testimony was stricken and Judge Richardson ordered it to be disregarded by the jury.
After the ensuing confusion settled, the court room swelled in anticipation for the defense’s third character witness – Ashley Yudin, father of Sara Stone and grandfather of Sam Stone. Mr. Yudin began his testimony by telling Ms. Sequiera that he has known ‘Q’ for 12-13 years, and has grown to love his son-in-law as much as any biological son. Like the witnesses before him, Mr. Yudin described Mr. Stone as a “hands-on dad.” He added, “Maybe the most hands-on dad I’ve ever seen. He was all about being a dad.”
Regarding Sam’s change in behavior after the fall on Sept. 5th, 2012, Mr. Yudin testified, “We noticed subtle changes. When you have twins, there’s a tendency to compare, but there was a change. Hank was tracking with his eyes, and Sam wasn’t as much.” Ms. Sequiera nodded and asked, almost rhetorically, “Do you think you might be burying your head in the sand?” Mr. Yudin was visibly perturbed by the accusation. Following an abrupt, “No,” he went on to say, “Some people have a short fuse and will get upset over a paper cut; some people have no fuse and you can’t make them upset no matter what… ‘Q’ falls into the latter category.”
Ms. Sequiera took a moment to organize her thoughts before inquiring if Mr. Yudin had talked to the doctors while Sam was in the ER. The response she was given was heartbreaking. “Yes,” said Mr. Yudin, “I asked the doctors why they couldn’t do surgery to stop the bleeding and they said it wasn’t that much blood. They said the bleeding was causing the seizures, not the other way around. When I asked later [after Sam died] why they chose not to stop the bleeding, they said, ‘well, it’s our decision.'” Ms. Sequiera had no further questions.
DDA Mount’s cross-examination began with, “Do you remember telling Investigator Harmon that the dog or Jack may have caused what happened to Sam?” Mr. Yudin admitted he could not remember. For the next ten minutes, Mount attempted to draw forth the truth, but eventually gave up and resorted to a vaguer angle, “Would you say that good people can sometimes make mistakes?” Ms. Sequiera, fangs drawn, leapt out of her seat and scolded, “Objection! Vague!” Mr. Mount tried to rephrase the question, but ultimately failed as the defense’s rapid objections were sustained.
On re-cross, Ms. Sequiera, shaking with frustration, roared, “Mr. Yudin, would you consider it a mistake if I’m supposed to get milk on the way home, but I’m too tired?” Confused, he responded, “No.” “Okay,” heaved Ms. Sequiera, “What D.A. Mount wants to know is could Quentin Stone have hurt Sam Stone?” Mr. Yudin, jaw set, spoke the words slowly, “No. Absolutely not.” Sequiera thanked Mr. Yudin for his time and he was dismissed.
The next three witnesses, a neighbor and two school teachers, added similar testimonies to the three preceding them. The neighbor explained how she could see into the Stone’s backyard and windows, and even hear into their house. “I never heard any disagreement. They were a happy couple.” She added, “Knowing the charge, I would still trust Quentin with watching my three children. Having lost a child, there is a bond between parents who have lost and ‘Q’ definitely had that.” The school teachers, who happened to be married, had similar sentiments. “Quentin was wonderful with kids. All kids.” The husband recalled, “When Sam was rushed to the ER, ‘Q’ was distraught and anxious to get there, yet he took the time to calm down Jack and tell him Sam was going to be okay.”
After breaking for lunch, the defense called their expert, Dr. O’Donohue, to the stand. The jury was not present while Judge Richardson determined if the doctor should be able to testify. He ultimately ruled in favor.
Dr. O’Donohue has practiced clinical psychology for 30 years and has written over 75 books. He specializes in child and sexual abuse and has testified in court previously. On March 27, 2014, Dr. O’Donohue met with the Stone family to observe Jack and his interactions with his parents, looking primarily at Jack’s pathology, an explanation of Jack’s strange behavior (i.e., “shutting down” the day that Sam underwent the alleged fall), and Mr. Stone’s profile (i.e., does he fit an abusive profile?). Prior to the meeting, Dr. O’Donohue received and looked over police reports and medical records. The defense asked, “Should there be behavioral issues in Jack if abuse is present within the home?” The doctor responded, “Yes.”
Dr. O’Donohue was reminded of his professional report on the Stone family. He determined that Jack had no obvious pathology and did not appear to be traumatized. He might play rough and not know his own weight, sometimes needing a reminder to “watch out,” but “that is normal for a boy of his age.” Jack also did not appear fearful of Quentin Stone during observation. As for his “shutting down” behavior, lying on the floor while facing the wall, Dr. O’Donohue believes this was an indication of guilt and shame. He concluded with the fact: “Children who have older siblings – older by 2 years — have higher risks of injury.”
Mr. Mount stood to address the witness in cross. “Would you see behavioral change in a child if abuse took place out of sight and only occurred twice?” Dr. O’Donohue was forced to admit, “No, you would not.” Mr. Mount followed up by asking, “Did you clinically treat Jack at all?” Again, the doctor admitted, “No, I did not.”
A final character witness, the Stone’s babysitter of 3 years, was brought to the stand. She, like all others, testified to Quentin Stone’s “hands-on” parenting style, as well as his loving, playful temperament and complete absence of aggression. Her testimony was brief and to the point.
Court was adjourned and set to continue tomorrow at 8:30am in Department 1.
“D.A. Mount shocked the court room by asking a question that led the witness to exercise her 5th Amendment. As a result, her testimony was stricken and Judge Richardson ordered it to be disregarded by the jury.”
What was the question ?
So has the prosecution finished presenting their case? I am assuming that they have if the defense is now calling experts. They are ahead of schedule?
“On re-cross, Ms. Sequiera, shaking with frustration, roared…”
I think you meant “on re-direct” since Mr. Yudin is a defense witness.
A great report! I am very thankful for the Vanguard’s coverage of this case.
Tia, I was wondering the same thing.
The question was probably about her own parenting history or some stupid question purposely meant to discredit and humiliate the person. Evil, but did the trick.
That is a frustrating element of loyal friends testifying and wanting to help their friend. Also, it can be a financial hardship for the loyal friend.
D.D.
I especially wanted to know what the question was in this case because it was asked not
of a “loyal friend” but of the Public Guardian. Not that the two are exclusive, but that a question of the Public Guardian might have broader implications.
not much information given from Dr a Donahue. Hopefully the defense will put on a medical expert today.
yes, Elizabeth defense begin their case yesterday.
I’m hoping defense has more than character witnesses, sure they would have a medical doctor testifies sometime before this trial ends.
A lot to come back from with physical evidence.
agree Antoinnette, the defense will need to have some nationally recognized experts in the child abuse field to debunk the faulty SBS science if they want to avoid a conviction, character witnesses just won’t get the job done. But I have every confidence that we are going to hear from some excellent defense experts in the very near future.
Well, disagree the evidence ,”is faulty,” but do agree they need a comeback. But this guy on the stand now, isnt doing them a whole lot of good…and laughing in between answers?
Pretty awful to find humor when an innocent life has been taken…..makes me want to vomit!!
that is certainly not good, a witness acting inappropriately! who is he?
it’s not the evidence that is faulty, it is the science behind the theory of SBS that is faulty -whereas it used to be thought that nothing but abuse could cause the SBS triad of symptoms, we now know that there are many different conditions and situations that can result in the triad. It will be up to the defense experts to go over all of the medical and scientific literature that shows the flaws.
Elizabeth
“it’s not the evidence that is faulty, it is the science behind the theory of SBS that is faulty -”
For the non medical folks that may be following, I would like to make distinction.
In medicine, when we look for the cause of an injury, or a condition, we have to consider all of the possible causes. This is a list called a differential diagnosis. There will be some common items on that list and some things that one might not see in one’s entire career. They all have to be considered.
In this case, there are some complicating factors.
1. Past errors ini the definition and identification of SBS as the diagnosis have been made. It is important to realize the overzealous application of this diagnosis in the past does not exclude this as a possible real cause in any individual case. For that to be true, one would have to be able to demonstrate that this action could not, under any circumstances lead to the particular set of injuries. That attempt has been made, and unfortunately for this case was also not completely conclusive.
An example from my field. Once PMS was identified as a real constellation of symptoms that many women experienced before their periods, there was a point in time where some people started attributing all female mood alterations to their hormones. Obviously this is not true as women suffer from anxiety, depression , phobias and many other unrelated conditions.
This “bandwagon” diagnosis of PMS was not useful for those suffering from these other conditions, but that does not mean that PMS does not exist or that we shouldn’t consider the diagnosis and treat appropriately when we encounter it.
2. When we are practicing medicine we are on the same side as the patient. It is in the best interest of both the doctor and the patient for the patient to stay well or to get well as quickly as possible. This is not the case in our adversarial legal system in which, by definition
one side is going to “win” and the other to “lose”. This inevitably sets up the tenancy not to
seek the truth, but rather to maximize pieces of evidence or witnesses for your side and to try to discredit those of the other side. The sleazy demeaning and un professional behavior
( shouting, smirking, shaking) engendered by this competition does nothing in my opinion to arrive at the truth about what occurred.
all good points, Tia
I don’t know if there is a better legal system than ours, but I haven’t seen one thus far. What would you like to see instead of our current adversarial system?
I have a couple of thoughts about alternative possibilities. These would obviously require a major restructuring of our entire judicial system.
1) A panel approach in which lawyers representing the state and those representing the accused have equal funding, equal access to all of the relevant information at the same time ( no gotcha moments), equal say in what information is to be brought before the jury ( in conjunction with a neutral judge) and in which once the evidence has all been agreed upon it is presented to the jury by a neutral fact presenter thus avoiding any of the theatrics and disparaging of each others witnesses.
2. An alternative approach which would require a lesser degree of change
would be to require that all trial lawyers spend half of their time representing the state and half of their time representing defendants. This would ensure that no one person could build their entire career on the number or cases won either for the state ( thus establishing their
“tough on crime” credentials nor by the number of cases won for the defense thus establishing their ability to “get people off” regardless of their guilt or innocence.
The system that we have now is rife with the possibility of lawyers and judges slanting their presentation and / or instructions to cater to their own aspirations rather than to the determination of fact and administration of justice. I am not saying that this is common, but I think the Court Watch and other journalistic reporting on our courts also demonstrates that it is not rare.
Those are both interesting ideas, Tia.
Your first suggestion, is that not very similar to the French legal system? I don’t know but it sounds familiar to me, maybe someone else knows. And I thought that the Italian legal system was also along those lines, as in the Amanda Know trials, again, I don’t know, just wondering out loud.
Your second suggestion sounds very intriguing to me, in fact, I think it could be very advantageous for everyone to have experience on both sides.
Sometimes people giggle or laugh nervously in the worst scenarios. When the Dixon police verbally bullied me, I giggled because at one point I found the question so extremely ludicrous. even though they were trying their best to intimidate. I was shocked at how low they sank, thus, giggles. Later, remembering it for my memoir, it was shocking that I laughed.
I saw a woman giggle all the way through her marriage vows, she was so nervous. She was a mature school teacher, usually serious. Nervous laughter is just nerves.
At a well publicized criminal trial many years ago, a woman giggled nervously at a horrendous moment in the trial. Just nerves. Inaproppriate, but physically almost uncontrollable.
Dr. Patrick Barnes from Stanford did a phenomenal job today IMO. He addressed the rickets issue, the fact that SBS needs to be reworked. He’s a true child advocate, exactly what this case needed.
Thank you for posting this! I am so pleased that he testified for the defense and I am looking forward to hearing the details about his testimony. Did he finish today or will he be on tomorrow as well?
Totally agree! Dr. Barnes was excellent and convincing. It was refreshing to hear an educated perspective that lends a little faith to the Stone family. I wonder what the jury thought.
No, he finished today and they ended with two fabulous character witnesses. I forgot to mention, he did all his research and today’s testimony for the price of a sandwich. 🙂
I don’t like to hear that. People should be paid for their time and expertise. I know that he is very passionate about getting the information out about the very flawed SBS theory.
It’s a shame that character witnesses cannot be paid for their time away from work and family. Also, when expert witnesses are paid a large sum of money, it sends the wrong message, IMHO.
I understand your point, that when an expert is paid it provides fuel for the opposing attorney on cross-examination (as we have seen in this trial on both sides). But someone of the stature of Dr. Barnes could spend 100% of his time being involved in cases like this, and the fact is, he needs to make a living just like the rest of us. For that reason, I think it is ultimately unfair to expect experts to devote their time and expertise to a case for free.
Nerves or not….it made this whole trial today sound like a joke..in fact everyone laughef with him….sorry, it felt disgusting to say the very least!
I couldnt disagree more, gj..
He never could rule out abuse…and his theory.on Rickets has already been disproved. I dont know how many more times one can hear, “he had NO illness?
Now, we’ve not only heard 6 to 7 theories on different causes….but at least three contradicting stories involving the toddler….which is it? The fall or a sickness?
The truth never changes………but a lie told over and over again begins to fall apart.
Sorry, folks….this story is grossly becoming harder to swallow by the day!
This doctor today acted as if he really said anything significantly different, but when it came down to brass tactics, he could not answer any real facts but rather his own interpretations as the others are accused of……only HUGE difference is…”He never cut into the brain for himself”
In fact, all of most of what he relied on, in his own words, was.liteterature?
But, one thing I did agree with was the baby should have had xrays done right away….
Again, I can comprehend somewhat why Kaiser docs did not run the tests, but once that baby was taken to UCD, he should have had an immediate MRI, and then had surgery to remove the fluid…
Every doctor that has testified so far, be it prosecution or defense, all share that one thing in common; removal of fluid/blood, should have been the first thing they did!
Even if they suspected abuse, they could have set the investigation into that aside long enough to focus on saving the babys life……they chose not to….now, it leaves me wondering if perhaps they may be covering up their own Garganteous deadly mistake……but, I dont think we will ever really get to the truth…..hopefully, the man upstairs will reveal it.
Antoinnette,
if you can take the time to read the case in the link Elizabeth provided – about the Del Prete case –
you will find it very illuminating about SBS.
Antoinette
Just as I would caution, as does Elizabeth, about making assumptions about the guilt or innocence of Mr. Stone,
I would also caution against making assumptions about the appropriateness of actions taken by the doctors.
Clinical decision making is based on many complicated factors. It is based not only on the acute diagnosis but also on the over all condition of the patient. Some patients may have a condition that while it looks terrible,may actually be able to be managed by conservative or medical means thus avoiding the risks of surgery. Other patients may have other conditions that have to be considered and or stabilized prior to preceding with surgery. A third group of patients may be too ill to undergo surgery and have a high probability of dying “on the table” and whose best bet of survival may be medical stabilization ( if possible) prior to surgery. Each case is unique and what worked best in one situation does not mean that it is the best course of action in a different case.
Again an example from my field. Sometimes a woman with breast cancer will be best served by surgery, possibly a lumpectomy if the cancer is found at a relatively early stage.
A second patient, also diagnosed with breast cancer, may first be sent to an oncologist and have her surgery significantly delayed. Does this mean that the doctor has done the wrong thing even if she dies from her disease before her surgery could be done ? No, because what I did not tell you is that our second patient had metastatic disease meaning it had spread to other parts of her body. This particular set of circumstances requires chemotherapy prior to surgery. To the family members of the second patient, it may look as though the doctors were incompetent, especially if they know other women who have survived. But this would not be true.
Sometimes the doctors do everything that they can reasonably due and there is still a bad outcome.
I do not know enough about this particular case to know whether or not things could have been handled differently to achieve a better outcome. I am just pointing out that judgements made on the basis of partial information, comparison with other cases, or the emotional context are frequently incorrect.
This is equally true whether it is the defendant who is being prematurely judged or whether it is the doctors or others involved.
I wonder if anyone has actually talked to the toddler about what happened or asked him to show with dolls how he played with the baby. He might have things to get off his little toddler chest that would help clear up some questions.
As a parent, I would want to choose who talks to my children, especially a fragile toddler who just lost his brother.
But….I am waiting on a decent, credible expert… For defense…..hopefully the one tomorrow will be better.
Antoinette, Dr Barnes is an internationally recognized expert in the field of child abuse, they don’t come any more credible than he. He testified for the prosecution in the Louise Woodward (the British nanny) case that first brought SBS into the public awareness, and he has been involved in every major case since that time including the recent Del Prete appeal that I posted on another thread. And, as I have said before, infantile rickets was certainly not eliminated in this case, in fact, Dr Coulter’s testimony was that the serum Vitamin D level was low, which is completely consistent with the disorder.
Elizabeth,
I understand the association between infantile rickets and the brain bleed and rib fractures. But how does infantile rickets explain the severe retinal hemorrhaging that the baby suffered in this case?
good question, ga
Retinal hemorrhage is a fairly non-specific sign that can occur any time there is increased intracranial pressure, which happened in this case as a result of the brain bleeds. I am certain Dr. Barnes would have covered your question in his powerpoint presentation but for those of us who missed it, a few years ago he published a foundational paper about the epidemic of rickets and how it is being mistaken for child abuse. You might find it interesting. What I found particularly compelling about Dr. Barnes testimony, or at least what I have heard about it thus far, is that he found radiographic evidence of rickets in both twins, which wraps up the diagnosis.
http://www.stanford.edu/~pbarnes/docs/publications/Rickets_Abuse.pdf
It seems like if infantile rickets were a viable explanation for the constellation of injuries on this infant, that the defense would have mounted a much larger and more specific argument towards rickets as the cause or a likely cause of these injuries. It seems that Dr. Barnes testimony would have been much more specific and focused on rickets. I certainly don’t have the medical background that you have but I am wondering what it is about this case that makes you think that Shaken Baby Syndrome and/or non-accidental trauma is NOT the explanation for the infant’s injuries?
Antoinette, I also thought I read that a Detective was being called to testify but never read anything about his testimony? Am also wondering if anyone interviewed the toddler, who depending on his language ability, may or may not have been able to provide important information.
once again, very good questions
First, I have not heard or read Dr Barnes complete testimony so I am not in a position to say whether or not he emphasized infantile rickets sufficiently, although it is clear to me from what I have read that he certainly believes that is what happened. Remember, it is not necessary for the defense to show the cause of death, only to cast reasonable doubt on the prosecution’s theory. As far as why I don’t believe that this is a case of SBS, I offer the following:
– SBS is a discredited theory and criminal convictions based upon it are being overturned on appeal, so I was very surprised when this case was even brought against the defendant
– there is no evidence, zero, that Stone or anyone else shook the baby. In fact, the absence of any neck abnormality or injury suggests that the baby was, in fact, not shaken
– we now know that the baby had a metabolic bone disease, as evidenced by a “very low” serum Vitamin D level (per Dr Barnes) and radiographic evidence of this disease process (also per Dr. Barnes), and we also know that this disease process completely explains the symptoms and the unfortunate sequence of events that resulted in the baby’s death. I was always taught in medical school that when you hear hooves, you look for horses not zebras. In this case, the horses are metabolic bone disease or infantile rickets. The only way you can conclude SBS is if you completely ignore the metabolic disease and hang your hat on a discredited theory. That is simply not a reasonable way to look at this or any case.
Would you expect to see the severity of the symptoms/injuries that the child had in a 3 month old baby who had rickets? Are their other symptoms of infantile rickets that the baby did not show?
SBS is not a theory. It is a “syndrome” whatever that means, but it happens more often than maybe we as a society choose to believe and there are people who actually confess to shaking a baby, and that child then often times will die or be severely disabled, and the medical community can gather information about the injuries which can inform us about the syndrome and injuries we may see on other cases. Certainly each SBS case is unique (force exerted, pre-existing medical conditions, head impact or lack thereof) and we should not just assume that a child that presents with a. b. c. injuries then the child has suffered from SBS. A complete rule out should be done on other possible explanations for the child’s injuries.
Of course there will be times when people are wrongly accused of SBS and there is another rare but credible explanation. I just have not hear that yet in this case. And there are lots of highly trained and skilled professionals in all different arenas involved in this case. The Defense does not have to show the cause of death, but if I am on the jury on a case where an infant died, I sure would like to hear a credible explanation on what caused the baby’s death. The Defense seems all over the place on this. Maybe it was the accidental low grade fall. Maybe it was rickets. Maybe it was a metabolic bone disease. These have all been thrown out there an nothing has stuck so far.
The tricky thing about SBS is that it can happen to the most high functioning of people. When we think of child abuse, we think of drug abusers, violent criminal history, welfare recipients, etc. but SBS occurs in seconds to a person who loses self control. And if we who are parents are honest, we have ALL felt out of control at some point. Throw in sleep deprivation, a toddler, newborn twins, and who knows what else, and I can see how a person could momentarily lost control in a catastrophic way.
I would like to hear more from the medical experts about the lack of neck injury. I would like to see the research on how many known (not convicted) SBS cases, the infant suffered a neck/spinal injury.
As for evidence, I am not sure what you would hope for aside from an eyewitness or a confession. I assume the police determined that no other adult had access to the child in that time period to cause the injuries. The “evidence” in this case is the severe injuries that the child suffered. Just because there is no “evidence” other than injuries in SBS cases, certainly does not mean that people don’t shake babies to death.
If you would like more information about the SBS controversy, I would refer you to a number of references, all with excellent information.
You might start with law professor Deborah Tuerkheimer’s law review paper here: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1354659
She has also recently released an excellent book on this topic, “Flawed Convictions: Shaken Baby Syndrome and the Inertia of Injustice” that is shaking up the child abuse communities.
Dr. Barnes 2012 powerpoint presentation on this topic is excellent: http://www.stanford.edu/~pbarnes/docs/publications/UpdateBrainImagingNAI.pdf
and for even more information about the confusion of infantile rickets with SBS, have a look here and in particular watch the video interview with radiologist Dr. Ayoub: http://articles.mercola.com/sites/articles/archive/2014/02/16/infantile-rickets.aspx
i definitely think that infantile rickets is looking in the wrong place, but i do agree with dr. bowler here that the prosecution is presuming more than they should based on flawed science.
I was able to get some interesting notes from Barnes’ testimony that I would like to contribute, but I’m unable to at the moment. His points regarding the fabrication of SBS and subsequent research based on its blind acceptance was disturbing and illuminating. I can see how viewers might’ve been offended by his giddy demeanor since the case is tragic, but I thought Dr. Barnes’ giddiness (for lack of a better word) was harmless – laughing not at the case, but at the fallibility of scientific “research.”
@Goaggies….could not have said it better myself…
@Elizabeth, I am nit sure why you keep insisting on Rickets or anything else? Its all been ruled out by Patholgy…are you arguing with that?
@Tia, agree, but was not really judging, just call like I ser it and trying to bring out some.points.
People say the Science is faulty, flawed…and this story isnt??
The contradictions, the 6,7 different the of illnesses, the three different stories involving the toddler
Dr. Barnes is the one who disagreed because there was a “very low” serum level plus radiographic evidence of the disease which is how the diagnosis is made, not by pathology. I find Dr. Barnes opinions to be very persuasive because this is his particular area of expertise.
Oops…
They bring pause…even if we could say, injuries were caused by illnesd…how do we disregard the totality of other circumstances?
I am not saying he is guilty, only stating the obvious here and so far,.My only doubt, reasonably, is Who did it, not What…..
Defense has three more days…anxious to hear what they have to convince my doubts…albiet, I am not the trier of fact…
@Jane, really couldnt disagree more…..he did.nothing to convince me, whole lot if dancing around a direct answer…and could not realky refute certain findings at the close.day.
Still think the laughter was eerily disgusting…..I sure wouldnt want anyone laughing in testimony talking about the pictures and xrays of my deceased baby nor thinking it humorous while Im fighting for my kife?
Yuck!!!#
OK, I may be missing something here but what was the actual number of the level of Vitamin D ? To me this is critically important because we have one expert who seems to say that it was “very low”. This same expert is an individual who has built reputation based on distinguishing SBS from infantile rickets. We have another expert who appears to have characterized the level as “low”. However we don’t know what kind of “low”. Does this mean outside the reference range but not clinically significant ? Does it mean towards the lower end of the normal reference range ? And we have an expert who does not believe that it was low enough to be consistent with a diagnosis of infantile rickets. My question is simple. What is the number and what is the reference range for the lab that was used.
I realize that this information may not be available, but it is what would be needed in order to lay this question completely to rest. Without the number, the rest is speculation.
there is also
there is also radiographic evidence of bone disease per Dr Barnes, which would confirm the diagnosis
I would also like to present an alternative point of view to that presented by Elizabeth.
Dr. Ayoub, the speaker in the video recommended by Elizabeth is a radiologist. He has also established a reputation for himself on line and in the alternative medicine community as an expert on vaccination and autism. His beliefs in these areas are not widely accepted nor backed by research. For an alternative view of the positions taken by
Dr. Ayoub one might want to consider that Dr. Ayoub, a radiologist by training, has been instrumental in disseminating the mistaken idea that vaccines cause autism and are linked to Alzheimers. Both of these concepts have been thoroughly debunked but not before causing a great deal of fear and real harm due to parents refusing vaccination on the basis of unsubstantiated claims. One outcome of the teachings of Dr. Ayoub and those of like mind has been the resurgence of measles.
The interview that Elizabeth has recommended is one of a series promoted by a Dr. Mercola. Dr. Mercola is best known for his extremely lucrative on line business of selling vitamins to people who may or may not benefit from his products. Dr. Mercola has been sanctioned on a number of occasions by the FDA for making unsubstantiated and misleading claims about his products. In fairness to Dr. Mercola, benefitting from selling products such as
Vitamin D does not mean that he is incorrect in any given statement. However, I have to question whether an individual who has made the incorrect assertion that Vitamin D is used to “treat cancer” on one of his Web pages leads me to question the veracity of his claims and those of the doctors he chooses for his interview series.
I realize the Elizabeth is not in agreement with my skepticism about the expertise and claims of these doctors, however, I think that this is one instance in which hearing both sides is critical in judging the validity of the evidence being provided. Of course, this is only with regard to the experts that Elizabeth has referenced and has no direct bearing on the current case.
Dr Ayoub has been qualified as an expert in many courts around the country and around the world on this topic and has many peer-reviewed publications to his name. I do not and have not recommended Dr. Mercola for anything, but Dr Ayoub’s interview happens to have been done by him and is excellent and enlightening especially for laypersons. I think it is extremely unfair, even meanspirited, to diminish Dr Ayoub’s rather hefty credentials because of Dr Mercola. I also recommended Dr. Barnes, do you reject him as a qualified expert as well? He has been qualified as an expert around the world probably more than anyone else and is one of the medical giants in the field of child abuse authoring many of the foundational peer reviewed papers in the medical literature. What about the law review article published in a peer-reviewed law review journal that I recommended? Is that not worthy of consideration either in your opinion even though the law professor is one of the leading legal scholars on this topic? When people refuse to listen to leading experts in this field because their opinions do not agree with some preconceived ideas that have been around for decades with little to no science behind them , then we will continue to have legal travesties such as the Jennifer Del Prete case. She was only recently released from prison after serving 10 years following a conviction for SBS that turned out to be faulty. It was thanks to the efforts of Dr Barnes and others that this injustice was finally overturned.
Fair questions Elizabeth.
I certainly did not have any “mean spirited” intentions with regard to Dr. Ayoub. The fact that he has been certified as as “expert” by courts and the fact that he has many publications does not mean that he will be accurate in all of his assessments and this is certainly true outside his area of expertise. I think what is fair is to at least question the statements of someone whose reputation has been built in part on inaccurate statements about the harms of vaccines. If you have other specific references to work done by Dr. Ayoub that you feel is pertinent to his expertise I would be more than happy to check them out, just as I did with this video.
I am unaware at this point in time of the work of Dr. Barnes and so am unable to make any statements with regard to his level of expertise. We seem to have crossed posts at the point where I was clarifying how I currently approach medical decision making using an evidence based approach as opposed to reliance on “expert opinion”. I feel that while medicine has lagged in utilizing this approach, our courts seemed to have lagged even further continuing to rely on an outmoded model of attempting to arrive at the facts of a case through reliance on “dueling expert witnesses”.
One can clearly see the downside to this approach in the current case. I have also posted elsewhere my preference for a collaborative approach in which the all parities would acquire, evaluate and agree to present evidence in a non prejudicial manner to the jury, or better in this case, to a qualified judge.
One last comment, for now, on a process that I feel essentially ties a jury’s hand behind their backs. On cases involving medical issues, health care providers are typically excluded from the jury pool. This has the supposed advantage to having a “blank slate” where the jurors come without preconceived notions. What I feel is the actual effect is that it ensures the persistence of a “blank slate” in which the jurors are likely to be swayed by whomever is the more skillful in putting forth their favored theory. This is not, in my opinion, the best way to arrive at truth.
@Tia……….just read all the same.stuff , I believe? And agree!
You asked fir the level the baby had:20mg.
Normal level is 30 to 100, 20 to 29, insufficient, and below 20, one could opine Rickets….spell out anything?
But……running the risk of sounding like broken record, “Which cause are we sticking to?”
Illness or fall?
Pick a card……
I think Rickets can be put to rest? Believe the experts.for prosecution have already done that, over and over again.
I think what we have here is a whole lot of denial……
Also, Tia, the cases I researched on wrongful convictions entailed exculpatory evidence:.eye witness and/other physical evidence found not given or known during trial and not much to do with disease.
Very few…….but could be the defendants did not have strong enough counsel?
The biggest concern is the growing literature on SBS itself and whether the prosecution’s experts reached a conclusion first and laid out the facts in a way to prove that conclusion. That is a large concern in the literature and without being a medical doctor (two of the posters here actually), it’s hard to counter that.
The second problem is worse – we are now going to ask a jury to weigh competing medical evidence. While a judge is not a doctor, they may be better suited to weigh complex evidence of this sort. A court trial therefore, like we saw in the car crash case, might be the better approach.
David
Agreed on both counts. It is not unusual even for doctors who practice the same specialty to disagree on the best interpretation of complex medical cases. Fortunately, at the end of the day we usually conclude this disagreements with an admission that each view point has its strengths and weaknesses.
Within our judicial system, this admission of complexity does not seem to be encouraged.
Since each side benefits by claiming that their side is uniquely accurate and that the other side is presenting false or misleading information by incompetent witnesses. I don’t see how we can ever, in good faith, expect a jury to get to the essence of what we, as medical doctors cannot agree upon.
All good points David, a court trial could turn out very differently than a jury trial. I have found that jury trials can have a greater element of “emotion” especially when it is a particularly horrific crime (Marsh, for example) or involves the death of a child, both of which are very upsetting to jurors. A judge is likely to be more dispassionate and look just at the facts that have been presented, at least that has been my experience.
Antoinette
I really appreciate you taking the time to post the actual value and the reference ranges.
According to the standards of our lab and that provided below from Up to Date as of 4/2014, there is a difference of opinion with regard to “normal levels”. These are the cited levels for children. I do not treat women whose Vitamin D levels are 20 or above. It is also very important to consider that Vitamin D is a fat soluble vitamin and it is possible to overdose, thus supplementation should be used with caution.
●Vitamin D sufficiency: 25(OH)D ≥20 ng/mL (50 nmol/L)
●Vitamin D insufficiency: 25(OH)D between 15 and 20 ng/mL (37.5 and 50 nmol/L)
●Vitamin D deficiency: 25(OH)D ≤15 ng/mL (37.5 nmol/L)
According to these standards, baby Stone’s vitamin D level was within the normal range albeit at the lower end.
I sincerely doubt that this is the level of Vitamin D that one would associate with rickets, and I completely agree that this should be taken off the list of possibilities for this case.
What about the radiographic evidence of the disease in the long bones according to Dr. Barnes? Surely you can’t just dismiss that.
Also, the baby’s Vitamin D level at 3 months is going to be considerably higher than it was in utero because it will rise after birth
I will have to double check this, but I recall that the average serum level in rickets cases in infants if is 21. In any event, a level of 20 is certainly “low enough” to result in the disorder, and it was undoubtedly lower still in utero.
Elizabeth
I simply do not have the expertise to judge Dr. Barnes statements about the long bones.
No dismissive intent here. I simply cannot speak to the full differential that could lead to the findings he sites and since in the reporting presented the differential was not presented, I have no basis on which to form an opinion.
Getting back to your statements about Vitamin D, I simply do not agree. Without knowing the level of the baby’s mother and without knowing the value at birth, we simply do not know whether or not this could have played a role. What we do know is that the level of at the time of draw was 20.
The information that I posted previously was from Up to Date. A more extensive explanation of the basis for this is as follows
“Standards for defining vitamin D sufficiency in healthy children are not well established. In children, radiological changes of rickets and low bone density have been reported at 25(OH)D levels of <16 to 18 ng/mL (40 to 45 nmol/L), and alkaline phosphatase (ALP) levels have been noted to rise at 25(OH)D levels <20 ng/mL (50 nmol/L) [36-42]. Among 500 immigrant children in Scotland during the 1970s, radiographic changes consistent with rickets were found in 32 children (6 percent) [42]. The mean 25(OH)D level among children with subclinical rickets was 8.5 ng/mL (21 nmol/L), as compared to 16.5 ng/mL (41.5 nmol/L) among patients without radiographic changes; the positive predictive value of a 25(OH)D level ≤15 ng/mL for rickets was 41 percent. In separate studies in adolescent girls in Finland and boys in Tasmania, 25(OH)D levels less than 16 ng/mL (40 nmol/L) were associated with elevated markers of bone turnover and reduced bone mineral density [38,40,43]. At this time, there is little evidence from studies in children to indicate that vitamin D levels above the threshold of 20 ng/mL (50 nmol/L) are necessary to optimize calcium absorption or bone density.
Based on these considerations, currently accepted standards for defining vitamin D status in healthy children and adolescents are [1]:
●Vitamin D sufficiency: 25(OH)D ≥20 ng/mL (50 nmol/L)
●Vitamin D insufficiency: 25(OH)D between 15 and 20 ng/mL (37.5 and 50 nmol/L)
●Vitamin D deficiency: 25(OH)D ≤15 ng/mL (37.5 nmol/L)
These cut-offs may need to be revised if future pediatric studies demonstrate efficacy of higher 25(OH)D levels.
With regard to whether the Vitamin D level would have risen or fallen post delivery, there is no definitive answer. This issue is more complex than you are portraying. If the mother's Vitamin D level were in a normal range during the pregnancy, there is a good chance that baby Stones' level would also have been in the normal range. What would happen after birth depends on a complex series of interactions. Was baby Stone exclusively breast fed ? Was he regularly supplemented with Vitamin D to prevent a drop ?
Elizabeth
As I was making the above entry, a possible source of apparent difference of opinion may be the fact that each of us has chosen to post numbers without referencing which units we are using. In my posts, I have consistently used the ng/ml number thus arriving at my conclusion that 20 ng/ml is within the accepted normal range.
If one is using the nmol/L unit this will indeed appear to be a deficiency.
I will stand by the contention that 20 ng/ml is a normal value albeit at the lower end of the normal range and would not be associated with the diagnosis of rickets.
A serum level of 20ng/ml is not in the normal range according to the numerous societies and boards that are commonly referenced. I cannot seem to duplicate the table with the various reference ranges for different agencies, but you will find it on this link if you scroll down on the page. You can see that 20 is “deficient” per all agencies except the Food and Nutrition Board where it is “insufficient”. But no matter what the actual serum level is, if there is radiographic evidence of bone disease there exists a very serious problem.
http://www.vitamindcouncil.org/about-vitamin-d/testing-for-vitamin-d/
I think that our disagreement over the likelihood of Vitamin D deficiency is likely based on using different sources of information.
The American Academy of Pediatrics, The American College of Obstetrics and Gynecology, The American Academy of Internal Medicine and the American Academny of Family Practice all use
20 ng/ml as their lower limit of normal. It is reasonable for people to differ in their opinion, however, I would be hard pressed to hold up the reference that you posted against all of the above colleges. Do you have other supportive evidence ?
Yes, there are other organizations that recommend levels above 30ng/ml, and European ones in particular tend to recommend along those lines. But in this case, the recommended guidelines are irrelevant because there is radiographic evidence of bone disease. Even the prosecution expert called the level “low”, presumably because it was below the reference range, and the defense expert called it “very low” no doubt based upon his vast experience in this area. It does not seem reasonable, given the evidence, to call it “normal”.
I am not a radiologist either so I have to take Dr Barnes opinions as fact until or unless I hear other explanations for those findings. Additionally, that is Dr Barnes particular area of expertise so I would have to weight his opinions accordingly.
“I am not a radiologist either so I have to take Dr Barnes opinions as fact”
This may or may not represent a difference of approach between us.
30 years ago, I would have been much more likely to agree with your statement than I am now. What has changed for me over that time is the movement from relying of “expert opinion ” to an evidence based approach.
For virtually every condition in medicine save perhaps the most obvious such as a broken bone or a baby crowning, there is a differential. What I have learned over time is that recognized experts frequently have become expert by extolling their favored point of view over and over.
Many times they are accurate. Sometimes they are not. Knowing that this is the case, I choose not to take their opinions as fact until I have done due diligence in researching the issue. I may or may not have the time to do so today, but remain curious and open minded in the meantime.
Since neither of us will be able to look at the X-rays ourselves or get someone else we trust to do so, we will both have to wait and see if the prosecution provides any new expert testimony to contradict Dr .Barnes findings of disease in the long bones. Until then, it remains as powerful evidence for metabolic bone disease.
Thank you Tia…..agree…It was ruled more than once and by more than one doctor.
But so were several other medical causes…cant stop my investigative nature. So much is missed in these trials…often due to lack of funding….
I fail to find good or professional reason to bring up cost for services of experts? Where is the relevance? It is used as to discredit a credible witness, I believe?
Excuse the pun…but I would leave NO Stone unturned to ferret out the truth in any case;be it defense or prosecution.
But from all indications…it appears so…
I have to say, I agast that people are still insisting on “disease?”
For the sake of argument, lets say it was, lets even go a step further and say FOUR experts were wrong, misread, pissibly misinformed opinions of their raddiographic findings?
What are we left with? What is the Trunk, foundation,thrust, of this case?
The baby died from severe, forced, impacted brain injuries.
when you clear away the brush, you still have that one proven fact(by all experts, no one yet denys injuries)
So now what? What do you build from, or on?
You must build on that foundation to either prove or disprove the charges, the crime.
How do we do that? Putting together the totality of circumstances; they just dont fit.
1. We have 6,7 different theories involving illness(albiet, they have all been ruled out.
2. We have 3 different stories involving the toddler.
3. We have 1 story told to friends, and one told to the fireman who arrived on scene.
4. We have a ten minute long wait before 911 call is made.
5. We have 2 character witnesses, contradict a statement.
6. We have 3 diifferent accounts assumed on how the toddler may have caused the fall(babysitter contradicts)
7. We have unwitnessed fall(typical of SBS response)
8. We know from Patholgy, fatal blows were done within minutes, to 3 hours.(possibility of someone else shaking)
9.Pediatrician never told Toddler pushed or pulled him, only he fell.(to my recollection)
10.Babysitter testifys infant seemed fine, no seizures, no projectile vomitting within days, weeks of watching him prior to death and after alleged fall.
11. Only people witnessing seizures, vomitting, are parents.(with exception of one or two? Others were only told)
12. Old injuries on the brain( healing from first incident)
13. Not one expert can rule out trauma, abuse.
14. Paper trail of emails to doctor, but baby never taken back to doctor.
15. No acid reflux found.
16. Fractures to ribs, not just regular breaks from suggested diseas, but compression, squeezing in form.
17. Not enough force from fall to cause injuries( not enough space to gain speed to fall hard enough)
18. Woodfloor gives (more likely injuries would not be severe)
19. No real theory? Death by fall? Or by diseases already ruled out?
20. Most events unwitnessed(fall, in particular)
Most of these points raised left out doctors findings, with the exception of a few.
Just a few things for now to ponder.
But I do understand we all think differently. These are points, testimonial facts heard so far that raise an eyebrow..I tried to clear away the brush and start from the foundation.
However, trying to leave out the disagreeing testimony from a few doctors.
At the end of the day though, all have agreed on trauma, possibility of abuse.
Personally, dont see how Pathology can lie….but if there is a way to contradict the truth, there will always be someone to do it……just an observation.
Set aside all argument over findings; You still have a whole lot of circumstances that simply do
Oops….not add up!
Antoinette
I think that you have done an excellent job of laying out the uncertainties involved in this case. You have done a wonderful job of illustrating what is frequently the case in medicine. One interpretation of findings leads down an established path. It is our job to conclude whether that is the only available path or whether another will lead to the truth. The responsibility for doctors is to decide under sometimes urgent circumstances which is the best path.
The responsibility of our judicial system is to decide whether or not a criminal path was taken. It is cases like this that make me very grateful that I chose the path where I had at least the possibility of intervening for the benefit of my patients.
I see no good coming out of this scenario. If Mr. Stone is found not guilty, it will be because of reasonable doubt, not a complete exoneration. If he is found guilty, will we have robbed a family of one member because of the presumption of “a snap” or temporary loss of control. I doubt that there is anyone, including the prosecution who believes that this was a deliberate choice to injure a three month old. There is no win here for anyone.
Thank you, Ta…..
I am certainly not an attorney, nor the investigator in this case and I do believe if we can hear something substantial that will be more of a tell/tale piece of evidence, my ears are inclined to listen.
I also know he is innocent til proven guilty.
I have actually watched several documentaries from cases and a few doctors around the world with different beliefs. All were certainly worth listening to. I believe there are innocent people wrongfully convicted but one would have to take a look at more than just the injuries themselves, thus why we must take the totality of circumstances. On occasion, even circumstances can be misinterpreted.
This is why these cases are extremely tough. I hope this is studied further. I hope more specifics can be found so we have no questions of cause.
Sadly, as Dr. Plunket put it,”we never talk about what loss the baby suffered, even in his/her death, but instead feel for the perpretator and try to come up with anything/everything medically possible because we dont want to believe a person could do that.”
Agree, no win, either way.
It almost seems like there has been a pendulum shift with SBS. As proven in a few high profile cases where the defendants have been exonerated, there are other circumstances/conditions that mimic the injuries most often seen in SBS babies. There are very solid, reasonable medical explanations for why a child had brain and retinal bleeds and broken bones and were not ever shaken. And I am sure there are those accused of SBS who are innocent and sitting in prison for a crime they did not commit. And thank goodness for people like Dr. Barnes who can use his expertise and knowledge to help those people.
So while in the recent past, we (as a society) may have jumped to conclusions, assumed SBS from the start and not really considered other reasonable alternative explanations for the injuries, in some SBS cases, it would be wrong to swing all the way to the other side and immediately assume that an infant who presents with brain hemorrhaging , severe retinal bleeding and compression rib fractures is NOT a victim of SBS. Just because in the past we have over assumed that those injuries are a result of SBS. We should be looking at the specific circumstances and medical history of each case on an individual basis. We should do a complete medical rule out on all other possible medical explanations for the injuries. And if all of that comes back negative, we should consider the possibility of SBS and investigate that possibility thoroughly.
From what I have heard and read, there was a medical rule out done for a variety of diseases and disorders done for this baby. While Dr. Barnes found “radiographic evidence of bone disease” I have heard nothing more specific about that as testified to in Court. I imagine if that were a viable explanation for the myriad of injuries this baby suffered, there would be an immense amount of testimony and the prosecution would have called their own expert in this area. Same for Rickets. Same for any other real viable medical explanation in this case. So if the medical explanation for the injuries (which would be rare) does not exist, where does that leave us? To a dark place. To a place that has to try to believe that a father, a loving and involved father by most all accounts, could cause those injuries to his baby. Again, it would take seconds to lose control in a fatal way…
I could not agree more that there are no winners here. If he is found not guilty, he and the family will forever be without their son, their brother. If he is convicted, a family loses a dad and a husband and a seemingly good man goes to prison, as would be his punishment. Though I imagine his real punishment, that he will carry forever, was the tragic loss of his little boy.