by Antoinnette Borbon
In what would now be the third week of an emotionally charged trial, the prosecution would seem to leave little room for a reasonable doubt.
Quentin Stone has been charged with causing his infant’s death in October of 2012. Quentin Stone is the father accused of “shaking” his two-month-old baby, which potentially may have caused the baby’s death. The trial involves the contention that three-month-old Samuel Stone died from injuries that included bleeding in his brain, retinal hemorrhages and fractured ribs, and has left many questioning the charges at hand.
In the x-rays taken of baby Stone, there were fractures, and two doctors have now testified that “this type of fracture comes from compression, a squeezing around the rib cage.”
But according to a pathologist, Dr. Organo, it was not just the rib fractures so much as the type of severe trauma to the brain in the areas of both the subdural and subarachnoid parts. Dr. Organo stated that he ran several tests to rule out other medical conditions. He said, “He had low sodium and was anemic but they were not causes.” He also explained that the baby was negative for any blood disorders or vitamin deficiencies, or brittle bone disease that could have caused the type of injuries found. However, he told the prosecution that these were only his interpretations.
The doctor expressed that he could not answer certain theoretical questions which defense counsel posed. But he asserted, from several findings, the cause of death was not accidental.
He said the multiple contusions could not have come from a fall or seizures, and “the CT scans and MRI reports, show abnormalities, deformations consistent to blows, severe trauma and most kids are resilient.”
He stated, “It is really not possible to have suffered this trauma and lived with no signs for several days.”
In cross, the defense asked if the doctor knew about the baby vomiting, going limp and not visually tracking after the initial fall in September, and he replied, “No, ’til the autopsy, and I read all the medical reports.” Defense attorney Martha Sequeira asked Dr. Organo if he had ever viewed the x-rays, and he answered, “No, just read reports.”
DDA Steve Mount questioned Organo about the possibility of the types of injuries stemming from a fall. The doctor stated if the baby had fallen onto an object, causing the bleeds on the brain and fractures, there would have been a focal point. He said there would have been visible bruising near the location of where he had hit and the findings did not show any location.
“Bleeding was on both hemispheres and in the retinas that have only been seen in non-accidental injuries,” Organo stated.
The doctor was asked again by DDA Mount, “So what would you say is the cause of death?” Dr. Organo asserted once again, “Non-accidental brain trauma.”
The defense called a couple of witnesses out of order this afternoon, in the interest of time as prosecution awaited their last witness for the day.
Carrie Willis, a close friend of Sara and Quentin Stone, testified to the behavior of Sara and Quentin in the years they had been friends. Carrie stated she was excited to be pregnant the same time Sara Stone was and amazed they were both carrying twins. Carrie, breaking down in tears, said, “I…I was just ecstatic! I…I was so happy to be pregnant the same time as my best friend.”
The defense asked if she knew what kind of father and husband Quentin was, and she said, “He was amazing, attentive, supportive and loving.” Carrie replied.
“So would you trust him with your kids?” Sequeira asks, “Yes, I would,” answered Carrie.
“And have you ever seen him yell or snap at his wife or the kids? Did Quentin ever act like Sara’s success bothered him?” asked the defense.
“No, never, he was always supportive.”
Another witness, Ann Bullis, testified to being around the couple. But Ms. Bullis stated that Quentin was like a son to her [she could have been an in law], someone she trusted and who had always been a good husband and loving, concerned father.
“Do you know what Quentin is being accused of?” asked Deputy Public Defender Sequeira. “Yes, and I think it’s tragic,” replied Bullis.
The prosecution had no cross for either witness.
Last to take the stand was the captain of the Woodland Fire Department. He testified to arriving about 5 min, 33 seconds after being dispatched. He said once he arrived at the residence on Bartlett, he found Quentin lying next to the baby, holding his hand. He stated Quentin told him the baby had been like that for about ten minutes. Quentin told him the baby had seizure-like symptoms, gurgling, and then became unresponsive.
The fire captain said the ambulance arrived about a minute later. He said, “The house was clean and Quentin was nervous, scared over the baby but was able to tell me about his toddler pulling or pushing the infant off the bed and since then he had been vomiting and going limp.”
He testified that he did not see signs of CPR done on the baby. “Oxygen was being given to the baby by EMT.” He said the baby had a gurgling noise coming out of his mouth with labored breathing.
Defense asked what Quentin was doing while he was on the floor next to his baby. “He was holding his hand,” he answered.
The day ended with the fire captain.
What’s most important in cases like these is looking at the WHOLE picture.
Xrays and MRI’s aren’t the whole picture of whether abuse happened, or not.
Children used to be wrongly removed from their parents if they had a spiral fracture, with no attention paid to the
whole picture.
Here’s a family with no drinking, no drugs, no mental health issues, no particular stressors. The baby had injuries but as one doctor testified, though trauma occurred, he couldn’t say the defendant caused the trauma.
Not much question about how this baby died, but more like, at who’s hands.
Agree, there are no red flags with common stressors but how can you refute the physical evidence, now backed up by three doctors? Character witnesses are always good, but they are also no documented proof nothing physical happened….
We never really get to the,”whole truth, any case? Do
we?”
“Not much question about how this baby died, but more like, at who’s hands.”
I think you will find that once the defense experts testify, there will be a lot of questions about the cause of death. Not only can accidental injury cause the SBS triad of symptoms, but so can other conditions including metabolic disorders, infectious and autoimmune diseases and others. The medical literature no longer supports a conclusion that intentional injury is the only thing that can cause these symptoms.
Elizabeth
What infectious case would create the triad of intracranial injury, retinal hemorrhage and posterior rib fractures ?
http://www.stanford.edu/~pbarnes/docs/publications/UpdateBrainImagingNAI.pdf
Tia, in this presentation, slide 68, Dr Barnes (one of the leading experts in this field,) shows a case of pneumococcal meningitis that presents with the SBS triad.
To be clear, the SBS triad does not include fractures. With fractures, it begins to sound more like metabolic bone disease.
This brings up one problem with not being there to hear the evidence.
Some appear to be using the terms SBS and abuse interchangeably.
While every episode of shaking a child is abusive, not all abuse is due to shaking. A lack of proof of SBS does not preclude the possibility of physical abuse.
I agree that a metabolic disease would certainly be on the differential. I would be very interested to hear what the full work up was however, I doubt that we are going to receive the actual values for the entire work up that was done.
When the triad of symptoms was originally described as a syndrome, it was called SBS by the originator, neurosurgeon Norman Guthkelch. That term has largely fallen out of favor in recent years and is now usually referred to as Abusive Head Injury. I still prefer to refer to it as originally described, SBS.
I expect that you are correct and only part of work-up will be presented to the jury during the trial although all of the experts will have access to everything, or should have access at least.
Agreed, at who’s hands?
We shouldn’t put someone away for life, or at all, when there’s no way to know what happened.
And I think it’s clear that negligent medical care after the fall was not what the baby deserved.
I was initially persuaded Mr. Stone might be innocent when you reported what he said on the 911 call, i.e,
essentially “please listen!”. I know as a parent with a severely ill child, too often doctors don’t listen and don’t take things seriously even when the patient is desperately ill. Mr. Stone sounded desperate that someone pay attention to his son’s condition.
_______
Antoinnette, you asked that I email some questions to you, but you never responded in return.
“He also explained that the baby was negative for any blood disorders or vitamin deficiencies”
This contradicts Dr. Coulter’s testimony that the Vitamin D level was low, ie that there was a deficiency.
“This contradicts Dr. Coulter’s testimony that the Vitamin D level was low, ie that there was a deficiency.”
We would have to know the actual numbers to know whether or not these are truly contradictory. When you consider whether or not a “low” value is actually a “deficiency” what you have to consider is whether the reported value is actually clinically significant. For example, a Hgb of 11.0 is .5 below our lower limit of normal of 11.5
There are many people who will have this “low” number, but will not have any adverse effects from this level. One doctor might call it “low” while another might consider this to be normal ( and therefore not deficient ) since it has no clinical significance.
In the presence of brain hemorrhages, retinal hemorrhages, encephalopathy and bone fractures, a “low” (below the reference range) vitamin D level is certainly clinically significant.
It might, or might not be. A significantly low value is certainly suggestive of a possible alternative explanation but does not prove causality. I would say that in this case it would certainly lead to reasonable doubt but does not constitute proof. Luckily we still operate within a system where reasonable doubt is the standard.
“Luckily we still operate within a system where reasonable doubt is the standard.”
complete agreement on that!
“He said the multiple contusions could not have come from a fall or seizures…”
This is the type of testimony that underscores how important it was for the family to have their own pediatric pathologist present at the autopsy. They were dealt a great injustice when their request to do so was denied.
In the Jennifer Del Prete case (her conviction on SBS was recently overturned on appeal and she was ordered released from prison after serving 10 years) the matter of brain contusions was one piece of the evidence that was the source of considerable disagreement among the experts. The original pathologist said, as in this case, that there were contusions that could only have resulted from abuse. Subsequent experts said that the so-called contusions had been misdiagnosed by the original pathologist and that the blood clots that were actually present did not indicate abuse. The back and forth on some of this evidence is captured in the judge’s 97 page opinion here: http://www.medilljusticeproject.org/files/2014/01/Actual-Innocence-Ruling.pdf
In an excellent 2009 Washington University Law Review article on SBS, “The Next Innocence Project: Shaken Baby Syndrome and the Criminal Courts,” law professor Deborah Tuerkheimer writes, “the most important predictor of an acquittal in an SBS case is the defense presentation of nationally prominent experts who challenge the science.” The quality of the nationally prominent defense experts who will debunk the science for the jury will determine the outcome of this trial. I am very much looking forward to hearing what the defense experts have to say.
Ms. Bowler, Your link to the case above, the “Innocence Ruling”, was well worth accessing, thanks very much!
Elizabeth, the blood tests showed no metaboluc disorders. Alsi, it was already proven the vitamin D kevel was NOT liw enough to have caused his death.
To Tia, yes, there were several tests ran to rule out anything else. Read the article in am with the pathologist who actually took slices if brain tissue to test, examine closely and conckude this child did not, could not, have died from a short.fall or ANYTHING else!
You can choose to take the words, and/or theories, opinions of a very few dictors who dusagree with the now, three doctors, findings, but I will put my trust in a doctor who has actually cut into the brain, the eyes, and ribs to test himself and determine a true, accurate cause of death…pictures were shown today allowing jurors to see for themselves the damage. What they chose to believe as to how the baby sustained them or got them will surely be determined in careful deliberations, hopefulky.
Also, Dr.Coulter did NOT, disagree with Dr.’s. What he said was that the CT and MRI’s would only show a limited amount and nothing more, thus cutting open the brain woukd give more accurate findings.
Once again, the question if how he died, especially after todays testimony, is apparent to me, but I stilk beg the question of at,”who’s hands?”
But do agree the baby was indeed failed by some of the doctors chouces
“it was already proven the vitamin D kevel was NOT liw enough to have caused his death.”
Antoinette, as I understand the pathologist’s testimony, he testified that it was his “interpretation” (opinion?) that the level was not low enough to cause the symptoms that resulted in death. That does not mean that it is a proven fact. That also leaves the door open for disagreement from experts who have much more experience in deficiency symptoms than the pathologist. Again, I think that before making a decision about how the baby died, everyone should wait and hear all of the testimony including the defense exxperts. The prosecution wants you to be so convinced by the testimony of their experts that you discount any testimony that you subsequently hear that disagrees with it. That is never a wise thing to do in controversial cases like this.
Oops….apologize for typos.
Hopefully, tomorrows article will clear up any misconception, although some maybelieve it to be opinion….
I find it irrefutable…….sadly, the denial to believe the real truth can blibd the eyes and ears of another…
A few thoughts about medical tests and interpretation. The significance of medical tests is always about someone’s interpretation of what the tests mean within the entire context. There is a fine balance between clinical judgement, imaging studies, and pathology with evaluation of the tissue directly. Many people believe that imaging ( mammography, ultrasound, CT, MRI, PET scan) is always better than clinical judgement. This is simply not true.
All of these modalities are the interpretations of the evaluating radiologist and do not always provide a better judgement than will clinical opinion. While it is true that pathology specimen evaluation is also the interpretation of the pathologist, it is generally accepted to be the most definitive testing we have.
I would like to give an example from my area of expertise.
A young women, say in her late 20’s comes in with a breast lump. Usually a breast lump in a patient this age is benign. In my example, clinically the lump has characteristics of breast cancer being hard, fixed to the surrounding tissue and irregular in shape. An US is obtained ( best imaging for this type of lesion in a woman of this age) and is suspicious for cancer. So one would think that on the basis of the clinical exam and imaging this woman is in trouble. So a biopsy is taken. The result is an entirely benign entity called fat necrosis which is due to previous trauma to that area, often minor enough that the patient does not even recall any trauma . Pathology is indeed the gold standard. All other testing provides clues and suggestions of what may be the case. Pathology is our current “bottom line”.
I agree that pathology is extremely relevant in the case you described. But what if you knew that the rate of misdiagnosis by pathology was quite high in such cases? What if the science underlying the pathologist’s interpretation of the pathology, was flawed? Would you then be as willing to rely solely on the pathologist’s interpretation or would you want corroborating evidence including US, CT and MRI?
It concerns me when I hear a pathologist claim that MRIs and CTs are inaccurate when they no not support his findings. It is of even greater concern that the family was denied the presence of their own pediatric pathologist at the autopsy for a second opinion. I cannot understand why that was allowed to happen.
“It is of even greater concern that the family was denied the presence of their own pediatric pathologist at the autopsy for a second opinion”
This I also do not understand.
A distinct needs to be made here. That is the difference between the pathologic findings and the means by which the pathologic findings came to be present. The pathology itself does not lie and although all tests have margins of error including that of pathology studies, well trained pathologists should very close in their interpretation of slides.
Where the disagreement arises is the way those particular findings may have occurred. In my example one cannot tell whether the fat necrosis occurred because of the minor MVA the patient failed to recall years ago or because her St.Bernard jumped up and greeted her with paws to the chest. The mechanism may not be known, but the pathology is clear. Again, it is the totally of evidence that is important here.
The timeline and type of injuries sustained seems to make it highly unlikely that the unwitnessed fall was responsible.
The blood tests are seeming to make a metabolic or deficiency disorder unlikely.
As you said, it will be very interesting to hear what the defense witnesses have to say.
I agree, it would be nice to think that everyone would agree on the pathology and that the only question would be how the pathology came to be present. Numerous cases, however, demonstrate that there can a great deal of difference of opinion between different pathologists about even the nature of the pathology, as in the recent appeal of the Del Prete case for example.