Gannett News Service Series
Marjorie Lundstrom and Rochelle Sharpe
Part 1: Sloppy investigations miss murderers
It is easy to kill a child and bury the secret.
Throughout America, poorly trained coroners and shoddy death investigations are helping mothers and fathers get away with murder. Children are frequently buried without anyone knowing why they died, according to a three-month investigation by Gannett News Service.
“I believe all kinds of homicides are being missed,” said Mary Case, medical examiner in St. Louis, Mo. “Children are being killed and just buried.”
Dr. Ronald Reeves of Tallahassee, Fla., said he believes child-abuse deaths are “grossly underestimated.”
“Children are expendable items that can be killed and disposed of,” said Reeves, a former medical examiner now specializing in children’s deaths.
Three children are known to die of child abuse every day, but at least three more child-abuse deaths each day are believed to go undetected, according to pathologists, prosecutors and child welfare advocates interviewed in 32 states.
These are the children whose deaths are incorrectly labeled accidental, undetermined or due to natural causes – sometimes as Sudden Infant Death Syndrome. These are the children no one bothered to autopsy.
However disturbing an autopsy may be – especially to grieving families – experts agree the procedure is a key to detecting child abuse.
But in a computer study of all death certificates nationwide in 1987 – the latest year available from the federal government – Gannett News Service found that autopsies on children are conducted almost by whim. Whether dead children are autopsied appears to depend more on where they lived than on the circumstances of their death.
Nobody suggests that every child be autopsied, since many die of birth defects or well-documented illnesses. But since children are the least likely to die unexpectedly, their deaths should be the most thoroughly examined, experts say.
Yet, this is not the case. The 49,569 death certificates for children under 9 revealed:
– Overall, autopsy rates for these children vary widely from state to state, ranging from 29 percent in Mississippi to 67 percent in Rhode Island. The autopsy rate dipped to 23 percent in Tennessee, but the poor performance may reflect lax bookkeeping: Officials there did not completely fill out nearly half the death certificates.
– The South consistently had the nation’s lowest autopsy rates. An examination of rates reported by the 305 largest cities showed that the bottom 10 were all in the South. Florence, S.C., for instance, autopsied 13 percent of their children under 9 compared with 82 percent in Great Falls, Mont. Overall, the East South Central states (Alabama, Kentucky, Mississippi, Tennessee) autopsied an average 31 percent of their children, compared with a 54 percent average in the Pacific states (Alaska, Hawaii, California, Oregon, Washington.)
– Of 7,422 child deaths in the United States in 1987 that most experts would call suspicious, 531 were not autopsied. These were children whose deaths were labeled, among other things, Sudden Infant Death Syndrome, undetermined or asphyxiation – yet no autopsy supported those findings. Experts fear undetected murders are most likely slipping into these kinds of categories.
– Across the country, almost one out of every in 12 deaths diagnosed as SIDS was not autopsied – a flagrant violation of accepted medical procedure. A finding of SIDS, also known as “crib death,” means that every other cause of death should have been ruled out through autopsy, according to the National Institutes of Health, the nation’s leading biomedical research center.
“I would expect there would be some regional differences in . . . autopsies, but this is an amazing difference,” said Dr. Gib Parrish, epidemiologist at the Centers for Disease Control.
These discrepancies and shortcomings are due in part to wide variations in state autopsy laws.
Tennessee, which had the lowest autopsy rate in the country, restricts medical examiners to ordering an autopsy only in cases of suspected homicide, said Dr. Charles Harlan, the state’s chief medical examiner. “Tennessee has one of the most regressive medical examiner acts in the country,” Harlan said.
To plug such loopholes, states like Pennsylvania and Georgia are advocating mandatory autopsies in all sudden and unexplained deaths of children.
Other states, including California, Colorado, Illinois, Missouri, and Oregon have formed review committees to scrutinize the way every child’s death was handled. By rounding up every potential player in a death investigation – including the medical examiner, the social worker, the police, the prosecutor – officials hope to identify flaws in the system and protect other children.
Colorado and Missouri, for instance, found that more than a third of all their child deaths had been inadequately investigated – or not investigated at all.
“We all sit a little straighter when someone is watching us,” said Dr. Michael Durfee, a California psychiatrist who has promoted child death review commissions nationwide.
Without thorough investigation of children’s deaths, others may be in danger. Many times, children had siblings – brothers and sisters who remain in the custody of a killer.
“Parents don’t just abuse one,” said Dr. Richard Krugman, chairman of the U.S. Advisory Board on Child Abuse and Neglect. “There are substantial risks to other children if we don’t accurately make this diagnosis.”
Added Dr. Linda Norton, a former medical examiner in Dallas: “It’s like leaving a child with a pit bull.”
In recent years, experts have seen an alarming increase in reported child-abuse fatalities. In 1989, a record 1,237 children died from abuse – up 39 percent from 1985, according to the National Committee for Prevention of Child Abuse, the only agency that tracks such deaths. These figures say nothing of the hundreds of children who suspicious deaths go unexplained.
Authorities are convinced some of them were murders.
In Missouri, for example, a pathologist found that 3-year-old Justin Minogue had died last March of peritonitis, an inflammation of the abdominal lining. While the coroner planned to attribute the boy’s death to natural causes, a funeral director was shocked by the child’s bruised and battered body and called police. A second autopsy proved that a severe beating had caused the peritonitis, and his 26-year-old stepfather, Leon Williams II, has been charged with second-degree murder.
In Utah, a coroner declared 3-year-old Michael Benjamin Barrie had died of an aneurysm in December 1986. Months later, after the body was exhumed, an autopsy proved that the boy had been suffocated – and that 11 ribs had been broken. Stephen Ray Allen, the mother’s boyfriend, was convicted this year of second-degree murder.
It was not until this year that authorities in Kansas and Texas began unraveling one of the most grotesque child death cases in history. Diane Lumbrera, 32, is suspected of murdering six of her children and another child relative over a 14-year period.
Although six of the children died in the Texas Panhandle, the horrible pattern was overlooked as investigators attributed each death to natural causes. But the death of a seven child in May aroused suspicions in Garden City, Kan., where Lumbrera had moved, and the former meatpacker was sentenced to life in prison in November for the 4-year-old’s death. She since has been extradited to Texas, where she has been indicted for killing the other six. Lumbrera faces a possible death penalty in Texas.
In each of the cases, death investigators may have unwittingly done more to conceal the crimes than they did to solve them.
Where once social workers absorbed the blame for botched child-abuse cases, today coroners and medical examiners are coming under increasing scrutiny. In every county, it is the coroner or medical examiner who decides whether a death is suicide, accidental, homicide or due to natural or undetermined causes. Most urban areas depend on highly trained medical examiners and forensic pathologists, skilled detectives in the mysteries of death.
But rural areas rely on elected coroners – often the local funeral director or a janitor, bus driver or coal miner – and the quality of death investigation is more uneven. While some coroners have impeccable records, others are not trained to recognize child-abuse and lack the budgetary or political incentive to order an autopsy.
Michael L. Norris, coroner in Cumberland County, Pa., used to talk to one of his fellow coroners about the financial constraints of their profession:
“I told him if I were going to commit a homicide, I’d do it in his county in the last three months of the year, because he’s always out of money and he wouldn’t do an autopsy.”
Money could well be the underlying reason autopsies are not done nationwide. Several medical examiners and coroners believe that the South may have some of the lowest rates because some of its counties are among the nation’s poorest.
“The South does not have a forward tradition in forensic pathology, even though there are some very very good centers,” said one prominent medical examiner, who asked not to be named. “They have a tradition and lifestyle that’s still very laid back – innocent in some ways, oppressive in others.”
In Florence, S.C., which has the lowest autopsy rate of the 305 largest cities, county coroner James C. Gregg Jr. said he investigates every death as thoroughly as he can. But often, he said, he does not even know about some cases, because local physicians sign the death certificates without autopsies.
Even when they get the cases, the best investigators can still miss murders.
“It’s very easy to kill a child and not leave a whole lot of evidence,” said Reeves, the Florida forensic pathologist. “A child is so small he can’t fight back, so there can’t be any evidence of trauma.”
In one case in Texas, a mother wrapped her child in blankets until his temperature reached 107. The circumstances of the child’s death, which confounded medical professionals, came to light only after the woman confessed to her psychiatrist.
“There’s no way I would have thought of that. Without her confession, there was no way to prove it,” said Dr. Jeffrey Barnard, senior medical examiner in Dallas, who handled the case.
But more often, a child’s body holds the clues of abuse – evidence that only an autopsy can reveal.
In Hamilton, Ohio just north of Cincinnati, it was a coroner who discovered what 50 other physicians had missed: the reason 3-year-old Matthew Peters could never stop vomiting.
Only after an autopsy did Dr. Harry Bonnell, chief deputy coroner in Hamilton County, find that Matthew’s mother had fed him Ipecac, a syrup that induces vomiting. While Judi Peters appeared the model parent, hovering over her suffering son, she slipped more Ipecac into his hospital feeding tube. The boy vomited to death. Peters confessed to the crime and was sentenced to five to 12 years in prison for involuntary manslaughter and child endangerment.
“When my office received the results from the coroner’s office, I can only describe it as mass shock,” said Dr. Robert Lerer, the boy’s pediatrician. “She seemed to be almost an inspiration to other parents.”
Part 2: Sloppy investigations miss murderers
Deep in the boot heel of rural Missouri, no one knows why Dante Mosby died.”¨ The last months of the boy’s short life were spent in hospitals, where doctors suspected child abuse and called authorities.
But when the 19-month-old toddler died, the acting coroner saw no need to autopsy or investigate further. “Natural causes, exact cause unknown,” he wrote on the death certificate.
Then the case was closed.
Today – more than six years after the boy’s death – Dr. Mary Case, the St. Louis medical examiner, is continuing her crusade to dig up the child’s body to search for clues of a crime.
“The truth was buried with that boy,” said Gary Stangler, director of Missouri’s Department of Social Services, which went to court this year seeking authority to exhume the body.
The Dante Mosby case is not unique. Often, the death of a child can go overlooked and almost forgotten.
Nationwide, many coroners and medical examiners do not autopsy children who die under suspicious circumstances, according to a three-month investigation by Gannett News Service. Some don’t even bother to visit the death scene, a crucial element in determining why a child died. Those willing to do thorough investigations often don’t get the chance because private physicians failed to refer cases to them.
“One of the best ways to detect murders would be to mandate the children be autopsied,” said Dr. Linda Norton, a former Dallas medical examiner. “They get buried, and we never know.”
No one can know how many children’s murders go undiscovered. But Gannett News Service found overwhelming evidence that many states’ death-investigation systems are so flawed that hundreds of child homicides could easily be missed.
A computer study of all 1987 death certificates nationwide for children under nine revealed that officials in Southern states often fail to investigate suspicious child deaths. Of the 10 states with the lowest autopsy rates, eight are in the South.
Some counties in Southern states saw no need to autopsy any children at all. In Arkansas, which has one of the nation’s lowest rates, officials in 30 of 75 counties autopsied no children in 1987 – yet 72 children died in those counties.
The death certificates for 1987, the latest year available from the federal government, also showed that rural areas are more lax than urban areas in handling child deaths.
In cases where experts say the cause of death must be determined by autopsy – such as asphyxiation and Sudden Infant Death Syndrome, or “crib death” – rural counties nationwide autopsied 77 percent of their children. Urban areas tackled 95 percent of their cases.
Rural areas were so lax that they often ruled a child died of “undetermined causes” without performing an autopsy. In rural counties, only 64 percent of the “undetermined” cases were autopsied, compared with 85 percent in urban areas.
“That’s just a total paradox. How do you say a case is undetermined without an autopsy?” said Dr. Paul Kleinman, director of pediatric radiology at the University of Massachusetts Medical Center.
The computer findings underscored the haphazard nature of death investigation in America, with its patchwork of state laws and individual expertise.
In many states, bus drivers, janitors, gas station attendants and funeral directors are elected as coroners, often with little more than high school educations. Yet they are charged with determining whether to call for an autopsy.
“I just worry about some of the coroners in the less populated counties, far away from pathologists,” said Frank Barron, county coroner in Columbia, S.C. “I don’t think they’re competent to be coroners, but the reason they’re elected is because nobody else wants the job.”
Said Dr. Kris Sperry, an associate medical examiner in Atlanta: “There are coroners in Georgia who are functionally illiterate. They can’t even spell the things they have to put on the death certificates.”
Only 23 states rely solely on medical examiner systems, where full-time physicians or forensic pathologists investigate deaths. Highly trained in the scientific and legal investigation of death, forensic pathologists are a scarce commodity. With only about 300 in the country, states often compete for their autopsy skills.
The autopsy of the child, which generally takes two to four hours involves a thorough external examination and the opening of the torso and skull to view internal organs. Incisions often are made in the child’s back, arms, legs and buttocks to find bruises. In suspected child-abuse cases, many pathologists also will scrutinize X-rays for bone fractures, and take specimens to search for drugs and poisons.
Parents do not normally object to autopsies on their children, said coroners and medical examiners. But some states, including New York, New Jersey and Ohio, allow families to refuse an autopsy on religious grounds.
“An autopsy may be repulsive to a lot of people – it’s even repulsive to me,” said Dr. Ronald Reeves, a former medical examiner in Florida. “But at the same time, if the child dies there ought to be a reason for it. We ought not to just write it off.”
In child deaths, autopsies have yielded key evidence. Reeves, who now specializes in child-abuse autopsies, said he proved that one suspected SIDS victim actually had died of head injuries, which a hospital pathologist had overlooked. In New York City this summer, a teenage couple told police their 6-day-old son had been eaten alive by their German shepherd. But the medical examiner’s office said an autopsy on both the dog and on the child’s remains indicated that the infant had been killed and dismembered before the dog ate him. The 19-year-old father has been charged with second-degree murder.
Unlike medical examiners, who do most of their own autopsies, coroners must send bodies to the nearest pathologist – sometimes hundreds of miles away. Jimmy Owens, a spokesman for the coroner’s office in Florence, S.C., said his county often must send bodies to the Medical University of South Carolina in Charleston. “It takes forever and ever to get results,” he said, adding that reports can take four to six months.
Some pathologists are better than others. One pathologist who studied a full-body X-ray of a child could not determine the cause of death, said Michael Norris, coroner in Cumberland County, Pa. Later, the pediatric radiologist scanning the same X-rays spotted dozens of fractures, he said.
In one rural Southern county, the coroner is forced to transport most child cases to nearby cities because the local pathologist “breaks out in hives if you mention ‘court.’ ”
Fear of the courtroom is not the only obstacle to thorough death investigations. Officials in several states agreed that coroners often are hamstrung by budgets. When the money’s gone for autopsies – which average $950 each – the squeeze is on to stop requesting them.
“When you have a dead body, you can’t wait two weeks to get a decision from county council about whether you can afford to do an autopsy,” said South Carolina coroner Baron. “I’m afraid a lot of these coroners just don’t do them.”
Coroners are susceptible to other kinds of small-town politics, too. Missouri, for instance, pays its rural coroners an average of $1,200 a year to be on call 24 hours, seven days a week.
At those wages, it is often only the local funeral director who is eager to moonlight as coroner – an arrangement that’s good for business, but potentially bad for autopsies.
“If the family says, ‘No, I don’t want my baby autopsied,’ they’re not going to do it – especially if the family is their customer,” said Jay Dix, medical examiner in Boone County, Mo.
In settings that thrive on neighborliness and familiarity, experts fear, it is tempting for many death investigators to bypass autopsies on children because they sympathize with a grieving family, or can’t believe them capable of murder.
In one Pennsylvania county this year, a coroner ruled a suspicious death SIDS and allowed the body to be cremated without an autopsy. An outraged social worker speculated that the coroner had been influenced by the middle-class parents’ demeanor. The coroner, who denied any wrongdoing, was chastised by the state’s child death advisory board.
It was an inexperienced coroner in Missouri who failed to order an autopsy for Dante Mosby, who died Aug. 1, 1984, in rural Portageville. On the day Dante died, Sheriff Walter Ivy was acting as coroner because the elected coroner was campaigning for Ivy’s job. He pronounced the boy dead, unaware that several specialists had diagnosed the boy’s previous injuries as abuse-related.
Dr. Mary Case, chief medical examiner in St. Louis and St. Charles counties, heard about the boy’s death from his doctors. She was horrified by the rural authorities’ apparent lack of interest; they were outraged by her interference.
“You could talk with these people until your tongue drops out, but it makes no difference,” she said. “These are backward people. They don’t really care.”
Before the state intervened this year, Case had waged her own long-distance fight with officials in southeastern Missouri, where they continue to oppose Dante’s exhumation.
Ivy, who said he can “just barely recall the incident,” acknowledged that it was “ridiculous” that he should be filling in for the coroner. “I wasn’t a medical examiner,” he said. Prosecuting attorney Hal Hunter Jr. contends he has no suspects, and that an expensive exhumation likely would prove nothing.
But the state Department of Social Services has vigorously filed court actions seeking authority to exhume and autopsy the boy’s body, a move also opposed by the child’s family, who say they have endured enough anguish. The state filed an appeal last month after a lower court rejected its request.
Alarmed by this and other disturbing cases, a Missouri task force last month proposed sweeping changes in the way the state investigates children’s deaths. Among many recommendations is a requirement that counties aggressively review all suspicious deaths of children under 15, which is guaranteed to require more autopsies, especially in rural areas.
Georgia, too, recently overhauled its system for reviewing child deaths. The state passed a law early this year requiring autopsies for all children under age 7 whose deaths are unexplained. The law also doubled training requirements for coroners, and established a regional system of forensic pathologists to aid rural coroners.
Although Georgia’s regional system is yet to be funded, similar approaches have been successful in states like Oregon, with vast rural areas.
But requiring more autopsies may not be enough. Experts say death-scene investigations are as important as autopsies in detecting child murders Many coroners and medical examiners skip this crucial step.
“You cannot do a proper job in the morgue if you don’t know what the scene looked like,” said Dr. George M. McCormick, coroner in Shreveport, La., and a private forensic pathologist.
McCormick said he investigated one case where a toddler had been scalded to death in the bathtub. The mother claimed the child had accidentally burned himself while she dashed out for cigarettes.
To McCormick, the story and the scene didn’t match. The tub spigots were too high for the baby to reach and the child wasn’t strong enough to turn them anyway. And, the burns were far too severe to corroborate a quick errand.
“The scene proved the homicide,” he said.
But coroners and medical examiners can’t do anything about a child’s suspicious death unless it is reported to them. For that, they must rely on pediatricians, family doctors and emergency room physicians.
“We have no control over which cases we autopsy. If I didn’t get a body, I don’t know anything about it,” said Dr. Fahmy Abdel Malak, Arkansas state medical examiner. He surmised this might be one reason why his state had one of the nation’s lowest autopsy rates.
Dr. George Nichols, chief medical examiner in Kentucky, said hospital doctors sometimes forget to refer suspected child abuse victims to the morgue, especially when the child lingered for weeks.
Worse yet, some doctors actually help parents conceal their crimes by looking the other way. Dr. Lloyd White, chief medical examiner in Mississippi, said some physicians are ignoring telltale signs of abuse.
“They don’t want to get involved; they don’t want to testify,” he said. “What happens is, people get away with it.”
Part 3: Tiny victims leave tiny clues
In the tiniest of murder victims, even the best medical detectives can miss the clues.Ӭ Shaking a baby to death may leave no obvious trace. Drowning a child could easily be called an accident. Locking a child alone in a house that later burns might seem like an unpreventable tragedy.
The subtlety of these child-abuse and neglect cases has turned some coroners and medical examiners into super sleuths.
In Ohio, more than 50 doctors performed thousands of tests between 1986 and 1989, but none could figure out why Matthew Peters kept vomiting. The answer came too late for the 3-year-old boy, whose real problem was his mother.
The boy died last year in Hamilton, near Cincinnati, because his mother suffered from Munchausen Syndrome by proxy, a bizarre psychiatric illness that compelled her to induce illness in her child to gain attention for herself.
“You only find what you look for, and you only look for what you know,” said Dr. Harry Bonnell, chief deputy coroner in Hamilton County.
It was Bonnell who discovered what every other physician in the Peters case had missed: a small body full of poison. After completing the autopsy, Bonnell compared the results with the mother’s stories and unveiled a web of lies.
Judi Peters, a single mother, pleaded guilty last year to filling her child with Ipecac – a medication that induces vomiting – for his entire life. The fatal dose had been administered to the boy while he was hospitalized in intensive care; his mother later confessed she had poured it into his stomach tube.
No one ever suspected the doting mother, who seemed so concerned about her child’s plight that civic and religious groups held fundraisers to defray medical costs.
“She got a lot of sympathy from people,” said Mark Piepmeier, chief assistant Hamilton County prosecutor, who saw her sentenced to five to 12 years in prison. “She loved the limelight. That’s why she did it.”
In most cases of Munchausen Syndrome by proxy, an uncommon disease that afflicts mainly women, mothers don’t intend to kill their children, said Dr. Alex Levin of Lansdale, Pa., an expert on the mental disorder.
One woman kept oxygen tanks in every room of her house, claiming she couldn’t get dressed some mornings because she was so busy resuscitating her children, said Dr. James D. Frost Jr., a Houston physician who treated one of the woman’s children. In fact, the woman was covering her children’s mouths and noses with her hand until they almost suffocated, then was reviving them just in time, he said. The mother was caught before any of the children died, said Frost, who had a video camera set up in one child’s hospital room and taped her in the act.
Munchausen Syndrome by proxy is not the only form of child abuse that confounds death investigators.
Rib factors – a common child abuse injury – may not be apparent in a standard autopsy, said Dr. Paul Kleinman, who recommends that all dead babies have detailed X-rays. Doctors, who routinely use X-rays to treat live patients, now believe these images can reveal fractures to expose a murder.
“This has had a tremendous impact on our success in prosecution of abuse cases here,” said Kleinman, director of pediatric radiology at the University of Massachusetts Medical Center.
Many parents have argued that “mysterious” fractures in their child’s body were due to cardiopulmonary resuscitation, but Kleinman says his research has refuted such claims.
Technology also is helping experts detect “shaken baby syndrome,” the violent death of an infant that leaves few traces. Unlike adults, babies have watery, gelatinous brains and weak neck muscles that can’t withstand shaking, said Dr. Jonathan Arden, deputy chief medical examiner for New York City. When the baby is shaken, blood vessels surrounding the brain can be torn.
In Florida, state trooper Kurt Frank Frueh claimed his 4-month-old stepdaughter slipped from his arms during a bath, but six doctors testified that a violent shaking had caused bleeding in her brain, spinal cord and behind her eyes. He was sentenced this year to 12 years in prison.
All the sophisticated methods for detecting child abuse may mean nothing without aggressive leg work at the death scene. Many coroners and medical examiners conduct their own death-scene investigations, although some large cities have turned over the spadework to former police officers, morticians and nurses. In rural Florida, officials are videotaping the death scenes and sending the tape to Jacksonville for expert analysis.
“I wish I had a nickel every time someone came into the office and says his kid fell down the stairs – and then you find out they live in a trailer,” said Gary Spangler, director of the Missouri Department of Social Services.
Comparing the details of the death scene with the parents’ story often provides the evidence to crack a child-abuse murder case.
Alan Kunzman, a former deputy coroner in Southern California, was skeptical when a man claimed at the hospital that his girlfriend’s 5-year-old son had fatally injured himself while playing outside. “There wasn’t an inch on that little boy’s body that wasn’t bruised or marked in some way,” he said.
Kunzman didn’t believe the boyfriend, but he couldn’t believe what he found at the death scene, where he spent a grueling 14 hours.
The plaster walls, speckled with hair particles and blood, were indented where the boy’s head had been slammed, he said. Next to the sofa, Kunzman found a cloth belt – freshly cut – that matched the ligature mark around the child’s neck. The boy had been tied like a dog to the couch, just out of reach of a peanut butter sandwich, he said.
“I went home and just wanted to hold my boys,” he said. “You feel so helpless. By the time I get there, it’s over and done with.”
Part 4: SIDS sometimes used to cover up child-abuse deaths
Sudden Infant Death Syndrome is so hard to distinguish from murder that some medical examiners say they rely on the Three Baby Rule.
If they find no cause for a baby’s death after a thorough autopsy, they declare the case SIDS. The second unexplained infant death in a family is “undetermined.” The next, they suspect, is homicide.
“You wait until they kill the third kid,” said San Antonio medical examiner Vincent DiMaio. Then the exhumations and the accusations begin.
It is a crude way to deal with a delicate problem, but one that circumstances and statistics almost demand. SIDS, a perplexing condition that kills about 5,000 seemingly healthy babies each year, is the most common cause of death for infants one week to 1 year old.
It is also the most common alibi used by parents who murder a child.
Two of every three child-abuse deaths that go undetected are labeled SIDS, speculates Dr. William Sturner, Rhode Island’s chief medical examiner and a specialist in child-abuse deaths.
While the vast majority of suspected SIDS cases are legitimate, some murders are discovered only by chance – years after they occur.
Carla Porritt, 30, of Alexandria, Va., who had pretended for three years that SIDS had killed her 2-month-old son, confessed in October she had suffocated her child by pinching his nose and covering his mouth. Porritt, who is now pregnant, will be sentenced for first-degree murder in January.
Sandra Pankow, a babysitter in Wisconsin, came under suspicion only after three children died mysteriously in her care. She even joined a SIDS support group and spoke about the children’s tragic deaths before she was convicted in 1986 of two of their murders. She is serving a 40-year prison sentence.
Before Marybeth Tinning was suspected of murdering any of her nine children in Schenectady, N.Y., she masqueraded as a SIDS mother, requesting contributions for the SIDS Foundation in one daughter’s obituary. Tinning, whose children died between 1972 and 1985, claimed six had died of the mysterious disease. She was convicted of smothering her ninth child and sentenced to 20 years to life in prison.
To distinguish between SIDS, where babies suddenly stop breathing, and deliberate suffocation, Dr. Sturner has devised an elaborate system.
First, he compares observations made at the death scene with the parents’ description of events, making sure there are no discrepancies. Then, he autopsies the child, ruling out all diseases.
These steps are essential since SIDS is an official medical mystery, defined as a sudden death that remains inexplicable after autopsy.
But Sturner goes beyond these basics. He checks the bladder, which is almost always empty in SIDS infants. He also searches for telltale spots on the lungs and heart, pinpoint hemorrhages that usually appear in SIDS babies but not in victims of suffocation.
“You’d better look very carefully,” he warned. “For SIDS, you have to exclude everything and anything.”
Yet almost one of every 12 deaths classified as SIDS is not even autopsied, according to a Gannett News Service analysis of all 1987 death certificates nationwide for children under age 9.
The South is particularly derelict. Eleven of the 14 cities with the worst records were Southern.
While 128 of the nation’s 305 largest cities autopsied all their SIDS cases, Athens, Ga., and Lynchburg, Va., autopsied only 20 percent, the lowest rates of the cities surveyed. Athens and Lynchburg each had five cases attributed to SIDS in 1987, but each autopsied only one. By comparison, Los Angeles managed to autopsy all 212 of its SIDS cases.
Across the country, several counties appeared to have chronic lapses investigating SIDS. Davidson County in Tennessee, which includes Nashville, had 15 suspected SIDS cases but did not autopsy eight – the highest number of unautopsied SIDS cases in any single county. Adams County, in the metropolitan Denver area, did not autopsy seven of its 15 suspected SIDS cases that year.
Although the National Institutes of Health dictates that all suspected SIDS cases be autopsied, only 11 states have laws that mandate the practice, according to Dr. Cyril Wecht, who published a 1989 survey of autopsy laws. They are: California, Illinois, Iowa, Louisiana, Maine, Minnesota, New Hampshire, New Jersey, South Dakota, Utah and Wisconsin. States and counties that routinely failed to autopsy SIDS offer a variety of explanations.
Clark County, Ga., coroner Tom Lord, who handles Athens’ deaths, said he does autopsy all suspected SIDS cases. But sometimes, he said, the local hospital does not refer cases to him.
In Virginia, which autopsied 86 percent of its suspected SIDS cases in 1987, officials readily acknowledged they sometimes disregard the scientific community’s directives for investigating SIDS.
“I’ve been here 13 years and, and it’s always been our policy that we don’t do an autopsy without the family’s wishes – unless, of course, there’s foul play involved,” said Richard Delpiere, spokesman for the medical examiner’s office that handles Lynchburg cases. “A lot of people, they just hate the thing of going in and having their baby cut up.”
Virginia state medical examiner David K. Wiecking, who says he autopsies 90 percent of his suspected SIDS cases, said he can diagnose SIDS without an autopsy. He said he sometimes relies on “external examination” and by reviewing his checklist of “sociological factors” – clean home, loving family, good hygiene, no history of child abuse, and “intelligence of the parents.”
Many medical examiners were flabbergasted by Wiecking’s remarks.
“That’s outrageous. It’s unethical and improper,” said Sturner of Rhode Island.
No one can tell by looking at people if they’re capable of murder, he said. “We’re not in the guessing business.”
Babies who are smothered don’t struggle, so their bodies aren’t bruised. If they are shaken to death, the tiny rib fractures and hemorrhages often can only be seen through comprehensive X-rays and thorough dissection.
Then there are the children whose deaths do not arouse suspicion because their mothers are clever at cloaking abuse. These women, who suffer from a bizarre psychiatric disorder called Munchausen Syndrome by proxy, induce illnesses in their children to get attention and sympathy for themselves. Such women have injected feces into their children’s arms, blocked their infants’ breathing, even fed them loads of poison.
“Nobody comes in and says, ‘My child is dead and I shook the heck out of it two hours ago,” said Dr. Harry Bonnell, chief deputy coroner for Hamilton County, Ohio, whose office is known for its careful investigations. Of the 30 cases of suspected SIDS he sees each year, four or five turn out to be homicide, he said.
But in the zeal to detect these cases, some investigators have trampled on the feelings of parents whose children really died of SIDS.
“This is very hurtful to SIDS parents,” said Phipps Cohe, spokeswoman for the Columbia, Md. National SIDS Foundation. “Not only do they have to suffer the grief of (losing) the baby they loved and wanted, but then they have to suffer the suspicion that maybe they did something wrong. It’s a double whammy.”
It took the death of a prominent family’s baby in New York City some 30 years ago to lead to the discovery of Sudden Infant Death Syndrome, said Dr. John Smialek, Maryland’s chief medical examiner. When the New York medical examiner found a skull fracture and accused the parents of abuse, they were outraged, Smialek said. An investigation revealed that the baby had been dropped on a concrete floor while being transported to the autopsy table.
The parents discovered others with similar experiences and founded a support group, which pressured doctors nationwide to study why so many babies were dying unexpectedly.
In 1969, doctors from across the country convened in Seattle and defined Sudden Infant Death Syndrome. It was an unusual condition – one that could only be determined after an autopsy. Unlike other syndromes, which consist of a cluster of symptoms and findings, SIDS was defined as a constellation of no symptoms and no findings. The designation allowed researchers to isolate such cases into one group to search for a possible cause. No one yet knows what triggers the syndrome, although scientists now believe fetuses may be subtly handicapped while still in the womb.
But over the years, some coroners and medical examiners began to use the SIDS category as a dumping ground, throwing in cases they could not figure out. It became a convenient wastebasket for those who were too busy or lazy to tackle the toughest cases.
After a while, said Ohio coroner Bonnell, his colleagues became so skeptical of the classifications they developed a new axiom:
“The only difference between SIDS and suffocation is a confession.”
As child abuse became the topic of the ’80s, SIDS parents found themselves under increasing – and sometimes devastating – scrutiny.
“It’s been a witch hunt in some areas,” said Gayla Reiter-Scott, president of the California SIDS Council, who lost a child to SIDS. “You are presumed guilty until you are found innocent.”
One grieving SIDS mother in Massachusetts, who had rushed out of her house hysterical when she found her baby dead, discovered police on her doorstep when she returned home, said Mary McClain, project coordinator for the state’s SIDS chapter. “They read her her rights on the sidewalk, and refused to let her go back in,” she said.
Michelle Rosancrans of Northumberland, Pa., was so devastated by her experiences after her baby died of SIDS that she is now crusading for a mandatory autopsy law. When her 7-week-old son died, her local coroner reassured her that an autopsy was unnecessary. But two hours after the funeral, police knocked on her door, telling her they had received a tip that the baby may have been abused. The body would have to be exhumed.
Rosancrans was eventually exonerated, but not until she’d hired three lawyers and undergone two more burials of her son. She called her state legislator and asked him to introduce a bill mandating autopsies for all sudden infant deaths. It is one of several bills nationwide that the SIDS Foundation plans to support next year.
“There has to be a line between guilty and innocent,” Rosancrans said. “The only way you’re going to know is by doing an autopsy.”
Part 5: Reforming the investigation system
When the hospital notified coroner Sue Townsend about the baby, she was alarmed. The child was 11 months old, dead – a simple case of Sudden Infant Death Syndrome, she was told.”¨”I just didn’t like it,” said Townsend, coroner in Aiken, S.C., who is skeptical of any SIDS victim over six months. “It was one of those gut feelings that something here wasn’t right.”
Townsend picked up the body, then rushed with police to the child’s home. Her fears were confirmed. Inside, the baby’s identical twin was near death, so malnourished he was suffering from rickets.
Robert, who weighed less than 13 pounds, was quickly removed from the home and hospitalized. Today, nearly four years later, he is a thriving preschooler whose adoptive parents still marvel that it was a coroner who saved the baby’s life.
But coroners and medical examiners nationwide do not deal only with the dead. In the desperate struggle to identify and prevent child abuse, they’ve stepped out of the morgue and into homes, courtrooms and legislative halls.
Although the nation’s death investigation system is in disarray – enabling many child-abuse deaths to go undetected – there are promising signs of reform. A three-month investigation by Gannett News Service showed that while many states don’t bother to autopsy their most suspicious child deaths, some medical examiners and coroners are setting an example.
“¢ The New England and Pacific Coast states had outstanding track records in aggressively investigating child deaths, according to a review of all the nation’s 1987 death certificates for children under nine. While some states give absolute discretion to the local coroner, Dr. William Sturner, Rhode Island state medical examiner insists that every child’s death be reviewed by both a pediatric and forensic pathologist.
“¢ Some states are promoting laws that would mandate autopsies in all suspicious child deaths, and require their coroners to receive better training.
“¢ Many coroners and medical examiners are joining newly formed death review committees that can save the lives of other children.
“¢ A handful of medical examiners are willing to scrutinize the injuries of live children and pursue those difficult cases in court.
“In America, the coroner or medical examiner has a very bad reputation – that here’s this guy with a hunchback and abnormal personality who eat sandwiches between dead bodies,” said Dr. Boyd Stephens, the San Francisco medical examiner who also heads the county’s child death review team.
“It’s hard to translate that into someone who is concerned about life and the welfare of the community.”
Stephens had nearly a flawless performance record in the city and county of San Francisco. Gannett News Service found that San Francisco officials had ordered autopsies in 96 percent of their child suspicious child deaths in 1987. Like Rhode Island, the Northern California city is a believer in collaboration in all child deaths.
It was a highly publicized death of 14-month-old Nathan Moncrieff in the Bay Area that inflamed the city and helped spawn its successful child death review committee. Nathan had been beaten to death in 1986 by his foster parents – a transvestite and his male lover, posing as a married couple.
Today, every sudden and unexpected death of a child in San Francisco is carefully reviewed by a committee, which includes Stephens and representatives of social services, police, mental health and other child advocacy groups. The members share their information and hope to learn why every child died, which agency, if any, made mistakes – and whether any other children may still be in danger.
Out of these tragedies have come heartwarming victories.
When the San Francisco medical examiner’s office told Michael Hancock, a death review committee member and the Welfare Department investigator, about the autopsy of a dehydrated 6-month-old infant last year, he raced to the child’s home. There, the day after Christmas, he found a second child living in an impoverished household without food, heat or furniture. The child immediately was removed.
California now has 23 such committees, and the idea is spreading rapidly across the country, where feuds among agencies have hampered child-abuse investigations.
Turf battles are so vicious in some places that social services workers jealously guard their files on murdered children to avoid any public blame. Those workers who are anxious to expose details of disturbing cases can be paralyzed by state confidentiality laws, which restrict release of information about children.
In fact, some social workers are forbidden by state confidentiality laws to confirm that a child has even been killed, making it impossible for anyone to accurately count the number of child-abuse deaths nationwide.
“We can tell you how many cars are sold in the last hour, but some states don’t keep track of how many children are killed,” said Leslie Mitchel, an analyst with the Chicago-based National Committee for Prevention of Child Abuse, the only agency that attempts to quantify child-abuse deaths.
Asked Douglas Besharov, a child-abuse expert at the American Enterprise Institute: “Why do we have to have confidentiality after a child is dead? Who are we trying to protect?”
Missouri’s Department of Social Services, for one, has asked its lawmakers to relax confidentiality laws so that child-abuse information can be readily revealed to medical examiners, coroners, school administrators, juvenile court officers – and, in some cases, the general public.
The proposal grew out of a statewide furor this month over Dante Mosby, a 19-month-old child whose death in 1984 helped spawn numerous recommendations for reform. The Missouri Department of Social Services, which has been blocked from releasing many details of the Mosby case, has gone to court seeking the right to exhume and autopsy the child’s body. A decision is expected early next year.
It was the brutal death of 11-week-old Jeremiah Nissly in Pennsylvania in 1986 that also precipitated action. Two years after the child’s death, assistant attorney general Marylou Barton, haunted by the Nissly case, formed a statewide child death advisory board.
When she was prosecutor in Lancaster County, Barton received a call that Jeremiah may have died of child abuse. Furious that a hospital pathologist took only 30 minutes to conclude the baby was a SIDS victim, Barton ordered a second autopsy – standing guard over the eight-hour procedure.
Indeed, the second pathologist found more than 35 fractures; the child had been shaken to death. The father was convicted of third-degree murder and sentenced to five years probation.
“It made me mad,” she said. “I was determined that this was not going to happen again.”
Today, at Barton’s urging, Pennsylvania’s board is going beyond its bimonthly review of disturbing child deaths. In September, panel members considered the plight of a living child – a 2-month-old baby who appeared to be severely beaten, yet doctors were reluctant to declare it a child-abuse injury.
Angry and frustrated, the Pennsylvania state trooper had traveled to the board’s meeting in Harrisburg to plead with members to take action in the case; they agreed to examine the child’s X-rays and apply some pressure locally.
Examining live victims of child abuse also is becoming a new focus for some medical examiners, not content to confine themselves to the morgue. Prosecutors and social workers increasingly consult forensic pathologists about live children, whose injuries may be difficult to discern.
“It makes perfect sense to go and look at a living child,” said Dr. Kris Sperry, an associate medical examiner in Atlanta. “We’re trained as doctors first, anyway. And we’re experts at injury interpretation.”
As a medical examiner in New Mexico between 1985 and 1989, Sperry estimates he saw 175 living children, of whom 75 percent were abuse victims. For all his efforts, Sperry said he has been criticized by other pathologists and defense attorneys who believe he is overstepping his bounds.
“I had a defense attorney in New Mexico tell me I could see child-abuse in a peanut butter sandwich,” he said. “What that told me is, ‘I’m doing my job.’ ”
Sperry dismisses criticism from some colleagues as the product of their own laziness and discomfort at getting involved with social workers, police and prosecutors.
“I believe I’m in the position where I’m the only one who can speak for a dead child who can’t talk – and maybe never could,” he said.
Speaking for abuse victims lands many medical examiners like Sperry in court, where they frequently testify as key witnesses for the prosecution. Often, they are the only witnesses because spouses stick together, and surviving siblings are too young or too frightened to talk.
Medical examiners’ testimony has become even more important in recent years as prosecutors lose interest in pursuing these difficult cases, said Robert Parish, assistant attorney general in Utah.
“It’s got to be almost a perfect case before they prosecute,” he said.
Testimony of medical examiners also can be key to defense attorneys, whose clients may be falsely accused of murder. “It works both ways,” said San Francisco medical examiner Stephens, who proved that one child died of SIDS despite accusations by family members that the mother had been abusive.
Without an autopsy, neither side is likely to have a solid case, experts said. Yet autopsies on children are conducted haphazardly in America, and children frequently are buried without any investigation whatsoever, Gannett News Service found.
With the autopsy key in detecting child abuse, some states, including Pennsylvania and Missouri, are considering laws that would require more autopsies of children who die unexpectedly. Several more states, like California and Minnesota, have joined Illinois’ lead in drafting protocols for the death investigators – guidelines that spell out precisely how children’s deaths should be handled.
Many coroners and medical examiners are skeptical of these moves, saying they should have complete discretion in ordering an autopsy. They believe the emphasis should be on education and increased training – particularly for coroners, who often don’t have medical degrees.
“You cannot mandate quality. You can only train quality,” said Dr. Harry Bonnell, chief deputy coroner in Hamilton County, Ohio.
Townsend, who has fought for more coroner training in South Carolina, honed her investigative skills working for the state police and sheriff’s department. A coroner since 1982, Townsend continues to attend child-abuse seminars, a practice she says may help her save more lives. In her office in Aiken, S.C., she gazes often at a memento of her greatest triumph: a picture of Robert, the child she saved four years ago. The child’s natural parents were convicted of negligence of a child and each received a 10-year prison sentence, which was suspended to one year, plus probation.
“He’s what keeps me going,” she said. “When you get up at 2 in the morning, get out of your warm bed and go out in the freezing rain – and you’re wondering what in the hell you’re doing – you see this picture of Robert and say, “That’s why I’m here.”