Expert disputes brain injury allegations

Date: 2006-06-29

Doctor: Trauma to toddler's head could have been days old, not fresh.
Author: Ruth Ann Krause, Post-Tribune correspondent

The defense presented Wednesday its own medical expert to challenge allegations that Natalie Fabian Evans caused the death of her 16-month-old son by violently shaking him.

Dr. Jan Leestma, a forensic neuropathologist who retired two years ago from Children's Memorial Hospital in Chicago, is the author of a 2005 article that examined other medical journal articles about 54 cases in which someone admitted to shaking a baby. All but 11 of the 54 cases showed evidence of impact such as bruising and skull fractures.

Leestma, who once believed a baby could be injured through shaking alone, said he now has a different opinion. He referred to a case he reviewed in which a day care worker was caught on surveillance videotape violently shaking a child who was not injured.

"It appears some kind of shaking may not be harmful at all," he said.

Leestma was the only witness Wednesday in Evans' trial on charges of murder, neglect and battery in the Nov. 30, 2001, death of Luke Evans.

Evans, 36, and her estranged husband, Steve, adopted Luke and another boy from Russia in May 2001.

Testimony continues this morning.

Leestma said he reviewed the medical records in Luke's case, including translated Russian birth records, hospital CT scans and pediatric records.

Responding to questions from defense attorney T. Edward Page, Leestma said he made several observations about Luke, including that his growth and maturation were behind for a child his age and that his development may have been stunted from complications at birth.

Leestma also said the bleeding in the space between Luke's brain and skull may not have been acute, or a fresh injury inflicted within 24 hours or less as earlier witnesses described. Leestma said the bleeding could have occurred three to five days before death, or earlier.

Leestma also said Luke could have had a prior bleed on the brain before he fell in the bathtub when Evans attempted to revive him on Nov. 29, 2001.

"I find no evidence of shaking. I found no evidence of grip marks," he said.

Deputy Prosecutor Kathleen O'Halloran elicited testimony that Leestma charges $500 per hour for courtroom testimony and $350 per hour for review of records during his consultation.

Leestma also acknowledged that after his 2005 article was published in the American Journal of Forensic Medicine and Pathology, 72 doctors signed a letter critical of his position and called his conclusions inaccurate and contrary to vast clinical experience.

Leestma was a defense witness in the case of Louise Woodard, a British au pair who was charged with murder in the death of one of the children she was hired to care for in Massachusetts. The child had injuries similar to Luke's, including bleeding between the brain and the skull and brain swelling.

Woodard was convicted of murder, but the judge set aside the verdict and found her guilty of a lesser offense.

Leestma said a majority of pediatricians accept the theory that shaking a baby can cause significant injury, while about half of all pathologists ascribe to that theory and those who are most involved in studying the biomechanics of such injuries are critical of the theory.

"You think you're in a better position to make that determination than a clinician who sees hundreds of abuse cases a year?" O'Halloran said.

"Yes, it's my business," Leestma said.

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