'Shaken baby' expert witness found guilty of misleading courts

A senior British doctor, who has been an expert defence witness for parents accused of killing their children, has been found guilty of multiple charges that include giving misleading evidence in court.

The Medical Practitioners Tribunal Service said that Waney Squier, a consultant pathologist at John Radcliffe Hospital in Oxford, UK, had failed to work within the limits of her competence, failed to be objective and unbiased, and failed to heed the views of other experts. In many of the cases investigated, her actions were deliberately misleading and irresponsible.

The MPTS had considered Squier’s work as an expert witness in six child abuse cases and one appeal in which parents faced charges of non-accidental head injury, formerly known as shaken-baby syndrome.

Squier is prominent among several researchers worldwide who have challenged a long-standing belief that a trio of symptoms of head injury provide unequivocal evidence of abusive behaviour. Squier has argued in the scientific literature and in court that the symptoms in question – haemorrhages on the surface of the brain, haemorrhages in the retinas, and a swollen brain – can have innocent causes, such as choking or other difficulties in breathing. These symptoms, they say, can also arise from the birthing process itself.

Michele Codd, chair of the tribunal, gave examples of where the panel felt Squier’s court evidence had strayed outside her field of expertise. These included offering opinions on biomechanics in relation to injuries from falling, pathology of the eyes, and paediatric medicine.

“The tribunal is in no doubt that you have been a person of good character and have not acted dishonestly in the past,” Codd told Squier. “[But] it found that in your written and oral evidence you were dogmatic, inflexible and unreceptive to any other view,” she said. “The furthest you were prepared to accept any criticism was to state either that you had made a typing error or that you could have been clearer in what you had said in your reports or evidence. The tribunal was not able to accept large tracts of your evidence.”

Passionate support

But several prominent researchers support Squier’s work. “The impact of her research in blunting the false prosecution of innocent caregivers is beyond value or measurement to those impacted,” said Steven Gabaeff, a practitioner of emergency medicine in the US for 35 years and a diplomat emeritus of the American Board of Emergency Medicine, in his submission to the tribunal.

“This is clearly a witch hunt against a physician who has done society a great service by levelling the playing field for parents and caregivers who face allegations of child abuse when their infant presents with unexplained brain injury,” says Marvin Miller, professor of paediatrics at Wright State University in Dayton, Ohio, in a submission to the tribunal supporting Squier. “Regarding her professionalism, she has unimpeachable integrity.”

The UK General Medical Council, which brought the charges against Squier, will make a final decision by 24 March on whether she should lose her licence to practice. A spokesperson for the GMC told New Scientist that full details of the case will be published at the conclusion of the proceedings.

Doctors whose submissions to the tribunal did not support Squier have not replied to requests for comment.

The big issue

No one doubts that frenzied shaking can cause the triad of symptoms, but only after severe accompanying damage to the neck. A baby’s head striking a solid surface would also cause such damage but then there would be other evidence of an impact. For these reasons, there is increasing pressure for the triad not be used as evidence of guilt in the absence of any other evidence of child abuse. In the UK, the Royal College of Pathologists last December cautioned against viewing the triad as “absolute proof of traumatic head injury in the absence of any other corroborative evidence”.

“The decision today does nothing to deliver justice to devastated families whose children have suffered intracranial injuries,” says Carrie Sperling, co-director of the Wisconsin Innocence Project aimed at preventing miscarriages of justice. “Instead, it ignores the issue at the heart of the matter – that experts cannot diagnose abusive head trauma with any degree of reliability. Squier has provided a scientific perspective in an area fraught with emotion, a lack of objectivity and a demand for easy answers.”

In 2010, another researcher challenging the triad, Marta Cohen – a pathologist at Sheffield Children’s Hospital in the UK – was summoned by the UK General Medical Council but cleared of any wrongdoing.

“I suspect there will be no one in England willing to dispute allegations of shaken baby syndrome now the finding against [Squier] is unfavourable,” says Edward Willey, a forensic pathologist in St Petersburg, Florida. “Opposition is eliminated.”

At a 2010 conference on child abuse, in Atlanta, Georgia, Colin Welsh of the Metropolitan Police – now retired – gave a talk in which he listed defence expert witness testimony as “top of the list” of reasons for losing cases in 2008 and 2009.

“Without doctors like Squier, parents stand virtually no chance of overcoming medically complex false allegations of abuse,” says Michelle Weidner, a mother in Peoria, Illinois, who was falsely accused of abusive head trauma in 2010. “When defence experts are attacked, justice is silenced, and it’s really an attack on scientific inquiry,” says Weidner, who explained that following a CT scan, her infant was mistakenly judged to have a skull fracture that turned out to have been an artefact caused by the child moving its head during the procedure.