Tuerkheimer writes that the presence of all three factors in a case has been — wrongly, from where she sits — "in essence, a medical diagnosis of murder."
The new research, she says, "has cast doubt on the forensic significance of this triad, thus undermining the foundations of thousands of shaken baby syndrome convictions."
courtesy of the Randall Family
Lisa Randall feeds one of her seven grandchildren.
Lisa Randall's mug shot after her November 2007 arrest.
Several medical journal articles corroborate the professor's point of view, revealing that experts are in serious disagreement as to whether the existence of the "triad" is proof-positive of child abuse.
Dr. Patrick Lantz, a medical examiner in North Carolina, said at a 2006 meeting of the American Academy of Forensic Science:
"Contrary to what many doctors have been taught, we found [in a years-long study] that the number and location of hemorrhages of the eyes' retinas aren't always proof of child abuse . . . Retinal hemorrhages occur in child abuse, but they don't always mean a child was abused."
And there is the issue of the supposed telltale bleeding in the protective layer between Dillon's skull and his brain.
Recent medical studies show that people who suffer brain bleeding similar to Dillon's, which in his case supposedly was an epidural bleed, may not show signs of serious injury for many hours.
A well-known example came in March 2009, when actress Natasha Richardson died after what first seemed a minor fall on a Canadian ski slope. Hours passed before Richardson took ill, slipped into a coma, and soon died.
Experts call the period of time before the effects of a brain injury kick in a "lucid interval," and medical journals report that it can occur in infants as well as adults.
The "lucid interval" is important in the Randall case because it means Dillon could have gotten injured — again, if he was injured at all — hours before Lisa Randall ever saw him that day.
Is it possible that Dillon Uutela did seem fine (even though he still had that viral infection) on the morning of April 18, 2007 — first to his parents and then to Randall — until he just stopped breathing?
The answer, according to defense expert David Posey, a pathologist from La Canada, California, is yes.
Posey also surmised that Dillon may have been suffering from an undiagnosed case of acute lymphocytic leukemia, a blood cancer characterized by a greatly elevated white blood-cell count.
As possible evidence, Posey notes that Dillon's white blood-cell reading at the two hospitals after he stopped breathing was about five times what would be considered normal.
Laboratory tests on April 18 also showed a low red blood-cell count, indicative of anemia and other medical issues that Dr. Posey has claimed could not have been caused by blunt-force trauma.
"When Dillon was admitted to the hospital on April 18, 2007, he was a very sick little baby," Posey wrote in May 2008. "No external injuries are found on Dillon, yet he had very abnormal blood tests that could not have been caused by trauma of any type.
"No physician caring for Dillon or the forensic pathologist who performed the autopsy used the laboratory tests to analyze and explain why Dillon was suddenly found unresponsive. They focused only on alleged trauma and not on the medical facts and data they had in front of them."
As Dr. Posey sees it, the lack of subdural hemorrhaging (by far the most common type of brain bleeding seen in child-abuse cases) and the absence of any injury to Dillon's neck or any external evidence of injury tell him that "the findings reported in this case are not those of the shaken infant syndrome either with or without impact."
Instead, he suspects that an illness may have caused Dillon's brain to swell and move around, which led to the epidural and retinal bleeding, perhaps even the supposed skull fractures.
Posey suggested that medical personnel may have caused the tiny "depressed" skull fracture — if that's what it was — during their emergency treatment of the infant.
But not even Lisa Randall's defense experts agree on the most likely cause of baby Dillon's death, other than to say it's not what prosecutors say it was.
Last January, Dr. F. Ralph Berberich of Berkeley, California, concluded that the infant may have been the victim of sudden infant death syndrome.
The doctor wrote that "it would appear most likely that this baby, in recovery phase from a viral illness, had a SIDS-like event leading to apnea and cardiopulmonary arrest from which he was resuscitated. There followed the physical effects, laboratory abnormalities and organ failure associated with profound and prolonged apnea."
Berberich concluded that "it would likely [be] held unwise, but not negligent, to place a 4-month-old infant in prone position on a blanket without constant supervision."
But prosecutors and their medical witnesses — doctors from Phoenix Children's Hospital and the pathologist who conducted the autopsy on the baby — were expected to testify that the defense experts were wrong.
Dillon would have shown immediate signs of severe neurological damage after suffering the blunt-force trauma, prosecutors alleged during pretrial court hearings and in police interviews.
"This is a non-accidental blunt-force injury case," key prosecution witness Dr. Kevin Horn testified in 2008, "and that baby would have been affected right away after it was inflicted. I am very sure of this."