Abstract:Parneet, Sukhsaihaj, and Imaan were born at 30 weeks gestation via cesarean section and their weights were 1.31, 1.38, and 1.46 Kg, respectively. They suffered from respiratory acidosis, hypoglycemia, respiratory distress syndrome, sepsis, jaundice, gastroesophageal reflex, and anemia. They were discharged from the hospital at 42 days of age. The triplets were vaccinated with DTaP, IPV, Hib, and PCV vaccines at the age of 61 days in Imaan’s case and 75 days in Parneet and Sukhsaihaj’s case. At 15 days following vaccination, Parneet suffered from apnea, metabolic acidosis, seizures, infections, intracranial and retinal bleeding, and a skull fracture. Sukhsaihaj developed respiratory tract and eye infections, severe anemia, bleeding, and skull fracture. Imaan had severe anemia and a skull fracture. It was alleged that the babies’ injuries were caused by blunt trauma to the head. The parents were accused of causing the triplet’s injuries.

The clinical data described in this report reveal that the tripletÕs health problems were caused by vaccines. The severity of their injuries correlates with their hemoglobin levels at the time of vaccination. The subcutaneous and the intracranial bleeding resulted from protein and vitamin K deficiencies and infections. Severe anemia, vitamin K deficiency, and systemic infections are the likely causes of ParneetÕs retinal bleeding. The skull fractures resulted from protein and vitamin K deficiencies. The severity of the fractures correlates with the severity of the protein and vitamin K deficiencies, the degree of the infection, and the level of the intracranial pressure.

Abstract: A male toddler suffered from cardiac arrest on May 26, 1988 after receiving amoxicillin. His stepfather, Daniel Childs, performed cardiopulmonary resuscitation (CPR) and called 911. The child was brought to the hospital, resuscitated, and given epinephrine 0.8 mg endotracheally and IV. He had a blood pH of 6.82, infection, and kidney and liver damage. The child was given sodium bicarbonate, antibiotics, and IV fluids. He died 4 days following admission.

An autopsy was performed and the medical examiner (ME) found separation of the coronal suture in the child’s skull, a subarachnoid hemorrhage, brain edema, five healing rib fractures, and one acute rib fracture. It was alleged that the child died as a result of blunt trauma. However, the paramedics, physicians, and nurses at two hospitals did not observe any injury caused by trauma on the child’s body. His X-rays and a CT scan of the head did not show skull fracture.

Daniel was accused of killing his stepson. He was convicted and sentenced to life in prison. The medical evidence presented in this report indicates that 1) the child’s cardiac and respiratory arrest, pulmonary edema, and liver damage were caused by an allergic reaction to amoxicillin; 2) his subarachnoid bleeding was caused by epinephrine, liver injury, infection, and vitamin K deficiency; 3) the separation of the coronal suture was caused by the increased intracranial pressure which resulted from bleeding and edema; 4) the causes of the healing rib fractures were vitamin K and protein deficiency; 5) the acute rib fracture was caused by CPR; and 6) Daniel is innocent.

Abstract: Stryker is a 55-day-old white male infant who was found dead in his bed on September 6, 2005. Based on the finding of methanol (20 mg/dL) and formic acid (23.2 mg/dL) in a blood sample taken from his heart at the time of autopsy, his parents were accused of poisoning him with methanol. My investigation reveals that the baby died as a result of severe hyponatremia. He had a critically low serum sodium level of 114 mmol/L (normal range: 135-145 mmol/L). Moreover, the gross and microscopic examinations of the brain showed evidence of edema and hypoxia and these lesions are reported in people suffering from hyponatremia.

My investigation also reveals that there is no evidence that the baby suffered from methanol poisoning. He did not show any symptom of metha-nol poisoning prior to his death. His brain, spinal cord, eyes and optic nerves, heart, lungs, liver, kidneys, pancreas, and other tissues were examined grossly and microscopically and no lesion was observed that indicated intoxication with methanol.

It is likely that the methanol and formic acid detected in Stryker’s blood resulted from the contamination of the blood with formalin used to fix tissues. This fixative contains 1 to 1.5% methanol and 3 to 4% formaldehyde. The oxidation of formaldehyde to formic acid is facilitated by formal-dehyde dehydrogenase present in the red blood cells.

Abstract: A female infant from Texas stopped breathing and her mother took her to the hospital. Blood analysis revealed the baby suffered from severe metabolic and respiratory acidosis, hyperglycemia, hyperkalemia, and lymphocytosis. A chest X-ray showed evidence of pneumonitis. Physical ex-amination revealed no evidence of injury caused by trauma. She was treated with epinephrine, sodium bicarbonate, antibiotic, and other medications. She developed bleeding outside the skull and intracranially. No skull or rib fractures were noted on the CT scans and X-rays taken during the fist four days following admission. However, skull and rib fractures were observed on the CT scan and X-rays taken at a later date.

Resuscitation efforts failed and the baby died at 11 days following admission. At autopsy, the medical examiner (ME) found healed skull and rib fractures, bleeding of various ages outside the skull and intracranially, and brain edema and necrosis. His microscopic examination of the H & E stained sections of the lung revealed evidence of bronchopneumonia, hyaline membranes in the alveoli, and bleeding. The ME alleged that the baby’s injuries were caused by trauma and her father was accused of killing her.

[Dr. Al-Bayati’s] investigation reveals that the infant suffered from acute bronchopneumonia and respiratory distress syndrome on August 6, 2004, which led to hypoxemia, severe metabolic and respiratory acidosis, hyperkalemia, loss of consciousness, respiratory failure, and cardiac arrest. Her bleeding, brain edema and necrosis, and skull and rib fractures occurred in the hospital. These injures were caused by infection and medications

Abstract: Christine, a 40-year-old white female, suffered suddenly from a fatigue syndrome in August 2000. Her blood and urine analyses, chest x-ray, abdominal ultrasound exam were normal. She consulted with several physicians who treated her symptoms and she made progressive recovery in her health. In February 2003, she felt that she had about 80% of her energy back and she was working full time. However, she consulted with a physician in California to get her full energy back and he recommended a detoxification treatment plan with high doses of vitamin C, glutathione, minerals, and vitamins. He gave her 39 intravenous injections of vitamin C (10-35 g per injection), glutathione (0.4-2.0 g per injection), calcium, and other vitamins for about 10 months. In addition, he also treated her with therapeutic doses of levothyroxine and cytomel for more than a year, although she had normal thyroid functions.

Christine’s clinical record indicates that she suffered from symptoms of hypercalcaemia and calciurea as a result of her treatment with vitamin C and calcium. The treatment with thyroid hormones also aggravated her condition and she became a 100% disabled. I have not found any medical justification for the use of detoxification agents or the treatment with thyroid hormones in this case. Christine’s blood, urine and hair analyses revealed that she was not exposed to chemicals at her workplace or home or ingested toxic chemicals. In addition, Christine’s blood thyroid hormones levels were within the normal range and she was not suffering from hypothyroidism.

Abstract: Christine, a 40-year-old white woman, suffered from acute gastrointestinal pain, diarrhea, malaise, and fatigue shortly after receiving oral herbal treatment and drank eight glasses of clear liquid in a clinic in California. On October 19, 2004 between 1540 and 1730, she was given Uro-well herbal supplement prescribed by her physician as a kidney-cleansing agent. Christine was transported by ambulance to the Stanford Emergency Department (SED) at approximately 1930. She was treated with activated charcoal orally and N-saline by IV. An electrocardiogram test showed that she developed sinus tachycardia. Christine’s blood test was negative for alcohol and her urine test was negative for the use of illicit drugs. The treating physicians did not order screening tests for the presence of heavy metals and arsenic in blood and urine, even though, she stated that a poison might be the cause of her symptoms.

Christine was released from SED after ten hours of admission. However, she continued to suffer from abdominal pain, fatigue, vomiting, and diarrhea for several weeks. A 24 hour-urine sample was collected and analyzed for arsenic on day 26 post-her hospitalization on October 19th. It revealed a significantly high level of arsenic (270 µg arsenic per 24 hour urine collection). Christine’s arsenic background level in urine was 18 µg arsenic per day. Furthermore, analysis of the Uro-well herbal supplement revealed arsenic level of 25 ppm, which is five-times the maximum permissible level of arsenic (5 ppm) in herbs set by the American National Institute of Standards and Technology. My investigation revealed that the exposure to a toxic level of arsenic by ingestion is the likely cause for Christine’s acute symptoms developed on October 19th.

Abstract: At the age of two years, Jeanett developed vitiligo within days of receiving her first MMR vaccine and the fourth injection of DTaP and IPV vaccines. Furthermore, at five years of age, she developed many more unpigmented spots on her body with acrofacial vitiligo, following receipt of the second injection of MMR and the fifth injection of DTaP and IPV vaccines. Jeanett’s susceptibility to developing adverse reactions to vaccine was notable a few hours after birth following receiving her first injection of the hepatitis B vaccine. Furthermore, the intensity and the frequency of her adverse reactions to vaccines were significantly increased following receipt of more doses of hepatitis B, DTaP, IPV, Hib, and MMR vaccines. Jeanett’s health condition during her second year of life, when she was not given any vaccine was better than during her first year of life, when she received several vaccines.

It is likely that the MMR vaccine induced the depigmentation of Jeanett’s skin through local and systemic autoimmune reactions. Synergistic actions between the MMR vaccine and other vaccines given to Jeanett could also be involved in causing the depigmentation of her skin. I believe that Jeanett should not receive any vaccines in the future. Vaccines probably will aggravate her present illness and trigger more illnesses. Jeanett was treated with corticosteroids ointment but the steroid did not help in stopping the depigmentation of her skin. Recommendations for clinical tests and treatment plans are presented in this report that I believe will help Jeanett’s pediatrician to better monitor and treat her vitiligo.

Abstract: James K. Ribe is a supervising pathologist for the LA County Coroner who oversaw the investigations in Eliza Jane Scovill’s and Destiny Jacobo’s cases. Eliza Jane suffered from cardiac arrest and died following the administration of four doses of amoxicillin (400 mg twice a day). She died in Los Angeles, California on May 16, 2005 at the age of 3.5 years. Destiny Jacobo, a 21-month-old female toddler died suddenly in December of 1995 in Los Angeles. Ribe concluded that Eliza Jane suffered from Pneumocystis carinii pneumonia and died of AIDS. He listed the cause of death in Destiny’s case as shaken baby syndrome with associated head trauma. Ribe also alleged that there was forcible rectal insertion causing a retrorectal contusion.

My review of the medical evidence in Eliza Jane’s case clearly indicates that Eliza Jane died as a result of allergic reaction to amoxicillin and she did not die of AIDS. The histological features of her lungs show no evidence of inflammation and fibrosis. Ribe’s allegation that Eliza Jane suffered from Pneumocystis carinii pneumonia is not supported by the clinical data and medical facts. Furthermore, my review of the medical evidence in Destiny’s case revealed that she suffered from severe acute hemorrhagic pneumonia and septicemia. The bleeding in her case was caused by septicemia and vitamin K deficiency. It also shows that James Ribe’s allegations of shaken baby syndrome and sexual abuse made in Destiny’s case are not supported by medical facts.

Abstract: Ezbjörn Hahne was accused and convicted of killing his 40 day old daughter, Nadine, by shaking force (Shaking Baby Syndrome). Nadine suffered from cardiac arrest and died on September 16, 2004. The examination of her body and organs at autopsy and bone x-ray revealed no evidence of injuries caused by trauma. Ezbjörn was accused and convicted of killing Nadine based on the finding of old and new intracranial bleeding during autopsy.

My investigation of this case clearly indicates that Nadine died as a result of health problems and vitamin K deficiency that led to intracranial bleeding, edema of the brain, neurological problems, and cardiac arrest. Nadine was treated with three courses of antibiotics during her short life and had other predisposing factors for vitamin K deficiency. The evidence indicates that the intracranial bleeding occurred probably during the four weeks prior to Nadine’s death.

Nadine was born at 33 weeks of gestation by caesarean section. Her mother suffered from pregnancy complications that led to the premature rupture of the fetal membranes. She also had a urinary tract infection that was treated with antibiotics for 10 days following delivery. Nadine suffered from infection, hemolytic jaundice, neurological problems, and retardation of growth. She gained only 625 g during her 40 days of life (15.6 g/day), which is about 58% below of the weight gain expected for an infant her age.

Abstract: Patrick and his twin sister, Peyton, were born 5 weeks premature. He suffered from acute abdominal and nonspecific symptoms at the age of 21&Mac218;2 months. CT scans, X-ray, and eye exams revealed that he had subdural and subretinal bleeding and seven rib fractures in various stages of healing. He also had severe anemia, thrombocytosis, low blood creatinine levels, hyperglycemia, and elevated neutrophills and monocyte counts. The treating physicians alleged that Patrick’s health problems resulted from shaking [shaken baby syndrome (SBS)] and child abuse. Patrick’s parents were accused of causing Patrick’s injuries.

My investigation revealed that Patrick’s acute symptoms resulted from acetaminophen intoxication. Patrick was treated with Tylenol/cold and he received about 200 mg of acetaminophen per day (64 mg/kg) and 3200 mg per 16 days. He was also treated with Zantac® (ranitidine) and Zantac® potentiates the hepatotoxicity of acetaminophen. The subdural and subretinal bleeding was caused by vitamin K deficiency, intoxication with acetaminophen, and severe anemia. The healed rib fractures occurred due to vitamin K and protein deficiencies and chronic coughing. It seems that the treating physicians alleged that Patrick’s health problems resulted from abuse, without considering the clinical data that lead to different causes, or performing differential diagnosis in this case.

Abstract: Destiny Jacobo, a 21 month-old Hispanic female toddler, died suddenly in December of 1995 in Los Angeles, California. The Los Angeles County Coroner, Dr. James K. Ribe, conducted an autopsy on Destiny on December 9, 1995 (Case No 95-09550). Ribe listed the cause of death in his report of February 13, 1996 as shaken baby syndrome with associated head trauma. He also alleged that there was forcible rectal insertion causing a retrorectal contusion. Destiny’s parents were accused of abusing and killing their daughter. They were convicted and sentenced to life in prison. The mother has been incarcerated since 1996; the father served five years of a life sentence before being released in 2001. Destiny’s family and their attorney requested that I review the autopsy report to identify the probable cause(s) of their daughter’s sudden acute illness and death. My analysis of the autopsy report indicates that the child died as a result of infections and vitamin K deficiency. It also shows that the allegation of sexual abuse is not supported by medical facts.