Short abstract
Channel 4, 23 June at 9 pm
Rating: ★★★⋆
Items reviewed are rated on a 4 star scale (4=excellent)
Towards the end of this powerful documentary, Stephanie Drake, whose son in law was convicted of the manslaughter of her grandson, said: “They're not going to take someone to court for no reason. They don't convict innocent people... really.” Her daughter, Katrina, from whom she is now estranged, sees it differently: “It's unfair... we had four weeks of medical evidence. The jury don't know anything medical. They had to ask what `paediatrician' meant,” she said.
Katrina's partner, Jo, was alone with their 4 month old son, Joshua, when the baby stopped breathing. In recounting events, Who Killed my Baby? played the recording of Jo's desperate call to the emergency services and informed viewers that Joshua was found to have subdural haemorrhage, cerebral oedema, and retinal haemorrhages, characteristic of what has become known to the public as “shaken baby syndrome.”
The treating specialist, whose job title was so unfamiliar to the trial jury, explained his duty to report a baby with brain injury and an inadequate explanation for it to a child protection team. Regrettably we were not told that it was more than a duty, rather a requirement of the Children Act.
The filmmakers set out to explore the controversy that arose in 2001, when the neuropathologist Jennian Geddes and her colleagues described the patterns of brain damage they had seen in inflicted head injury in children (Brain 2001;124: 1299-1306). This gathered pace in 2003, when they proposed a hypothesis on the causes of subdural bleeding as being primarily hypoxic rather than necessarily traumatic, and Kemp and others stated that we could not know the minimum force required to cause brain damage when a baby is shaken (Archives of Disease in Childhood 2003;88: 472-6).
Who Killed my Baby?—transmission of which was timed to coincide with the decision of the court of appeal in four shaken baby cases (see News, p 1463)—told us more about the dilemmas faced by investigating police officers and the suffering that a family goes through than about the medical arguments. To some extent that was a relief. Many of us believe that the criminal courts, with their need for certainty, their gladiatorial nature, and their arcane rules of evidence, are no place to settle medical disputes. Determining them with trial by television, with its short cuts and its appeals to the emotions would surely be no more constructive.
The film tried hard to be fair. Unlike some previous attempts to highlight controversies in child protection, the doctors and police officers were allowed to be themselves rather than portrayed by actors whose ideas of their subjects had been gleaned from the stereotypes of Holby City and The Bill. I was disappointed, therefore, that while we learnt—from Dr Geddes, Oxford neuropathologist Dr Waney Squier, and Oxford neuroradiologist Dr Philip Anslow—some of the reasons why they doubted that all “shaken babies” had been victims of violence, we did not learn why so many others disagreed (Pediatric Rehabilitation 2004;7: 173-84). An anonymous neurosurgeon appeared, lecturing to an eager police audience. But just as he got to the point of mentioning Geddes' hypothesis, we cut away to more drama in the police interviewing room.
What would viewers unfamiliar with the topic have gleaned from this documentary? Possibly that there is something in the well loved media fable of the maverick on the white charger coming to the rescue of innocents threatened by a malevolent—or ignorant—medical establishment. If so, is this fair? Are we doctors too slow to take on board new ideas? Do we persist in committing the Procrustean crime of fitting the facts to our opinions rather than the other way around?
Figure 1.
Katrina... desperate to find out what happened to baby Joshua
Credit: SEAN POLLOCK/CHANNEL 4
The documentary balanced the story of Joshua, Jo, and Katrina with another scenario. The Metropolitan Police received a report of a dead baby found to have subdural and retinal haemorrhages. While the father told hospital staff that the child went limp while he was bouncing him on his knee, neither parent would answer questions. A little later, Professor Anthony Risdon, pathologist at London's Great Ormond Street Hospital, told the police that the baby had several healing rib fractures sustained at an earlier date. In a subsequent interview the parents remained silent, much to the frustration of the investigating officer. Given bail, the parents left the country and have not returned.
The distraught Katrina, desperate to find out what happened to her baby and convinced that her partner is innocent, told us that her family had been demolished now that she had only her father and her brother to turn to.
Meanwhile, away from the pain and hurt of individuals, the medical debate continues its stately gavotte—and its occasional less than stately spat—in the journals and conferences. Dr Geddes has concluded from her research that where an infant has a swollen brain, subdural and retinal haemorrhage, but no indisputable evidence of trauma, an expert has to admit the findings alone do not constitute evidence of abuse—even where no other explanation is found. She has added that non-traumatic events culminating in catastrophic apnoea could, however rarely, produce an identical clinical picture to trauma (Pediatric Rehabilitation 2004;7: 261-5). I am not sure the programme makers have taken the “however rarely” on board, but otherwise this programme was thoughtful and balanced.