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This story was initially printed by ProPublica. Co-published with APM Stories.
Images by Sarahbeth Maney.
Reporting highlights
- A strong physician: Dr. Nancy Harper is a number one youngster abuse pediatrician based mostly in Minnesota. She testifies in legal trials throughout the Midwest, virtually all the time for the prosecution.
- Casting doubt: Protection attorneys and judges have known as Harper’s testimony into query. Two households have filed federal lawsuits towards Harper.
- A brand new overview: Prosecutors in Hennepin County stated they’re conducting a “ultimate, thorough overview” of certainly one of Harper’s circumstances that may embrace an analysis of the “medical conclusions.”
In courtroom, Dr. Nancy Harper comes throughout as skilled and authoritative. Typically she begins her testimony by explaining her subspeciality: youngster abuse pediatrics, which focuses on the analysis and documentation of indicators of kid abuse. Her position, she usually reminds judges and juries, is solely medical. Whether or not or to not take away a baby from their house, terminate the guardian’s rights or, in probably the most severe circumstances, cost a caregiver criminally is lower than her.
In keeping with Harper’s testimony, she and her staff on the Otto Bremer Belief Heart for Protected and Wholesome Kids in Minneapolis deal with about 700 circumstances of suspected abuse annually. She has testified that 10% to twenty% of these wind up confirmed for bodily abuse, though it’s troublesome to find out if these figures are correct since youngster safety circumstances aren’t public.
When Harper, the middle’s director, and her staff diagnose abuse, dad and mom and caregivers usually wrestle to problem these opinions. By Harper’s personal estimation, she’s by no means been flawed.
“I don’t suppose I’ve ever had a case the place I assumed it was abusive head trauma and the opposite specialist didn’t,” Harper testified in 2023, within the case of a day care supplier charged with the loss of life of a kid in her care.
The protection lawyer within the case pressed her: “Have you ever ever incorrectly identified a baby with abusive head trauma?”
“Not at the moment to my recollection,” she answered.
However in a handful of circumstances, judges and juries have discovered day care suppliers and fogeys not responsible of crimes after Harper has testified that abuse occurred, although a verdict can not essentially be interpreted as a repudiation of Harper or another knowledgeable witness’ determinations or credibility.
Moreover, two federal lawsuits filed not too long ago accuse Harper of ignoring and even concealing different explanations for youngsters’s accidents. And, extra broadly, medical and authorized specialists are more and more questioning a number one youngster abuse analysis, shaken child syndrome, which is also referred to as abusive head trauma.
Harper didn’t reply to requests for remark. She has but to reply to both lawsuit. In previous courtroom testimony, Harper has stated that each shaken child syndrome and abusive head trauma are thought of scientifically legitimate diagnoses by the mainstream medical neighborhood. Any controversy, she has stated, exists primarily within the authorized world reasonably than the medical one.
Kathleen Pakes, a former prosecutor who now specializes within the forensics of kid abuse circumstances for the Workplace of the Wisconsin State Public Defender, stated Harper’s declare of by no means making an incorrect analysis strains credulity.
“There isn’t any different specialty in drugs that has zero error price. None,” she stated.
Under are 4 circumstances by which Harper concluded there was abuse however courts or juries decided in any other case.
On July 12, 2017, an 11-month-old boy named Gabriel Cooper collapsed in his excessive chair on the day care that Sylwia Pawlak-Reynolds operated in South Minneapolis. Paramedics took him to Hennepin County Medical Heart, the place he was declared mind lifeless a day later.
Harper reviewed Cooper’s medical data and wrote that “within the absence of a well-documented constant extreme unintended damage, non-accidental trauma or abusive head trauma stays the first diagnostic consideration.” The kid, she wrote, was primarily shaken to loss of life. Earlier than any legal expenses have been filed, Pawlak-Reynolds boarded a aircraft for her native Poland to look after her ailing father, in keeping with her lawyer. In February 2018, prosecutors charged Pawlak-Reynolds with two counts of second-degree homicide, citing Harper’s analysis.
In keeping with her husband, Will Reynolds, they didn’t understand Pawlak-Reynolds was pregnant when she boarded her flight to Poland. She remained there to provide delivery to their third youngster, who’s now 6, whereas Reynolds remained in Minnesota with their two older kids, who at the moment are 13 and 16. Reynolds stated he and his spouse haven’t any confidence that she is going to get a good trial, and that she fears she is going to lose custody of their youngest youngster if she reenters the nation. The household has now been separated for eight years.
Early within the case, Pawlak-Reynolds’ attorneys obtained the identical copy of Cooper’s hospital data that had been offered to Minneapolis police, which included the paramedics’ report. The doc had been printed out at a considerably diminished scale, shrinking the textual content to the purpose that some fields have been illegible. Two years later, they obtained a second copy, printed at regular measurement, which revealed a potential alternate clarification for the accidents: “Mother recollects (affected person) did fall 2 days in the past, hanging the again of his head.”
“That was the form of proverbial silver-bullet proof that we’re all the time searching for in each case and normally by no means discover,” stated Brock Hunter, Pawlak-Reynolds’ lawyer.
Polish courts, together with an appeals courtroom, have denied extradition requests from the U.S. thrice, and the nation’s minister of justice has affirmed the rulings. The denials are notably crucial of Harper’s evaluation. Polish forensic specialists evaluated the case data and took be aware of a discovering by a neurology knowledgeable employed by Pawlak-Reynolds, who wrote that Cooper carried a gene tied to a blood clotting dysfunction.
The ambulance report, the Polish judges wrote, “was hid from the protection.”
“Then, after the very fact was made public, it didn’t have an effect on the actions of the American authorities in any method,” a Polish district courtroom choose wrote in 2022.
The Hennepin County Medical Examiner’s Workplace licensed Cooper’s method of loss of life as “undetermined” and the date and place of damage “unknown,” a tacit disagreement with Harper’s opinion that Cooper would have collapsed “shortly after infliction of the trauma.”
The Hennepin County Medical Examiner’s Workplace declined to remark.
Then in 2023, Hennepin County Lawyer Mary Moriarty wrote to Pawlak-Reynolds’ attorneys after assembly with them: “We agree that to resolve the present deadlock relating to Ms. Pawlak-Reynolds, the perfect course for all concerned is to dismiss the pending expenses with out prejudice, and for her to return to the USA.”
However months later, Moriarty modified her thoughts.
In an announcement to ProPublica, a spokesperson for the Hennepin County Lawyer’s Workplace wrote that the workplace is finishing a “ultimate, thorough overview” of the case that may embrace an analysis of “considerations relating to the medical conclusions and the general power of the case.”
Gabriel’s dad and mom, Joseph and Samantha Cooper, didn’t reply to requests for remark. In a tv interview in June, they denied that Cooper struck the again of his head two days earlier than his collapse. They stated that they need justice for his or her son.
Pawlak-Reynolds declined to remark by her lawyer. In late February, her husband filed a federal lawsuit towards Harper that claims she “knowingly and deliberately falsified, modified and erased exculpatory data” from her analysis of Cooper, and she or he identified abusive head trauma to “promote her personal private, tutorial, reputational and monetary wants.”
Harper has but to reply to the lawsuit. A spokesperson for Hennepin Healthcare, which operates Hennepin County Medical Heart, declined to touch upon the case or the lawsuit.
“There isn’t any oversight,” Reynolds stated. “It’s the factor they’re most resistant towards and the factor that’s most crucial to cease this legacy of brutality, that leads to youngsters being taken away from harmless caregivers and harmless caregivers going to jail.”
In August 2017, Kathryn Campbell known as 911 after a 4-month-old woman at her day care appeared torpid and was “respiratory flawed.” First responders didn’t take the newborn to the hospital, however her mom ultimately did. On the hospital, MRI scans confirmed fluid within the child’s mind and docs famous small bruises.
Dr. Barbara Knox, a baby abuse pediatrician then with the College of Wisconsin, instructed police it was “apparent youngster abuse.” The Dane County district lawyer charged Campbell with bodily abuse of a kid. Campbell pleaded not responsible.
However earlier than the 2021 trial, Knox left the College of Wisconsin after she was positioned on depart for “unprofessional acts that will represent retaliation” and intimidation of her personal employees. A Wisconsin Watch investigation forged doubt on Knox’s judgment in a number of circumstances of alleged abuse.
Knox didn’t reply to the Wisconsin Watch collection or to ProPublica’s requests for remark. After two households in Alaska sued her in 2022, alleging she had wrongly concluded their kids had been abused, Knox wrote in an affidavit that she has no management over whether or not police and youngster safety companies employees take kids away from dad and mom, that she didn’t “conspire” with police or anybody else on custody points, and that she didn’t personally consider one of many kids. The lawsuit was dismissed in 2024 after the households agreed to drop the matter.
A pair says Dr. Barbara Knox wrongly suspected youngster abuse. A forensic pathologist testifies Knox pressured him to report an damage he didn’t see.
Knox moved on to a job on the College of Florida. In keeping with a spokesperson for the college, Knox resigned as a pediatrician with the Baby Protecting Staff in late June, efficient Aug. 15. He declined to touch upon the circumstances.
At Campbell’s trial, Knox’s title was by no means talked about. As a substitute, Harper stepped in as an knowledgeable witness. When Campbell heard Knox had been changed, she was initially hopeful.
“I’m like, oh, nice, new eyes,” Campbell stated. “They’re going to take a look at it and go, ‘That is nuts, I don’t agree with this.’ And I positively was flawed.”
Harper’s evaluation affirmed Knox’s analysis of abuse. She instructed the jury that the bruises have been possible attributable to squeezing by an grownup’s hand. A medical knowledgeable employed by Campbell’s protection argued that the kid’s bleeding couldn’t be exactly dated and {that a} preexisting medical situation might have prompted it.
After simply two hours of deliberation, the jury returned a not responsible verdict. Campbell stated she is grateful to have the case concluded, although she stated she remains to be haunted by the accusations towards her.
“That was the toughest factor too, going house after this case was completed, and being like, ‘Am I allowed to be alone with my kids now?’” she stated. “It’s all due to the quote-unquote specialists not doing their due diligence and searching additional into underlying points that these youngsters might have.”
Dr. Barbara Knox’s declaration of ‘apparent youngster abuse’ fell aside after a five-day trial that centered on the controversial analysis of abusive head trauma.
In an announcement to ProPublica, Dane County District Lawyer Ismael Ozanne expressed confidence in each Harper and Knox, saying “their testimony had been according to many alternative medical professionals and specialists in their very own areas of observe.”
“It is very important be aware {that a} not responsible verdict by lay jurors hardly invalidates the widespread acceptance of abusive head trauma as a analysis within the medical neighborhood nor would it not trigger us to have considerations about Dr. Harper’s {qualifications} or data within the discipline,” he added. “Jurors aren’t certain to simply accept any knowledgeable testimony as correct.”
Within the winter of 2022, a 4-month-old boy started respiratory abnormally at his day care in Mineral Level, Wisconsin. His dad and mom took him to a hospital, the place he died days later. A police investigation decided that his day care supplier, Joanna Ford, left him and a number of other different kids alone in her house for over an hour whereas she went to a tattoo and piercing parlor.
Prosecutors used Harper as an knowledgeable witness within the case. After evaluating the kid’s medical data, she concluded that his accidents have been “clinically diagnostic of abusive head trauma,” or, put one other method, Ford shook the newborn violently. She was charged with first-degree reckless murder. Ford pleaded not responsible.
Ford’s protection legal professionals efficiently petitioned the choose within the case for a listening to to find out whether or not Harper’s knowledgeable witness testimony could be scientifically legitimate and admissible at trial. In response to questions, Harper defined why the kid’s signs — mind swelling, blood underneath his cranium, injury to his eyes — pointed to abuse, and why, regardless of the controversy surrounding it, the analysis of abusive head trauma was scientifically sound. She additionally defined that, as a result of the newborn was not strolling or crawling, the truth that none of his caregivers might clarify his accidents indicated abuse.
“Individuals ought to know what occurred,” she testified.
On cross examination by Ford’s legal professionals, Harper stated she couldn’t say for sure what time the abuse would have occurred, precisely how Ford had injured the newborn and that there are not any “nice biomechanical fashions” for shaken child syndrome.
A bit over a month later, Choose Lisa McDougal delivered a extremely crucial ruling that barred Harper from telling the jury that the kid died as the results of “abusive head trauma, non-accidental damage, youngster abuse or homicide.” She additionally took challenge with the concept an absence of clarification for accidents is indicative of abuse, calling it a “leap in logic.”
“Providing a conclusive opinion as to how an damage could have occurred crosses a line and doesn’t match throughout the dictionary definition of what analysis is,” McDougal stated. The choose additionally stated that Harper views herself as an advocate, and that that casts doubt on her “constancy to the scientific validation of abusive head trauma diagnoses, particularly when it’s a shut name.”
The homicide cost was dismissed. For leaving the kids alone, Ford pleaded responsible to the lesser cost of neglect of a kid the place the consequence is loss of life. She is serving a 10-year jail sentence. Ford, by her lawyer, declined a request for an interview. The Iowa County district lawyer additionally declined to remark.
On Feb. 4, 2022, Paul and Sarah Marshall hosted a dinner for her dad and mom and a household buddy at their house in Hudson, Wisconsin. Afterward, their 7-week-old son, Fox, turned fussy. Paul Marshall carried him into the mother-in-law unit on the decrease degree of the home, which was cool and darkish, to attempt to calm him. He emerged minutes later in a panic, yelling that the newborn spit up and stopped respiratory.
Paramedics rushed Fox to Kids’s Minnesota, a hospital about 25 minutes throughout the state border in St. Paul. Docs ran assessments, and a scan confirmed Fox had a cranium fracture with fluid pooling on either side of his mind. He died days later.
Harper examined Fox, in addition to his twin sister, Liana, and located “cranium fractures, possible rib fractures, metaphyseal fractures.”
“This constellation of findings in a nonambulatory toddler is clinically diagnostic of inflicted damage or youngster bodily abuse possible occurring on multiple event,” she wrote.
However the Marshalls stated that wasn’t true. They instructed Harper that Sarah Marshall had skilled a troublesome being pregnant with gestational diabetes and extreme anemia, and that Liana had a vacuum-assisted supply. Each twins had been to their common pediatrician over well being considerations. Whereas Liana’s well being improved, Fox’s had not.
A spokesperson for Kids’s Minnesota declined to touch upon the case.
As a result of he was the final particular person alone with Fox earlier than he stopped respiratory, Paul Marshall was charged with first-degree reckless murder. He was additionally charged with bodily abuse of a kid for hurting Liana. Sarah Marshall stated there was no proof that her soft-spoken husband had harm their kids.
“The state wished to forged me as a naive fool,” she stated. “I selected to not imagine it due to the logic and info in my face. I had no cause to imagine the accusation.”
At Paul Marshall’s 2023 trial, his protection lawyer, Aaron Nelson, cross-examined the opposite docs who handled or evaluated Fox and Liana, and was in a position to spotlight factors of medical disagreement. A physician who examined Liana for genetic issues stated she couldn’t rule out rickets as a potential reason behind her bone fractures. A neuropathologist didn’t agree with Harper that Fox had a trauma-induced blood clotting dysfunction. By Harper’s personal admission on cross-examination, figuring out the age of the cranium fractures in kids Fox and Liana’s age was troublesome. Nelson known as six of his personal medical specialists to recommend that the troublesome delivery or a vitamin deficiency might clarify the twins’ accidents.
“How many individuals need to be flawed for Dr. Harper to be proper?” Nelson stated in closing arguments.
After an 11-day trial, the jury discovered Marshall not responsible.
In an announcement to ProPublica, St. Croix County District Lawyer Karl Anderson identified that Harper was not the one treating doctor who was involved that Fox and Liana had been abused.
“A not responsible verdict doesn’t imply that the jury concluded that the kids weren’t abused,” Anderson stated. “Fairly, it signifies that they didn’t conclude that the state proved that Paul Marshall prompted the loss of life, past an inexpensive doubt.”
Six weeks after the trial, the household moved three hours away right into a century-old farmhouse that’s removed from the neighborhood that they felt wrongfully villainized by.
One of many cruelest impacts of the abuse analysis, they stated, got here after it was clear that Fox would die and the hospital employees started making preparations for his organs to be donated. Sarah Marshall stated she had hoped to sometime hear her son’s coronary heart beating in one other youngster’s chest. As a substitute, a courtroom order put a halt to the process.
“They have been already treating him as proof,” she stated.
The expertise of going from a grieving guardian to an accused assassin, her husband stated, has given the couple post-traumatic stress. Paul Marshall stated he’s grateful to be along with his spouse and kids, however what he calls a “damaged system” has left them uncertain whether or not or to not have one other child and even be left alone with certainly one of their daughters.
“You get pregnant. You go to all your appointments. You voice all your considerations. You do every thing you’re speculated to do as a guardian and your youngster nonetheless dies. And the state tells you it’s your fault,” Sarah Marshall stated. “I don’t perceive why I reside in a world like that.”
Mariam Elba contributed analysis.
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