Rosanna Hoffmann with one of her daycare children after she was found not guilty
A Dangerous Rush to Judgement of Child Abuse
By Douglas M. Smith MD, PhD (Dr. Smith is a retired Professor of Pathology from the University of Michigan)
Rosanna Hoffmann has successfully run a licensed daycare in her home in St. Joseph, Michigan for 20 years. On January 29, 2014 a baby girl in her care had an apparent seizure. The seizure was brief and Emma recovered quickly, for the most part (she was sleepy and took a bottle but later vomited). The seizure was frightening and Rosanna immediately called Emma’s mother and asked her to pick her up. Emma’s parents were not immediately convinced that what Rosanna saw was a seizure but after getting advice from Emma’s pediatrician and a neighbor who was a nurse, they took her to the Lakeland Hospital emergency room.
Emma arrived at Lakeland Hospital alert and she took a bottle but the ER doctor noticed that she had an unusually large head and with the history of an apparent seizure he ordered an x-ray of her head. The x-ray showed that Emma had bleeding over the surface of her brain (called a subdural hematoma). Emma was quickly transferred to Bronson hospital with a presumed diagnosis of shaken baby syndrome. The admitting doctor at Bronson was later asked what other medical conditions he considered and he said “my first diagnosis was shaken baby syndrome, my second diagnosis was shaken baby syndrome and my third diagnosis was shaken baby syndrome”. An eye doctor also found a single small hemorrhage in the back of Emma’s right eye. The Bronson doctors also took a full set of x-rays looking for any broken bones. Initially they thought she had a fracture in her leg but later x-rays showed that to be wrong. There were no other signs of injury, no bruises and no sign of an impact to Emma’s head.
The Bronson doctors presumed that since the seizure occurred while Emma was at the daycare that Rosanna Hoffman had violently shaken Emma in a fit of frustration because Emma was crying. Emma had a history of being fussy and crying in the daycare and on that day there was an exchange of text messages between Rosanna and Emma’s mother saying that Emma was being particularly fussy that day. Suspected child abuse was reported and child protective services and the police began to investigate.
The investigators accepted the doctors opinion that this was shaken baby syndrome and that it must have happened while Emma was in Rosanna Hoffmann’s care. They found Rosanna’s daycare was clean and she was very well organized. They interviewed the oldest child in the daycare, who was 4, and she told them she had not seen anything happen at the daycare. The mothers of the other children in the daycare were interviewed and none had any concerns for the care of their children. Rosanna was interviewed by a detective and the CPS investigator and freely told them everything that had happened. Later she went for another interview with the detective and she was told that the doctors said that Emma was violently shaken at the daycare and that she had a broken leg (which turned out not to be true). Rosanna vehemently denied that anything had happened at the daycare, not even an accident. Rosanna was charged with first or second degree child abuse and put on trial.
On January 31, 2014, Emma had a special type of scan taken of her head, called a magnetic resonance image (MRI), that shows a much more detailed picture of the brain and surrounding tissues. The MRI showed that the bleeding in Emma’s head was a mixture of old blood with a small amount of fresher blood. At trial, all of the prosecution’s doctors, except one, and the defense’s doctors agreed that the old blood was weeks or months old. Several of the doctors even thought it could have started at birth (5 months prior). One doctor, the child abuse pediatrician, said that she thought what the other doctors thought was old blood could be cerebrospinal fluid (CSF) and therefore everything seen on the MRI might have happened on the day she came to the hospital. The doctors all agreed that the fresher blood could have been 3 to 7 days old. All of the doctors agreed that old subdural hematomas can grow through a process of repeated bleeding and that this does not require any trauma. In Emma’s case, the bleeding was not immediately treated but was followed for several months until an April MRI scan showed that the hematoma had grown quite large and she required a surgery to drain the fluid. The hematoma has now healed and she shows no signs of long term effects.
Everyone agreed that Emma did not have any obvious signs of bleeding in her head before she went to daycare that day, but both Rosanna and her assistant agreed that she had been very fussy in the daycare for some time. In older children and adults it is very common for patients with this type of bleeding to complain of severe headaches. Indeed the most common reasons that children with this type of bleeding come to the attention of doctors are irritability and seizures.
In retrospect, Emma’s head had been growing rapidly since shortly after birth. By 4 months of age her head had grown to the 96th percentile (her head was bigger than 96 percent of babies her age) and by the time she presented to Lakeland Hospital her head was significantly above the 97th percentile. The Lakeland doctor had also noted that her head was disproportionately large. Most commonly this is caused by an increase in the amount of fluid surrounding the brain. This condition is known by a number of names, including external hydrocephalus. More than 95% of babies with this condition outgrow it without any complications but a small number of them develop the same type of bleeding on the surface of the brain that Emma had. This condition is known to run in families and Emma’s two year old brother had a large head and was seen at the University of Michigan hospital when he was younger.
The prosecution and some of Bronson’s doctors tried to convince the jury that because the seizure occurred on January 29th and because Emma had that one hemorrhage in her eye that she must have been violently shaken on that day. However, the jury was convinced that it was more likely that Emma’s bleeding had started weeks or months earlier because of a medical condition and she was acquitted.
Rosanna’s daycare was closed by the state in June 2014 and without any income her house is near foreclosure and she has legal bills. If Emma’s seizure had happened while she was in the care of one of her parents, then they would have been on trial and more than likely Emma’s two year old brother would be in foster care. We want doctors to report suspected child abuse but when there is a rush to judgement without proper care to rule out other medical conditions, these doctors send innocent people to prison for long sentences and break up families. Also, since many of these Bronson doctors will be teaching medical students at Western Michigan University’s new Stryker School of Medicine, they are teaching a whole new generation of doctors to make similar premature judgements.
The University of Michigan Innocence Project is working on a number of similar cases, trying to win appeals for new trials. Falsely accused caregivers are at a great disadvantage in the court system, particularly if they are poor, because the state has an overwhelming advantage in providing medical expert testimony. Many defendants don’t even have a single expert to scrutinize the testimony of the state’s witnesses.
There are undoubtedly many people falsely convicted and spending their lives in Michigan prisons. There needs to be reforms both of what we are teaching doctors about shaken baby syndrome and how the court system treats medical expert testimony.
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