by Alan R. Yurko
|Note, the text of this report has been updated since originally written, so the wording will not coincide with previously published versions. The essence of it has not been altered, however. - FY Webmaster|
Post-mortem findings revealed callus formations in the 5th, 6th, 7th, and l0th ribs, all posterior on the left. Chest X-rays showed callus formations in the 6th and 7th ribs. Upon autopsy, a single, very pale ovoid bruise was noted laterally on the left over the lower ribs. No other bruising was present in this area of the torso, or on the trunk, extremities or buttocks. Other bruises noted were minor, on both temporal and associated areas of the head (these were noted in autopsy and court to be caused in hospital from handling and medical monitoring devices), and one thin, rimmed ["eyeliner" type] bruise on the lower eyelid of the right eye caused accidentally by a feeding bottle. No internal thoracic injuries were found or reported by the autopsy. During the trial, the medical examiner testified that the l0th rib had "been broken while handling," something to be kept in mind, as will be explained later.
and Internal Thoracic Injuries: an Analysis:
Bruising and cutaneous injuries occur with a similar statistical frequency in traumatic fractures, especially in child abuse cases. My son had a single, very pale ovoid bruise over the area of the rib callus formations that were dated to be old (no new bruising directly related to the case itself) and appeared to be in various stages of healing or growth. Does this indicate trauma at home, prior to the terminal hospital admission? Not at all, for the following reasons:
The noted bruising could hardly have occurred during the six or seven weeks between hospitalizations, save for the bruise under the right lower eyelid, which will be discussed. Baby Alan had weekly visits to a pediatrician during the intervening weeks when he was at home. During these visits he was given reflexive tests, pokes, pushes, and other forms of routine examinations by pediatricians trained to watch for signs of abuse. Not only did these weekly visits fail to reveal bruising, but none was observed when Alan was examined during an emergency room visit. Not only did doctors and nurses fail to find and report cutaneous evidence of trauma, but Grandma and Grandpa, who lived not l0 doors away, and who doted over and cared for Alan, and changed his diapers every day, failed to note any bruises. His mother never noted them, nor did the baby's older sister. The same can be said of doting relatives, neighbors, neighbors' children, and friends, who all visited frequently.
The bruise under the right eyelid occurred when our daughter lost control of a feeding bottle. I was holding Alan in my lap when she (age four at the time) lost her grip on the octagon-shaped bottle, and the edge "doinked" him under the eye. The testimony of the mother, Francine, confirms this. Further proof is the written opinion of Horace B Gardner, M.D., J.D., an ophthalmologist who, after review of the records and the photographs of the post-mortem slides, states that the linearity and constricted scale of this bruise would not indicate abuse, in that a blow by a hand or a fist would cause a "shiner" or much more diffuse ecchymoses. Dr. Gardner also pointed out, and concurred with the medical examiner’s testimony in court, that the causes for the other bruising reported at autopsy must have been iatrogenic, possibly caused by procedures such as resuscitation or handling after Alan was brought to the hospital.
Upon terminal admission, quite a few nurses, doctors, and members of child protection teams did thorough examinations in which evidence of trauma, such as bruises, cuts, etc., were avidly sought. This is standard protocol when children are brought in with unexplained injuries. All reports on initial day of hospitalization failed to mention bruises or cutaneous injury, except that involving the lower eyelid. Dr. Ben Guedes, the attending (terminal) physician, testified that the only bruise noted at admission and before autopsy was the eyelid. Thus the bruise over the ribs and temporal areas of the head had to have been iatrogenic, occurring while Alan was under the care of hospital staff.
If these rib callus formations, indicative of healing fractures at various stages of healing, denoted multiple traumatic or non-accidental incidents occurring at different times, then I, the convicted, would have been very lucky after a single traumatic event to have hit the 15% margin previously discussed, without causing severe internal thoracic injury. However, the state experts at trial testified that these alleged fractures happened at different times. If these assertions are accepted, it would mean that I had to hit that 15% margin four times in a row! That carries the statistical probability of a traumatic etiology to considerably LESS than l%, or the same probability of hitting 1 through 15 on a roulette wheel four times in a row.
The 15% margin is narrowed considerably when one considers that infants have great osseous plasticity and that their bones are extremely pliable due to immature ossification. If, as alleged by state witnesses, I caused the alleged fractures by squeezing, a great deal of pressure would be required. This same pressure, in all likelihood, would have caused damage to the lungs or other internal organs. This did not happen. It did not happen "four times in a row." Also, if the ribs were fractured at different times, as state witnesses contended, when a second rib was fractured, it would have been a virtual certainty that rib fracture #1, already weakened, would have been fractured a second time.
If each of the four ribs was fractured sequentially, then almost certainly, rib fracture #l would have been re-fractured three times, rib fracture # 2 re-fractured two times, and so on. In the re-fracturing, it is highly probable that fractured fragments in at least one instance would have taken on dagger-like dimensions pointed into the internal vital organs. This also narrows the less than 1% margin for abuse-type trauma even further—exponentially so. Surely, such a pattern of fractures would have caused internal thoracic injury and/or cutaneous injury, but no such injury took place.
Remember, Alan was a tiny baby, premature, only 48 centimeters long. If I squeezed him, why are all of the fractures only on the left side? Did I squeeze him only on one side? That in itself is a physical improbability, I would venture to say. I have doctors who agree that it would take a team of super-orthopedic surgeons to reproduce those fractures in model and not cause thoracic or cutaneous injury. I doubt that any trauma could reproduce these alleged fractures without bruising or internal injuries, especially not four times in a row— not even once.
Metabolic Explanation For Rib Fractures:
The fact that the l0th rib broke "while handling" during the autopsy, as the medical examiner testified, tends to confirm an unusual fragility of the bones and a vulnerability to spontaneous fractures.
Considering the following in the present case—that the fractures occurred at or near the epiphyseal plates; that there were no observations of bruising or cutaneous injury by trained experts; that a chalky appearance was indeed described by experts (but was attributed to overlay); and that it would be virtually impossible to bring about sequential rib fractures at different times without causing internal thoracic injury, as reflected in a statistical application of the Garcia study—the probability of a non-traumatic, metabolic etiology of the rib fractures becomes compelling.
Additional supporting evidence in the case for non-traumatic etiology of the bone fractures would be that of temporary brittle bone disease, as described by Marvin Miller, M.D., Ph.D. in his publications. He showed that unusually close uterine confinement, which reduces fetal movement, resulted in increased fetal bone fragility and vulnerability to spontaneous fractures. As outlined by Patterson and cited by Miller, reduced movement in such instances delays fetal neo-ossification, which is controlled by a "mechanostat" mechanism of bone. The history of the mother's pregnancy is suggestive of such a process, in that she was constantly sick. She gained only a net of two pounds and was unable to take proper nourishment, not even prenatal vitamins. She suffered many complications during pregnancy, including, but not limited to, recurrent urinary (E coli) infections and a lack of amniotic fluid, which is produced by the baby’s kidneys, which were found to be abnormal (this coincides with the baby’s failure to thrive and overall lack of development as described by Dr. Shanklin in court).
Lastly, one of the strongest points in differential diagnosis is found in the work of Australian Archivides Kalokerinos, MB, BS, PhD, noted for his work among the Australian aborigines, in which he reduced an infant morality rate approaching 50% in some areas to virtually zero. Noting features of scurvy among some of the infants and children, and observing that many deaths followed vaccinations, he hypothesized that the vaccinations provoked death by throwing the infants into fulminating scurvy. Based on these observations, he improved the nutrition of the children, provided generous amounts of vitamin C, and avoided vaccines when children were ill with colds or other minor infections. As a result of this work he was awarded, with his great colleague, Glen Dettman, PhD, the Australian Medal of Merit in l978.
Dr. Kalokerinos also observed rib lesions, attributed to scorbutic factors, which healed with callus formations easily mistaken (as in the present case) for healing fractures.
HE & Yazbak FE, Shaken-Baby Syndrome, or Vaccine-Induced Encephalitis?
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