When it comes to possible criminal cases involving infant deaths, are Massachusetts state medical examiners being unduly influenced by defense attorneys who employ their own experts?

Cases headed for court are increasingly being derailed, even before they go to trial, by medical examiners changing the cause of death from 'homicide' to 'undetermined'. 

In three child deaths, handled by three different medical examiners over the past three years, the specific cause of death was initially determined to have been the result of a violent act, or shaken baby syndrome. 

All three care givers were charged with murder. But in each case the cause was subsequently changed to "undetermined". Those reversals have triggered the release of two who had been charged.  A third case, where the reversal is being challenged, appears headed for trial. 

Some pediatricians worry that defense experts aim to debunk shaken baby syndrome by sifting through a dead baby's medical record, looking for any kind of alternative explanation for the death.

"They're finding any little piece of dust in the medical record and imputing that that was the cause of death," says Doctor Michael Yogman, a respected Cambridge pediatrician. Among the patients at his practice was 1-year-old Rehma Sabir of Cambridge, who, in January 2013 arrived at Boston Children's Hospital with the symptoms: a swollen, bleeding brain and retinal damage. These are classic signs of shaken baby syndrome, otherwise known as abusive head trauma.

The baby's Irish nanny, Aisling Brady McCarthy was charged with murder. Doctor Yogman says that as the case wound through the courts, he was caught off-guard. "At a substantially later time, as the case was about to go to trial, the medical examiner changed the cause of death....I was shocked, I was astounded."

Doctor Yogman talked to the family, and says they felt "astounded as well, and horrified."

The nanny went back to Ireland immediately.

The medical examiner had initially concluded that Rehma Sabir's death was, "homicide from blunt force trauma and excessive shaking". What prompted the switch to "undetermined" cause of death? According to the Boston Sunday Globe, defense attorneys representing the nanny brought in nine medical experts who offered a wide range of alternative explanations, from an immune system problem, to a rare infection, to a bone disorder. Yogman suspects the fact that little Rehma had been tested in his office for a bleeding disorder called von Willebrand disease could have triggered the reversal.

"I was not asked, nor afforded the opportunity to say anything," says Yogman. "I would have said von Willibrand was not a factor in the baby's death."

The test for von Willibrand disease is easy to misinterpret, says Yogman, depending on blood type. Rehma Sabir had O positive blood, putting her test results within the normal range. "I think in the case of Rehma Sabir, their assessment of the medical science and medical evidence was not accurate."

Plus, he says, there's the question of the baby's bloody clothes and pillow, bloody baby wipes found in a wastebasket, and damaged drywall near her crib.

"Defense lawyers, rather than vetting their alternative explanations in a court of law, are instead providing their own theories to our medical examiner and decisions are being made at the level of the medical examiner without being properly adjudicated in a courtroom," says Yogman.

Like Rehma Sabir, 6-month-old Nathan Wilson of Malden also exhibited the classic signs of shaken baby syndrome. Also like Rehma Sabir, the medical examiner changed the cause of death to 'undetermined' after a defense medical expert offered an alternative explanation: In this case, an inherited condition affecting connective tissue called Ehler's Danlos Syndrome. 

That reversal effectively freed the father who had been charged with murder.

The same defense expert in the Wilson case also weighed in on the third case, the only of the three reversals still being litigated – that of 6-month-old Ridhima Dhekane of Burlington. The Boston Globe reported on the alternative explanation offered: that the baby had had a heart attack. But what about the classic brain bleed? The expert claimed it was caused by efforts to revive her. Once again the cause of death was changed to "undetermined", making it hard to convince a jury. But this time the charges were not dropped. The Middlesex County District Attorney has reason to be confident. Turns out that the baby's heart was successfully transplanted into another infant and, as the DA told the Globe, that baby is thriving.

"Babies are essentially dying from inflicted injuries and people are inventing their own pet theories of alternative diagnoses," says Yogman. "And if you notice, it's different every time.

Yogman says the inconsistency of the diagnosis is a red flag. "I mean, you know, there's always something in a child's history that, you know.....kids have colds! Did that kill the child? No!"

The Massachusetts chapter of the American Academy of Pediatrics, which represents 1800 pediatricians in the state, is calling on the Governor to investigate this pattern of reversals by the medical examiner's office. 

Yogman stays in touch with the parents of his patient Rehma Sabir. He says they filed a wrongful death suit against Aisling Brady McCarthy, back in February. This month the Irish nanny, after failing to respond, was issued a default ruling.

We emailed and spoke with the office of J.W. Carney, the attorney who represented Aisling Brady McCarthy, seeking comment, and got no response.  

We reached out to the medical examiner's office for comment and were directed to the State's Public Safety secretary, Daniel Bennett. Bennett's office referred us to the secretary's statement to the Boston Sunday Globe, indicating he sees no reason for an investigation, because, "I'm satisfied it's not something about the medical examiner's office itself that has caused those three cases to be changed from homicide to undetermined."