Pediatrician is at the center of storms on child abuse

Dr. Alice Newton races down the hallway of Massachusetts General Hospital in a black-and-white dress and cowboy boots. The longtime pediatrician is more than 10 minutes late on a September morning to deliver a lecture on one of medicine’s bleakest topics: hidden signs of child abuse. She is a bundle of energy, part nurturing physician, part streetwise cop.

When she arrives before two dozen medical students, the 52-year-old head of the hospital’s child-protection unit launches into a PowerPoint presentation, showing graphic photos of children whose bruises and fractures — described by their caregivers as mere accidents — were the result of violence.

“If you have a story that’s just not hanging together, think about it. Maybe it’s abuse,” said Newton, who previously ran the Boston Children’s Hospital child-protection unit for seven years.

After toiling in relative obscurity for nearly two decades, Newton has recently emerged as one of the state’s most controversial pediatricians, admired by many but reviled in some legal circles as a messianic physician who is too eager to see a dark side in the parents and caretakers who bring ailing — or dead — children into the emergency room.

In the past few years, her medical judgment has been openly questioned in three high-profile cases, two of which involved shaken-baby abuse charges that were later dropped. The third involved her role in filing medical abuse charges against parents of a Connecticut teenager on grounds that they were seeking overly aggressive and inappropriate care for their daughter. She has received threatening calls and letters, and has taken some security precautions.

Her critics don’t mince words. Melinda Thompson, attorney for an Irish nanny who was recently released after the shaken-baby charges against her were dropped, referred to Newton as a “maniac” who recklessly misuses her medical power.

“She has become more of a prosecutor than a doctor,” said Thompson, who represented Aisling Brady McCarthy. “I think it’s shocking that she’s heading a child abuse team at a major hospital.”

But many pediatricians and child advocates defend Newton as a highly respected physician who fearlessly speaks the truth as she sees it. Jetta Bernier, executive director of the Massachusetts Citizens for Children for more than 30 years, said Newton is among the best in her field and “does not shoot from the hip.”

Newton’s supporters also see something more insidious at work, which threatens the state’s ability to stop harm to vulnerable children.

They say Newton’s critics are part of a vocal niche of the nation’s defense bar, committed to attacking the medical community’s ability to identify child abuse, especially shaken-baby syndrome. Not just in Massachusetts, but in other parts of the country, these tactics have been successful, leading to scores of criminal cases being dropped or overturned in the past decade.

Dr. Cindy Christian, former head of the child abuse committee of the American Academy of Pediatrics and a pediatrician at Children’s Hospital in Philadelphia, said she and others are feeling compelled to speak out against what they see as an ominous trend in child abuse prevention, including the scapegoating of highly competent pediatricians.

“Dr. Newton is very professional,” she said. “She and those that she works with are careful and thoughtful physicians.”

.  .  .

As a student at the Boston University School of Medicine, Newton had initially thought she might like the adrenaline rush of the operating room. But as time passed, she sought to be a different kind of doctor, one that put her closer to fixing problems involving young patients and their families. Newton switched to pediatrics, and then, as she tells it, “wandered into” the field of child abuse pediatrics.

She said a key moment was an educational forum on child abuse held at Boston Children’s Hospital one day in the late 1990s. She was drawn to the complexity of cases involving medicine, social work, and the courts, and the detective work of ruling out — or ruling in — possible explanations of a child’s physical problems.

In 2006, she became head of the child protection team at Children’s, while also working at MGH; throughout most of the past decade, she has worked as a child-abuse specialist and practicing pediatrician at both hospitals.

Her typical day includes calls from doctors in the emergency room or clinics, who see perplexing symptoms and suspect child abuse. They consult Newton, one of a relatively small number of board-certified child abuse pediatricians in the country. Often, she said, she concludes that a child’s ailments are related to the ordinary ups and downs of childhood — a bad diaper rash, an accidental fall off a bed, a rare virus.

“I’m not into this to accuse people,” said Newton, who grew up in Boulder, Colo.

But it’s when she identifies possible violence perpetrated by a parent or caretaker — and detects a sudden shift toward secrecy within the household — that her work triggers intense emotions among families and clinicians, particularly when infants are involved.

With disturbing regularity — about once a month on average — she is reminded of one of the darkest truths involving crying babies: that throughout the world and over centuries, caretakers can become so frustrated that they vigorously shake or abuse the infant’s head. It might be an impulsive reaction, but often it becomes a repetitive abusive behavior, studies show.

The only way for doctors to understand what happened is indirectly through tests such as CT-scans, X-rays, MRIs, and blood work, she said.

“Sometimes it feels like good versus evil,” she said in her small office, which she shares with another staffer, in an administrative building blocks from MGH. “My only motivation is to make sure that the child doesn’t suffer further abuse and there’s justice for children and families.”

Child-abuse specialists say that, conservatively, several hundred infants a year nationwide are victims of shaken-baby syndrome, which is also called abusive head trauma. Over the past decade, Newton’s testimony about shaken-baby syndrome has helped convict numerous defendants, including a day-care provider from the North Shore, an East Bridgewater father, and a Woburn man. This summer, her testimony helped convict a father charged with shaking his infant son, causing permanent neurological damage, while in a Danvers hotel room that took in the homeless.

For the past two decades, she has kept up a grueling schedule, even as she raised three children with her husband, a lawyer-turned-teacher, and weathered a personal health crisis when she was diagnosed in 2006 with breast cancer. Her chemotherapy and radiation began just as she was starting her job leading Children’s child-protection program. She said her follow-up appointments in recent years have shown her to be cancer-free.

.  .  .

Despite her years in the stressful trenches of child-protection work, nothing prepared Newton for the public exposure that she would receive beginning in the winter of 2013.

At around 5 p.m. on Jan. 14, 2013, an unconscious 1-year-old infant girl from Cambridge was brought by ambulance to the emergency room at Children’s. The baby, Rehma Sabir, had been cared for that morning and afternoon in her family’s Cambridge apartment by Aisling Brady McCarthy, her nanny from Ireland, while her parents were at work.

Newton found that the girl had the “triad” of symptoms associated with shaken-baby syndrome — brain bleeding, brain swelling, and retinal damage — and numerous Children’s Hospital specialists agreed, including ophthalmologists and neurologists. Newton said she also found signs of past abuse, including healing bone fractures — on the spine and limbs — and significant bruises near one ear, and had systematically ruled out other causes.

Within 24 hours, Newton had a point of view: that the girl had died of a violent act committed a few hours before she was brought to the emergency room, and that she was likely the victim of ongoing abuse in the week or months prior to that, due to her healing bone fractures.

Newton said she is barred from speaking to the media about the specifics of the case, but her conclusions can be gleaned from the public court record.

“When we see blood around the brain, especially in a child without a cause for bleeding . . . then we automatically worry that there’s been a trauma that’s unexplained and so it does bring up the issue of abuse,” she said in a transcript of pretrial testimony.

When the medical examiner in the case, Dr. Katherine Lindstrom, concurred with Newton that Rehma died of a nonaccidental head trauma, police arrested McCarthy.

But the nanny’s defense lawyers passionately fought back, and accused Newton of relying excessively on the triad of symptoms and ignoring other possible causes, a methodology that they say has been discredited by numerous medical specialists who have successfully helped overturn many child-abuse prosecutions.

“This is a Shaken Baby Syndrome (SBS) prosecution,” her attorneys wrote at the start of a brief to exclude Newton’s testimony. “That means it is a prosecution based on a scientific hypothesis that has crumbled over the last decade.”

The defense said Newton, among other shortcomings, failed to take seriously that Rehma had been tested at Children’s a month before her death for a rare bleeding condition called von Willebrand disease, and even her own parents said Rehma bruised easily. (Court records suggest Newton did consider von Willebrand disorder, but was told by the child’s hematologist that the baby did not have a confirmed case of it; and even if the infant did, it would have been a mild version and not likely to cause catastrophic brain bleeding.)

In perhaps the defense’s most compelling argument, McCarthy’s lawyers noted that one of the hospital’s specialists dated the bone fractures as most likely occurring a month before Rehma was brought to the emergency room — a time when the child was out of the country with her parents and the nanny wasn’t caring for the child. (Newton has said healing bone fractures are hard to date with such precision, and court records show doctors also offered a wider time frame for the fractures, from roughly a couple weeks to a couple months, during which the nanny was with Rehma.)

As Newton sought to defend her findings in the McCarthy case, another one of her shaken-baby cases suffered a profound setback.

A different state medical examiner, Dr. Peter Cummings, had decided that he could no longer say that the 2010 death of a 6-month-old boy in Maldenwas a homicide, and ruled the cause to be undetermined.

His change came after Jay Carney, an attorney for the baby’s father, Geoffrey Wilson, presented medical reports showing that the child’s family had a history of a rare genetic disorder that can cause blood vessels to rupture easily.

That medical examiner’s ruling caused the prosecutors to drop charges against Wilson.

Christian, as part of her work for the American Academy of Pediatrics, said she does not know the specifics of the McCarthy and Wilson cases, but knows that medical experts hired by the defense in these cases typically offer a wide array of possible alternate explanations for abuse. She called it the “maybe, maybe, maybe” strategy. However, she said, few can do what seasoned child-abuse medical experts can do, and say that these constellation of symptoms have no other logical explanation but abuse. “Legal justice is not the same as science,” she said.

In the winter of 2013, Newton found herself at the center of a much different child protection battle after the Massachusetts Department of Children and Families took custody of a Connecticut teenager, Justina Pelletier, whose parents had sought treatment for her at Children’s.

The parents said the girl’s gastrointestinal ailments and trouble walking had to do with a rare metabolic disorder, but Newton and others suspected the girl’s troubles were largely psychiatric. When clinicians at Children’s Hospital filed medical child-abuse charges, the state took custody of Justina, and assigned the girl to the hospital’s psychiatric wing.

Some parents’ rights groups, patient advocacy groups, and conservative Christian organizations loudly backed the parents. And while most of them focused their anger on the Massachusetts child-protection agency, which kept custody of Justina for 16 months, and a judge who supported the agency’s view, Newton was cast as the medical enabler of a profound abuse of power.

Judges, DCF officials, and doctors received threats. Newton recalls receiving one message over Facebook, suggesting she kill herself.

Ultimately, the girl was released to the custody of her parents in Connecticut in the summer of 2014.

.  .  .

Newton said the past few years have been difficult, though she confesses that she can also be energized by the unpredictable nature of her work.

“I’m a person who likes to have a lot going on,” she said.

But when the emotional strain of her jobs gets to her, she said, she finds ways to decompress, including marathon training and hot power yoga.

Two months ago, prosecutors announced they were dropping shaken-baby charges against McCarthy. They reported that Dr. Lindstrom, the medical examiner in the nanny case, had changed the manner of death for 1-year-old Rehma from homicide to undetermined, and they no longer felt they could prove their case beyond a reasonable doubt.

Lindstrom, in her findings, wrote that she was convinced that new information from attorneys raised the possibility that Rehma had “some type of disorder that was not able to be completely diagnosed prior to her death,” and she cites von Willebrand disease. She also said the girl’s death could have been “related to an accidental injury in a child with a bleeding risk or possibly could have even been a result of an undefined natural disease.”

Newton said she got the news through a phone call from the prosecutors’ office. She said she sat in shocked silence in her office, having once seen the trial as a chance to educate the public about the realities of shaken-baby syndrome. She said she respects the criminal justice system, but maintains that she accurately interpreted the baby’s medical data in front of her.

“I become the voice of the child,” she said.