Justice for Rehma

<span class=”dropcap”>I</span>t was late April 2019. Stormy gray clouds hovered over a Boston courthouse, mirroring the grim mood inside. Click. In a courtroom, prosecutors were showing the jury sobering images of the damage inside the brain and eyes of 6-month-old Ridhima Dhekane. Click. Here was the severe swelling in Ridhima’s brain. Click. Here was her blood-red eye. Her severely damaged retina. All injuries that occurred, prosecutors argued, when she was violently shaken to death in 2014 by her babysitter. Sitting in the courtroom in support of the Dhekane family, Sameer Sabir stiffened with each sharp click of the prosecutors’ slides. Despite himself, Sameer began to imagine the images were of his daughter Rehma’s brain, her once-twinkling eyes. Rehma had been violently abused on her first birthday in 2013, her nanny accused of shaking her so badly the back of her eyes bled and her brain swelled into her spinal cord, hindering her ability to breathe. Like the babysitter in this trial, Rehma’s nanny maintained her innocence. Unlike this trial, Rehma’s case was never heard by a jury. It was dismissed when the medical examiner changed her mind about Rehma’s cause of death; a reversal that occurred after she read opinions from defense medical experts who questioned or rejected the shaken baby diagnosis. Rehma, Sameer often said, never had her day in court. She was denied justice. <span class=”dropcap”>S</span>itting next to Sameer on the hard bench, Debbie Eappen glanced over in concern. She could feel Sameer’s deepening misery, a feeling she shared. Her 8-month-old son Matthew, nicknamed “Matty,” had been shaken to death in 1997. Their British nanny Louise Woodward was charged with the crime and convicted of second-degree murder. Yet shortly after Woodward was convicted, the judge rejected the jury’s decision. He reduced the charge to involuntary manslaughter and sentenced Woodward to time served. Matty too had been denied justice, Debbie Eappen often said. She and Sameer had become close to the Dhekane family as a newer member of a club no parent wants to join. The Dhekanes were not allowed to watch the trial because they were scheduled to testify, so she and Sameer were sitting in the courtroom in their place. “It meant a lot to me to be able to be there,” Eappen said, “I knew that it was going to be very traumatic ... very difficult for Sameer. “The idea that an infant who was beautiful and perfect is now dismembered and you’re seeing slides of pictures of eyeballs and brain and you know this is really, really...” Eappen stopped to collect herself. “You have to almost dissociate in order to look at it,” she finally continued. “It’s a lot like getting kicked in the gut all day and pretending it didn’t hurt.” <span class=”dropcap”>T</span>oday, eight years after Rehma’s death, life is much different in the Sabir household. Nada and Sameer have moved to a new home in Boston and welcomed three sons and a daughter into their family. As scary as it was to bring new life into a world that had taken Rehma’s, those four blessings have helped them heal. “We are forced out of bed every morning,” said Nada, “and we look forward to it because we have these little happy faces that greet us. You don’t have the luxury of lying in bed and letting awful thoughts take you over.” Family life may consume their daily focus, but keeping Rehma’s memory alive is still paramount. Her picture sits next to those of her siblings in the foyer. A montage of her short life covers a portion of the wall in the family room. Brothers Zaki and Zayn and sister Hanna call her by name and blow goodnight kisses to her picture. Baby brother Rayaan, less than two months old, blows bubbles. “We feel Rehma with us all the time,” said Nada. “Not in any supernatural sense … it’s like a little reel just constantly playing.” Sameer agreed. “I think about Rehma constantly. I’m sitting in a meeting or having a conversation with somebody she is just there. But I also think about the fact that we left her with someone who hurt her.” The couple won a $4 million wrongful death lawsuit against Aisling McCarthy, the Irish nanny accused of shaking Rehma. The verdict came after McCarthy defaulted on the lawsuit by failing to respond. The purpose of the civil suit was not to get money or keep McCarthy from making a living, Sameer said. It was simply to keep McCarthy from writing a book or otherwise making a profit from Rehma’s story. On a visit to Rehma’s grave in a cemetery near Boston, he told CNN Chief Medical Correspondent Dr. Sanjay Gupta why. “For us, this has become about protecting Rehma’s legacy,” said Sameer, “and trying to make sure to advocate in some way such that the debunking of good science is rectified.” To accomplish that goal, Nada and Sameer created <a target="_blank" href="http://www.rehmafund.org/">The Rehma Fund for Children</a>. In addition to supporting children’s health care agencies in the UK, Canada, <a target="_blank" href="http://www.rehmafund.org/supported-causes/vietnam-vascular-anomalies-center/">Vietnam</a> and <a target="_blank" href="http://www.rehmafund.org/supported-causes/indus-hospital/">Pakistan,</a> the fund paid for a <a target="_blank" href="http://www.rehmafund.org/supported-causes/boston-childrens-hospital/">physician training module on abusive head trauma</a>. The training module lives on <a target="_blank" href="https://www.openpediatrics.org/">OpenPediatrics,</a> an online educational community run by Boston Children’s Hospital, and focuses on scientifically validated research on abusive head trauma and the dangers of shaking a child. The couple funded the training to counter the proliferation of unfounded theories by defense witnesses who maintain a child’s neck would have to be broken to create the injuries seen in shaken baby syndrome. Even though abusive head trauma is recognized by 24 national and international medical associations, the defense approach has resonated in courtrooms and the national media in ways “very similar to the vaccine debate or the climate change debate,” Sameer said. Now, these <a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/29796797/">unsubstantiated theories</a> have trickled down to family courts and medical examiners, affecting decisions about whether an allegedly abused baby’s case — like Rehma’s — even makes it to trial. It would be unbearable, Sameer said, if Rehma’s case was used in court by a small group of defense experts as fodder for their unfounded theories to explain abusive head trauma. He wiped tears from his eyes and brushed his hand across his daughter’s headstone. <span class=”dropcap”>S</span>ameer and Nada were not the first Boston parents to see criminal justice proceedings change dramatically after the death of their young child. Two other Boston medical examiners also reversed their decisions in separate shaken baby cases over an 18-month period from 2014 to 2016. Just like in Rehma’s case, a murder charge was dismissed in the death of 6-month-old Nathan Wilson, who was found by his mother in his crib, lips blue, on March 7, 2010. Boston medical examiner Peter Cummings originally ruled Nathan’s death a homicide, a result of “blunt/shaken injuries to the head.” But in July of 2014, Cummings changed his ruling. Now Nathan’s injuries were from an unknown cause; therefore, the cause of death was “undetermined.” In 2015, Cummings quit his job at the Boston medical examiner’s office and in subsequent years did consulting work for court cases, including for the defense in shaken baby cases. One notable case was that of <a target="_blank" href="https://www.thedailybeast.com/doctors-said-they-shook-their-baby-to-death-they-didnt">a three-month-old</a> boy who allegedly died of abusive head trauma. Cummings could not be reached for an interview prior to publishing this piece. He later declined a reporter’s interview request. He told the <a target="_blank" href="https://www.bostonglobe.com/metro/2016/08/20/life-and-death-decision-without-supervision/gRzxpXjWQ0gHY2y49Nb8LK/story.html">Boston Globe in 2016</a> he changed his findings based on new information. In his consulting practice, he told the Globe he hoped to be a “reasonable voice” in the shaken baby debate, adding that he will tell defense lawyers if he sees evidence of abuse or if the case is not clear-cut. <span class=”dropcap”>T</span>he third case was the death of 6-month-old Ridhima Dhekane, the murder trial Debbie Eappen and Sameer Sabir were attending in April of 2019. Ridhima almost didn’t have her day in court. Following in the footsteps of her colleagues, Boston medical examiner Dr. Anna McDonald changed her mind about the baby’s cause of death. In her original autopsy report, McDonald said Ridhima died of “Blunt Force and Shaking Injuries” of the head and declared her death a homicide. Then, almost a year after leaving the job, she wrote the medical examiner’s office requesting an amendment to the autopsy. Despite the fact that Ridhima’s heart had been transplanted into another infant who was thriving, McDonald said she now believed Ridhima had died due to “sudden unexplained cardiopulmonary arrest.” The about-face occurred after McDonald went to work with Wake Forest pathologist Dr. Patrick Lantz, a vocal critic of what he says are unreliable means of diagnosing shaken baby syndrome. “I didn’t even know she had done the case or had reversed her opinion about the cause or manner of death until it came out in the newspaper,” Lantz told CNN. Lantz was one of the nine medical defense witnesses who wrote an opinion about Rehma Sabir’s death. Instead of blunt force trauma to the head, Lantz said Rehma likely died of an inflammatory disease so rare that barely more than a hundred people in the world have ever been diagnosed with it. <span class=”dropcap”>B</span>y the time a third Boston medical examiner reversed another alleged shaken baby’s cause of death, some had had enough. News reports questioned the integrity of the medical examiner’s office. The <a target="_blank" href="http://mcaap.org/suspected-abuse/">Massachusetts chapter</a> of the American Academy of Pediatrics was outraged and sent a letter to the governor demanding an investigation. “Such a dramatic change [in a decision] is a very unusual event, and then to have three of them in rapid succession was concerning,” said Dr. Stephen Boos, chair of the child abuse committee of the AAP’s Massachusetts chapter. CNN asked the state’s Office of the Chief Medical Officer for a response to these criticisms. Jake Wark, then a public affairs officer for the agency, said he was unable to speak about specific cases, but added that if medical examiners “receive additional relevant information, then they factor it into their analysis, which in some cases could result in a change in their original opinion.” However, McDonald’s request to have the autopsy of Ridhima Dhekane changed was denied and trial preparations proceeded when Boston’s chief medical examiner, Dr. Henry Nields, agreed to testify. Nields, who is now retired, had been supervising McDonald at the time of the autopsy and was adamant that Ridhima Dhekane’s death was consistent with abusive head trauma. McDonald declined CNN’s request for an interview. <span class=”dropcap”>C</span>reating doubt in advance of a trial is a defense tactic being successfully used in shaken baby cases across the country, said former prosecutor Brian Holmgren, who edited a manual on the Investigation and Prosecution of Child Abuse Cases for the American Prosecutors Research Institute. Typically, both defense and prosecution experts are allowed to discuss a case with a medical examiner in order to prepare their medical opinions. But not all medical examiners, especially those in rural areas and small cities, have a complete understanding of the complicated science of abusive head trauma, he said. “That’s kind of the new defense vogue,” Holmgren said. “They hire a defense expert, bring their report in and see if the medical examiner’s office will change up. It has been effective in a lot of these cases, especially with less experienced medical examiners.” Allowing fringe beliefs to color the outcome of a court case as if those beliefs represent mainstream, reputable science is a mistake, pediatricians say. The legal profession, including the courts, should realize that any single doctor’s alternate testimony “doesn&#39;t mean the (entire) medical profession has formed a different opinion,” the current president of the American Academy of Pediatrics, Dr. Lee Savio Beers, told CNN. “Medical decision-making and medical diagnosis really shouldn&#39;t be influenced by legal pressures (from the defense),” Beers said. The consequences of this could be deadly, wrote Dr. Suzanne Haney, who chairs he AAP Council on Child Abuse and Neglect, <a target="_blank" href="https://theindependent.com/opinion/columnists/junk-science-puts-even-more-babies-at-risk-of-abusive-head-trauma/article_b9f34ea0-b214-11eb-b46e-e389a64841e4.html">in an editorial published in May.</a> “In documented cases of abusive head trauma, <a target="_blank" href="https://pediatrics.aappublications.org/content/132/6/e1546">nearly one-fourth of babies</a> under 1 died,” she continued, while “survivors have permanent brain injury, including cerebral palsy, seizures, intellectual disabilities, behavioral problems and learning disabilities. “ On July 3, 1984, in Broward County, Florida, five-month-old Benjamin Dowling survived severe abusive head trauma. Doctors told Benjamin’s family he was shaken so badly that nerves were severed, leaving him with severe brain damage. The babysitter caring for Benjamin, Terry McKirchy, denied hurting him but pleaded no contest to a charge of attempted murder and assault. She was sentenced to weekends in jail for 60 days and three years of probation. In 2019, 35 years later, Benjamin died. After an autopsy concluded his death was directly caused by his old injuries, McKirchy was indicted this year by a Florida grand jury on a new charge of first-degree murder. “The facts speak for themselves and this case was presented to the grand jury, which determined that this was a homicide,” the Broward State Attorney’s Office said in a statement. McKirchy, 59, was arrested in July near her home in Sugar Land, Texas, and was voluntarily transferred to Florida. She maintains her innocence and pleaded not guilty to the new charge. If convicted, she could face life in prison. “There should be justice for Benjamin,” said his parents, Rae and Joe Dowling, in a statement released to the press. “He had to endure several very invasive surgeries,” Rae Dowling wrote, “such as the placement of metal rods in his spine. At the age of 18 months, a feeding tube was placed in his abdomen where it remained his entire life. He had rods placed along his spine because he couldn&#39;t hold himself upright. “Benjamin never crawled, fully rolled over, walked, never talked, never fed himself, he never enjoyed a hamburger or an ice cream cone, he could never tell us when he had an itch or anything hurt,” she wrote. “When he cried in pain, we as a family and caregivers had to guess as to what was wrong and hope that we could satisfy his need.” The Dowlings’ cry for justice haunts Sameer. Ever since news of McKirchy’s arrest broke, he has been reliving Rehma’s death, wondering what life would have been like for her if she had survived. He also worries that defense medical experts will use Rehma’s case to come up with more unfounded theories for Dowling’s death. “The focus always ends up being on the victimization of the accused, but we should always remember that the victims are the children who have been abused,” he told CNN. <span class=”dropcap”>I</span>n an effort to bridge the divide between medicine and the law, the American Academy of Pediatrics submitted a proposal in 2019 to the Health and Medicine division of the National Academies of Sciences, Engineering and Medicine asking the academies to examine the science behind abusive head trauma. The National Academies recently told CNN they are still actively considering the proposal. Once a decision is made and funding is found, the academy would convene a diverse group of experts, including critics of the science behind shaken baby syndrome, to <a target="_blank" href="http://www.nationalacademies.org/hmd/About-HMD/Study-Process.aspx">objectively analyze current research</a> on the topic. The analysis from those experts would also undergo an independent external review. The final report would be <a target="_blank" href="http://www.nationalacademies.org/hmd/About-HMD/Making-a-Difference.aspx">considered the gold standard in current research</a> and could then be used by judges to vet expert testimony, say child abuse specialists, thereby removing any battle of the “experts” from the courtroom. Ultimately “we need to get to a point of impartiality,” said retired pediatrician Dr. Robert Reece. “The expert witness should be testifying to the facts for the court, not for one side or the other. The adversarial system doesn’t allow for that very easily. I think that needs to be changed.” <span class=”dropcap”>T</span>he four-week trial of babysitter Pallavi Macharla for the murder of Ridhima Dhekane ended May 13 when the jury reached a verdict after only eight hours of deliberations. As the jurors filed into the courtroom, Sameer Sabir and Debbie Eappen sat up straighter in their seats. The verdict: Macharla was guilty of second-degree murder. A bailiff placed her in handcuffs. <em>“</em>Debbie and I were clinging to each other’s hand,” Sameer said. “It was all really intense.” Sentencing was held the same day. Middlesex Superior Court Judge Kenneth Fishman chose the minimum sentence in Massachusetts for second-degree murder: 15 years. As Macharla was led away, Sameer was filled with a mixture of sadness and relief. “There are no winners in any of this,” he told CNN after leaving the courtroom. “I can’t say I’m happy about the outcome, because her children will lose their mother … but I’m grateful the jury came to the right decision. “I’m hopeful this may contribute to a better understanding of this issue and to help to protect children in the future,” he added. <span class=”dropcap”>T</span>hat sense of justice didn’t last long. A few weeks later, Fishman announced he was changing the jury’s verdict and reducing Macharla’s conviction to involuntary manslaughter — just as the judge did in the Louise Woodward trial nearly 25 years ago. Instead of a minimum of 15 years, Macharla would now serve less than four. Citing legal precedent which said “doubt has increased in the medical community ‘over whether infants can be fatally injured through shaking alone,’” Fishman said “the debate rages on” over the validity of a shaken baby diagnosis. “This court cannot permit a verdict of second-degree murder to stand in the presence of such highly contested and inconsistent evidence,” <a target="_blank" href="https://www.socialaw.com/services/slip-opinions/slip-opinion-details/commonwealth-vs.-pallavi-macharla">Fishman wrote in his ruling.</a> “It was like a punch in the gut, a literal punch,” Sameer said. “What trial was he watching?” Eappen wrote an anguished <a target="_blank" href="https://www.bostonglobe.com/opinion/2019/09/26/babies-massachusetts-courts/0e8lLNX47IEuynY3C3oZoK/story.html">opinion piece published by the Boston Globe</a>, arguing that the jury in Macharla’s trial had rejected defense experts’ unproven theories. “What is it about killing babies that these judges have trouble punishing?” she wrote. “Should we come to the conclusion that a child’s life does not matter in our state? Some judges seem to have more compassion for the perpetrator of a crime against a child than they value the life of the child.” Sameer vented his feelings in a <a target="_blank" href="https://www.bostonglobe.com/opinion/2019/05/20/shaken-baby-syndrome-controversy-all/25swaGmIUMqD382kf5DUrN/story.html">simiar op-ed:</a> “The ‘controversy’ surrounding shaken baby syndrome is yet another example of a vocal minority shunning facts in favor of a self-serving narrative and personal gain. The ones who suffer are always the defenseless, voiceless child victims.” In April, 2020, Judge Fishman took another step: He stayed Macharla’s sentence while her appeal is pending, allowing her to return home under confinement. She can only leave the house for doctors’ appointments and is barred from seeing any children but her own. Sameer and Nada still struggle to understand the judge’s amended verdict and reduced sentence. Sameer fears the decision will make their fight to protect Rehma’s legacy more difficult than ever. “I can see this decision – as well as what happened to Rehma – being used by defense teams across the country to bolster their claims that the science behind shaken baby syndrome is something other than the medically accepted fact it is,” Sameer said. “And that is a travesty of justice, not only for Rehma but for every baby who is shaken or abused.” <span class="section-end"></span>