I have spent about two hours Googling, to find any literature that supports Dr. Melinek's claim that...
* The more planes of injury ... the more likely that an incident is the result of an assault rather than a simple or even complex fall.
I eliminated any results that contained the term 'Shacknai' in my second search.There may be literature/research that supports what she is claiming, but I have been unable to find it nor anything that supports a simpler version of that statement.
Dr. Melinek has made a clear and definitive causal statement "The more planes, the more likely" as if it is a known mathematical/statistical relationship, but I believe it is not.
Claiming these sort of things is not good science as it is not even supported by science. It's not even inference in this case, it's worse. It's making a universal causal or correlational claim with no basis for making that claim. But she doesn't stop there, she adds on "even in a complex fall".
Granted if there are planes of injury that obviously cannot be explained by a certain incident and accompanying scenario, then you look elsewhere for explanations. In Max's case, you would look at other accident scenarios for an explanation. And, in Max's case there are so many possibilities precisely because it was a 'complex fall'. No one may be able to figure out what combination of events actually occurred - that would not be surprising. But there is NO basis for eliminating some possible variables and objects from the get go. I believe it is unethical to be claiming Max was murdered because someone is claiming they came up with one scenario where they forced the evidence to fit their theory.
Thank you to fellow WSer "time" for taking the "time" to attempt to find supporting studies for the "inferential leap" described in Dr. Melinek report to DS. That kind of effort is the beginning of what Dina should have gotten, imo.
I personally would have been quite interested to read an exhaustive forensic analysis of Max's injuries, most particularly his skull fracture and spinal cord injury. In my small amount of experience as a paid expert and consultant for several civil med cal cases, my role has been to support any opinion I would be willing to testify to with extensive references.
For instance, it isn't enough for me to say an act "did/ did not meet standard of care". Rather, in the cases I have participated in, it is essential to demonstrate exactly how a given act did or did not meet standard of care. That might be by omission, or commission. In substantiating opinions, many experts use a number of references, some of which include published standards set by professional practice groups, as well as a review of the relevant literature. On occasion, I have contacted authors of pertinent studies for more information, as well, and urged the attorney I was working for to add these individuals to the case as experts, as well. In looking up the last case I did, the duration was 3.2 years of my involvement, and during that time I authored several hundred pages of documents and supporting references for the attorneys I was working for. Now, I bring this up not to pat myself on the back, or pad my billable hours, but to demonstrate on a very small scale that most experts that I'm aware of are required to provide substantial academic documentation to support their opinions. That is why I was fairly astonished that Dr. Melinek provided a report in the Burford case that was barely 2 pages in substantive content, according to the judge's decision. And in the report for Dina Shacknai, I cannot find any supporting scholarly references beyond Dr. Bove's analysis.
It is very surprising to me that Dr. Melinek did not include any supporting references for her opinion about the analysis of the skull fracture and cervical cord damage suffered by Max. Now, I'm sure she is more than capable of doing this, and probably would even get a small herd of Medical Students to volunteer to help with research, if she bought them dinner twice a week, and agreed that they could use her as a professional reference. That's cheap, educated research labor.
An exhaustive report, with extensive references would have been MUCH more persuasive, IMO, to the law enforcement investigators when Dina and her attorney presented their petition to reopen Max's death investigation. Moreover, it would have given the law enforcement investigators a place to begin if or when they reopen the investigation. Now, in fairness, Dr. Melinek's report does include assault as ONE possibility. Rather than a general statement that multiple planes of injury point toward assault, I wish she would have connected those dots for the intended and incidental audience. We're not all as smart as she is, so we all rely on experts to not only opine, but to support their opinions with the opinions and research of others-- that's what being part of a profession is all about. No man (or woman) is an island.
If we put aside the theories of assault for a minute, there is a great deal of physical damage to Max's skull and spinal cord that we really need a forensic expert like Dr. Melinek to explain. Such as, what kind of forces are necessary to produce a non-comminuted 7 1/2 inch vertex sagittal fracture, WITHOUT any cervical vertebral damage, in a 6 year old with a normal skull? (Where force equals mass times acceleration.) And then perhaps an analysis of mass, acceleration, and directionality in VARIOUS models of injury (both accidental and intentional) to explain the above. That kind of analysis would have, imo, lent a great deal of confidence to her opinion that an assault occurred, and not an accident.
A very brief google search demonstrated to me that there is indeed literature on skull fracture forces-- a great deal of it. In fact, my very brief and decidedly non-expert search reveals that Michigan State University has been awarded (in 2011) a 2 year, $682,000 grant to forensically study pediatric skull fractures for the National Institute of Justice (among many other sources of forensic articles).
Now, it is certainly possible that the lead investigator , Dr. Todd Fenton, could have been contacted as a reference colleague, even without the study being complete, right? That is just one simple example, from one simple minded health professional of the direction I believe Dr. Melinek's scientific second opinion review should have taken-- that is, if she were approaching the issue as a scientist, and not wasting her time reading People magazine articles, Wikipedia articles, and one anonymous internet non-professional chat forum as part of her research into the case.
What Dina SHOULD have received from her expert is a veritable tsunami of sources substantiating her opinion of assault. THAT would be the most persuasive approach to reopening Max's case, imo. Absolutely BURY the investigators in scientific evidence supporting assault. But from where I sit, that report didn't even begin to do that. It's not like I"m a dentist explaining neurosurgery, or some such thing. Both Dina and Dr. Melinek essentially put all her eggs in one basket, rather than rallying support from the field of scientists. If a simple minded advanced practice nurse anesthetist can think of this-- what can a prominent expert like Dr. Melinek produce?? Wow, that is exciting to think about! It wouldn't have cost that much either-- med students work for food, lol! Let them do the research-- then the BIG expert can make the important phone calls to the OTHER experts. The more experts and scientists who agree, the stonger your case is.
So anyway, this is getting kind of long for a post, but here is just a smidgen of relevant sources about pediatric skull fractures , not even using a real database. ** Pay particular attention to the abstract for this first study-- because it's seeking to explain pediatric skull fractures and impact trauma, which is controversial, and not at all an established field of study (or else our tax dollars would presumably not be funding a $682,000 study.) But I guess maybe this study and it's PI could not have substantiated an assault scenario put forth by Dr. Melinek.
http://www.nij.gov/nij/topics/forensics/forensic-awards-abstracts-fy11.pdf
2011‐DN‐BX‐K540
Michigan State University
Pediatric Fracture Printing: Creating a Science of Statistical Fracture Signature Analysis
Principal Investigator:
Dr. Todd Fenton
fentont@msu.edu
Funding Amount:
$681,147 for 2 years
Abstract: In medicolegal death investigations, current techniques for interpreting pediatric cranial trauma are of questionable reliability due to a lack of baseline data that matches pediatric cranial fracture patterns with known impact scenarios. This research will address this significant gap in best practice through a multidisciplinary effort that: (1) continues the development of experimental data from an experimental animal model, to help correlate input forces and cranial fracture patterns; (2) develops a pattern recognition method for fracture‐printing to be used in the identification of injury causation, initially based on this ground truth data from an animal model; and (3) collects data on human pediatric deaths involving blunt force cranial fracture and known impact scenarios from current forensic case files at medical examiner offices across the country to establish a database (The Pediatric Cranial Fracture Registry).
This research will develop automated pattern recognition methods to classify cranial fracture patterns based on contact interface, impact energy, and head constraint condition based on subject age. The predictive analysis will use classification models that are generated using experimentally produced data (e.g. digital images of cranial fractures) and are accompanied with the ground truth data (i.e. contact interface, impact energy, and head constraint condition). The ultimate aim of this research will be that for a given cranial fracture pattern in a subject of a given age, we will be able to compute a statistical probability that a particular impact condition was the cause. Future studies will develop a computer program that will automatically generate a fracture feature set based on pediatric human fracture pattern inputs that can be compared to a known database, to help predict the most likely cause of a particular fracture print in a forensic case.
This proposal brings together a team of established researchers in forensic pathology, forensic anthropology, orthopaedic biomechanics, pattern recognition and machine learning, and database
development to work on this significant gap in best practice. This research builds on studies that have been performed during a recently funded NIJ research project titled A Forensic Pathology Tool to Predict Pediatric Skull Fracture Patterns
(Award No. 2007‐DN‐BX‐K196).
NIJ Point‐of‐Contact
Program Manager: Danielle McLeod‐Henning
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http://digitalcommons.wayne.edu/dissertations/AAI3495798/
Computational simulation of skull fracture patterns in pediatric subjects using a porcine modelChristina DeVito Wagner, Wayne State University
Abstract
In cases of suspected child abuse with skeletal trauma, it is often the role of the injury biomechanist, forensic pathologist, clinical radiologist, and forensic anthropologist to determine the mechanism of injury when the child victims cannot speak for themselves. This is a challenging task, especially for the head, as comprehensive biomechanical data on skull fracture in infants and children do not currently exist, and frequently the determination regarding cause of injury is based on anecdotal evidence from the medical literature and unsubstantiated eyewitness accounts. The current process may result in unreliable autopsy interpretation and miscarriages of justice due to a lack of scientific verification in expert witness testimony.
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http://gradworks.umi.com/14/71/1471830.html
Material property documentation and fracture analyses of the developing skull
by Baumer, Timothy G., M.S., MICHIGAN STATE UNIVERSITY, 2009, 100 pages; 1471830
Chapter 5 uses a simplified porcine cranial model and the finite element method to predict experimentally documented fracture patterns developed during impact loading to the parietal bone. The material properties of the cranial model were taken from the previously obtained results from Chapter 2. The experimentally inflicted fractures to the cranium from Chapter 3 were used for comparison with the theoretically developed principal stress and strain directions.
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http://jivresearch.org/jivr/index.php/jivr/article/viewArticle/46/107
Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims a critical analysis
Abstract:
Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries.
Gosh, I guess that's enough for one post. Thanks to anyone brave enough (or stupid enough, lol!) to read all of it!
