About This Series Stephanie Moomau, holding her daughter, Synthia, kneels by Samantha's grave in Burtonsville. (By Lucian Perkins – The Washington Post) Findings A review of recent child death cases in the Washington area found few that were followed by murder convictions. Part Two • Forensic challenges in telling accident from malice are one hurdle in the vigorous pursuit of child killers. Leniency of some judges enters in, as does the difficulty of proving an intent to kill. Part One • The Post created a database of causes of death for the 2,379 children younger than 5 who died from 1993 through 1995. • Sidebar: While most adults wish to spare children from talking about death, they are eager to discuss it, an interview specialist says.

Last of two articles

By Nancy Lewis
Washington Post Staff Writer
Monday, September 21, 1998; Page A1

Samantha Greene, a bright-eyed inquisitive toddler, was dead on arrival at Laurel Hospital in January 1996. Her mother's boyfriend, Troy Brookman, then 22, said he had found the girl on the floor of her bedroom after she had had a seizure. His 911 call was filled with panic.

Doctors questioned his story immediately. They saw a fresh bruise on Samantha's face in the shape of an open hand and bruises on her buttocks and later found small hemorrhages under her scalp and a mark on her head.

Laurel police had questions, too: What about the $50,000 life insurance policy that Brookman, a cash-strapped construction worker, had taken out on the healthy little girl just two days before she died?

Over several days, Brookman gave police six different accounts of what had befallen the 2-year-old. In one, she stumbled down steps; in another, she wrapped herself tightly in a blanket, fell and hit her head against a radiator.

None of the stories, the doctors said, explained her injuries. None of them persuaded a Prince George's County jury, either, and last year a judge sent Brookman to jail.

But not for murder.

Brookman is serving 15 years for child abuse.

A review of recent child death cases in the Washington area found few that were followed by murder convictions.

The forensic challenges in distinguishing accident from malice are one hurdle in the vigorous pursuit of child killers. The leniency of some judges enters in, as does the difficulty of proving an intent to kill.

In Samantha's death, the assistant Maryland medical examiner who handled the case said he simply couldn't tell what killed her. None of her injuries would have been fatal, yet because of them, he said, it would be "foolhardy" to say Samantha died of natural causes.

He wouldn't call her death homicide, and without that ruling, under Maryland law, Brookman couldn't be tried for murder.

It was an obstacle Laura Martin, the assistant state's attorney on the case, could not overcome, even after an expert testified that blood and saliva stains on a pillowcase in Samantha's room showed that the pillowcase likely was used to smother her.

Child killers can go undetected or accused killers can draw light penalties for a variety of reasons. Doctors and medical examiners may lack expertise in spotting telltale childhood injuries. Investigative resources are thin, with too few people and too little coordination. There are shortcomings in the laws covering such killings and in their sentencing. Family members often resist the idea a child killer may be among them. And, even among the most passionate advocates for a dead child, there is an emotional strain in developing case after horrible case.

Alone and in combination, those factors explain why area children too young to know they were in danger – and too young to fend off attack – have been killed, and little notice paid to their deaths.

The Forensic Puzzle

A small child is beaten or shaken to death by an adult who then claims the injury came in a fall from a couch.

Never mind that young children rarely suffer serious, much less fatal, injuries in falls from low heights. The killer couch excuse endures because there is too little training in the distinctive nature of childhood injury and too little suspicion about motives, experts say.

"We get a lot of very, very well made-up excuses," said Craig Futterman, associate director of pediatric intensive care at Inova Hospital for Children

Falls from sofas or tables or counter tops are offered as the cause of perhaps 20,000 deaths and injuries a year nationwide, according to Robert Kirschner, former Cook County, Ill., deputy medical examiner, who was one of the first pathologists in the nation to focus primarily on children's deaths from abuse and neglect. Probably none of the explanations is true, in his view. Many doctors "buy into" ludicrous explanations. "Minor falls cause minor injuries," Kirschner said, "not life-threatening ones."

Samantha Greene was 1½ in April 1994. (Family Photo)

Deaths of children from abuse and neglect have been the subject of medical investigation for about 50 years, a relatively short period. The rise of specialists in forensic pathology for children – doctors trained to read the clues that lie in a child's body – is even more recent, dating from 1990, according to the American Board of Pathology.

When the weapon is not a gun or a knife, but a pillow or a hand, the challenge in finding the cause of death soars.

"What's distinctive about children's deaths? Everything," said Jonathan L. Arden, the new D.C. chief medical examiner.

Children's bones do not break in the same manner, their quick healing masks old injuries, and they don't show the same bruising as adults. They also cannot react to violence as adults would. Adults who are smothered, for example, are usually strong enough to fight back, a defensive act that leaves physical evidence. Infants are weak and do not know how to fight off a smothering, leaving so few clues it would be hard to distinguish a homicide from sudden infant death syndrome.

All jurisdictions have their own rules governing when an autopsy is required in a child's death. Maryland, Virginia and the District do not require autopsies in every child death, even when abuse is suspected.

An autopsy does not guarantee a solid answer to what happened to a child, however. At times, the quality of completed autopsies has been so much in dispute that local prosecutors have brought in outside experts to shore up their cases. That problem has occurred in several places but was particularly acute in the District before Arden's arrival.

In the 1997 death of Robert C. Williams Jr., the D.C. medical examiner's office first said the 11-year-old died from an irregular heartbeat after being punched in the chest by his father, then changed the cause of death finding to strangulation. In less than a week's time, the office reversed itself after medical experts called in by prosecutors questioned the validity of the finding of strangulation.

In Samantha Greene's death, the prosecutor hired an expert in blood stains to supplement what the medical examiner reported. That expert testimony cost Prince George's County $10,000 – an expense that can be prohibitive in most cases.

National protocols for autopsying children suspected of dying of child abuse or neglect dictate extensive X-rays and toxicological testing. To be further confident a doctor feels secure testifying that abuse caused a death, "we have to run strange and unusual lab tests," to rule out everything from rickets to failure-to-thrive syndrome that might otherwise explain broken bones or stunted development, said Donna Seelye, coordinator of Shady Grove Adventist Hospital's sexual abuse and assault center.

Absent those tests or testimony from a high-priced medical expert, a defense attorney will offer every alternative explanation for a death, confounding a jury or a judge.

The vicious nature of a fatal baby shaking, for example, comes through only with a medical report that shows how fierce the motion is, how it pops blood vessels behind a child's eyes, literally scrambling the brain and causing it to swell until it can swell no more inside the skull.

Said Sandra Sylvester, a prosecutor in Prince William County: "Shaking doesn't sound that terrible unless you can show that its effects are like what would happen if an 18-wheeler rear-ended your car. And then did it again. And again."

Carol Jackson holds photos of her granddaughter, Hayli. (By Michael Clevenger for The Washington Post)

Probing Suspicious Cases

To get crucial information – which helps before an autopsy and as a case unfolds – police need to get quickly to a death scene. Delay, and scalding water can cool, witnesses can flee or a house can be scrubbed clean.

Determining the true cause of every child's death demands examining a home as thoroughly as any other crime scene, said Bill Hammond, who conducts training sessions nationally for the U.S. Justice Department in how to investigate children's deaths.

"You have to jump on these cases quick," said George Taylor, a detective and 21-year veteran of the D.C. police force. A day or two later, "the cooperation has faded away."

Taylor has spent a half-dozen years chasing the meanest gang members in the city. Now he is assigned to the "naturals squad," the homicide unit charged with investigating bodies that suddenly float to the surface of the Potomac River, old people who die at home in their sleep, people who jump off bridges to commit suicide and most of the city's baby deaths.

A former seminarian with a grown son and daughter whose childhoods he concedes he missed by being a workaholic, Taylor said investigating child deaths is his "way of giving something back to the children."

Imposing at 6 feet 2, street-smart but unfailingly polite, Taylor has become the department's point man for child abuse and neglect deaths. He's signed up for every training session possible, paid his own way to many, put himself on call 24 hours a day, seven days a week and is supposed to be notified and briefed on all child deaths.

Taped inside his notebook is a laminated card of about a dozen questions that a D.C. police detective is expected to ask concerning any child death. It's the same list detectives have been using for at least two decades. A new multi-page protocol has been under development for more than a year, but in the meantime, detectives rely on that short list.

The tools D.C. homicide detectives have to help them investigate child deaths are just as old and out of date as the laminated card. There is no computerized directory of child deaths, no quick way to check whether other children in the same family have died. There is no list of families with histories of child abuse reports. There is no easy way to obtain medical histories of children whose deaths are suspicious, nor are there cooperative agreements among area hospitals for routine sharing of medical records.

Such sharing could help counter the "hospital hopping" that several national studies have found precedes some child abuse deaths. The studies show that parents who eventually kill their children often make several failed attempts and usually take the children to different hospitals for treatment to escape detection.

Federal prosecutors are reviewing the suspicious deaths of two children – one in 1984 and another in 1988-of a District woman, Tracey McPherson, who pleaded guilty last year to cruelty to children after another child, Tre, fell out of a third-story window. Three days after the fall, according to a police report, a nurse found McPherson holding a plastic bag over Tre's head in a hospital bathroom. He survived that, too.

Prosecutors later uncovered that during a 30-month period, Tre had been to various emergency rooms 16 times – mostly for unexplained breathing difficulties.

Laws in the District, Maryland and Virginia require health professionals, school officials and social service workers to report suspected child abuse. But those laws are rarely followed, in letter or in spirit.

The focus should be not only on "the pain of knowing that children are dying needlessly but on the knowledge that what we do determines whether children live or die," said Deanne Tilton Durfee, past chairman of the U.S. Advisory Board on Child Abuse and Neglect.

Thousands of children in the Washington area visit emergency rooms, private physicians and health maintenance organization offices, yet most reports of child abuse and neglect made by hospitals to area jurisdictions come from only two centers: Children's Hospital in the District – about 400 referrals a year – and Inova Hospital for Children in Fairfax County – about 200 referrals a year. Those hospitals are the main trauma centers for children in the area.

There are virtually no reports from private practices or HMOs, and several other area hospitals require that abuse and neglect suspicions first be "vetted," or reviewed and screened, before they are reported.

Suburban jurisdictions make it easier for hospitals to report suspected abuse and neglect cases because they maintain special hot lines. Reporting cases to the District is tougher, hospital officials say, because there is no central number to call, leaving hospitals to contact one of four agencies.

Neither Children's Hospital nor Inova Hospital for Children has a full-fledged child protection team of the sort common in children's hospitals operated by teaching institutions across the country.

As a final backstop on some children's deaths – suspicious and not – the District, Maryland and Virginia each has a child fatality review committee to study the details and suggest ways to prevent similar deaths. The reviews, which involve looking at official records and causes of death, however, routinely trail a death by weeks, occasionally years, and not every child death comes before the committees. The jurisdictions vary on the circumstances that prompt a review.

All three committees also lack reliable public funding and operate with borrowed employees, donated computer space, volunteer members and few grants.

And they have little clout.

None can order a criminal investigation and only the District and Maryland committees may challenge an original finding on a cause of death. Only the District's committee has done that, and it has done so only once and not in a child homicide case.

The Fairfax County committee, a separate group, has issued general recommendations about preventing child deaths, focusing on car safety seats and seat belts. The Virginia state committee deals with no active child fatality cases, instead conducting themed campaigns, such as last year's on preventing gun-related injuries.

The Maryland child fatality committee, operating since 1993, has never issued a report of any kind.