Part I, Section I

Prosecutors build murder cases on disputed Shaken Baby Syndrome diagnosis

Interview

Mother acquitted of shaking a baby: ‘I would have committed suicide’

Part I, Section II

Doctors who defend shaking diagnosis dismiss scientific challenges

Interview

Prosecutor: ‘The public should know that this can kill’

Graphic

The unsettled science of Shaken Baby Syndrome

Part I, Section III

Mother released from prison: ‘It hurts too bad to remember’

Video

After five years in prison, a young mother is set free

Part I, Section IV

In Maryland, a baby collapses and a babysitter is blamed

Part I, Section V

Prosecutor to jurors: ‘Healthy babies just don't die’

Part I, Section VI

But that year, the case took a significant turn.

Interview

Babysitter once sentenced to 20 years in prison: ‘I’m not gonna say that I killed somebody’

Graphic

A breakdown of the dismissed cases

Graphic

Map: Parents and caregivers accused of shaking nationwide

Interview

Former medical examiner: ‘Alleged cases of pure shaking are unusual’

Part II, Section I

Doctors who diagnosed Shaken Baby Syndrome now defend the accused

Interview

Doctor who helped introduce the hypothesis behind Shaken Baby Syndrome: ‘I don’t think innocent people should be in jail’

Part II, Section II

A child abuse diagnosis raises questions, doubts

Interview

Accident reconstruction specialist: ‘We need to apply the science’

Part II, Section III

Engineers: Falls could be more dangerous than shaking

Graphic

A biomechanical look at shaking

Graphic

How much acceleration can be generated by shaking a 22-pound crash-test dummy

Part II, Section IV

Doctor: ‘What could be right about getting it wrong?’

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Shaken science

A disputed diagnosis imprisons parents

Doctors who diagnosed Shaken Baby Syndrome now defend the accused

You are reading one part of an investigative series on the disputed Shaken Baby Syndrome diagnosis that has put people behind bars.

The forensic pathologist who had spent the better part of 30 years investigating violent deaths walked into a Minnesota courtroom in 2012, braced to testify at another grueling murder trial.

Jonathan Arden quickly took stock of the case: A 4-month-old boy had collapsed in his father’s care and died from lethal head injuries. Damien Marsden, 33, faced decades in prison, accused of shaking the baby to death.

Once, Arden had been a firm believer in Shaken Baby Syndrome, long considered a deadly form of child abuse. But in rural Warren, Minn., in April 2012, the former state expert took the stand for the defense, describing how a thin layer of old blood on the surface of the baby’s brain was a telltale sign of an injury that had occurred before the baby had been left alone with his father.

Jurors spent less than three hours deliberating before acquitting Marsden of murder.

“A lot of people in this field, especially many of the pediatricians, make statements that are absolute and dogmatic and do not allow for the exceptions that we know exist,” Arden told The Washington Post. “Do you want to be involved in somebody’s wrongful conviction because you had this dogmatic approach that it must be trauma, it must be shaking?”

Arden is among a number of doctors who once diagnosed Shaken Baby Syndrome but now doubt the science behind it, swayed by more than a decade of research that’s documented how diseases, genetic conditions and accidents can, in some cases, produce the conditions long attributed to violent shaking.

The doctors’ journeys from supporters to skeptics expose the uncertainty at the heart of a medical diagnosis that has fueled hundreds of abuse and murder cases. In courtrooms across the country, the doubting doctors are now using the same evidence that once supported a shaking conviction — medical records, autopsy reports and brain scans — to challenge the diagnosis. The Post chronicled the stories of nine of those doctors through interviews, documents and trial transcripts.

The issue is not whether violent shaking can harm babies: Even doctors who dispute the diagnosis say shaking can damage an infant’s fragile neck, torso or spine. But the doctors say that shaking has not been shown to produce the conditions often attributed to Shaken Baby Syndrome — namely, bleeding on the surface of the brain, bleeding in the back of the eyes and brain swelling.

The challenges have come from doctors and scientists worldwide, including a forensic neuropathologist in Illinois, an ophthalmologist in Colorado, a radiologist in Pennsylvania, a physicist in Idaho, a forensic pathologist in North Carolina, a neurosurgeon in the District and several doctors in Britain, Sweden, Hong Kong and Argentina.

Although they are outnumbered by the doctors who support the science, those who challenge it are gathering strength. More than a hundred share their ideas on a private e-mail group called ­“Evidence-Based Medicine and Science.”

They have published their concerns in medical journals and teamed up, sometimes as paid witnesses, with private defense attorneys and lawyers affiliated with the Innocence Network. In courtrooms across the country, the doctors have questioned high-profile criminal convictions, drawing attention from journalists at the New York Times, ProPublica and other media outlets. Northwestern University law professor Deborah Tuerkheimer published a book on the subject last year, “Flawed Convictions: ‘Shaken Baby Syndrome’ and the Inertia of Injustice.”

In Fairfax County, Va., pediatric neuroradiologist Patrick Barnes, once a well-known state witness in shaking cases, has come to the defense of a mother of two who has so far spent five years in prison. At a widely watched trial, 45-year-old Trudy Muñoz Rueda was accused of violently shaking a 5-month-old in her home day care in 2009, causing serious brain injuries. She is serving a 10-year prison sentence.

Barnes, a professor at the Stanford University School of Medecine, looked at scans of the baby’s head at the request of defense attorneys and came to a different conclusion: The baby had likely suffered from an infection that caused blood clots in the brain, leading to a series of strokes.

“All of the treating physicians simply assumed trauma and stopped looking for alternative explanations,” Barnes wrote in a 2012 affidavit. “That is not sound science and cannot be the basis of a reliable prosecution.”

A petition challenging the conviction, filed by the Innocence Project at the University of Virginia School of Law, is pending in federal court.

Other doctors have also stepped forward to defend parents and caregivers, including George Nichols, the former state medical examiner of Kentucky, who made a surprising offer at a meeting for public defenders shortly after he retired in 1997.

“I said if they had a case in which I had testified that somebody had died as a result of Shaken Baby Syndrome alone, that they were to contact me and that I would now testify for a reversal,” Nichols said. “Shaken Baby Syndrome is a belief system rather than an exercise in ­modern-day science.”

Arden, who spent five years as the District’s chief medical examiner before starting his own practice, began questioning the diagnosis a decade ago. Like other doctors, he started asking: If natural causes and accidents could produce the same conditions in babies, how could doctors diagnosis shaking with certainty?

There’s no good way to validate the diagnosis. Shaking tests on animals have been inconclusive, and doctors cannot test on babies. Some biomechanical engineers say adults likely cannot generate enough force through shaking to cause the lethal bleeding and swelling, but the injury threshold among infants isn’t known.

The National Institutes of Health funded a shaking study on anesthetized baby pigs in 2009, but the research was unable to determine whether shaking can cause the severe brain and eye injuries linked to the diagnosis.

“The jury is still out and we need to do much more basic science,” said Valerie Maholmes, who leads a newly formed NIH branch on pediatric trauma. “We want good, strong science that has been confirmed and verified.”

Nagged by mounting doubts, Arden on his own started looking into the theory behind Shaken Baby Syndrome, which was forged more than 40 years ago with just a handful of cases and an intuitive leap.

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