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Monday, May 1, 2017

An Amish Nightmare: Shaken Baby Misdiagnosis

     On December 23, 1999, Liz Glick, the 4-month-old daughter of Samuel and Liz Glick, Amish dairy farmers in Dornsife, Pennsylvania, died in the hospital two days after her parents had found her unconscious in her crib. The baby had been ill with a fever and had been vomiting. At the Geisinger Medical Center in Danville, pediatricians experienced in treating Amish babies determined that the infant had died of vitamin K deficiency, a genetic and sometimes dietary condition associated with babies born at home and breastfed who have not been given the vitamin through precautionary shots or formula. The symptoms of vitamin K deficiency include bleeding in the brain and eyes as well as the presence of bruises caused by normal handling and movement.

     Dr. Michael Kenny, a pathologist at Geisinger, performed the autopsy and, as Kate Rush would later report in "Genomics in Amish Country," concluded that the baby had died of a "closed-head injury" (as opposed to a "penetrating head injury" caused by a bullet, stabbing instrument, or a blunt object.) Since Dr. Kenny was not the medical examiner, and it was not his job to make an official manner of death ruling, that decision fell to the county coroner, an elected official without a medical degree. Instead of conferring with pediatricians familiar with Amish patients, the coroner took the unusual step of convening an inquest, a jury-empannelled hearing to determine if the death was suspicious enough to warrant a full-scale criminal investigation. (The coroner's inquest, as a first step in the criminal justice process, while still available in most states, is an antiquated way of determining manner of death.)

     Dr. Kenny's "closed-head injury" finding, combined with the bruises, and the brain and eye bleeding, led the coroner's jury to rule that Liz Glick may have been the victim of a shaken baby syndrome (SBS) homicide.

     The Glick case became national news when a child protection agency speculated that the other seven Glick children, in the wake of the coroner's jury decision, were in danger. For their own protection, the children were placed in foster homes until the Pennsylvania State Police, and perhaps a jury at a murder trial, determined if the parents had committed criminal homicide. The Glick children were split up and sent to non-Amish (English) foster parents, an action that stunned and terrified the residents of this traditional central Pennsylvania community.

     The plight of the Glick family caught the attention of Dr. Holmes Morton, a Harvard trained pediatrician who in the 1980's had treated Amish patients at Children's Hospital in Philadelphia. Dr. Morton had moved to Strasburg, Pennsylvania, where in 1989, he had founded a nonprofit clinic in the heart of Amish country called the Clinic for Special Children, specializing in the treatment and study of illnesses and disorders affecting the Amish. Supported by donations and fund-raising events, the clinic incorporated a state-of-the-art laboratory for the diagnosis and study of biochemical genetic disorders. Dr. Morton should have been one of the first experts consulted by the authorities in the Glick case. He was well-known, had expertise pertinent to the case, and was local. No one, however, sought his opinion on the cause of the Glick baby's death.

     Without being asked, Dr. Morton conducted his own inquiry into the Glick baby's medical history. A few days later, he announced that the infant had been born with a genetic liver condition that rendered her body incapable of breaking down vitamin K. The symptoms of vitamin K deficiency--the bleed in the brain and eyes, and the severe bruising--could easily be mistaken for signs of SBS. In Dr. Morton's opinion, the Glick child had not been killed by shaking. There had been a terrible mistake; this baby's death had been of a natural cause.

     But criminal investigations are like freight trains--once they get rolling they are hard to stop. Even though Dr. Morton had thrown his body across the tracks, the train kept coming. Weeks passed. Finally, in February 2000, the case went before a state medical advisory board of physicians. The doctors heard testimony from several pediatricians who agreed with Dr. Morton's diagnosis. The panel of physicians voted to recommend that the manner of death in the Glick case be changed to natural.

     The local coroner, in light of the physicians' recommendation, changed his cause of death ruling, and shortly thereafter, the child protection agency gave the Glick children back to their parents. A month later, the district attorney announced that Samuel and Liz Glick were no longer the targets of a homicide investigation. One can only guess how far down the criminal justice track the prosecution train would have rolled had it not been for Dr. Morton's intervention. One or both of these parents could have been sent to prison. 

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