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The evidence base for shaken baby syndrome

BMJ 2004; 328 doi: (Published 25 March 2004) Cite this as: BMJ 2004;328:719

Rapid Response:

“Shaken baby” conviction overturned. The case of Alan Yurko

The following is an account of the evidentiary hearing that took
place August 23-26 in Orlando, Florida. The judge overturned Alan Yurko’s
conviction for murdering his baby son. This account is published on the
website of the Association of American Physicians and Surgeons
( and is a very significant indictment of the
role played by members of the medical profession in an outrageous


September 9 2004

On August 27, Judge Alan Lawson overturned the conviction of Alan
Yurko, who had been sentenced to life imprisonment without possibility of
parole, for allegedly shaking his 10-week-old son to death. Yurko had been
imprisoned for six years, 125 days.

At a week-long hearing, defense witnesses argued that the infant’s
death resulted from natural causes and medical error.

“Mr. Yurko was convicted of doing the impossible,” stated Jane
Orient, M.D., Executive Director of AAPS. While subdural hemorrhage can be
caused by acceleration-deceleration injury (whiplash) alone, recent
experimental evidence shows that an adult male cannot generate the needed
force by shaking alone, without impact. Autopsy showed no head trauma, and
also no neck injury.

Unquestionably, the baby suffered a respiratory arrest, followed by
cardiac arrest, and had anoxic encephalopathy as a result. These facts
could explain all of the autopsy findings, Dr. Orient argued, especially
since the baby was started on intravenous heparin soon after admission,
and some five hours before a CT scan showed a small subdural hematoma.

Several witnesses stated that the apneic episode as well as other
findings resulted from a vaccine reaction. The infant, who was born after
35 weeks gestation, received six vaccines at once, while ill, 13 days
prior to the fatal event. Dr. Orient stated that vomiting with aspiration
was another possible explanation.

Horace Gardner, M.D., of Colorado, an ophthalmologist, observed that
alleged shaken baby syndrome occurs at much younger ages in the U.S.,
peaking at age 3 months, than in Japan, where it peaks at 9 months. There
is less than a one in a million chance that the age distribution is
different on the basis of chance alone. Dr. Gardner notes that the age of
vaccination is later in Japan, with the timing consistent with a causal

Dr. Gardner also testified that shaking could not produce unilateral
retinal hemorrhage, as observed in Baby Yurko, for biomechanical reasons.

The DtaP, Hib, OPV, and hepatitis b vaccines were contraindicated at
the time that they were given, testified pediatrician F.E. Yazbak, M.D.,
of Massachusetts. The pediatrician did not even record the baby’s
temperature on that day.

Dr. Yazbak also raised the possibility of late hemorrhagic disease of
the newborn in addition to other reasons for a bleeding tendency.

A key element in Yurko’s conviction was the presence of four
“probable” healing rib fractures of various ages. This sustained the
charge of aggravated child abuse. Dr. Yazbak stated that the probability
of inflicted injury was very low in the absence of any bruising or damage
to the lung. Each traumatic fracture has a 75% probability of damaging the
lung, he stated. (Thus, the probability that four independent traumatic
fractures will not damage the lung is [0.25]4 or 0.4%). Dr. Orient also
noted the improbability of breaking just one rib in each of four presumed
episodes of violent squeezing.

Nontraumatic explanations for rib fractures include temporary brittle
bone disease, for which the baby was at risk because of oligohydramnios.
Barlow’s disease or vitamin C deficiency is another possible explanation.
Dr. Archie Kalokerinos had flown in from Australia to testify to this, but
early in the hearing was disqualified as an expert because he had stated
that his views were not “generally accepted” by the medical community. He
had reduced infant mortality in his district from one of the highest
levels in the world to near zero by giving vitamin C at the time of
vaccination; however, the court chose to exclude these results from

The prosecution’s case depended on the autopsy report by Sashi Gore,
M.D., the first chief medical examiner in the history of Florida to be
disciplined so harshly for errors on an autopsy. He had reported a gross
and macroscopic examination of the heart, which had previously been
removed for transplantation. As Dr. Yazbak pointed out, Dr. Gore had
testified at trial to the presence of “diffuse” axonal injury on the basis
of examining only one section. Dr. Orient noted that the window of time
for the supposed injury, which happened to coincide with the time when
Yurko was alone with the child, was dated back from the time of
certification of brain death. The senior manager from the medical
examiner’s office testified that the corpse had been received on Nov. 27,
1997. However, at 3:45 a.m., Nov. 29, 1997, the child was on an operating
table undergoing an organ harvest.

Dr. Orient raised questions about the timing of brain death, based on
failure to follow the accepted protocol. The report of the EEG that
purportedly showed electrocerebral silence gave the child’s temperature as
90 degrees Fahrenheit. An EEG is uninterpretable in a patient so severely
hypothermic. Moreover, drug levels were never done to rule out
oversedation. The child had been treated with an anesthetic agent Versed
and a paralyzing agent Norcuron, which could mimic all the signs of brain

Judge Lawson found that “the credible cause and manner of death
cannot be gleaned from Mr. Gore's autopsy because of the very serious
deficiencies that were found by the medical board and brought to light in
this hearing and of course in other places.”

“Because of that I think it does cast doubt on the entire trial,”
Lawson held. “I don't know how you can maintain public trust in a system
of justice if you let stand a conviction obtained through reliance on an
autopsy that is later so thoroughly discredited.”

Mr. Yurko then entered a plea of no contest to manslaughter, and the
Judge sentenced him to time served.
The Orlando Sentinel reported that “Mr. Yurko stated that he was accepting
responsibility for permitting the vaccination of his son at a time when he
was ill, without adequately investigating indications and adverse effects.
He was then released from prison.”

Competing interests:
None declared

Competing interests: No competing interests

07 September 2004
Mark Struthers
Bedfordshire, UK