A Daycare Provider, Shaken Baby Science And Hope For A Pardon

Jul 24, 2018

While thousands of refugees are heading back to their countries, with or without their kids, two Virginia sisters are desperately trying to keep their mother here. 

Trudy Munoz came to the U.S. legally from Peru but now faces the prospect of deportation because of a controversial medical diagnosis.

It’s been nearly ten years since Trudy Munoz was locked up at the Fluvanna Correctional Center for allegedly shaking a 4-month-old baby.  To this day she insists she did not hurt the child, who suffered a seizure at her home daycare center in Northern Virginia.  At the time, doctors thought three symptoms – swelling of the brain, bleeding beneath its top layer and behind the eyes -- were proof that an infant had been shaken violently.  What they didn’t know was the history of what had come to be known as Shaken Baby Syndrome.

“The entire thing is based on a misinterpretation of one single experiment that was done for an entirely separate purpose by one of my own teachers,” says Dr. Ronald Uscinski, a neurosurgeon at Georgetown, George Washington and Howard Universities.  Uscinski says the concept of Shaken Baby dates back to a study done of how much force it took to injure the brain of a monkey in a crash test.   

That study led a British neurosurgeon to speculate that hard shaking could produce brain injuries in infants. Years later, that neurosurgeon was dismayed that pediatricians had accepted his idea as gospel rather than theory, and a whole industry had grown up around prevention of Shaken Baby Syndrome, complete with public speakers and videos.

“There will be times when you’re tired and stressed – when your child cries for reasons you may not understand, and when you are overwhelmed to the point that frustration may lead to the injury of your child,” one video states.

But today some doctors are disputing the original thinking around Shaken Baby. Dr. Waney Squire spent 30 years studying the infant brain and testifying against people accused of shaking babies.  Now, she gives a Ted Talk explaining why the original theory was flawed.

“The shaken baby hypothesis depends on the assumption that shaking can generate enormous forces equivalent to a fall from a second-story window," Squire says.  "It wasn’t even tested until 1987 when biomechanical studies showed that adults shaking a crash test dummy as long and as hard as they could generated only half the forces of a one-foot fall.” 

And Dr. Uscinski says it’s common sense.  A baby who was shaken would have injuries to the neck and spinal cord. When there’s no sign of those things, he considers another possibility.  For babies, birth is traumatic.  “The baby is expelled by pressure from behind, and brain is taking the brunt of this,”  Uscinski argues.

He points to one study at the University of North Carolina where doctors scanned the brains of 88 newborns.  Twenty-two of them had some bleeding. “Wow.  That’s a lot,” Uscinski says.

Trudy Munoz, before her incarceration, with her daughters

Later, Uscinski says, an infection, a high fever or a blow to the head could cause new bleeding.  Which brings us back to the baby allegedly abused by daycare operator Trudy Munoz.  When the Innocence Project reviewed his medical record, attorneys Deirdre Enright and Jenny Givens say they found something shocking.

“The dad reported that a plaque had fallen on the baby’s head within the week before, and then the child protective services worker came in and told them Trudy had admitted shaking the baby – which she had never done,”according to Enright.

“What she was describing to the social worker was how she was patting and jiggling the baby on her shoulder, but that was after the baby had already begun to seize or choke.  It was after the triggering event,” Givens adds.

With a felony on her record she could be sent back to Peru – unless Virginia's governor steps in.

But the jury didn’t know about that, and Munoz was convicted.  Next month, she’ll be released from prison, but with a felony on her record she could be sent back to Peru – unless Virginia’s governor steps in.

Cindy Christian holds a chair in the prevention of child abuse and neglect at the Children’s Hospital of Philadelphia. She says doctors now look at many other factors before concluding a baby was shaken.

“There’s no doctor who sees three findings and makes an immediate diagnosis. We take a detailed history from parents.  We do a complete physical examination.  We do laboratory testing and radiographic testing and x-rays and MRIs, and we do follow-up imaging, and then we come up with a working diagnosis,” Christian says.

That process should catch other possible causes of swelling and bleeding on the brain or behind the eyes. “Children can have bleeding disorders that can lead to subdural hemorrhage.  Babies can have metabolic diseases.  Babies can have accidental trauma.”

And that’s what caught the attention of UVA’s Innocence Project.  Lawyer Deirdre Enright reviewed the Munoz case and found, in the medical record, that the baby’s father reported a wooden plaque fell on the boy’s head a week earlier.  That information and the fact that he had a blood clot in one of the vessels supplying his brain were not shared with the jury.

“The child had a cortical thrombosed vein in his head. Many doctors would say you cannot shake a baby into that condition.  He had infection in his lung.  He had a fever, and he was treated with antibiotics, and none of that came up at trial,” Enright argues.

The baby had no bruises on his body, no injuries to his neck that would suggest hard shaking.  He has recovered and is in school, learning at grade level, but Enright says he continues to suffer seizures.

Trudy Munoz's daughters, Jimena and Renata Ames
Credit Sandy Hausman/Radio IQ

Whatever their cause, Trudy’s daughters were looking forward to getting their mother back when she’s released on August 13th, but they say their mom could, instead, be deported to Peru because she was convicted of a felony.   “It would be very hard for us to see our mother leave once again, and us be a continent away, and it almost feels like she’s going to be sentenced to another punishment,” 22-year-old Renata says.

Her only hope is a pardon from Virginia’s governor, and as luck would have it, Ralph Northam is highly qualified to review the case.  As a pediatric neurologist, he knows Shaken Baby Syndrome.

“A lot of people don’t realize how fragile infants are so, yes, I’m very familiar with it, and it’s a tremendous tragedy when it happens, and anything we can do to help educate the public and keep this from happening will be in our best interests,” Northam said at a recent media availability.

But Northam has referred the matter to the parole board, where retired state police officers work part-time to investigate claims of innocence.  The governor’s office says that’s standard procedure for the 15-20 pardon requests it gets every week, so it’s no surprise that Trudy Munoz has been waiting more than a year for a decision, an upsetting fact for her 14-year-old daughter Jimena.   “The whole situation is very twisted.  They could have investigated it more, but they didn’t.”

In 2008, just before Trudy Munoz was convicted, an appeals court judge in Wisconsin wrote: There is fierce disagreement among doctors about the shaken baby diagnosis, signaling a shift in mainstream medical opinion.  That same year, the government in Ontario, Canada ordered a review of all 142 cases branded as Shaken Baby Syndrome, and two years a group representing 18-hundred pediatricians asked the Governor of Massachusetts to investigate cases where shaken baby syndrome was diagnosed. Here in Virginia, no special action has been ordered by lawmakers or the governor.