GIST: "Brenna
Siebold had just returned home from teaching third grade at Mount Horeb
Intermediate Center. Her 9-month-old son, home with his sitter, was
acting sluggish. She took Leo’s temperature: 103 degrees. The
fever was only the latest health scare in Leo’s short life. He was born
with heterotaxy syndrome, in which the internal organs are abnormally
arranged. He had already endured two surgeries, and doctors instructed
the Siebolds, of Mount Horeb, to bring him to the emergency room
whenever he ran a fever above 100.4 degrees. That
day, Sept. 5, 2018, Brenna dropped off her two older children at her
parents’ house. Her husband, Joel, was at work as a middle school
custodian. Then she drove Leo to a familiar destination: American Family
Children’s Hospital in Madison. The visit was
traumatic. Leo thrashed and screamed while ER staff and Siebold
struggled to hold him down to insert a needle into his veins and poke a
catheter into his groin. “There was blood all over the table,” Siebold
recalled. The following day, staff confronted the
Siebolds about bruises on Leo that Dr. Barbara Knox, head of the
hospital’s Child Protection Program, flagged as possible signs of abuse. The
encounter sparked an investigation that threatened to rip apart the
Siebold family. Surgical scars on Leo were listed as bruises.
Demonstrably false information was inserted into his medical record. And
Knox allegedly misrepresented herself as a specialist in an attempt to
convince the family to approve additional medical testing. Police
instantly dismissed the allegation. Child welfare officials would clear
the couple after two months. But the episode left Brenna Siebold
“petrified” of seeking emergency medical care for their children. Now Knox — who testifies as an expert for prosecutors around the country — is under the microscope. The
UW School of Medicine and Public Health placed her on paid leave in
mid-2019 after colleagues accused her of bullying, an internal letter
shows. Pediatrics department chairwoman Dr. Ellen
Wald wrote to Knox on July 5, citing concerns about “your workplace
behavior, including unprofessional acts that may constitute retaliation
against and/or intimidation” of colleagues. The
university took three months to produce that two-page letter after
Wisconsin Watch requested complaints against Knox in her personnel file. A
UW-Madison spokeswoman confirmed that Knox voluntarily left her
$204,000-a-year position as an instructor and physician at the
UW-affiliated children’s hospital in October. “She
found bruises everywhere — things that weren’t even there. His surgical
scars — he has two scars on each side of his abdomen. She charted
those.” Joel Siebold UW
Health spokesman Tom Russell said the hospital took “appropriate
action” after investigating the allegations against Knox but declined to
offer details. Russell also said UW Health hired a
consultant in September to evaluate the Child Protection Program — and
implemented recommendations. Among them: a monthly multi-disciplinary
conference to review cases. Knox now works as the
medical director of Alaska CARES, a child abuse response and evaluation
program based at the Children’s Hospital at Providence in Anchorage. She
is also president of the nonprofit Academy on Violence and Abuse. Knox did not return two emails and a voicemail with questions for this story. Knox
is a prominent member of the growing field of child abuse pediatrics.
Board certification for child abuse pediatrics began in 2009. As of
2018, there were 346 such physicians in the United States, including
five in Wisconsin.
News
investigations and advocacy groups are increasingly questioning some of
these doctors’ qualifications to separate the hundreds of thousands of
legitimate cases of child abuse from accidents or underlying medical
conditions. Russell defended the work of the Child
Protection Program. Abuse is a leading cause of death and disability in
children, and program staff are dealing with “some of the toughest
issues imaginable,” he said. The program’s staff and physicians “are
committed to approaching each patient and family with empathy,
compassion and support.”
Knox ‘pressured’ colleague to find abuse:
Soon
after arriving at the children’s hospital in 2006, Knox drove the
prosecution of Jennifer Hancock, a Verona day care provider who was
convicted of killing an infant in her care. Hancock, now serving a
13-year prison term, is appealing the conviction in Dane County Circuit
Court. Hancock’s attorneys, led by the Wisconsin
Innocence Project, presented three medical experts during testimony in
late 2019 and early 2020 who say pre-existing medical problems could
have contributed to the death of the 4-month-old. Among the experts: the
UW Hospital forensic pathologist who conducted the baby’s autopsy. During
a post-conviction motion hearing in November, Dr. Michael Stier
described “peer pressure” from Knox and others at that hospital to
conclude that the baby suffered a skull fracture and that it was caused
by abuse, possibly coloring his testimony at the 2009 trial. Anyone who voiced an objection, he testified, “probably would’ve been laughed out of the room.” Stier
said he has witnessed brain bleeding similar to that child in other
people who died from natural causes, accidents or drug overdoses. The
baby also had a heart virus that may have contributed, Stier said. He is sure the infant had no skull fracture. Were
Hancock granted a new trial, “I would testify that there is no
definitive cause of death,” Stier wrote in a sworn affidavit. Knox’s
leave came as she worked with Deputy District Attorney Matthew Moeser,
the prosecutor in the Hancock case, and on two FBI cases, according to
the UW. Dane County District Attorney Ismael Ozanne
told Wisconsin Watch that he had no reason to doubt the diagnoses of
Knox’s former team, which consults with specialists as needed and relies
upon research “widely accepted” by major physician organizations. “My
office’s goal in any prosecution is to seek the truth and to pursue
justice. The UW Child Protection Program has been and remains an
invaluable partner in this work,” he wrote in an email.
Parents accused of abuse
On
Leo Siebold’s second day in American Family Children’s Hospital, three
women approached the Siebolds and Brenna’s parents in a playroom. One
was Knox, who identified herself as a “blood specialist,” according to
the Siebolds and Brenna’s parents, Randy and Nancy Gerke. Brenna
Siebold was instantly suspicious. She had talked to Leo’s hematologist
at the hospital earlier that day, and that doctor had not mentioned any
problems. UW Health declined to address the allegation that Knox had
misrepresented herself. Siebold said Knox
eventually admitted she was there on behalf of the Child Protection
Program. She mentioned the bruises on Leo’s arms, legs and torso. She
wanted the Siebolds to consent to a full body X-ray and additional blood
tests. Her suspicion: possible abuse. The
hospital’s guidance advised doctors to notify the Child Protection
Program of even small bruises found on infants who are not yet
“cruising,” or pulling themselves up on furniture. Such bruises, the
guidance warned, are “sentinel” injuries that can signal possible child
abuse. Knox helped to write the policy, which is based on “national
guidelines and practice,” Russell said. The
Siebolds suggested the bruises came from Leo’s “Army crawling” over toys
on the family’s wooden floor — or from Leo’s ER examination struggle a
day earlier. Knox and physician assistant Amanda Palm rejected those
theories, reporting the bruises to authorities as “unexplained.” Two
Mount Horeb police officers interviewed the Siebolds at the hospital.
They quickly discounted the allegations, concluding in a one-paragraph
report that the bruises were “caused by medical staff.” After a two-month investigation, the Dane County Department of Human Services also concluded there was no evidence of abuse.
Doctor charged with abuse — experts disagree:
Recently,
a Milwaukee hospital’s handling of child abuse allegations has
attracted national attention. Officials at Children’s Wisconsin hospital
say they are investigating their approach to identifying child abuse
after NBC News reported on a case involving one of the hospital’s own
doctors. In January, Dr. John Cox was criminally charged with abusing a
1-month-old infant whom he and his wife, fellow Children’s Wisconsin
physician Dr. Sadie Dobrozsi, were adopting. The
story cited 15 experts, including physicians from Children’s Wisconsin,
who identified a series of medical mistakes and misstatements that cast
doubt on whether the baby showed signs of abuse. Cox
had taken the baby to the hospital after he fell asleep with her in bed
and feared he may have rolled onto her. The child later was found to
have a broken collarbone. NBC News quoted unnamed
ER doctors who described an “out of control” child abuse team at
Children’s Wisconsin that routinely reported minor injuries to
authorities. Three doctors at the hospital told NBC News that the child
abuse team instructed them to alter medical records — labeling children
as possible abuse victims even when the doctors did not suspect it. “Child advocacy is the reason I went to law school. It sickens me how it’s become so twisted.” Notesong Thompson, Madison attorney and former member of the Wisconsin Child Abuse and Neglect Prevention Board. The story also quoted experts who found the baby’s birthmarks were mistaken for bruises. Kate
Judson, executive director of the nonprofit Center for Integrity in
Forensic Sciences in Madison, told Wisconsin Watch that a finding of
child abuse requires ruling out other causes by taking a thorough
history, diagnostic testing and consultations with experts such as
hematologists, endocrinologists, neurologists and dermatologists. But
she has seen child abuse pediatricians ignore these “important steps,”
even ignoring contradictory expert opinions and laboratory testing. Judson
said these doctors can wield significant power within a hospital and
“physicians can run into problems when they get sideways with child
abuse pediatricians.” She cited cases of doctors who faced discipline or
criminal prosecution for contradicting the findings of child abuse
pediatricians. Madison attorney Notesong Thompson, a
former member of the Wisconsin Child Abuse and Neglect Prevention
Board, believes child advocacy teams at hospitals have “way too much
power” and are “running amok.” “Child advocacy is the reason I went to law school,” she said. “It sickens me how it’s become so twisted.”
Surgical scars marked as bruises:
During an interview at their home dining room table, the Siebolds documented issues similar to those raised in Cox’s case. The
couple showed photos taken of Leo shortly before and after his
hospitalization. The bruises on his arms, leg and abdomen were barely
visible. Joel Siebold says Leo did have a few bruises before he went to
the hospital. But Amanda Palm reported many more.
“She
found bruises everywhere — things that weren’t even there,” he
recalled. “His surgical scars — he has two scars on each side of his
abdomen. She charted those.” Brenna Siebold jumped in. “She was charting diaper rash — like the tabs from the diaper.” UW Health declined to discuss the situation, citing patient confidentiality. The
Siebolds found false information in Leo’s medical records, including an
incorrect reference to the family being covered by BadgerCare, the
state’s health insurance program for low-income residents. Brenna
Siebold remains haunted by her family’s run-in with Knox’s team at
American Family Children’s Hospital. She wonders how less-educated
parents — or ones without such strong community ties and family support —
could weather such accusations. That is why she is speaking out. “I
knew there were other people out there like us — and who we will never
know because of (health care) confidentiality,” Siebold said. “I
worried about a single mother. I worried about a mother of color. I
worried about a family that doesn’t speak English. … And that’s the
teacher in me. I was like, ‘If this happens, I want to prevent (it.)’ ”
PUBLISHER'S NOTE: I am monitoring this case/issue. Keep your eye on the Charles Smith Blog for reports on developments. The Toronto Star, my previous employer for more than twenty incredible years, has put considerable effort into exposing the harm caused by Dr. Charles Smith and his protectors - and into pushing for reform of Ontario's forensic pediatric pathology system. The Star has a "topic" section which focuses on recent stories related to Dr. Charles Smith. It can be found at: http://www.thestar.com/topic/charlessmith. Information on "The Charles Smith Blog Award"- and its nomination process - can be found at: http://smithforensic.blogspot.com/2011/05/charles-smith-blog-award-nominations.html Please send any comments or information on other cases and issues of interest to the readers of this blog to: hlevy15@gmail.com. Harold Levy: Publisher: The Charles Smith Blog;
-----------------------------------------------------------------
FINAL WORD: (Applicable to all of our wrongful conviction cases): "Whenever there is a wrongful conviction, it exposes errors in our criminal legal system, and we hope that this case — and lessons from it — can prevent future injustices."
Lawyer Radha Natarajan:
Executive Director: New England Innocence Project;
------------------------------------------------------------------
