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;
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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;
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