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Speaker shares lessons learned after testifying in pediatric trauma case
WAIKOLOA, Hawaii — In lessons learned from a day in court, Robin A. Vora, MD, shared his insights into being called to testify in a pediatric abusive head trauma case.
In his experience, a baby was said to have fallen off a bed and was brought to the emergency department where chronic and subdural hemorrhages were found. Upon examination, Vora found multiple hemorrhages in the right eye consistent with non-accidental trauma.
Then, 3 years passed before he was called to appear in court.
“Document exactly what you’re seeing [in the exam], because that is definitely going to be part of the evidence,” Vora told colleagues at Retina 2019. “Take your time. Don’t rush through these notes.”
In the courtroom, Vora said every ophthalmologist should be confident in his or her ability to lend “expert” testimony. Examination of the adult and pediatric retina is in the core skill set of any ophthalmologist
A typical line of query would be to have the expert identify other causes of retinal hemorrhages other than trauma that could account for the findings.
“There is a laundry list of things that can cause retinal hemorrhages in children, but any [pediatric intensive care unit] worth its weight is going to rule out most of these things before they call you,” Vora said.
Retinal hemorrhages are commonly seen in newborns, in up to 50% of births, he said. These are usually restricted to the posterior pole, are usually gone by 4 weeks of age and are not considered suspicious.
Seizures are unlikely causes of retinal hemorrhages, as well. In a study of 247 children admitted after convulsions, only two had retinal hemorrhages, and they were both eventually diagnosed as child abuse, he said.
Importantly, because time passes and memory fades, everything said in conversation with government agencies at the time of the incident is on the record and can be interpreted in ways not intended 3 years later.
Another pearl to bear in mind is that it is OK to say no and to not be intimidated into saying otherwise.
“Stick to your guns,” he said. – by Patricia Nale, ELS
Reference: Vora RA. Pediatric abusive head trauma: Defending yourself in court. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.
Disclosure: Vora reports no relevant financial disclosures.