After the Webinar: Presenting Medical Evidence in Child Physical Abuse Cases. Q&A with the Presenters

Webinar presenters Roger Blevins and Laurie Blevins answered a number of your questions after their presentation, Presenting Medical Evidence in Child Abuse Cases. Here are just a few of their responses.



Audience Question: From a definitional perspective, what is an open fist hit and open what open fist? Is that a slap?

Laurie Blevins:  I would say an open hand is a slap. A fist usually implies hitting something with a close fit. And so if it’s a question, and I’m sorry, I don’t remember what that slide says. It should have said an open hand. If it says fist that was incorrect the beginning one. I mean you’re talking about talking with the flat of your hand and part of the issue is I think for a lot of defendants they think well, as long as I’m not hitting with a fist, then it’s permissible punishment. But I think what people need to take from this is: the smaller the child, the larger the size differential between the child and the perpetrator the more damage that can be done from an open-handed slap. Because again, you’re making that kid’s head spin. Which means the brain inside the skull is going to spin as well and maybe not necessarily in the same direction as the head. That’s what causes all the damage to the blood vessels and the nerves that run between the outer portion of the brain and the inner portion of the skull which exposes a kid who’s been slapped with an open hand almost more damage or at least as much damage as a kid that’s been hit with a closed fist would. Would you agree with that Roger?

Roger Blevins: Pretty much, yeah



Audience Question: We have questions about myoglobin. Misty describes that she’s done CPS for 18 years and have has never heard of it before. She’s wondering is the test for myoglobin a test that is typically done in these cases when children are seen at hospitals?

Roger Blevins: Yeah, I think that if you’re dealing with a place that does a lot of work with child abuse and does a lot of work up with kids, if you have a child with really extensive bruising. The myoglobin should be a part of the work, as I mentioned before it may not always get done because people don’t think about it. But it’s it should be part of the workup of the child.

Laurie Blevins:And a lot of that depends on the top of examination that you can get for children. If you’re in a small town and there’s not a child abuse center anywhere around with a trauma team and as an experienced child abuse team than your average, I think country physician or physician a small town may not know to run that kind of test. I practice in a small town that was three hours away from the nearest Child Abuse Center where Roger work. And so if you are in as a frontline investigator, you’re working these cases, please try if you can to develop some good working relationships with some of the larger child abuse centers in the bigger cities that hopefully are within driving distance of you because of those types of trauma team know to run these specialized tests that your average physician isn’t going to run.



Audience Question:So in terms of the technology and laboratory equipment to be able to run a myoglobin test, does a typical even a small rural Hospital have that equipment or it is a kind of all over the place and you couldn’t even say?

Roger Blevins: Yeah. It’s not an exotic test. You can do just you can just do a urinalysis and find the myoglobin in the urine. If it’s there then you can get a serum(?) myoglobin level, so it’s not exotic at all.



Audience Question: How long is myoglobin excreted after the trauma is inflicted?

Roger Blevins: It’s going to be variable depending upon the amount of force that was used and the amount of damage. Certainly, it will come out probably days after the injury. The trick is to make sure that when the myoglobin peaks it doesn’t peak in a dangerous level for the kidneys and that you keep the child on IV fluids to keep the kidneys washed out and the myoglobin diluted.


Aaron (host): Great. I did want to share a comment from Laris who said your presentation was amazing. I would love all of my criminal justice students to attend someone. So informative, great job. Thank you both.


Audience Question: Do you have any significant recommendations for crime scene investigators in child death cases?

Roger Blevins: Wow, that’s tough.

Laurie Blevins: That’s the subject for a whole other lecture.

Roger Blevins: I think the most important thing that they can do is get really detailed interviews of whoever was involved, was in charge of the child at the time of the death. Get a really detailed interview with that individual and really hammer down a good timeline. The other thing is take pictures. Take pictures of everything even if it doesn’t seem to be particularly important or related to the case get pictures of it in the room, get pictures of the child, hopefully in the position they were found in. Get those interviews because we really need a good timeline to begin to make some reasonable assertions about the death.

Laurie Blevins: From a legal perspective. I would absolutely agree with that. You’re going to need as detailed as you can get. Accounts from the alleged perpetrators, the people who were in the house, the witnesses. Because chances are they are going to try if they say that it happened and they admitted at all. They’re going to try and resort to this spanking or discipline defense even with the graphic injuries that you are seeing here. And so you’re going to need those admissions from the perpetrator because I want to be able to ask while you’re in trial, in your training and experience medically does what this particular person is saying, is that consistent with the injuries that you are looking at. Is that what you would call a spanking? No, certainly not. It’s a beating and unless you get those admissions from the alleged perpetrators, you’re not going to be able to make use of the medical expert who can testify and say, “No, what I’m seeing is not at all consistent with reasonable ordinary force.”



Audience Question: Stephanie just submitted that ultraviolet and infrared photography can increase bruising contrast and also reveal marks that have yet to appear or have healed and I just wanted to get your thoughts on that and especially since earlier you mentioned that if you’re going to introduce photographs, they have to be black and white, what you can see with the naked eye and so on. 

Laurie Blevins: Yeah, that’s the problem that I ran into. For the lawyers, and for the frontline investigators too, just so you will know there is a legal rule that says if you’re going to use a photograph as a trial exhibit and it’s going to be introduced into evidence that I have to prove that that photograph was authentic. That’s the legal term. We have to authenticate it. In order for it to be authenticated, you have to have the person who actually saw the injury. It doesn’t have to be the person that took the picture. But it has to be someone who saw the injuries and can say that the picture fairly and accurately represents the way that the injuries looked to the naked eye. And the problem is a lot of times those infrared photographs, black and white photographs. You can see there are a lot of options that you have with computer software where you can increase the ability to see those things with different applications like Trying on the black and white filter. The problem is then, the photograph no longer fairly and accurately from a legal perspective shows what the injuries look like. Because the black and white photo is not what the naked eye sees and so you’re going to have a real problem and I’m not saying don’t try and use those things. I’m saying if you use them as an attorney be prepared to answer a defense objection to the exhibiting admitted on the grounds that it doesn’t fairly and accurately represent what the injuries actually look like to the naked eye.

Roger Blevins: You need an expert but can speak to that because you’re going to have a hearing about that. Unfortunately. I can’t I don’t have any experience with that but I would assume that if you’ve got that technology available to you, you’ve got somebody who can talk to the judge about it, I think you’re going to need that person.



Audience Question: Are medical examiners required to review the medical history of dead children?

Roger Blevins: They should and I don’t know what the regulations are, but I’m certain that they will change from state to state. Absolutely. You need to know the medical history of the child before you can rule out organic problems, congenital problems with the child. You need to know if the child has been ill recently. You need to know if the child has had an accident within the past at least two weeks or so, all of those things need to be done before they can offer a good conclusion on that. So, I don’t know what the statutes say. It is absolutely my assertion that you have to have all of that stuff before you can say anything reasonable about a child’s death.

Laurie Blevins: From the legal perspective, the problem that I run into if you have a child death, then you’re going to have possibly someone who’s a really really good medical examiner and coroner with absolutely no experience in child abuse. Not every medical examiner knows what your average child abuse expert knows and so the real problem becomes I’ve seen and heard of cases where your medical expert does not know what the child abuse expert knows.


Click Here to Watch a Recording of Presenting Medical Evidence in Child Abuse Cases. 



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