Doctors Question SIDS Verdict

By LYNNE TUOHY
The Hartford Courant
February 02, 2001

All six doctors at the state's Office of the Chief Medical Examiner have taken the unprecedented step of publicly opposing a jury verdict this week that held a Bolton day-care provider liable for the death of a baby who died of Sudden Infant Death Syndrome while in her care.

Dr. H. Wayne Carver II, chief medical examiner for 15 years, said he and his staff have never before joined forces to take a stand on a public issue, but felt compelled in this case to decry the verdict and emphasize the medical mysteries that still surround SIDS.

"The cause of SIDS is unknown. Its occurrence is unpredictable and unpreventable," the six doctors wrote Thursday in a letter to the Hartford Courant. "Until we find the cause or at least find a reliable physical or chemical marker, we cannot with reasonable medical probability assign responsibility."

A Rockville Superior Court jury Tuesday found Barbara Horne of Bolton liable for the death of 2½-month-old Shelby LePage, who died of SIDS in Horne's care two years ago. Horne had permitted the baby to sleep on her stomach, contrary to instructions from Shelby's mother that the child sleep only in her portable car seat or in a baby swing Horne had at her home. Shelby died on the second day she was in Horne's care. The jury awarded the LePage family $800,000.

Carver and his associates - Deputy Chief Medical Examiner Edward T. McDonough and Drs. Malka Shah, Arkady Katsnelson, Ira Kanfer and Thomas Gilchrist - stated in the letter that they all support the "Back to Sleep" campaign that says babies who sleep on their backs are at a reduced risk of SIDS.

"But the fact still remains that almost all of the children who sleep on their stomachs, still a large number, will survive, and a few who sleep on their backs will suffer SIDS," the doctors wrote.

Because there are no known markers or indicators of SIDS, an extensive autopsy is done on the body to eliminate other possible causes of death. Tissue and organ samples are analyzed microscopically. Likewise, the location where the baby died is examined for other possible causes of death, and family members and caregivers are interviewed.

Carver acknowledged in an interview Thursday that he and his staff had become deeply involved in SIDS cases and with the families involved.

"There are an awful lot of misconceptions we go out of our way to help people through," Carver said. "The relatives of all our patients feel awful, but these people are just crushed. I don't know how parents survive this. I really don't.

"But I also think about how badly this [verdict] affected the day-care provider for what we perceive are the wrong reasons," Carver said, adding that he believes no one should be blamed for a SIDS death when the medical community itself still hasn't detected its cause.

The letter notes that the decline in ratio of SIDS deaths, from 1 in 500 to 1 in 1,000 live births, began before the "Back to Sleep" campaign was launched in 1994.

According to the National SIDS Research Center, 2,991 infants died of SIDS in the United States in 1997, down from 3,050 in 1996. In 1998, there were 2,529 deaths attributed to SIDS.

In Connecticut in 1997, of 55 babies autopsied, 23 were diagnosed as having died of SIDS. In 1999 in Connecticut, 23 SIDS cases were diagnosed by Carver's staff. Babies between 2 and 4 months old are at the highest risk for SIDS.

Carver said medical advances offer new explanations for some deaths that previously would have been attributed to SIDS. He cited one genetic illness, detected only 10 years ago, that affects the breakdown of fats in the body's energy production process, and can be fatal.

"It was only 10 years ago we learned this existed and how to test for it, using urine and bile tests," he said. "A small percentage of those cases that would have been labeled SIDS is now attributed to this genetic abnormality."

Kanfer, who performed the autopsy on Shelby LePage and testified at the trial, said Thursday that he fears the verdict's fallout will be seen in the number of licensed day care providers who now refuse to take infants for liability reasons.

"This is a really big problem," Kanfer said. He added that the woman who cares for his 3-year-old daughter was "hysterical" over the plight of Horne.

"It's hard enough to get good day care as it is," he said. "SIDS is a fancy way of saying we don't know what killed the baby."