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COUNTY MICHIGAN
L J. Dragovb M.D., Chief llediel Examiner K Ymi, M.D., Depug Chief Medi(, EEmirer
B. Pacris, M.D., Deputy Medicat Eaminer B. Ortiz-Reyes, M.D., Deputy Medtca! C- bere, M-D., Degrty Medlca! E)Grnirer

ANIDF
Esrns

L. BROOKS PATTERSON, OAKL.AND COUNTY DGCUTIVE

PUBLIC SERVICES G. Kunsrnan, Ph. D., Chief Foreosic Toxicologist R. Gerds, Administrator

OFFIGE OF THE IIIEDI,CAL EXAMINER

September 24,2A12 David Egan, EsqPublic Defender Office of Public Defender Superior Court Judicial District of Ansonia-Milford l-4 West River Street
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Re: State of Connecticut vs- Angel Santiago AAN CR11-145515-T

Dear Mr. Egan: Pursuant to your request I have reviewed the following materlals in reference to the above captioned

rnatter:

1)
2l

,The copies of

death"flII}

the warrants and records of Ansonia Police Department of the investigation of

The report of the autopsy performed on the body of-. decd. (#11-08406), issued by Dr. Susan S- Williams of the Office of the bhief uedical Examiner of the State of Connecticut
The neuropathology report of the examination of the central nervous system and its coverings

3)

thedeceaseainfantGissuedbyDr.LuryRorke-Adams,oftheChildren,sHosphalof
Philadelphia and

of

4)

The digital images obtained at the autopsy

of-bperformed

by Dr. Susan Williams

It is quite obvious from the detailed autopsy report, issued by Dr- Williams, supported by adequate evidentiary autopsy photographs that this 5-month-old infant,Illllrdied of complications of head trauma, sustained as a result of the infant's head impacting an unyielding surface. There is a welldocumented fracture of the right par:ietal area of the skull, which together with the finding of bilateral organizing subdural hernorrhage is indicative the infant's moving head impacting an unyielding surfaceHowever, it is not possible to distinguish whether the infant was dropped or thrown/slammed against the uhyietding surface, based on the injury pattern atone.
The gross autopsy findings and the yet unverified reported microscopic findings are suggestive of the

injury being older than two days.

1200 N TELEGRAPH RD DEPT43S BUILDTNG 2S EAST

PONTIAC, Mt48341-0438

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14:tB #700 P.0m/m3

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Notwithstanding that anything is possible, any other theory of the mechanism of the infant's head trauma does not come even close to anything logicalor rational and contradicts the physical evidence in this case. The unfortunate term of the so-called "shoken boby syndrome" has been renounced eyen by Dr. Norman Guthkelch (tl, the pediatric neurosurgeon who actually introduced the concept in clinical
Practice ;P 1971
(zxa).

While the term had been in use with questionable justification in clinical setting, it is totally unacceptable as a cause of an infant's death. Strictly speaking, syndrome means a group of symptoms appearing together in a given patient in clinical practice and cannot be applied to autopsy findings. /t shoutd be kept cteorty in mind, iowever, that syndromes ore not diseoses but rother abstroctions set up by clinicians in order to facilitate the diognosis of disease @lFurthermore, in order to fulfill the proposed mechanism, there first has to be a violent contact established with an infant's body and maintained for a period of time. Such violent contact invariably

ieaves physical evidence of violent grasping/squeezing in the areas of contact on infant's body. The evidence is in the form of bruises and/cr scrapes found on the surface of the skin. Additional findings would inctude broken ribs, collar bones, etc.

evidenceinILdeath.Thefractureoftheskullandsubduralhemorrhagefoundinthis
infant COULD NOT have resulted from shaking.
I

The photographically documented autopsy procedure clearly and without any doubt excluded any such

trust this answers your queries.

References:
1)

Guthkelch, A. N.: lnfantile SubduralHematoma and its Relationship to Whiplash lnjuries British Medical Journal, \97 1", Z, 430-431

2l Guthkelch, A- N. : Problems of lnfant Retino-subdural Hemorrhage with Minimal External lnjury

3)

Guthkelch, A. N-: Deposition re: State of Arizona vs- Drayton Shawn Witt, No.: Tuscon, Arizona, November Zg,2O7lAdams,
R- D. and

CR 2OOO-O17311

4)

victor, M. in: principles of Neurology, McGraw Hill, 19g1