Why Do the Hospital Doctors and Defense Experts Disagree?

How then can there be a difference of opinion between the hospital doctors who claim abuse and the defense medical experts who say otherwise? This question must usually be confronted in preparing a defense to a claim of false abuse. At some point either a judge or jury will be forced to choose between the experts from the hospital and the defense medical experts. Understanding why there is a difference of opinion is critical to successfully defending a false claim of abuse. Below I address a few of the reasons why the two "sides" often disagree.

The first and most direct explanation is that in the complex world of medicine, doctors often disagree. I believe that we have all had the experience of receiving two different opinions from two different doctors about the same issue. This has been and always will be the case in the medical field. So the fact that two sets of qualified doctors disagree as to the cause or nature of injuries should not be surprising.

The second reason doctors may disagree is a difference in perspective. Most hospital doctors operate on the assumption that absent a clear explanation for existing injuries (auto accident, fall down a flight of stairs) the only remaining explanation must be abuse. Abuse is the default diagnosis when there is no obvious explanation. Conversely, defense experts begin by looking for external signs of abuse (significant bruises, cuts, burns) and when they are not present, they do not conclude abuse by default. Instead, they begin a systematic examination of the child's entire medical history to find the explanation for the observed internal injuries. Because abuse is not the default answer they are able to consider all possible explanations.

The third reason why the experts disagree is the scope of the examination. At the hospital the doctors who claim abuse usually does not have the entire medical history of the child. They do not have birth records, prenatal care records, well baby records or complete understanding of the family medical history. They only sees internal injuries (fractures or hemorrhages) with no explanation provided by the parents, and hence the default option of abuse is selected.

Alternatively, the defense expert will examine all of the facts before reaching a conclusion. For example, was there a significant event during pregnancy or delivery that may have caused a hemorrhage at birth which subsequently rebled. Or maybe there is a genetic disorder, such as Osteogenesis Imperfecta or EDS which can explain the fractures. This systematic and thorough examination of the child's complete medical history combined with a full review of the social history of the child and parents allows the defense expert the ability to find the explanation ignored by the hospital doctor.

The role these differences play in defending a false allegation of abuse cannot be overlooked. It is critical that your defense attorney understand the differences, identify them in your particular case, and, most importantly, be able to successfully present them to a judge or jury.

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