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The markings looked like bruises. That concerned doctors, who couldn鈥檛 immediately identify a medical explanation. They sent the three-month-old girl to Toronto鈥檚 Hospital for Sick Children, where Cory leads one of the country鈥檚 oldest and most prestigious units for suspected child abuse.

Cory examined the baby. Her findings pointed to abuse. Police arrested Sriram.

鈥淭hose bruises were caused by somebody,鈥� the detective said while questioning a potential witness. 鈥淭he medical field say this is what鈥檚 happened, this is what the diagnosis is.鈥�

But in court, the defence lawyer poked holes in Cory鈥檚 medical opinion.

Cory conceded that she did not review a swath of the baby鈥檚 medical records before finalizing her opinion on the case. She agreed that her report misstated the normal range for a blood protein that affects how easily the skin bruises, so did not note that the baby鈥檚 level was low.

When confronted with the opinion of a pathologist who said Cory hadn鈥檛 thoroughly ruled out natural disease, which the pathologist believed had caused the marks, she agreed that there are 鈥渟ome factors鈥� that suggest the possibility of an underlying medical cause.

鈥淚 think it is appropriate to have a high level of concern about these markings, and no physician can conclude 100 per cent what they were caused by,鈥� Cory said.

Medical opinions face concerns of reliability

Across Canada, child maltreatment specialists like Cory practice in pursuit of a noble cause 鈥� to protect kids. These doctors lead medical investigations into the causes of unexplained bruises and fractures. They don鈥檛 treat, rather they provide opinions on whether the symptoms were likely caused by an underlying medical condition, an accident or are inflicted injuries. Their findings can lead to children being removed from their homes. Parents may face criminal charges.

Judges and medical experts have voiced concerns about the reliability of opinions rooted in the controversial discipline of child maltreatment pediatrics, raising troubling questions about the weight Canada鈥檚 justice and child protection systems place on this kind of evidence.

Ten cases, from B.C. to Atlantic Canada, involve parents who sought medical treatment for their babies but wound up under a cloud of suspicion that upended their lives. They say they were wrongly accused of abuse, based on the flawed opinions of child maltreatment specialists.

These families fought back, obtaining evidence from other medical experts, who disagreed with the abuse findings. One such expert is Dr. Julie Mack, a Pennsylvania State University radiologist who says child maltreatment pediatrics purports to provide answers where no such medical certainty exists.

When faced with something like an unexplained broken bone, Mack said testing can rule out some underlying medical conditions. But when a pediatrician claims that a break was likely inflicted, they go beyond what science can reliably discern, Mack said.

She compares it to using an X-ray of a patient鈥檚 lungs to not only diagnose pneumonia, but to also determine how they contracted the infection.

鈥淥f course you can鈥檛 do that,鈥� she said. 鈥淭hat鈥檚 ridiculous.鈥�

The child maltreatment specialists involved in the 10 cases did not thoroughly investigate possible medical causes, the families and medical experts they retained to review the abuse findings say. In some cases, the families allege, doctors provided 鈥渕isleading鈥� and 鈥渂iased鈥� information to child protection workers or intervened inappropriately in child protection proceedings, and refused to revisit their findings, even as contradictory evidence mounted.

This story is drawn from thousands of pages of records, including medical reports and court testimony. The Star also obtained child protection files that would have ordinarily been shielded by strict privacy laws. The records illustrate in rare detail a system where police and child welfare agencies rely heavily on the opinions of child maltreatment specialists, without the checks and balances needed to scrutinize these opinions before families may be torn apart. A growing chorus of critics is calling for changes to prevent wrongful accusations, while allowing the system to continue in its crucial role of protecting vulnerable kids from abuse.

As case crumbles, a mother’s relief turns to rage

In the Brampton case, the certainty police expressed around the medical findings while interviewing witnesses contrasts with what Cory told the court.

鈥淚 never provide a definitive conclusion that something is 100-per-cent physical abuse,鈥� Cory testified. 鈥淚 can raise a level of concern that something is inflicted trauma, but there are other systems that need to be involved in that assessment.鈥�

Cory testified that she and her colleagues take steps to avoid 鈥渋mplicit bias.鈥� Her medical opinions are reviewed by other doctors on the suspected abuse team, and allow for alternative explanations.

She said she may provide an opinion to child welfare agencies or police about the most likely cause of a child鈥檚 symptoms or injuries, but doesn鈥檛 鈥渋nfluence鈥� their decisions about whether to apprehend children or press charges.

It was only under questioning from Sriram鈥檚 lawyer, Phillip Millar, that Cory acknowledged the flaws in her opinion. Cory鈥檚 findings were informed by the opinion of a dermatologist at SickKids, who had seen photos of the baby. If Cory 鈥渉ad to do this case again,鈥� she said she would have asked the specialist to examine the baby in person.

However, she testified that it was still her view that the markings on the baby鈥檚 skin were 鈥渕ost likely鈥� bruising, caused by trauma. She stood by her decision to report her concern for possible abuse.

None of the child maltreatment doctors named in this story agreed to be interviewed.

The Star sent detailed questions about three suspected abuse cases involving SickKids to the hospital and doctors in the Suspected Child Abuse and Neglect (SCAN) unit. Their lawyers responded that the questions were 鈥渘ot appropriate鈥� and 鈥渋nclude assertions and suggestions that are factually wrong.鈥� They threatened to sue if the Star published a story based on the allegations. Citing patient privacy, they said they could not answer questions about specific cases.

Speaking generally about the SCAN unit, SickKids spokesperson Sarah Warr said that doctors state the limitations of their opinions, which are supported by evidence in the medical literature.

SickKids and Cory are facing two separate lawsuits over suspected child abuse cases, including one filed in January by the Srirams. The defendants have not yet filed statements of defence in the Sriram case. The doctors and the hospital have denied the allegations in the other filing, saying they acted competently and met the standard of care.

The day after Cory鈥檚 testimony in Brampton, the prosecutor told the court there was 鈥渘ot a reasonable prospect of conviction.鈥� The judge said he agreed with the prosecutor, and added that he had “some concern” about the evidence. He dismissed the charge.

As Sriram sat in the courtroom, she was flooded with relief. Then anger rushed in. She had pulled away from friends, left her job due to stress and laid in bed awake at night, gripped by waves of anxiety and panic.

鈥�(Cory鈥檚) wrong diagnosis took away so many moments,鈥� she said in an interview. 鈥淗ow can someone like that have that much authority to impact my life so much?鈥�

Can a doctor diagnose abuse?

The debate over the reliability of child maltreatment pediatrics strikes at the heart of the discipline: Can a doctor diagnose abuse?

The pioneers in the field believed they could. In 1962, an American pediatrician, disturbed by reports of children showing up in emergency rooms with serious, unexplained symptoms, such as fractures and brain bleeds, published an academic paper that implored doctors to regard such cases with suspicion.

Piecing together evidence from instances where child abuse was thought to have been confirmed, Dr. C. Henry Kempe and his co-authors provided a blueprint for diagnosing abuse that included interrogation techniques, physical examinations and x-rays.

鈥淭o the informed physician, the bones tell a story the child is too young or too frightened to tell,鈥� the doctors wrote.

In Canada, some of the early adopters were based at SickKids, where doctors and nurses interested in the burgeoning field formed a dedicated child abuse team in 1973. As public concern mounted over high-profile child abuse cases, where it appeared authorities had missed red flags, the team was increasingly called upon to offer medical opinions.

By the early 1990s, the unit was known as the Suspected Child Abuse and Neglect (SCAN) team, and included Dr. Dirk Huyer, who is now Ontario鈥檚 chief coroner. In a 1991 decision in a child protection case, a Hamilton judge acknowledged that the concept of diagnosing child abuse was still relatively new, and there was no formal training available. Huyer, he said, was 鈥渂asically self-taught through his own readings and studies, attendances at conferences, and his experiences and interactions with colleagues on the S.C.A.N. team.鈥� Huyer declined to comment for this story.

Child abuse specialists formed a professional society based in Florida, trained authorities on how to detect abuse, and became trusted experts in court. The result, critics say, was an ecosystem that was allowed to flourish and continue self-reinforcing, because police, child protection agencies and the courts that kept calling on them often accepted their assessments without question.

Judges are 鈥渢errified of missing abuse,鈥� said Dr. Waney Squier, a retired neuropathologist based in the U.K., who used to testify for the prosecution in suspected abuse cases but is now an outspoken advocate for wrongfully accused parents.

鈥淚t鈥檚 much better to take the baby away, and to keep your own ass covered, so to speak 鈥� than to do the brave thing, and say, 鈥榃ell, actually, I believe the parents,鈥欌�� she said.

Disputed diagnosis used in wrongful convictions

The conclusions the system grew reliant on were sometimes deeply flawed. In the spring of 1993, Huyer spoke at a symposium at the former SkyDome Hotel in downtown Toronto. The audience of child protection workers and police officers listened as Huyer explained how to spot signs of 鈥渟haken baby syndrome鈥� 鈥� a theory developed by U.S.-based pediatricians, who claimed infants were dying from violent shaking with no sign of external injury.

Critics have long noted that there has never been scientific proof of the theory that shaking could be diagnosed from a 鈥渢riad鈥� of symptoms 鈥� brain damage, alongside bleeding behind the eyes and between the brain and skull. It was based, in large part, on a single study on the effects of whiplash on monkeys, who were strapped into chairs on wheels and sent careening into a wall. The author of the monkey study later said that shaken-baby syndrome was 鈥渋n the realm of mythology.鈥�

Experts remain deeply divided on when, if ever, to consider shaking in cases of unexplained bleeding around the brain or eyes.

Squier initially supported the theory but later grew skeptical. She was barred from practising medicine in 2016 after a medical tribunal ruled her testimony disputing shaken-baby diagnoses was 鈥渄eliberately misleading.鈥� Squier has said she became a target for challenging the establishment, and successfully appealed the ruling. A judge cleared her of dishonesty and reinstated her medical licence.

In Canada, courts have overturned wrongful convictions that relied on the theory. Several cases involved disgraced former SickKids pathologist Charles Smith, whose flawed autopsy analyses were probed in a public inquiry. In some instances, including one shaken-baby case, SCAN doctors supported his erroneous opinions before he left the hospital in the mid-2000s.

Around this time Cory became a staff pediatrician in the SCAN unit. Concerns about the child maltreatment opinions persisted. In 2005, a prosecutor sought to include Cory’s evidence that a burn mark on a child was 鈥渃onsistent with a non-accidental burn.鈥� The judge refused to admit the evidence.

Cory鈥檚 opinion, the judge found, didn鈥檛 鈥渕eet the threshold of reliability鈥� because the technique she used to determine the burn had been inflicted on purpose couldn鈥檛 be tested, and the court had 鈥渘o idea what the known or potential rate of error might be.鈥� The judge also criticized the language Cory used, noting that a public inquiry into a wrongful conviction had warned that it was confusing and should be avoided.

In the spring of 2021, a Brantford judge refused to qualify a veteran Hamilton child abuse specialist as an expert in child maltreatment pediatrics.

The judge questioned Dr. Burke Baird鈥檚 reliance on second-hand information in a child protection case, and questioned the reliability of 鈥渃hild maltreatment鈥� theory, which she described as a 鈥渘ovel鈥� science without universal standards or broad acceptance in the medical community.

Baird didn鈥檛 respond to questions for this story. Cory testified in the recent Brampton case that her understanding has evolved over the past 20 years. She said she doesn鈥檛 use the term 鈥渘on-accidental,鈥� and that it isn鈥檛 her role to opine on 鈥渋ntent.鈥� Baird and Cory are among roughly 20 doctors in Canada who are listed as having child maltreatment pediatrics as an area of focus.

There is no gold-standard test for abuse. Child maltreatment specialists argue that studies have found that certain types of fractures, such as rib fractures in infants, are red flags for abuse. But critics say such studies are of limited value because they are based on case studies where child abuse is believed to have been confirmed using the same methods and theories.

A 2023 paper published in the peer-reviewed journal Children asserts that unless rib fractures are accompanied by bruising or pain, they are more likely to have been caused by vitamin-D deficiency or birth trauma. However, as experts have often pointed out, there haven鈥檛 yet been any rigorous studies to settle the dispute over purported hallmarks of maltreatment, because no parent or board of ethics would condone submitting infants to x-rays and blood draws for the purpose of such research.

To allow for alternative explanations, pediatricians who handle suspected maltreatment cases may use couched language in their reports, such as 鈥渉ighly concerning鈥� for inflicted injury to flag possible abuse. But Mack, the Pennsylvania radiologist, said these phrases carry emotional weight, while being statistically meaningless 鈥� like saying, 鈥淚鈥檓 worried.鈥�

鈥淲e can鈥檛 diagnose something by being worried about it,鈥� said Mack, who routinely reviews suspected abuse cases at no cost for accused parents. 鈥淭here has to be a resolution. But in child abuse (cases), the resolution is the worry. And if the parents can鈥檛 explain that away 鈥� then they are still under suspicion.鈥�

‘We were guilty until proven innocent’

The opinions of child maltreatment specialists are rarely subjected to scrutiny in court, unless they are called to testify in a trial, where lawyers and judges can challenge their expertise and evidence.

In the absence of such scrutiny, parents who believe they have been wrongly accused can get outside experts to review the medical evidence. But the cases the Star analyzed raise questions about whether the system sufficiently considers those opinions once a child maltreatment specialist has raised concern for possible abuse.

One family whose case never went to trial obtained opinions from seven different medical experts at great expense to attempt to disprove the conclusions of Baird, the veteran Hamilton child abuse specialist.

Baird assessed the 12-week-old baby, who had 11 unexplained fractures, at McMaster Children鈥檚 Hospital in the summer of 2021. The doctor cast doubt over the parents鈥� explanations for what could have caused the breaks, and told a child protection worker that the injuries 鈥渨ould be inflicted and the result of significant force,鈥� according to case notes from the Family and Children鈥檚 Services of the Waterloo Region.

Informed by the medical evidence, the CAS was planning to impose a 24/7-supervision order so the parents would not be left alone with their son, the records suggest.

Baird texted the worker, and implored him to take the hospital鈥檚 findings seriously.

鈥淧lease don鈥檛 let their co-operativeness lull the Society into under-reacting or allowing safety provisions to be relaxed too soon,鈥� he said.

When the parents got home, they say the CAS worker was waiting. The agency apprehended the baby and placed him with his grandparents.聽The Star is not identifying the family as details of their child protection case are covered by a publication ban.

Police didn鈥檛 pursue charges, but the CAS pressed on. The CAS told the parents that Baird鈥檚 report 鈥渃learly outlines the lack of medical explanation for the injuries.鈥� The agency concluded 鈥渙n the balance of probabilities鈥� that one or both of the parents caused the fractures.

The family鈥檚 medical experts believed the fractures were due to a medical condition that was either overlooked or wasn鈥檛 picked up by the testing and imaging. CAS case notes show Baird remained in the background, defending his opinion.

鈥淲e were guilty until proven innocent, and even when we had the case to prove our innocence, it didn鈥檛 matter,鈥� the baby鈥檚 father told the Star.

Eighteen months later, the CAS allowed the baby to live full-time at home with his parents, then continued relaxing restrictions until closing the case in February 2024, two and a half years after it started. The聽Family and Children鈥檚 Services of the Waterloo Region declined to comment, citing privacy provisions.

Baird resigned from the hospital鈥檚 Child Advocacy and Assessment Program (CAAP) in 2023. The hospital did not address questions related to this case or what, if any, process exists for parents to challenge the opinions of CAAP doctors.

The parents complained to the province鈥檚 medical watchdog, claiming Baird colluded with CAS to 鈥減erpetuate unfounded allegations鈥� of abuse against them. The College of Physicians and Surgeons of Ontario (CPSO) dismissed the complaint, finding Baird had a 鈥渟olid foundation鈥� for his opinion, and that he didn鈥檛 identify the parents as the perpetrators. The parents are appealing the decision.

‘Huge systemic problem’

Mandatory reporting laws require doctors who suspect abuse to call child protection authorities and police. But in many cases, that鈥檚 where their involvement ends.

The Star asked 17 hospital-affiliated child maltreatment units in Canada how they monitor cases after doctors reach their conclusions. Nine responded that they do not track the outcome, while the rest would not say. Most of those that did provide information said they had no formal process for doctors to learn whether a court later found that a wrongful accusation had been made based on their findings.

At SickKids, the SCAN team reviews written decisions from cases where their experts testify or where the team is 鈥渘otified that a judge鈥檚 decision had raised concern鈥� about its medical opinions, said Warr, the hospital spokesperson. But such cases are rare: SCAN experts are only called to testify in criminal court in less than two per cent of the 800 cases referred to the team each year, Warr said. They testify even less often in family court proceedings.聽Other hospitals with child abuse units do not track court appearances, or did not answer that question.

Retired SickKids doctor Miriam Kaufman said the fact that SCAN experts don鈥檛 routinely receive external feedback in cases where they aren鈥檛 called to testify is a 鈥渉uge systemic problem.鈥�

Kaufman, who was the head of Adolescent Medicine at SickKids and had worked with SCAN in the 鈥�80s and 鈥�90s, realized the extent of that problem when she was connected to a mother whose family was under suspicion for several months in the fall of 2018.

The mother, Brooke Richardson, had sought medical attention for purple dots on the baby鈥檚 arm. SCAN doctor Romy Cho concluded the marks were bruises, and ordered x-rays, which she said showed that the seven month-old had irregularities in both knees that were 鈥渉ighly suggestive鈥� of fractures that 鈥渞aise concern鈥� for inflicted injury.

Richardson enlisted the help of a 海角社区官网dermatologist, who found the purple dots were due to a benign condition. Mack also provided an opinion. She found there were no fractures; the irregularities in the images were 鈥渁 normal variation鈥� that one would expect to find in a growing baby鈥檚 bones.

Richardson endured several months of scrutiny, but was ultimately cleared of suspicion. The police didn鈥檛 press charges. Richardson complained to the CPSO about Cho and a SickKids dermatologist, whose allegedly flawed opinion Cho had relied on. Richardson said she understands the need for SCAN, but that doctors have an “obligation” to ensure their assessment is “based on facts and not conjecture.”

Cho disputed Mack鈥檚 opinion, noting that the x-rays had been reviewed by four SickKids radiologists, whose findings informed the SCAN conclusions, and responded that she wouldn鈥檛 do anything differently if 鈥渇aced today with a young infant presenting as (the baby) did.鈥�

The CPSO found Cho and the other doctor had met the 鈥渟tandards of the profession,鈥� and did not display bias, based on the opinion of another doctor who assessed the complaint. The decision was upheld by the Health Professions Review and Appeal Board.

Richardson鈥檚 fight for justice left Kaufman feeling 鈥渄isappointed that a more nuanced approach has not developed in what is still a relatively new field,鈥� she said. 鈥淲e need to have our eyes open and realize that, yes, we do make mistakes,鈥� she said.

Advocates call for reform

The opinions of child maltreatment doctors must be subjected to external scrutiny as early as possible, said Kate Judson, a defence lawyer who runs the Wisconsin-based Center for Integrity in Forensic Sciences.

Too often, Judson said, that feedback is only occurring in an 鈥渁dversarial鈥� context, where experts on both sides are primed to defend their positions and dig in. She suggested adding a defence lawyer to hospital-based suspected abuse teams, so that these units benefit from more diverse perspectives.

In Texas, the parents of a child whose rare medical condition was mistaken for abuse successfully lobbied the state to allow families in such cases to seek a second opinion. The law, which came into effect in 2021, also prohibits the removal of children from their homes based on one medical team鈥檚 opinion. A senator in Florida is pushing for a similar law.

Checks and balances must be strengthened in Canada, said former B.C. Premier Mike Harcourt, who is advocating for change after learning of families whose 鈥渓ives have been almost ruined by accusations鈥� rooted in allegedly flawed medical evidence.

Child welfare workers and others who rely on the opinions of child maltreatment specialists must receive more training on the limitations of these opinions and medical conditions that can mimic abuse, he said.

In Ontario, more parents are speaking out about the problem. One of the families featured in a 2022 documentary by CTV鈥檚 W5 has created an online group called Medical Kidnapping Ontario. The website includes contact information for medical experts who have challenged the opinions of child maltreatment specialists.

Some families pursue justice through the courts.

In a statement of claim filed in 海角社区官网Superior Court in 2021, the parents of triplets allege that doctors overlooked obvious signs of bone fragility and wrongfully blamed fractures on abuse.

The babies were one month old in 2019 when x-rays detected the fractures. They were apprehended and placed in foster care. The parents claim the babies then suffered more fractures 鈥� further proof, they say, that an underlying bone condition caused the breaks. But Cory and other SickKids doctors refused to revise their opinions 鈥渄espite this compelling new evidence,鈥� the lawsuit states.

The parents got their babies back in late 2020 and Children鈥檚 Aid closed the file the following year. The police didn鈥檛 press charges.聽The Star is not identifying the family as details of their child protection case are covered by a publication ban.

In a joint statement of defence, Cory, Cho and another doctor denied the allegations, and claimed that they 鈥渁cted in a careful, competent and diligent manner that met the standard of care required in the circumstances鈥� and was 鈥渋n the best interests鈥� of the triplets, one of whom the doctors said also had bleeding around the brain. SickKids has also denied the allegations.

In January, the Srirams launched their own lawsuit, claiming SickKids, the police and children鈥檚 aid 鈥渟uccumbed to tunnel vision, implicit bias, and professional overconfidence.鈥�

The Srirams allege that Cory and other doctors relied on questionable scientific assumptions, overinterpreted results, 鈥減rovided misleading and/or biased opinions to support a finding of abuse,鈥� and that they failed to correct errors once new data became available, according to a statement of claim filed in Kitchener Superior Court.

The Srirams are seeking $3 million. No statements of defence have yet been filed. The Peel Regional Police Service and Peel Children鈥檚 Aid Society declined to comment for this story, citing confidentiality rules and the ongoing legal proceedings.

Sriram didn’t see Cory in court last summer, when the charge against her was dropped. She was disappointed. Sriram had hoped she could muster the courage to speak with the doctor, to get her to 鈥渟tep back and think about her actions鈥� and 鈥渞ethink how she draws conclusions.鈥�

鈥淚 thought, it might not do anything, but she should hear it from the person it impacted,鈥� she said.