Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses.

AIM: The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation. METHODS: Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation. RESULTS: A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults. CONCLUSION: The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts.

When insanity has gone undiscovered by the courts: The practice of the Norwegian Criminal Cases Review Commission in cases of doubts about insanity.

BACKGROUND: England, Scotland and Norway have established Criminal Cases Review Commissions to review the convictions of persons who may have been wrongly found guilty of a criminal offence. AIMS: The aim of this study was to explore the Norwegian Criminal Cases Review Commission (NCCRC) practice when legal insanity constitutes grounds for possible reopening of a criminal case. METHODS: We identified all cases between 2004 and 2012 where an application to the NCCRC to reopen a case was on grounds of concerns about insanity. Data were extracted from records. Differences between reopened and disallowed insanity cases and variables that may explain the NCCRC's decision to reopen a case were analysed using multiple logistic regression. RESULTS: Forty cases were allowed, and 34 disallowed. The NCCRC relied fully and unanimously on the conclusions of the expert reports in making these decisions. In 26 of the 40 cases that the Commission reopened, psychosis had gone undetected by the courts. Such undetected cases were most often discovered in the wake of a new criminal case in connection with the defendant. If the length of the sentence were short, it was less likely that insanity had been considered by the court in the index judgement. CONCLUSIONS: The NCCRC may rely excessively on the forensic psychiatric reports. The experts' conclusions may be uncertain, given that they often have to look back several years to establish mental state and its relevance at the time of the crime. As nearly two-thirds of the reopened insanity cases had been given penalties of under 6 months, it may be asked whether such further investigation of fairly low-level crimes is the best use of resources. Copyright © 2015 John Wiley & Sons, Ltd.