Charles J. Hyman, M.D., F.A.A.P.

General and Forensic Pediatrics 710 Brookside Avenue - Suite 4 Redlands, California 92373
Phone: (909) 748-5045 Fax: (909) 792-2919 Email: cjhymanmd@gmail.com

April 22, 2014

Re: In the Matter of **** Finner

Preliminary Expert Opinion of the **** Finner Case

Date of Birth: 10/10/13

To Whom It May Concern: I, Charles J. Hyman, M.D., FAAP, declare as follows: 1. I am a board certified pediatrician and a member in good standing of the American Academy of Pediatrics, licensed to practice medicine in the State of California since 1973. I was previously licensed to practice medicine in the State of Pennsylvania from 1967 to 1980 and the State of Idaho from 1969 to 1971 as a major in the USAF. The Pennsylvania and Idaho licenses were terminated voluntarily, since I no longer practiced within those states. I was invited to join the clinical faculty of Loma Linda University Medical Center in 1973. I rose through the ranks and was a Clinical Professor of Pediatrics from 1998 through June 2008. I was the founder and director of Loma Linda University Medical Center's child abuse team during 1976-1981. In 1981, the Loma Linda team, under my direction, was awarded the State of California Martha Lou Berkey Award for excellence in child abuse intervention and education. From 1982 to 1987, I was a co-director of the Children in Crisis Center (Child Abuse) of St. Bernadines Medical Center in San Bernardino. I am a member of the Criminal Division of the Superior Court of Los Angeles Expert Witness Panel 2011 to present. I have testified in approximately 60 trials in the area of child abuse; approximately 50% of these were on the behalf of state and county agencies. I have qualified as an expert or submitted expert reports 1

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in 31 states and have been retained as a consultant in seven cases in England and have given evidence in two of those. In one case, all charges were dropped in association with my report. In another case in England, my report on the misdiagnosis of child abuse in a child with scurvy allowed a family to retain their newest child, even though three older children were permanently adopted out based upon the erroneous diagnosis of child abuse. I have given evidence in cases in Scotland, Ireland, New Zealand, Israel, and Canada. In February 2011, I was also retained in a case in Australia in which I submitted a detailed report and the children were returned to the family. I have been involved in federal cases and cases with the U.S. military. 7. I am a current member of EBMS, an infant injury evaluation group, which includes an international multidisciplinary group of doctors involved in the study of the science of disease and injury of infants and children that could be misconstrued as child abuse. 8. I currently review approximately 4 cases per month, and I testify in around 6-9 cases per year. In approximately 15-20% of the cases reviewed, I find a diagnosis of non-accidental injury (NAI). 9. I have never had a malpractice judgment against me, nor have I ever been investigated for an ethical breach of medical conduct. My current area of clinical research for the last 12 years involves infants with multiple fractures. 10. I hold memberships in: a. The International Society for Prevention of Child Abuse and Neglect (ISPCAN) b. The American Professional Society on the Abuse of Children (APSAC) c. The American Society for Bone and Mineral Research (ASBMR) d. The British Association for the Study and Prevention of Child Abuse and Neglect (BASPCAN) e. The International Bone and Mineral Society (IBMS) f. The American Academy of Pediatrics g. The American Medical Association h. The American Academy of Pediatrics subsection on Child Abuse and Neglect i. The Federation of American Societies for Experimental Biology (FASEB) j. International Society of Bone Morphology k. The European Calcified Tissue Society 11. I completed a fellowship in neonatology at the Childrens Hospital of Pittsburgh (1971-1973) and practiced in that discipline for 12 years. 12. I have personally reviewed the medical records and prepared the report. I have knowledge of the medical citations and facts 2

contained in this declaration and if called as a witness, could and would competently so testify. I have reviewed a portion of ****s medical record. Her skeletal findings alone or in combination are not pathognomonic or highly specific for child abuse. The lack of an explanatory history for the fractures is not diagnostic of child abuse and is also consistent with cases of bone fragility disorders of infancy. Multiple fractures that may be in different stages of healing are not diagnostic of child abuse and are seen in bone fragility syndromes. Not all fractures are completed with a single application of force. Fragility fractures can be caused by the repeated application of normal forces in the daily handling of a child. In bone fragility states, microfractures can develop, which can progress with further applications of normal forces. The medical records that I have reviewed contain definitive evidence that **** had multiple risk factors that could have adversely impacted her bone quality framework and placed her at risk for bone failure. Both she and her mother had vitamin D deficiency. I have personally evaluated over 100 cases similar to ****s in which bone risk factors, such as vitamin D deficiency, contributed to fractures that mimicked child abuse. She was a sickly baby who did not gain appropriate weight, which also can affect the bone quality framework. ****s radiographs demonstrated evidence of hypomineralization and possibly an abnormality of bone turnover, suggesting a metabolic bone problem that could have contributed to her bone failure. At this point in my evaluation of the case, I believe that ****s alleged corner fractures were irregularities of mineralization and not fractures. The facts above support the familys lack of an explanatory history for many of ****s findings. I require additional time to review the complete medical record and to determine the etiology of ****s findings. If granted additional time, I would be happy to write a comprehensive report regarding ****s medical findings, supported by references from peer-reviewed bone science literature.

I declare under penalty of perjury under the laws of the State of California that the foregoing, to the best of my ability, is true and correct. Signed this April 22nd of 2014 at Redlands, California.

Charles J. Hyman, MD, FAAP General and Forensic Pediatrics Clinical Professor of Pediatrics (Retired)