Thread by @NBCNews

A prosecutor projected a photo for the jury. It showed a little girl’s feet, burned up to her ankles. The 2-year-old had climbed into a bathtub when nobody was looking, her grandparents had said, and the hot water must have been set too high. nbcnews.to/31C9wNG (1/13)

The prosecutor turned to his expert witness and asked whether the child’s injuries could have been accidental.

“The pattern of her burn injuries is what I would call a forced immersion,” Dr. Matthew Cox said.

Later, Cox was unequivocal: “Absolutely, this is child abuse” (2/13)

Following that testimony, the girl’s grandparents, Kenneth and Shelley Walker, 55 and 60 at the time, were both convicted of injury to a child and sentenced to 25 years in prison. They assumed they would die behind bars. (3/13)

But then, 4 years later, the Texas Court of Criminal Appeals took a look at the case and found serious problems. The court's concerns centered on the testimony of Cox, as well as one other physician who was less certain about whether the child had been abused. (4/13)

As a child abuse pediatrician, a growing doctor subspecialty, Cox is considered an authority in differentiating accidental injuries from abuse.
But some doctors have at times overstated their ability to make that call, an @NBCNews-@HoustonChron investigation finds. (5/13)

@HoustonChron In a scathing 6-3 opinion issued in October 2016, the Texas criminal appeals court concluded that the jury in the Walker trial should not have relied on Cox’s burn-pattern analysis because he “did not base his opinion on the particular facts of this case.” (6/13)

@HoustonChron Cox, who declined through an email to answer questions for this article, relied on an incorrect estimate of the water temperature, the court wrote.

After more than 4 years, the Walkers were set free. (7/13)

@HoustonChron But in a strikingly similar case less than a year later, Cox’s burn analysis helped send Jessica Byas-Lurgio to prison after her 3-year-old half-sister was scalded in the bathtub. nbcnews.to/31C9wNG (8/13)

@HoustonChron Byas-Lurgio told reporters she believed her race and economic status factored in the way doctors, police and the courts handled her case.

“It was like, because I was black, nobody believed me,” Byas-Lurgio said. (9/13)

@HoustonChron Research shows that, compared to white children, black and Hispanic children who come to hospitals with head trauma are twice as likely to be evaluated for abuse. And black children are more likely to receive testing like full body X-rays to screen for other injuries. (10/13)

@HoustonChron When a child comes into an emergency room with serious scald burns, a child abuse pediatrician is often called in to assess the injuries.

But some burn experts and forensic pathologists caution against drawing firm conclusions based only on appearance of a child’s burns.(11/13)

@HoustonChron Doctors and investigators should consider water temp, experts say, because that can affect how quickly a child is burned and whether a parent’s story is plausible.

And they should try to understand the child’s physical limitations, as well as the bathtub configuration. (12/13)

@HoustonChron Kenneth Walker says he couldn’t understand why Dr. Cox was so certain someone abused his granddaughter.

He and his wife have reunited with their grandchildren in Missouri. They declined an in-depth interview.

“It’s just too painful,” he wrote in a text. (13/13) #NBCNewsThreads

@HoustonChron Read the full @NBCNews-@HoustonChron series: nbcnews.com/news/us-news/d…

@HoustonChron Reporters for @NBCNews and the
@HoustonChron want to better understand the role physicians play in the child welfare system nationally.

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