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May|June 2004
A Bold Stroke By Emily Bazelon
Medea's Shadow By Charlotte Faltermayer
The Sword of Spitzer By Nicholas Thompson

Medea's Shadow

Marybeth Davis is serving a life sentence for killing her 3-year-old daughter and severely injuring her infant son. New evidence suggests that Davis might be innocent—and that the medical diagnosis used to convict her might be a medical fiction.

By Charlotte Faltermayer

A crowd gathered at the hillside grave of Tegan Marie Davis on an April morning in 2002. Using a backhoe, groundskeepers at the cemetery in Uniontown, Pa., worked the soil, soft from the spring thaw. They unearthed a small vault that housed a decaying casket. Pried open, the vault revealed the corpse of a 3-year-old girl, dressed in Easter finery, a straw hat, and white Mary Janes, and buried with her two favorite dolls. The priest who had presided over Tegan's funeral 20 years earlier said a prayer and apologized for disrupting her slumber. Tegan's uncle read an oft-cited passage from the Gospel of John: "The truth shall set you free."

The exhumation was one of the last steps in an effort to free Tegan's mother, Marybeth Davis. The defense hoped to find incontrovertible evidence clearing Davis of her daughter's murder. In 1997, Davis was convicted of killing Tegan 15 years earlier with a lethal dose of caffeine and, six months before that, of severely injuring her 10-week-old son, Seth, with a massive shot of insulin. (Seth remained in a vegetative state until he died in October 2002.) Prosecutors told a jury that Davis suffered from Munchausen's syndrome by proxy, a diagnosis not recognized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Because it's not an officially established mental illness, the syndrome can be used only as a weapon against defendants and never as a mitigating factor like schizophrenia.

Davis's fate is intertwined with that of a British pediatrician she has never met. In 1977, Dr. Roy Meadow wrote an article in an influential medical journal elaborating on an already-known syndrome. Patients with Munchausen's syndrome—named for an 18th-century German baron known for his outlandish tales—fake illness to gain attention. Meadow hypothesized that patients with Munchausen's syndrome by proxy fake or cause illnesses in their children for the same reason. Meadow's article described the cases of two children who were repeatedly brought to a hospital with symptoms that doctors could not explain. In each case, the hospital staff grew suspicious and ordered separation tests. They isolated the children from their mothers, and their symptoms disappeared. One mother, the doctors determined, had contaminated her daughter's urine with her own menstrual blood to make it seem as if her child was ill; the other had poisoned her son with salt.

But did Meadow's account of these cases prove the existence of a syndrome—or twist the facts into a made-up illness, one that prosecutors have been only too eager to exploit? Davis's supporters believe that Munchausen's syndrome by proxy was wrongly used against her at trial. They insist that Davis is no modern Medea—the mother of Greek mythology who killed her two children—and that she lost Tegan and Seth to rare genetic metabolic disorders. Her attorney, Paul Detch, has recently produced evidence—including tissue slides, medical records, and new genetic tests—that he hopes will clear his client. The judge who presided over Davis's original trial concluded last year that this new evidence did not merit a new trial. But in February, the West Virginia Supreme Court voted by a narrow majority to hear Davis's appeal.

I recently interviewed the 51-year-old Davis at Pruntytown Correctional Center near Grafton, W.Va., where she is imprisoned for life without the possibility of parole. She gazed at me over her bifocals and kept trying to scan my list of questions. Davis, whose cropped light-brown hair is graying at the temples, has become accustomed to such interrogations; she was guarded with me at first, covering her mouth with her left hand as she spoke. But the hand slowly came down, as she began to tell her tale.

THE STORY BEGINS IN UNIONTOWN, a former coal-mining community about 50 miles southeast of Pittsburgh where Marybeth Davis was born. She was raised by her mother, a librarian, and her stepfather, a physician. Hers was an upright childhood. She went to Sunday school at the Third Presbyterian Church. She was taught to master the intricacies of classical piano—her favorite piece was Chopin's "Polonaise in A-flat major"—and crocheting. She volunteered as a candy striper at the local hospital and eventually decided to become a nurse.

The Davises were a close-knit, and closed, family. When Marybeth was in second grade, the family mutt chewed up her beloved teddy bear, and she cried in front of her sister and two brothers. Her stepfather admonished her for the tears and sent her to her room. Marybeth understood that she was not to emerge until she had collected herself.

In high school, Marybeth began dating a tall boy who wore glasses. His name was Gary Davis, and they were often seated together because they shared the same last name. Gary asked Marybeth to the prom; she later asked him to marry her. She was drawn to his demonstrative nature and the warmth of his large Italian family. They wed in 1977.

A little more than a year later, after Marybeth had converted to Catholicism, their first child, Tegan, was born. The family moved to a tiny apartment in Lewisburg, then a town of 2,500, so that Gary could attend the West Virginia School of Osteopathic Medicine. Marybeth, a registered nurse, took a job in the Intensive Care Unit at Greenbrier Valley Hospital to support the family. She gave birth to Seth two and a half years later.

The new baby was often feverish, lethargic, jaundiced, and—most troubling to Marybeth—unable to feed properly. "I nursed Tegan, and I nursed Seth. A child automatically knows what to do," she said. "And Seth just wouldn't do it." Also peculiar, she said, was that "when he cried, he squealed like a pig, that shrill, gritty cry. As a mother, you know something is wrong."

Seth's physician, Dr. Joseph Aldrich, suspected that the 10-week-old boy had an underlying metabolic disorder. After monitoring the infant for four days in September 1981, Aldrich recommended that Seth be transferred to a larger hospital where he could receive a more thorough workup. The Davises chose the Children's Hospital of Pittsburgh for its reputation and proximity to family in Uniontown.

As they packed for the trip, Gary and Marybeth noticed a change in Seth. Sitting in a buggy in the hallway of their apartment, "he stiffened up and started to grunt, as if he were having a bowel movement," Gary told me. "I picked him up, and he was rigid. I realized that he was having a seizure." Gary and Marybeth said they rushed Seth back to Greenbrier and together stayed by their son's side. Following standard procedure, Aldrich drew Seth's blood and checked the baby's blood sugar, which was at a level of 72 milligrams per deciliter, within the normal range of 60 to 120. A draw of his spinal fluid, however, showed much lower levels of blood sugar.

A day later, when Seth arrived at Children's Hospital of Pittsburgh, he was in a dramatically altered state. The Davises say the baby was stable when he left Greenbrier. He was flown to Children's Hospital by an emergency crew that included a pilot, a nurse, and a pediatric resident. Marybeth took a separate flight to meet her son at the hospital, while Gary returned home to finish packing and to take care of Tegan, by now age 2.

At Children's Hospital, Marybeth said she was not allowed to see Seth for 12 hours. "I demanded to see him. A male employee, I don't know what his job description was, told me to shut up, be quiet, and let them do their job," she said. "I kissed Seth goodbye at four in the afternoon, and I didn't see him until he was in the ICU at four in the morning." The hospital staff told her and Gary, who had arrived by this time, that Seth had had several seizures but was now stable. The next day, doctors told them that Seth's blood sugar had plummeted on the flight and that he had been treated with glucose.

One week into a six-week stay for Seth at Children's Hospital, the Davises were told that their son had brain damage so extensive that he would likely have to be placed in an institution for the severely disabled. The doctor who discharged Seth wrote "it was felt . . . that he could be cared for just as well or even better at home." The doctor listed his primary diagnosis as hypoglycemia, low glucose that can lead to seizures, and noted that the hospital was awaiting further test results.

A month later, back in Lewisburg, Aldrich informed the Davises that a C-peptide blood test conducted at Children's Hospital after Seth was discharged found that he had high levels of insulin in him when he arrived there. Those levels could not have been created by his body; they had to have come from an outside source. According to Marybeth Davis, Aldrich dismissed the information. "He told us not to worry about it, that it couldn't be true," she said. At Aldrich's recommendation, the Davises took Seth to the University of Virginia Medical Center, where doctors found that Seth's symptoms were "suggestive of" Leigh's disease, a rare hereditary disorder that causes the central nervous system to break down. Symptoms run the gamut from continuous crying and poor sucking ability to seizures and loss of motor skills. A neuropharmacologist at Yale University School of Medicine later concurred. Seth's prognosis was not good. The Davises decided to try to care for him at home.

Six months later, in March 1982, Tegan began to exhibit flu-like symptoms. She complained of a burning sensation when she peed. Aldrich prescribed the usual flu remedies, including cold water baths. Gary, who was on rotation in Harrisburg, Pa., a five-hour drive away, became concerned when he called to wish his daughter good night. Tegan described "choo choos" on the walls (there were none), and said a statue of the Virgin Mary was speaking to her. Gary asked his wife to call Aldrich. Marybeth talked to Aldrich and then took Tegan to Greenbrier Valley Hospital.

There, Tegan's condition deteriorated. She was moved to the room where her brother, who was in for monitoring, was staying. Her temperature soared to 108. She began vomiting, hyperventilating, and convulsing. Later that night, she slipped into a coma.

Aldrich suspected either Leigh's disease or Reye's syndrome, an extremely rare disorder that causes the breakdown of the body's organs, especially the liver and brain. Marybeth Davis, who was accustomed to administering injections in the ICU, asked Aldrich's permission to give Tegan a shot of thiamine, a B1 vitamin that was a common treatment for Leigh's at the time. He approved, and Tegan received the shot from her mother. "I figured she had what Seth had," Davis said. "I needed to know that I was doing something to help my child." Aldrich also recommended that Tegan be transferred to a larger facility. Reluctant to transport another sick child, Davis was slow to consent to the move. Gary was still away. The next morning, she and Aldrich went with Tegan in the ambulance to a bigger hospital 80 miles away in Roanoke, Va. Tegan stopped breathing during the trip.

Dr. Anne Hooper, a pathologist at Gary's osteopathic school, performed Tegan's autopsy. She discovered what she described as hundreds of bead-like formations in Tegan's digestive tract, which she believed to be remnants of time-released pills. After receiving the toxicology report, which showed what she interpreted as a suspicious level of caffeine, she wrote down "homicide" and prompted the authorities to launch an investigation.

When they learned about Hooper's conclusion, the Davises searched their home, fearful that Tegan had found something bad for her and eaten it. In an outside garbage can, Gary's father came across empty packs of Dexatrim diet pills that belonged to Marybeth, who was 90 pounds heavier at the time. "I was taking the pills because I was fat," she told me. "That's it." The investigation into Tegan's death went nowhere, and the county prosecutor, who died in 1986, did not pursue an indictment.

A few months after Tegan died, in 1982, Gary and Marybeth placed their handicapped son at the McGuire Memorial children's home in New Brighton, Pa. They moved to Toledo, Ohio, where Gary had gotten a job. Marybeth had suffered three miscarriages, so they decided to adopt a baby girl, whom they named Katybeth, in 1984. "If I had believed for one minute that my wife had done anything wrong," Gary said, "I would never have permitted us to do that." The social workers in charge of the screening process asked about Tegan and Seth, but raised no objections to the adoption.

Gary and Marybeth began to grow apart, and Seth and Tegan were no longer there to knit them together. Marybeth missed her family, but Gary needed the change of scene. A year after they adopted Katybeth, Marybeth became pregnant. She gave birth to another boy, Gary Richard, but even his arrival was not enough to save their marriage. They separated that same year, but neither believed in divorce. (Not until 1997, when Marybeth was facing enormous burdens because of her legal fees, did they decide it would be in Gary's best interest for them to get divorced.)

Marybeth Davis moved back to Uniontown with Katybeth and Gary Richard. Other than a bout with appendicitis that the latter had in first grade, both children were in good health. For the next decade, they lived what Davis and the children describe as a happy existence, with regular visits to their father.

Life with mom was unremarkable, said Katybeth, who is now 20, and Gary, who is 18. Marybeth Davis was a Brownies and Cub Scouts troop leader and an active member at St. John's, a Catholic church. She also volunteered at her children's school cafeteria, helping to prepare pierogies, a kind of dumpling, every Friday. "I never felt in harm's way," said Gary Richard, a 4.0 student and member of the National Honor Society. Katybeth, who is completing a degree at a community college, added, "The only thing she ever did was ground us, not let us watch any TV."

A single moment of high drama stands out in both of their memories. In 1991, when the kids were 7 and 5, an electrical fire broke out at their home in Uniontown. "I noticed the fire first, and I told my mom," said Katybeth. "My brother was playing down the street. My mom swooped me up and took me in her arms. She got me out of there and had her arm around me the entire time." The fire was put out before the house was completely destroyed and, thanks to Marybeth Davis, no one was harmed.

IN 1995, WEST VIRGINIA ENACTED A LAW that required each county prosecutor's office to form a multidisciplinary task force on child abuse. At a meeting of the Greenbrier County task force in April 1995, State Trooper Michael Spradlin recalled, someone made the "offhanded" remark that, had a task force been in place 13 years earlier, perhaps the Davis cases would have been solved. Spradlin was slow to react to what he assumed were small-town suspicions. Marybeth Davis was an outsider, and her reserved manner had not won over the townspeople, who whispered that she was having an affair with Aldrich. (She and Aldrich deny the rumor, as does Gary Davis.)

But after Spradlin spoke with witnesses who remained deeply disturbed about the old events, he began to take the talk about Marybeth Davis seriously. Most troubling, he said, was a letter that one of Seth's doctors in Pittsburgh had written to West Virginia Child Protective Services. Dr. Ellen Wald said that Seth was a suspected victim of abuse, given the hospital's determination that he had been injected with insulin. For the next year and a half, Spradlin interviewed some 200 witnesses, amassing enough information to present a detailed case to a grand jury, which returned an indictment against Davis in November 1996.

Paul Detch, a defense attorney viewed around Lewisburg as a determined optimist, became the obvious choice to represent Davis. He had had a daughter with Tay-Sachs disease, a rare genetic disorder, and his priest had asked him in 1982 to reach out to the Davises. Detch's 3-year-old died a year after Tegan did. "We share a bond, absolutely," Detch said. "I still have a lot of anger about losing my daughter, and this is one way of venting my anger." Detch estimated that he's spent at least $400,000 worth of legal time on Davis's case and said that he has lost business because of it. "Could someone say I'm a little fixated with it? Well, yes." When his father died a week before Davis's trial was scheduled to begin, Detch did not ask for a postponement.

IN HIS OPENING ARGUMENT, THE LEAD PROSECUTOR MARK BURNETTE called Davis a "very, very evil mother." The explanation for that evil became Munchausen's syndrome by proxy. According to the diagnosis, a Munchausen's mother has one or more children with persistent and puzzling medical problems, about which she is either overly dramatic or overly calm. She is likely to be familiar with medicine and will often have an absent husband who has left her hungry for attention. Burnette characterized MSBP as a trigger for child abuse. "You hurt your kids because they are not kids to you," he said. "They are objects, your property."

Dr. Basil Zitelli, one of Seth's pediatricians at Children's Hospital and an expert on MSBP, testified that Davis's behavior was typical of someone suffering from the syndrome. "The mother, an intensive-care nurse, frequently went into emotional crisis while the father, who was an osteopathy student, was away during hospital rotations," he said. "The mother was polite but guarded, never spontaneous, and maintained a bland affect despite her child's critical illness."

The discussion of MSBP took up 15 minutes of the two-week trial, but it provided an organizing principle for the jurors as they waded through a mass of conflicting medical evidence. Burnette's witnesses filled in the story. At the time of the trial, Seth was 16 and weighed 57 pounds, 100 pounds less than an average boy his age. He had seizures every day at McGuire Memorial. According to prosecutors, it was Marybeth Davis who put him there—by injecting insulin into him just before he was hospitalized at Greenbrier 15 years earlier. Six months after damaging her son, they said, Davis killed her daughter with time-released diet pills containing caffeine.

Exhibit A was the C-peptide test performed on Seth. Dr. Dorothy Becker, a pediatric endocrinologist who treated Seth in Pittsburgh, said that Seth's insulin level when he arrived in Pittsburgh was at least five times the normal level. The absence in his blood of C-peptides, which are released with natural insulin, meant that the insulin had to have been injected. Insulin suppresses glucose, and a high dose of it would account for the seizures and dangerously low blood sugar level that Seth had on the flight, which would in turn explain Seth's brain damage and retarded growth.

The prosecution said that Marybeth Davis had the means to harm her son, since she was a nurse with access to a ready supply of insulin, and the opportunity, since, they said, she was alone with Seth at Greenbrier. While Gary Davis maintained that he was with his wife at the time, there was other evidence that he was at the osteopathy school in Lewisburg.

Detch tried to discredit the C-peptide test. The sample used in the test had been frozen and thawed several times, which is known to cause C-peptides to degrade. As a witness for the defense, Aldrich said that Seth's blood sugar was normal at Greenbrier. It was the large doses of glucose given on his flight to Pittsburgh, defense witnesses said, that prompted Seth's body to produce too much insulin. They also pointed out that Seth's growth hormone level was low and that Leigh's disease includes several subdisorders that could have set off the deficiency, which causes hypoglycemia and seizures.

The evidence concerning the death of Tegan hinged on Exhibit B, a test performed by the chief toxicologist for the state medical examiner's office on tissue and blood taken from the girl's body during the autopsy. The toxicology report stated that there were 66 milligrams per liter of caffeine in her blood and that the concentration of the drug in her tissues was one-tenth that of her blood. It had therefore not distributed evenly throughout her body as time-released caffeine would have. Hooper, who performed the autopsy, testified on behalf of the prosecution that the beads she found along the toddler's digestive tract were remnants of a time-released capsule. She said that the toxicologist had made a crucial mistake—he had underestimated the amount of caffeine in Tegan's tissues. Hooper estimated that the total caffeine in Tegan's body was 897.6 milligrams (roughly the amount in nine cups of coffee). Based on these assumptions, she and other witnesses testified that they believed Tegan had been poisoned with time-released capsules containing caffeine.

Detch's witnesses defended the reliability of the toxicology test, which supported their contention that the caffeine in Tegan's system was not lethal and that it came not from diet pills but from Coke syrup that nurses had given Tegan to stop her vomiting. A gastroenterologist said that the beads found in the girl's stomach and intestines were a common byproduct of digestion. The strongest piece of evidence in the defense's favor, however, was the absence of traces of phenylpropanolamine (PPA), a component of most appetite suppressants, including the Dexatrim that was found at Marybeth Davis's home. If Davis had poisoned her daughter with diet pills, where was the PPA? The defense insisted that Reye's syndrome had caused Tegan's symptoms and that she exhibited numerous markers of the disease—including brain edema (swelling), a fatty liver, and very high ammonia levels. The prosecution disagreed with this diagnosis.

In other words, as often happens in cases involving technically intricate knowledge, the evidence boiled down to a battle of experts. The prosecutors effectively made their own experts seem more credible and better respected than those of the defense. But the prosecutors' best weapon was the disturbing syndrome that seemed to explain everything—and that made it easy to believe that Marybeth Davis was a monster. Why, it was left for the jury to ponder, did Tegan's gravestone inscription—"You meant the world to me, love Daddy"—not refer to Mommy? Gary Davis explained that it was his way of saying goodbye to his daughter, because he had been absent when she died. But that explanation fell flat.

The other nurses who had worked with Marybeth Davis at Greenbrier Valley Hospital offered a more sinister explanation: Their former colleague was the rare mother who harmed her children. They testified that on several occasions Davis talked about putting wine, vodka, and Dimetapp in her children's bottles to get them to sleep. One of them, Helen Pack, said she walked in on Davis as she was giving Tegan an injection. (Davis said it was the thiamine she administered to help Tegan, with Aldrich's approval.) Pack also said that Davis joked about Tegan's "little butt jumping around" while the girl was convulsing. Most damning, several of Davis's fellow nurses testified that Davis often said that if her ill son didn't die soon he was going to outgrow his casket. The only explanation Davis offered, then and now, was this: "I think their memories are fuzzy."

Detch tried to contest the portrait of a Munchausen's mother that the prosecution had drawn. He raised questions about the validity of the syndrome, telling the jurors: "Let me tell you about an even worse mental disorder. It's called Munchausen's by prosecution. It's where a prosecuting attorney tries to poison jurors' minds by getting them to forget a lack of evidence." To no avail. The jury deliberated for a little over three hours before finding Davis guilty of the first-degree murder of Tegan and of attempting to injure Seth by poison. She was sentenced to life without the possibility of parole for Tegan's murder and a consecutive sentence of 3 to 18 years for attempting to injure Seth.

A year later, Spradlin got West Virginia's Top Cop honor for his efforts in the case. Burnette went on to become a state senator.

DETCH NOW REGRETS THAT HE DIDN'T CALL WITNESSES to refute the very existence of the syndrome. But its aura of scientific authority persuaded him to focus instead on dismantling the state's medical evidence. "I had gone to the medical school library and found articles on MSBP," he said. "I did not think there was a way of challenging it for not being scientific. It appeared to be recognized by at least a significant portion of people."

But in the years since Davis's conviction, that portion has fast diminished. Critics say that the supposed scientific basis of the syndrome is faulty at best. There are more than 100 signs and symptoms associated with MSBP, and they cover so much ground that they could apply to almost any mother with a sick child. For example, mothers suffering from MSBP are said to react too much—or not enough. Worse than that from a scientific standpoint is that many women, including Davis, are diagnosed as suffering from MSBP without being evaluated in person. "Are there standards for this diagnosis? Is it falsifiable?" said Eric Mart, a forensic psychologist and the author of Munchausen's Syndrome by Proxy Reconsidered. "The more subjective the diagnosis gets, the greater the danger of a miscarriage of justice."

And why does the syndrome strike only mothers? Ninety-eight percent of MSBP perpetrators identified in legal cases are mothers, according to David Allison and Mark Roberts, the authors of Disordered Mother or Disordered Diagnosis? They noted the strong incentives for an MSBP diagnosis: A father may make the accusation to retain custody, or a doctor, feeling pressured by an overzealous mother, may accuse her to pre-empt a malpractice suit after a child is injured or dies in his care.

Recent medical discoveries raise additional concerns about the credibility of MSBP. There are now likelier explanations for symptoms that once were mysterious and were attributed to the syndrome. For example, it has recently come to light that Propulsid, a popular remedy for reflux (when stomach acid backs up into the esophagus) that has been taken off the market in the United States and England, causes symptoms in children similar to smothering. It is estimated that more than 150 mothers in Britain whose children died while taking Propulsid have been wrongly diagnosed with MSBP. "This shows you how irresponsibly MSBP can be applied," said Thomas Ryan, an attorney who since 1991 has defended a dozen mothers accused of the syndrome in the United States.

The British government is so concerned about the diagnosis that it is reviewing 258 cases of parents (all of them mothers) convicted in the last decade of killing a child under 2. Margaret Hodge, a minister in charge of children's affairs in Britain, estimates that hundreds of other children were erroneously taken from their families as a result of civil cases. Meanwhile, the man who dreamt up the diagnosis—and was knighted in 1998 for his service to children's health—is being accused of misconduct for his role as a prosecution witness in the trials of three women wrongfully accused of killing their children. The doctor's aphorism, "One infant death is an accident, two is suspicious, and three is murder," became known as Meadow's Law. Sally Clark, for example, lost two babies, which prompted Meadow to tell a jury that the chance of two cot deaths occurring in an affluent family was one in 73 million. Britain's Court of Appeal later called that statement "grossly misleading."

Still, other physicians defend the syndrome as a useful analytical tool. Because Munchausen's mothers are so skilled at dissembling, these physicians believe that the general profile helps doctors to spot a particular pattern of abuse. And the sooner a doctor can spot a Munchausen's mother, the sooner a child can be saved. As Herbert Schreier, a child psychiatrist and the co-author of Hurting for Love: Munchausen by Proxy Syndrome, put it, "The point of that list of symptoms is to help doctors to suspect and then take the necessary steps to prove or disprove that the mother is abusing her children."

BEFORE DAVIS'S TRIAL, DETCH FILED A MOTION asking the prosecution for "any slides, tissue samples or otherwise" relating to Tegan. The state said the samples were no longer available because the case was 14 years old. Detch withdrew the motion.

That would have been the end of the matter but for Debra Whitmore, a former nurse who is affiliated with Mothers Against Munchausen Syndrome by Proxy Allegations, a group that assists mothers accused of MSBP. In an effort to find new evidence, Whitmore called Hooper in 1999 and asked her if she had anything that would help explain her theory of Tegan's death. Hooper said she had some "teaching slides" on caffeine poisoning and would be happy to share them. Whitmore asked Detch and Dr. Edward Friedlander, the chief of pathology at the University of Health Sciences in Kansas City, Mo., to accompany her to Hooper's office. When they arrived, Whitmore said, Hooper took out a bound set of about 80 slides with Tegan's name on them.

Friedlander and the medical director of the National Reye's Syndrome Foundation concluded on the basis of the slides that Tegan died of Reye's or, more likely, a mimic of Reye's. "The tissue slides themselves prove, in a graphic form that could be shown to a jury, that Tegan did have remarkable brain edema," Detch said. The state's experts had said such significant edema did not exist, but they "curiously had never seen the data that they were basing their testimony on." To assure himself that he hadn't prosecuted an innocent woman, Burnette showed the slides to his own experts in 1999. He said that they contain nothing exculpatory.

Hooper also had a spectrograph, a kind of photo, of the original toxicology report, which indicates the report is accurate, as the defense had maintained. The toxicologist now concedes that he might have underestimated the caffeine in Tegan's tissues. But even taking his new analysis into account, witnesses for the defense have now determined that the amount of caffeine in Tegan's body could not have been more than 200 milligrams—roughly two cups of coffee. (That much caffeine might make a toddler hyperactive, but it wouldn't kill her.) To the good of the defense, when Tegan's body was exhumed and given a second autopsy, nothing was found "suggesting contents of sustained released pills or tablets."

After the slides were found, Hooper turned over to the defense her day planner. In it, she had written a cryptic note in 1996 about Carol Beckett, the nurse who accompanied Marybeth Davis and Aldrich in the ambulance the day Tegan died. Hooper wrote that Beckett reported that "she had just witnessed a murder" because she had seen Aldrich inject Tegan with 10 milligrams of Valium, which Beckett characterized as "much too much to give a 3-year-old." In a recent interview, Aldrich explained that he gave Tegan the Valium to "calm her down." It is unlikely that Tegan suffered from an overdose of Valium, but Detch now thinks that Beckett's suspicions may have caused the ER to inject a shot of caffeine sodium benzoate into Tegan at the hospital to counteract a perceived overdose. There is no record of such a shot, and Beckett did not return repeated phone calls.

The new evidence about Seth's case is much simpler. Protein-binding tests that were not available at the time of the trial now prove with certainty that Seth suffered from human growth hormone deficiency. That evidence buttresses the defense's argument that Seth's seizures and low blood sugar were the result of natural causes and not of an injection of insulin. In addition, a radiology report from Children's Hospital indicates that Seth arrived in Pittsburgh with a breathing tube that had slipped and was improperly lodged in his trachea. Gary Davis brought a malpractice suit against Children's Hospital for this error, though the suit was dismissed last year. Detch will try to prove that the slipped tube, which caused one lung to collapse and nearly incapacitated the other, may be at least partially responsible for Seth's brain damage.

Jon Blevins, who was brought in as a special prosecutor in the Davis trial, is now the assistant attorney general handling the state's response to the petition for appeal. He conveyed through a spokesperson that Detch has "nothing new here that was not available and addressed at trial." But Detch has accused the prosecution of hiding key evidence at trial. Burnette, who is now in private practice, insists that no evidence was withheld then. "Paul Detch had the documents that showed the results of the slides but not the slides themselves. It's just a smokescreen to say that we withheld any evidence," he said. Burnette remains convinced of Davis's guilt. "There is no doubt in my mind that she harmed those children." If Davis is granted a new trial, jurors will find themselves again immersed in clashing expert witness testimony. But given the rising skepticism about Munchausen's syndrome by proxy, prosecutors will likely not rely on it to persuade jurors of Davis's guilt.

IN A PRIVATE ROOM AT THE PRUNTYTOWN PRISON, Davis became agitated and gripped the table at the mention of the syndrome she is supposed to have. "It's hogwash," she said. "The Munchausen thing is what enforced all those nurses' opinions of me. Some of that's my fault, because I've always had my walls." The walls are real now, and Davis doesn't have many friends in prison. Walking past the unit where the male prisoners live is particularly hard, she said, because of the jeers she hears from the inmates who know the basis of her conviction. "I guess you won't be killing any more kids, will you?" is a typical shout.

So Davis keeps company with Jason, a yellow Labrador that she is permitted to keep with her in prison and walks every morning. She is getting him accustomed to humans so that he can be trained to help a blind person. After the walk, she says the rosary, sometimes all 150 Hail Marys. Then she crochets for hours, making scarves, afghans, and stuffed animals for family and friends. She talks on the phone with her children at least once a week. She earns $50 a month placing orders at Wal-Mart to replenish the inmates' arts-and-crafts supplies.

Davis also dreams of what she'll do if she is released. She imagines going to Disney World with her kids, attending Katybeth's wedding if and when it takes place, and returning to nursing. When I asked her to give her version of the truth in her case, Davis paused for a moment. "Seth was born sick. Seth got sicker. Tegan got ill, and I lost my daughter," she said in a lowered voice. "This in here is bad, but it is not as bad as burying my children. There is nothing else that can make you hurt like that."

Charlotte Faltermayer is a freelance writer based in Scotch Plains, N.J.

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