CITATION:
Kohr RM. Inflicted compressional asphyxia of a child.
J Forensic Sci, Sep 2003, 48(5) p1148-1150
Email the author, Roland M. Kohr, at: RKohr10612@aol.com

I've posted this J Forensic Sci article in PDF file format.
If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.

CHAS' REVIEW:

The author (Terre Haute, Indiana Medical Examiner, Roland M. Kohr, MD) presents the case of a two-year-old little girl who refused to take a nap, and was forcefully-prone-restrained by an adult, who had an "orthopedic cast" and walking boot on one of her legs, "resting her legs across the prone child's back for an estimated 30–40 min" until the child "appeared to have fallen asleep" and was dead.

At the end of his case study's introduction, Kohr stated, "The case presented below describes such a case, in the hope of encouraging further study and discussion of the subject."
However, while reading Kohr's case study, some content and wording caused me to become quite suspicious of his true motivation for writing and publishing it.

INACCURATE CONTENT and SUSPICIOUS WORDING:

1. This case study is clearly that of a child who died due to RESTRAINT ASPHYXIA.
   Within his article, Kohr demonstrated his recognition of "restraint asphyxia" being a long-established and legitimate "cause of death" label. However, for some reason, Kohr refused to ever use the phrase "restraint asphyxia" in association with his discussion of this child's death.
   Were he placed under oath and specifically questioned, Kohr would have to admit that the facts associated with this child's death meet ALL the forensic requirements for "restraint asphyxia" being identified as her primary cause of death – thus, additionally identifying the "manner" of her death being "homicide." Yet, Kohr persistently referred to the child's mechanism of death as being that of "traumatic or compression asphyxia" – labels commonly considered "accidental" manners of death.

2. Kohr focused only on "chest compression" as having caused the child's death. In fact, within his discussion of other asphyxial death mechanisms, Kohr even attributed the respiratory compromise caused by "partial burial of construction workers" (Trench Death) as being primarily due to "no room for expansion of the chest, and inspiration is compromised, due to a tamponade like effect."
   Were Kohr at all familiar with NORMAL mechanisms of breathing, he would have discussed the fact that abdominal excursion (freedom for diaphragm function) is far more important to breathing than is "chest expansion." And that, evaluation of abdominal excursion interference – especially when one is evaluating any form of restraint asphyxia, "traumatic or compression asphyxia" death – is far more important. Were Kohr at all familiar with NORMAL mechanisms of breathing, he would have identified that the child in his case study likely suffered much greater respiratory compromise from abdominal compression than from chest compression, when being forcefully-prone-restrained in the manner he described.

3. According to Kohr:
   "The use of deliberate force against a child, in a manner sufficient to cause traumatic or compression asphyxia, appears to be highly unusual. ... A review of the literature has revealed no similar cases for comparison. ... Compressional or traumatic asphyxia of a child is uncommon, most often seen as an accident or as a consequence of overlaying."
   Clearly, Kohr's "review of the literature" failed to include research specifically related to deaths of children during restraint. Had he searched that subject on the Internet, Kohr would have found (at the very LEAST) the Hartford Courant DEADLY RESTRAINT article published in October of 1998.
   Perhaps Kohr doesn't consider an Internet search to be a "literature search." However, if he had searched medical literature databases (such as "MEDLINE") for articles specifically related to deaths of children during restraint, Kohr would have found several articles about the subject, published well prior to his case study – including medical literature discussing the 1998 Hartford Courant investigation's cases.
   Either Kohr DIDN'T research this subject (and lied about doing so), or he elected to disregard the MANY accounts of children who have died during the use of "deliberate force ... in a manner sufficient to cause traumatic or compression asphyxia."

4. Within his case study, Kohr stated his opinion that; because "Compressional or traumatic asphyxia of a child is uncommon," "forensic experts as well as authorities responsible for filing charges may be understandably reluctant to take such cases to court."
   WHY in the WORLD would Kohr suggest that "forensic experts" and "authorities responsible for filing charges" should be excused from failing to pursue prosecution, simply because they thought that a mechanism of death was "unusual?" That makes no sense, whatsoever.
   UNLESS KOHR is a forensic expert who failed to ensure that one or more individuals were adequately prosecuted after causing a child's restraint asphyxia death.

Because of his failure to accurately identify and discuss the issues associated with this restraint asphyxia case, and his bizarre statement that "forensic experts as well as authorities responsible for filing charges may be understandably reluctant to take such cases to court," I went to the Internet and researched Kohr and this case.
I searched the phrase: "Terre Haute restraint death."
The SECOND "hit" yielded by that search was a link to the Terre Haute Tribune Star website page;
Alexis Williams; A Timeline of Events.

In the event that the above link "disappears" some time in the future,
I've copied all of it to a separate page of this library:
Alexis Williams; A Timeline of Events.

The following EXCERPTS from the Terre Haute Tribune Star Timeline
identify activities specifically related to Kohr's handling of the case, and
the consequences of his failure to accurately identify the child's cause of death:

[REMEMBER; this is the case of a two-year-old little girl who refused to take a nap, and was forcefully-prone-restrained by an adult, who had an "orthopedic cast" and walking boot on one of her legs, "resting her legs across the prone child's back for an estimated 30–40 min" until the child "appeared to have fallen asleep" and was dead]

May 22, 2002
Alexis Williams is pronounced dead in Terre Haute Regional Hospital
[on the day that she was forcefully-prone-restrained to death].

May 23, 2002
Dr. Roland Kohr conducts an autopsy, with preliminary results showing no signs of foul play.

June 18, 2002
A death certificate [Kohr's?] indicates that Williams' cause and manner of death were undetermined. According to the document signed by the Vigo County coroner, Williams was found unresponsive [by Courtenay Scott] during a nap and did not respond to resuscitation efforts.

October 1, 2002
Vigo County Prosecutor Bob Wright says there's insufficient evidence to file charges [against Courtenay Scott – the cast-wearing adult who forcefully-prone-restrained Alexis] in Williams' death.

November 8, 2002
Williams' parents file a lawsuit against Scott, claiming the former day-care owner was not only careless and negligent, but directly responsible for Williams' death. The civil suit alleges Scott "asphyxiated and/or otherwise" caused Williams' death by holding Alexis down forcibly as a form of discipline or restraint."

January 28, 2003
Wright said he still considers the case open but indicates the evidence is "not even close" to sufficient to file charges.

January 29, 2003
Dr. John Pless, an Indianapolis forensic pathologist, signs an affidavit indicating Williams died of compressive asphyxia as the result of pressure applied by Scott's foot and leg.

February 14, 2003
Vigo County Prosecutor Bob Wright requests a special prosecutor be named to the case; Judge Michael H. Eldred approves the request.

February 28, 2003
At a news conference, Wright announces he is turning the case over to [Vanderburgh County Prosecutor Stan Levco].

March 14, 2003
Levco requests a grand jury investigation into Williams' death.

March 26, 2003
Williams' death certificate is re-filed with the cause of death listed as "compression asphyxia" and the manner of death as "homicide."

April 17, 2003
The grand jury indicts Scott for reckless homicide in Williams' death.

January 19, 2004
During a hearing, defense attorneys argue that statements Scott made to police should not be allowed in trial because the prosecution failed to prove independently that a crime occurred. The defense also asked that the cast and walking boot Scott was wearing at the time of Williams' death be inadmissible.
Later in the day, an agreement is reached that calls for Scott to plead guilty as charged in exchange for two years probation.

January 22, 2004
Scott pleads guilty to reckless homicide; the judge [Barbara Brugnaux] takes the agreement under advisement.

February 19, 2004
Despite public outcry against the plea, Brugnaux accepts the terms of the agreement and sentences Scott to two years probation, which includes 180 days on home detention.

CLEARLY ... What we have here is a case of restraint asphyxia homicide that went entirely UNPUNISHED primarily due to the INITIAL AUTOPSY report being so extraordinarily WRONG that it caused the prosecuting attorney to conclude that there was "INSUFFICIENT EVIDENCE TO FILE CHARGES" against the person who inflicted the homicidal form of restraint.
Since KOHR is the person RESPONSIBLE for the extraordinarily WRONG initial autopsy, he also is significantly RESPONSIBLE for the chain of events that led to Courtenay Scott being allowed to "do a deal" – being allowed to plead guilty to "reckless homicide" in return for receiving a mere "two years probation" as her "punishment" for having killed 2-year-old Alexis Williams.

Ah. Therein lies the most-likely-TRUE motivation for Kohr writing this case study in the manner that he did. Apparently, he is seeking to be "excused" for contributing to a child's homicide going practically unpunished.

YOURS, CHAS
(Ms. Charly D. Miller)

Email Charly at: c-d-miller@neb.rr.com
(Those are hyphens/dashes between the "c" and "d" and "miller")