The mystery of Lucas’ death

It was her first day back at work - a full slate of faculty meetings - and Lisa Mullenax might as well have been at home.

That was where her mind was. She had spent the summer falling in love with her baby, Lucas, but now it was August, back to work to pay the mortgage.

As the meetings droned on, the young teacher consoled herself that school was just two minutes away from home in State College, Pa. The baby was with his father, Alejandro Mendez Vargas, a tender spirit who was so good with Lucas that her mother teasingly called him "Mr. Mom."

It would be OK.

But then, as Lisa was getting out supplies for her Spanish classroom, her return to daily routine suddenly crumbled.

Someone was running up to her, screaming. Her neighbor's daughter?

Nothing made sense. Lisa heard the girl say Lucas was not breathing. An ambulance had taken him to the hospital.

Lisa started to cry and ran down the hall. She raced home to get her husband - but why was Alejandro talking to the police?

At the hospital, the doctors asked if Lucas had been in an accident. Did someone shake him? More stern-faced police arrived. And then her baby was being helicoptered to a bigger hospital 80 miles away.

Six days later, he was dead.

And the doctors and police believed that one of his parents had killed him.

A romance abroad

Lucas seemed like such a healthy baby.

He had chubby, dimpled cheeks, a soft hint of a smile. He had blue eyes from his mother and a hint of gold in his skin from his father, a native of Costa Rica.

That's where Lisa and Alejandro had fallen in love.

Lisa, a junior-high Spanish teacher in State College, was chaperoning a group of students on a 10-day "eco-tour" of the Central American nation. Alejandro was their guide.

They didn't hit it off so well at first.

The burly, smiling guide greeted the young teacher warmly - too warmly, she thought. Reserved by nature, the tall, slender woman was unsure of his intentions and gave him a frosty greeting in return.

Talking to his bus driver later, Alejandro rolled his eyes. Ten days with the standoffish schoolteacher.

"It's going to be a long one," he said.

But by the end of day two, she started to smile at his jokes. After the children went to sleep at the hotel, the teacher and the tour guide stayed up for hours, talking. She liked his lighthearted nature, and how children seemed to gravitate toward him.

Later that year and the next, the two flew back and forth to visit each other.

They got married in Pennsylvania in November 2001. The baby was born in May.

They called him Lucas, a name they took from a Latin word for light.

But childbirth was hard on Lisa. It was a natural delivery, and Lucas weighed 91/2 pounds. She had needed a blood transfusion.

She was slow to warm to motherhood. But Alejandro plunged right in, having taken care of a daughter from a previous marriage. Every night, he woke up with Lisa at feeding time to change the diaper and rock the baby back to sleep. At dinner, he couldn't bring himself to put Lucas down; he didn't want him to cry.

"You still have to eat!" his mother-in-law would lecture, watching his food get cold.

"I can hold him and eat," Alejandro would insist.

By three months, Lucas was a robust 16 pounds.

As far as their pediatrician could tell, he was fine.

A vital vitamin

The human circulatory system has an elaborate network for repairing itself - whether from major wounds or from the small internal bleeds that are happening all the time, unnoticed, inside our tiniest blood vessels.

The process involves more than 80 chemical reactions. If you draw it as a flowchart, it looks like a plate of spaghetti.

When an injury occurs, platelets stick to the exposed collagen in a torn vessel wall, forming a loose, temporary plug. The plug must then be held in place with a mesh made from a protein called fibrin.

The production of this mesh depends on four clotting factors, which in turn are dependent on a molecular matchmaker known as vitamin K.

The vitamin attaches a sort of chemical trailer hitch to these clotting factors so they can stick in place and accelerate the production of fibrin, said James Harper, a pediatric hematologist at Children's Hospital in Omaha, Neb. This attachment process takes place in the liver.

Babies are typically given a shot of vitamin K at birth, as Lucas was, and later they get it through their mother's milk or formula. Eventually, bacteria in their intestines can manufacture it.

Yet in Lucas' body, his parents would learn, something had gone badly awry.

Emergency

On the morning of Aug. 27, 2002, Lucas was spitting up more than usual, and acted fussy. Lisa thought he seemed lethargic lately, and he'd had diarrhea.

That afternoon, on Lisa's first day at school, her husband sat the baby in his lap and tried to calm him by playing music on the computer. Then he put Lucas down on a bed to rest, and left the room briefly.

When he came back, something was wrong.

Alejandro rushed to a neighbor's house, carrying Lucas in his arms. The baby was barely breathing, his skin clammy and ashy-gray. His eyes rolled back in his head, and milky fluid came out of his mouth.

The neighbor called 911, then tried mouth-to-mouth resuscitation. Lucas vomited. State College police arrived and took over, one officer trying to clear the child's airway and later doing chest compressions when paramedics showed up.

An ambulance took the baby to Centre Community Hospital in State College. His father stayed behind to answer questions from police.

In the emergency room, doctors found retinal hemorrhaging in Lucas' eyes. His fontanel - the soft spot on the head where a baby's growing skull has not yet closed - was bulging, indicating some kind of pressure on his brain. He had no reflexes.

A chest X-ray revealed a fracture in the lower left rib, and what the doctors thought was calcium forming between the ribs and sternum.

It was evidence, they believed, of multiple healing fractures. Evidence of abuse.

They shared their suspicions with police, who searched the family's three-bedroom house that afternoon.

Two days later, a doctor analyzed a repeat X-ray and saw something odd: There was no evidence of calcium formation after all. He concluded that, with the exception of the one fracture, the previous findings were "artifactual" - inaccurate. And later analysis would determine that the one fracture was old - with no connection to the baby's sudden collapse.

But by that time, Lucas had been helicoptered 80 miles away, to Geisinger Medical Center in Danville - home to a level-one trauma center with special accreditation for pediatric cases.

The diagnosis of child abuse was well on its way.

Death and doctors

Physicians coined the term shaken-baby syndrome in the early 1970s to describe a collection of symptoms that included retinal and brain hemorrhages, but not necessarily any external signs of head trauma.

The internal bleeding and other damage are thought to occur from a whiplash effect, made possible because an infant has weak neck muscles and a head proportionately larger than an adult's.

Some researchers and judges have begun to question whether shaking alone - without impact against a hard surface - is enough to kill a baby. This can't be proven by shaking an actual infant, so researchers study lifelike models.

But the mainstream medical view is that shaken-baby syndrome is all too real, and sometimes deadly - the tragic result when a caretaker simply becomes too frustrated to cope with a wailing infant.

One symptom attributed to shaking, called retinoschisis, is said to involve jelly inside the eye that is attached to the retina. If the eye is shaken back and forth, the jelly moves one way while the outer part, including the retina, moves in the other direction.

Blood vessels tear, and the retina is pulled away from its accustomed position, developing unnatural "folds." Some doctors have maintained that such folds can be explained only by shaking; that certainty is now in question.

Two days into Lucas' stay at Geisinger, doctors recorded that he had this problem in his eyes. The rib fracture worried them, too, though tests suggested it was not new. And he was bleeding inside his brain.

The baby's parents maintained a bedside vigil - when they were allowed. Child-welfare officials had decreed the couple could not see Lucas without medical staff present.

As a nurse stood by watchfully, Lisa sobbed at the baby's bedside while Alejandro held a tiny limp hands and kissed Lucas' forehead.

They insisted that no one had abused the baby. That there had to be a medical explanation.

"I know there is a disease that can cause these symptoms," Lisa told a doctor. "I'll need to call Cleveland Clinic to find out."

Geisinger staff considered that possibility. One test looked for a bleeding disorder called Von Willebrand disease. The results of that test were negative.

They also gave Lucas vitamin K - a common practice when coagulation disorders are suspected - though not right away.

Early on his second day in the hospital, Lucas suddenly went downhill. His lungs filled with blood, and his heart rate plummeted. Six hours later, after working to revive him, doctors gave him 1 milligram of the vitamin, and his clotting ability improved somewhat - suggesting he might have a deficiency.

But ultimately, the physicians concluded that only child abuse explained his symptoms. The law required them to report their suspicions to authorities, and they did.

The grim progression of the various doctors' opinions can be seen in their handwritten notations on the baby's hospital chart.

Aug. 27: "Possible shaken baby."

Aug. 29: "Probable shaken baby."

Aug. 30: "There can be no doubt whatsoever that this child is a victim of child abuse."

Three days later, Lucas died.

Awaiting blame

With Lucas gone, Lisa and Alejandro couldn't imagine going back to live in their house in State College.

Lisa took a leave from work, and the couple went to live with her parents in Hartstown, Crawford County, not far from Lucas' grave. On top of their grief, they knew an arrest could come any day.

But the District Attorney's Office in Centre County wasn't sure which parent to blame. Investigators took more than 11 months to make up their minds.

They reviewed the medical records, consulted with doctors, and spoke to people who knew the young couple. They asked Lisa and Alejandro if either thought the other was responsible for the baby's death. Neither did.

Finally, prosecutors took the case before a special state advisory board of medical and legal child-abuse experts, formed by the state attorney general in 1988 to help evaluate cases.

They asked: Did the child's injuries occur while he was in his father's care? Or could they have been inflicted earlier in the day, before his mother left for school?

Members of the board said that whatever had happened, it had occurred on the father's watch.

On Aug. 11, 2003, Lisa and Alejandro went swimming at her parents' house and went upstairs to change.

Suddenly, the police were everywhere.

Lisa's father remembers at least 10 cars: one cruiser at each end of the curved driveway, others in the street, officers with rifles out by the barn.

Prosecutors had taken an unusually hard line: Not only did Alejandro shake Lucas, he meant to kill him.

Alejandro was arrested on a charge of first-degree murder.

Lisa was hysterical as her husband was led away. Be strong! she cried out in his native Spanish. But police told her to be quiet, or else they'd arrest her, too.

Alejandro was held without bail. The next month, the District Attorney's Office announced it would pursue the death penalty.

An Amish case

D. Holmes Morton became a doctor to heal children. He never dreamed he'd spend so much time tangling with prosecutors.

Then, two days before Christmas in 1999, Sara Lynn Glick died. The youngest of eight children of an Amish couple who lived north of Harrisburg, the 4-month-old baby suffered from bleeding in her brain and right eye.

When the Plain People have a medical problem, they turn to Morton. He works in a sturdy, wood-framed health clinic that they built for him in the middle of a Lancaster County alfalfa field, where both cars and horse-drawn buggies are parked outside.

Once a pediatrician at Children's Hospital of Philadelphia, Morton was drawn to Amish country by the prospect of treating rare genetic diseases that occurred in these insular communities. The mustachioed West Virginia native would become famous for this work, last year receiving a $500,000 MacArthur Foundation award - sometimes called a "genius" grant.

After consulting with doctors at Geisinger Medical Center, prosecutors suspected that Sara's mother had committed abuse, perhaps shaking the baby in frustration. The girl's seven brothers were placed in non-Amish foster homes, provoking angry disbelief in the Plain community - a group leery of outside intrusion even in normal circumstances.

Despairing, Sara's parents asked Morton to take a look. Because of the bleeding, the doctor wondered if the child had had a clotting disorder, perhaps due to a lack of vitamin K. If so, the baby's blood would contain abnormal proteins that would otherwise have been used up in the clotting process.

So Morton sent a sample of the baby's blood for a test called PIVKA-II - protein induced by vitamin K absence.

In a healthy person, PIVKA-II levels are at or close to zero, as measured in nanograms of the protein per milliliter of blood.

Sara's level was over 100.

Morton then enlisted the help of Lucy Rorke-Adams, a renowned neuropathologist at Children's Hospital of Philadelphia. She examined the pattern of bleeding in the baby's brain, and concluded it could not have been caused by shaking.

The doctors suspected the real problem was a disorder in the baby's liver, which would prevent her from using vitamin K, meaning she could not make use of key clotting enzymes.

Morton called on Charles Hehmeyer, a Philadelphia lawyer who represented children with metabolic disorders. He agreed to represent the Glick family without pay.

In a closed-door hearing, Morton convinced prosecutors that the facts did not support a diagnosis of child abuse. Sara had died of a vitamin K deficiency and a rare liver disease.

It took months, but in the end, Sara's parents were not charged, and her siblings came home.

For Lisa and Alejandro, the wait would be much longer.

Seeking a fighter

Every day her husband was in jail, Lisa prayed for help. She visited him repeatedly, sometimes with relatives in tow, despairing as she thought of him surrounded by robbers and drug dealers. She flew to Costa Rica to beg officials there for help. She started a "Free Mendez" Web site, and someone made up Free Mendez lapel pins, which family and friends wore to a preliminary hearing.

But she needed more than pins. She needed ammunition, so she began a daily routine of searching the Internet.

Lisa found a California toxicologist who agreed to review the case. He concluded Lucas had died from a variety of factors, including an adverse reaction to vaccines. Prosecutors did not place much stock in his report, nor did Alejandro's attorneys.

One attorney started to pursue a medical defense but withdrew after the couple disagreed with him on strategy. The court then appointed two attorneys because the couple could no longer afford to hire their own, having sold their house to help pay more than $40,000 in legal and expert fees.

Aware that prosecutors had initially suspected the baby's mother, the court-appointed attorneys urged Alejandro to save himself by pinning the blame on her. He refused.

Back at home, Lisa fixated on one promising detail in the toxicologist's report: Six days after her son died, when doctors and prosecutors were already convinced it was a homicide, the hospital received the results of a lab test that had been done in Colorado.

It was a PIVKA-II test. The lab said a normal value would be between zero and 3.5. Lucas scored a 22.7.

Lisa did more online research, and she learned about another case in which the test had played a key role: the death of Sara Lynn Glick.

She read about Morton, the doctor who had helped the Amish family, and tried to reach him by phone. No luck. Months later, in early 2005, still doing research, she came across the Glick case again - and noticed something that chilled her.

Lucas and Sara had died at the same hospital.

Lisa decided to contact Morton again, only this time, she wrote him a letter. Within days, there was a message on her answering machine.

It was Morton, speaking in the West Virginia drawl that she would come to know well.

She called back.

The doctor said: "I want everything overnighted."

A legal gamble

At a glance, Holmes Morton and Charles Hehmeyer don't seem to have much in common. An amateur pilot, Hehmeyer wears suits and handles multimillion-dollar medical-malpractice cases from his Rittenhouse Square office.

Morton favors the tweed-and-bow-tie look, sometimes jeans, and likes to ride the two miles from home to his country clinic on his white 10-speed bicycle.

But both men are blunt-spoken, with a fondness for lost causes. And when they believe they are right, both are as unyielding as granite.

The two met on a case in the late 1990s, then worked together again for the Glick family. When Morton learned about Alejandro, he turned to Hehmeyer, who agreed to take the case pro bono, as he had for the Amish family.

On the medical side, again Morton sought the expertise of Rorke-Adams, the prominent neuropathologist from Children's Hospital.

Hehmeyer and a colleague, A. Roy DeCaro, made a motion in Centre County Court to dismiss the most serious charges. They didn't believe Alejandro should be charged with anything, but at the very least, they saw no evidence of first-degree murder.

Judge Charles C. Brown Jr. agreed, and the death penalty was out. But a charge of third-degree murder was still on the table. If the case went to trial, Lucas' father risked up to 20 years in prison before being eligible for parole.

It was time for a gamble.

The defense team wanted the case to go once again before the attorney general's advisory board - the one whose findings had led prosecutors to arrest Alejandro. Only this time Rorke-Adams and Morton would present the facts.

But the committee hears cases at the request of prosecutors; defense attorneys are not even allowed in the room.

DeCaro, a former federal prosecutor, said it was a bad idea, but Hehmeyer wanted to go for it.

"It was either extremely enlightened or extremely dumb," Hehmeyer said.

Assistant D.A. Lance Marshall considered the request. He was leery of Morton and viewed him as a media hound, having seen the glowing articles in national magazines about his work among the Amish.

But if the defense wanted to tip its hand before the trial, allowing its medical experts to lay out its theory of the case, why not?

The meeting was on.

The puzzle

A mere shortage of vitamin K is not necessarily enough to kill someone. Nor does having a vitamin K problem mean a child can't be abused - or killed.

Morton knows this. Yet he insists that some instances of suspected child abuse are not what they seem, and not just because of vitamin K.

The Harvard-trained doctor speaks across the country, reminding physicians that certain rare metabolic and bone disorders also can be mistakenly diagnosed. Some are prevalent among his Amish patients, others in the general population.

He is spending some of his MacArthur grant on this quest, and his bluntness has earned him a reputation as a maverick. Some physicians worry that defense attorneys will exploit Morton's views to shield guilty clients, but he is winning admirers.

"He's rocked the boat, which is OK," said David Turkewitz, chairman of pediatrics at York Hospital. "He's doing it for the right reason."

Turkewitz, president of the Pennsylvania chapter of the American Academy of Pediatrics, said he doubted many parents were in prison because a rare medical condition had been interpreted as child abuse. But he credits Morton for hammering the point that some of these conditions are not so rare as was once believed.

Shaken-baby syndrome has been estimated to occur in up to two dozen cases per 100,000 infants. In babies ages 2 to 12 weeks, meanwhile, studies suggest that unexpected bleeding due to a vitamin K deficiency occurs 1.4 to 7.2 times per 100,000 births.

That's about 60 to 300 U.S. babies a year.

"If we send all those parents to prison, that's not very good medical practice," Morton said. "What does our legal system allow? Does it strive to put as many people as possible in jail so we don't miss any cases?"

Still, the abnormal result of Lucas' PIVKA blood test wasn't enough for Morton to tell if Alejandro was innocent.

Bone and brain

Like most babies, Lucas was given a dose of vitamin K at birth. Later on, babies rely on vitamin K made by the mother's intestinal bacteria and transferred through breast-feeding.

Yet Lisa told Morton that she had taken potent antibiotics for mastitis, a breast inflammation; he figured this had reduced her - and Lucas' - ability to make vitamin K.

Morton and Rorke-Adams spent hours poring over Lucas' records, piecing together how the baby died. They also enlisted a neuroradiologist to look at the brain scans, and another radiologist and a pathologist to look at the rib fracture.

They found some unusual things. There was some evidence of new bone formation, indicating the break was weeks old. But the growth was abnormal: The broken edges of the fractured rib had not rejoined and were rounded.

Morton suspected that the break had happened during delivery, and that healing had been slow because vitamin K plays a role in bone repair. Broken bones during delivery are unusual, but Lucas was a big baby, and the birth was difficult.

In any event, the fracture did not happen the day Lucas' father was taking care of him, an opinion shared by Geisinger physicians. And if Lucas had been shaken hard enough to die, Morton's team felt, the edges of the rib fracture likely would have caused bruising in the surrounding tissue. This did not happen.

Then there was the brain. This was the specialty of Rorke-Adams - a legend in the field, having taught legions of neuropathologists in Philadelphia since the 1960s.

When Lucas was admitted to Geisinger, an initial CT scan revealed thin subdural hemorrhages - blood just beneath the brain's tough outer layer, or dura. A serious problem, and a possible indication of abuse.

But two days later, Rorke-Adams saw, a second scan showed matters had gotten much worse. There was more subdural bleeding, and new areas of bleeding inside the brain, in the frontal lobes.

Moreover, the bleeding in Lucas' eyes got worse after an initial inspection, and his retinas developed folds that apparently were not present upon admission.

Rorke-Adams has testified across the country in child-abuse cases - for the prosecution. This time, she didn't see evidence of a crime.

In her report, she wrote that Lucas' downward spiral after hospitalization was "not consistent" with what she normally saw in an abused child.

She also noted that the baby's liver and lungs had been unusually heavy. Later analysis found iron deposits in both organs - evidence of some unspecified disease, she and the team decided.

Lucas didn't have the same illness as the Amish girl, Sara Lynn Glick, but his liver, like hers, seemed to have trouble absorbing vitamin K. And he had an inadequate supply of the vitamin to begin with.

Rorke-Adams wrote: "It is clear that he died because of the bleeding disorder and hence the manner of death is natural."

Morton went further. With an impaired clotting system, he argued, Lucas' body could not handle the hours of in-and-out pressure from being hooked up to a ventilator. That was why his lungs began to bleed on day two in the hospital, Morton reasoned.

Hospital records showed that Lucas got a first dose of vitamin K at 9 a.m. that day - more than 17 hours after he was admitted, and about six hours after his lungs began to hemorrhage and his heart rate crashed.

The bleeding lessened after the vitamin dose, but by then, Morton wrote, the baby had suffered irreversible brain damage. If the vitamin had been given soon after admission, he contended, Lucas would be alive today.

The impact of the vitamin dose was enough to tell Morton that a bleeding disorder was at work. But there was also the PIVKA-II test, which came back six days after Lucas died. It's an unusual test, performed by only a few labs in the country, and it takes time.

But it is considered the most specific way to pinpoint a vitamin K problem. Clearly, Morton wrote, Lucas had a problem.

"The opportunity was missed," Morton wrote. "The infant died of a treatable bleeding disorder."

Lisa had been saying that all along. But she worried that the legal system wouldn't agree.

The showdown

The attorney general's board met in November 2005 in Harrisburg.

Morton and Rorke-Adams presented their case.

Then came Paul J. Bellino, a Geisinger pediatrician and specialist in diagnosing abuse, along with Samuel Land, an independent pathologist who had ruled Lucas' death a homicide.

Committee proceedings are not public. But in Land's written report, he concluded that Lucas had died of blunt-force trauma to the head. He wrote that while there was no sign of external trauma, the hemorrhaging and the rib fracture meant Lucas had been killed.

Bellino's report stated that it wasn't clear if the baby's head had struck a hard surface, as Land concluded, but that the internal injuries had been as bad as those that would occur in a high-speed, head-on car crash. Bellino cited the rib fracture, assorted bruises, and the brain and retinal hemorrhages, which he said cannot occur spontaneously in a child.

"Given these findings, there can be no explanation other than this child was the victim of shaken-baby syndrome," Bellino wrote.

Neither Land nor Bellino was made available to comment on the case. But Geisinger's chief medical officer, Bruce H. Hamory, said in a July 9 interview that he supported Bellino and his hospital colleagues in their findings.

"I'm certain there is a slight tendency on the part of experienced pediatricians everywhere, if there is an error to be made, to err on the side of a report" to the authorities, Hamory said. "And that's because of a concern for the safety of children."

Asked if his Geisinger colleagues might have been wrong, Hamory said the cases of both Sara and Lucas were well within the bounds of what should be reported as suspected abuse, though he said the hospital accepted the district attorney's decision to drop charges in the Amish case.

"I think in any instance, there is always a chance that somebody could be wrong, whether that's Dr. Bellino or Dr. Morton or whoever. That's why, at the end of the day, there is a legal proceeding."

Prosecutors are not doctors, but in cases with little else but medical evidence, they must take their cue from them. The state must make black-or-white decisions when the medical experts may span the spectrum of gray.

"This is such a tough area," said Michael Repka, a professor of ophthalmology and pediatrics at Johns Hopkins University. "You want to do no harm to anybody. Unfortunately, the burden is to report the suspicion and let the authorities straighten it out."

Bellino did not merely report a suspicion. He agreed to be an expert witness, and in his report he made some statements that are not universally accepted - specifically, that intracranial and retinal hemorrhages never occur spontaneously in children.

"People who work in this field will always think about why else do you get bleeding in the retina? And one of those is vitamin K" deficiency, Repka said.

Likewise, spontaneous bleeding in the brain can occur if someone has a coagulation or liver disorder, though it is not usually fatal. It may be triggered by the knocks and bumps of everyday life.

During the closed-door presentation by the dueling doctors, Lisa was a wreck. She waited and waited for Hehmeyer to tell her what had happened. Finally, that night, she called him, but the news wasn't promising. Some committee members hadn't been convinced.

She felt sick.

"I thought they were going to see the truth," she said. "I thought Alejandro was going to be out of jail the next day."

A decision

Yet Marshall, the prosecutor, was wary of going to trial. He would have to prove Alejandro was guilty beyond a reasonable doubt. And he knew Morton and Rorke-Adams were heavyweights.

"The last thing I wanted was Holmes Morton or somebody being able to write in the New England Journal of Medicine that vitamin K deficiency is a legitimate defense for shaken baby," he said.

The next day, Nov. 10, Marshall called Hehmeyer. He was offering a deal.

Alejandro had been in jail for more than two years without bail. If he would plead guilty to involuntary manslaughter, he could go free. It was a big retreat from the state's initial quest for the death penalty.

But the defense attorney suspected his client wouldn't go for it, and upon calling him in jail, found he was right.

"I'm not going to take any deals," Alejandro said.

The prosecution and the defense negotiated some more, and another deal was offered: Alejandro could go free if he pleaded no contest. He would admit no wrongdoing, yet in the eyes of the law, it would be a conviction.

Sitting in his cell, Alejandro mulled it over. If he didn't take the deal, the Costa Rican immigrant would go on trial before a jury from rural Centre County - not likely to be a sympathetic audience, he thought.

So far, a prosecutor and a judge couldn't even get his last name right - referring to him incorrectly by his mother's last name, Vargas, instead of Mendez or Mendez Vargas, in keeping with the Latino convention.

And he was missing his life. His grandmother had died while he was in jail.

Lisa cried when she heard about the offer. She didn't want him to take it; she thought he should stand up for himself. But her father, Ron Mullenax, said: "Lisa, you can't tell him what you want."

"What do you want me to do?" Alejandro asked her, from the jail telephone.

"I can't tell you," she replied. "I'm not the one who's going to spend the rest of my life in jail for something I haven't done."

He decided to take the deal.

Science and the law

Lisa feels many emotions when she allows herself to think about the last five years: outrage, heartbreak, longing for the time when Alejandro would wake up at night with Lucas, gently coaxing him back to sleep in his arms.

One thing she doesn't feel is vindicated.

Her husband is free, and yet he is not.

Alejandro got out of jail Nov. 22, 2005, but two years later, the couple, both 33, are living apart.

Wary of the U.S. legal system, Alejandro moved back to Costa Rica and went to work again at an eco-tourism company. Had he stayed in Pennsylvania, he would have been under court-ordered supervision until his probation ended - just a few weeks ago.

He was here legally before, but worries it would be tough for him to come back even for a visit, given that he has the equivalent of a conviction on his record. And he certainly does not want to live here.

"They took my son, they took my wife, they took everything I had," Alejandro said of his accusers.

Lisa stayed in Pennsylvania teaching so she could save money to move to Costa Rica someday and rejoin her husband. She visits when she can afford it, and had hoped to move there this fall. But that hasn't happened.

It's clear the ordeal has been a strain.

"I don't know if it's going to happen or not," said her father, Ron. "We love him like a son, you know."

Alejandro does not regret taking the deal.

"I didn't do anything," he said, sitting in his parents' living room, a photo of Lucas on top of the TV. And if he had been found guilty, he added, "I would never see the light for a long, long time."

Lisa can't fault him for wanting to be free. But part of her wishes he had taken his chances with a jury.

"What it ended up doing was ultimately making me have - it's awful to say - a little bit less respect for him for selling himself short," she said.

She said she thought others had been wrongly accused of shaking babies, and she stays in regular contact with a network of people who have spouses in prison. She still wants someone to suffer consequences for what happened to her family, some sort of finding that Alejandro did no wrong.

Prosecutor Marshall said that wasn't going to happen, though he said the original first-degree-murder charge - which was not his decision - was a reach.

"We had no evidence of motive," Marshall said. "Why would he want to kill his baby?"

Still, he said there was no chance that doctors Morton and Rorke-Adams were right.

"If I thought they might be right, then we would've dismissed the charges," the prosecutor said. "You've heard the maxim that the simplest explanation is most often the correct one? To me, this kid had all the classic symptoms of shaken baby. That just seemed to be the easiest explanation."

In the eyes of Morton and Hehmeyer, the hospital not only made a mistake and accused a parent of the unthinkable, it did so twice.

"What angers me about this story is that it happened at Geisinger, where it had happened once before," Hehmeyer said. "And what angers me is that the D.A.'s Office did not let him off. They offered him this choice which was not a choice. He lost two years of his life."

Bleeding disorders are uncommon, but emergency-room physicians are supposed to keep them in the back of their minds.

Hamory, Geisinger's chief medical officer, doesn't dispute that Lucas had certain symptoms that an underlying disease can cause. Despite the results of the PIVKA test, he said, the symptoms as a whole spelled abuse.

"It's the constellation of findings," Hamory said.

Most hospitals rarely use the PIVKA test. But Turkewitz, president of the state pediatrics chapter, said he thought Morton's efforts would cause it to become more standard.

"We're learning more and more about the subtleties of vitamin K," he said. "The message is: Every case, you really have to approach it with an open mind."

Medical science is forever shifting, and the answers are not always clear-cut. In forensic science, specifically, research has called into question techniques once unanimously accepted: eyewitness accounts, lie detectors, analysis of arson scenes.

But the judicial system doesn't wait for the messy process of science to reach its conclusion. No one can wait that long, because it never ends. Instead, society requires that science render a yes-or-no answer on the spot. Here, the question was whether science could spare a young family's anguish.

Unfortunately for Lisa and Alejandro, the answer was no.