In "The Death of Innocents," just published by Bantam Books, Richard Firstman and Jamie Talan reveal how the undetected murders of five children in one family in the late 1960s and early 1970s triggered a theory about sudden infant death syndrome (SIDS) that has misled the medical world for 25 years.
The book tells the story of Waneta Hoyt, an upstate New York woman convicted in 1995 of murdering her five children, one after another between 1965 and 1971. The book also tells the parallel story of how Dr. Alfred Steinschneider, who went on to become a world-renowned SIDS researcher, used their case as the basis of his theory that SIDS was the result of prolonged sleep apnea, that it could be predicted and prevented with the use of a new device called a home apnea monitor, and that it could run in families.
After studying the last two Hoyt babies, Molly and Noah, in his lab at Upstate Medical Center in Syracuse, N.Y., in 1970 and 1971, Steinschneider presented their deaths--and lives--as evidence of his theory in a landmark paper published in October 1972 in the prestigious journal Pediatrics. The theory triggered the multimillion-dollar industry of home infant monitors. There are an estimated 40,000 monitors in use today, despite the lack of any evidence that they can prevent SIDS. In a commentary about "The Death of Innocents" in the October issue of Pediatrics--the 25th anniversary of Steinschneider's paper--the journal's editor, Dr. Jerold Lucey, writes, "We should never have published this paper."
The following excerpt from the book describes the last days and hours of the life of 2-month-old Molly Hoyt in June 1970. While Steinschneider believed Molly--the fourth child of Waneta and Tim Hoyt--had shown a pattern of prolonged sleep apnea, the nurses who cared for her around the clock had become much more concerned about how uninterested her mother seemed to be in her--and what this might mean about the three children who had died before. Molly had twice been sent home with an apnea monitor--the first baby in the world to sleep with one at home--only to be returned to the hospital the next day by Waneta, who said the baby had stopped breathing. The nurses, increasingly frustrated at Steinschneider's refusal to heed their suspicions, began talking about their fears of what might happen the next time Molly was sent home with her mother.
Though she was by any standard measure a normal, healthy baby, Molly Hoyt had by the first of June spent 51 of her 75 days of life in the hospital. Her psychological well-being was another matter. The Hoyts' visits had trailed off to once every three or four days, and it seemed to the research clinic's head nurse, Thelma Schneider, that the baby was virtually motherless. In recent days, Thelma had been paying close attention to what she felt was a continuing divergence between Molly's physical condition and her emotional and mental development.
She ate well, slept well, and gained weight on schedule. But her rosy cast was giving way to a certain dullness, and Thelma began entering these observations into the record. "Child has little or no affect," she wrote on Tuesday morning, June 2. ". . . Does not smile at people."
Forty-eight hours later, on Thursday, June 4, Steinschneider scheduled Molly for her third discharge. By now, the nurses were speaking more openly about their suspicions. "I just know something's going to happen," Corrine Dower said to Thelma. "One of these times she's going to do it." Corrine was scornful of Steinschneider. "If he had any brains at all he would have seen that she didn't want the baby," she would say years later. "You can tell in the grocery store if a person cares about their child. We were just disgusted with Steinschneider."
For Thelma, talking to Steinschneider about Molly Hoyt had become nearly routine--and routinely fruitless. "Don't you want to know what's going on in that home?" she asked suggestively one day. She hoped he would pick up her signals and start broadening his perspective. The baby's chest was now red and raw from the monitor leads--was this necessary? Of course it was necessary, Steinschneider said--the baby has apnea. "He so believed in what he was doing," Thelma later remembered with high exasperation. "To him this was just a bunch of opinion from nurses."
On the morning the baby was to be sent home again, Thelma tried once more. Steinschneider listened, said nothing. Thelma found it unbearably frustrating that Molly's life hung in the balance, and only Steinschneider had the power to do something to confirm or refute the suspicion. In 1970, that was the immutable protocol of the hospital.
Shortly after noon, knowing that Molly would be going home in six hours, Thelma sat down at her desk and began to write her thoughts into the nursing record, which was by convention a dispassionate chronicle of routine hospital minutiae. "I discussed my concerns for this baby with Dr. Steinschneider this a.m.," she wrote. "At times Molly will not respond to her surrounding at all. . . . She rarely smiles in response to another person. The interaction between mother and baby is almost nil in my opinion."
This, meanwhile, was Steinschneider's note for that day: "Does not appear to have much apnea during sleep and has continued to do well on ward. Will discharge today and plan on readmitting to CCRC [Children's Clinical Research Center] in two weeks."
Early in the evening, Corrine Dower dressed the baby in a pink dress that another nurse had brought in for her. "She was absolutely adorable," Corrine remembered. "And I was livid." She watched as Waneta came onto the ward with Tim and used the phone at the nurse's station to talk to Steinschneider before taking the baby home. Waneta nodded as Steinschneider, who had already left the hospital, repeated his instructions about the apnea monitor she been using at home, and asked her to bring Molly back in two weeks for follow-up.
Joyce Thomas carried Molly onto the elevator, descending the five floors with the baby's mother in silence. She tried hard to keep her composure. So much was unknown, so much unspoken. The mind games confused and terrified her in a way she couldn't articulate--she couldn't bring herself to actually say, as Corrine did, that "something" was going to happen. Coming in for work that afternoon, she'd heard that Molly was going home in the evening. "Oh my God," she thought. Now she was the one carrying her out, putting Molly into her mother's arms.
Tim pulled the car up and Waneta got in. Joyce placed Molly on her mother's lap, then went back inside the hospital and rode the elevator upstairs. She went over to Corrine at the nurse's station, and began to cry. Corrine put her arms around Joyce. "We've done everything we can," she said, the consoling words poisoned by bitterness. "We're just nurses. We don't know anything."
She scribbled a final note in Molly's nursing record: "No apnea noted." Later that night, Corrine looked at the clock over the nurse's station. "I wonder if she's still alive," she said to Joyce.
The next morning, Waneta Hoyt called her mother-in-law and said that her baby had turned blue, and that she couldn't get her to breathe. Ella Hoyt came running to the trailer and found Molly in her crib, lifeless, the apnea monitor disconnected. Waneta called for help, and the emergency siren wailed once again across Newark Valley. Molly had been home from the hospital barely 12 hours.
Three rescue squad members converged at the fire station, piled into the ambulance, and a few minutes later they were screeching out the parking lot and turning the corner at the gas station on Main Street, where one of them saw Tim's brother, Chuck, at work and hollered that they were headed up to his brother's place. They raced up to Davis Hollow and made a beeline to the door of the trailer they knew as well as any home in Newark Valley. Chuck pulled up right behind them.
He dropped to his knees and held his tiny niece. He thought he detected a faint breath. The squad began trying to bring her back, first with mouth-to-mouth, then with oxygen. Waneta went to the phone to call Upstate [Medical Center]. In pediatrics, she reached nurse Polly Fibiger. "Are you giving CPR?" the nurse asked. Waneta said that the squad was working on her. Polly told her Steinschneider would be in any minute. He'd call her right back.
Ann Hoyt, Tim's sister, ran over to the trailer when she heard what was going on. She watched in disbelief as the tableau she'd imagined in her mind the first three times unfolded before her eyes. She saw Waneta off to the side, holding on to a neighbor for support, shaking. Ann had never wanted Waneta and Tim to have this baby in the first place. She saw that Molly was limp. Refusing to concede defeat, the men stayed with her. One of them kept feeling for a pulse. "She's deceased," he said finally. Molly was 2 months and 18 days old.
Arriving at the trailer a little while later, coroner Floyd Angel--a supermarket auditor in his regular working hours--ordered the body removed to the pathology lab at Wilson Memorial Hospital. "Mrs. Hoyt," he said awkwardly, "we need to conduct an autopsy on this child."
Waneta said she didn't want her baby's body cut into pieces.
Angel wanted Molly's body to be autopsied not out of suspicion, but because that was now the procedure with any unexpected death outside a hospital. He was reluctant to go ahead against the mother's wishes, however. He turned to Undersheriff Ray Cornwell, who had also arrived on the scene. Cornwell pressed her on the need for the post-mortem examination, and Waneta relented.
Steinschneider arrived at the hospital 15 minutes after Waneta's conversation with Polly Fibiger, and went right to the phone. Waneta told him that she had bathed and fed Molly early in the morning, then put her in the crib. "I left the room for a minute to get something," she said. "When I came back, her face was blue and she wasn't breathing. The squad came and they gave her mouth-to-mouth. But they couldn't bring her back."
A few minutes later, a chorus of agony--"Oh no! Oh my God!"--erupted at the nurses' station. "I told you she was going to kill her," Corrine Dower told Thelma caustically when she came in later for her shift. She had never been so furious in all her years as a nurse. Thelma was only slightly more circumspect. "There was not a thing wrong with that baby," she said to Steinschneider. "Something's definitely going on here." Again he didn't respond directly. He told her the baby would be autopsied that day. Thelma was anxious to hear the results.
Back in Newark Valley, Ray Cornwell commenced an investigation. Later that day, he completed it. ". . . This is the fourth child lost by these parents," he wrote in a one-paragraph report. "There seems to be a gland problem on the mother's side. This was verified by the family doctor. . . . People in the area spoke very highly of the couple and since the baby had been in the hospital recently for this problem I do not feel a further investigation is necessary other than the post."
As a rural pathologist, Dr. Rudolph Muelling didn't do many autopsies of 2-month-old babies. He had little practical experience with sudden infant death syndrome, an entity that had only recently been named and defined as the death of a baby whose cause remained medically unexplained after a thorough autopsy. Having found no natural disease process after examining every inch of Molly's body, inside and out, and viewing 20 slides of her organ tissue, Muelling decided to consult with a colleague. This pathologist thought the slide of lung tissue contained some cells indicating possible pneumonia. In a case like this, you couldn't go wrong with pneumonia. Under "immediate cause" on Molly's death certificate, Muelling wrote "interstitial pneumonitis, acute." He handed it to Floyd Angel, who signed it as coroner.
Three days later, Molly was buried beside her sister and two brothers in the family plot in Highland Cemetery, a few hundred yards from the house in which her mother had grown up. The day after the funeral, Waneta bought herself a new dress and decided she and Tim should go out dancing. The next day, she told people what a good time they'd had. One of her relatives asked her if it wasn't a little too soon to be having the time of her life. "People deal with grief in different ways," Waneta replied.
Molly Hoyt's death, and that of her brother Noah under nearly identical circumstances a year later, were the basis of Steinschneider's landmark 1972 paper, which suggested not only sleep apnea as the cause of SIDS and the use of monitors as possible prevention, but also that SIDS could run in families. This remains today a widely held belief, though the overwhelming weight of scientific evidence is that SIDS is a random occurrence with no genetic component.
Twenty-five years after Molly's death, in the spring of 1995, nurses Thelma Schneider, Corrine Dower and Joyce Thomas all testified for the prosecution in the trial of Waneta Hoyt. Hoyt was convicted of five counts of murder and sentenced to 75 years to life in prison. Steinschneider is now president of the American SIDS Institute in Atlanta, which he founded in 1983. He testified unsuccessfully for the defense. He continues to defend his 1972 paper, and still advocates the use of monitors as protection against SIDS.