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Munchausen Syndrome  by Proxy

by Walton R. Collins

On a February day seven years ago, Brian Stewart visited his 11-month-old son in a hospital in Lake Saint Louis, Missouri. He waited until the boy=s mother left the room, then injected the baby with HIV-tainted blood.

Or did he?

The prosecutor who tried the case in Saint Charles City, just across the Missouri River from Saint Louis, painted Stewart as a diabolical monster fully capable of the crime. The jury, agreeing, voted to convict Stewart of first-degree assault. The judge sentenced Stewart to life in prison, adding a warning that Stewart would Aburn in hell from here to eternity.@

Then there=s 1987 Notre Dame graduate Joseph I. Murphy, Stewart=s defense attorney, who has an entirely different view of things.

He calls the trial that sent Stewart to prison a grave miscarriage of justice. He insists Stewart was railroaded by a prosecutor who sought to hitch his political star to a high-profile case that would insure his re-election. Murphy maintains that evidence casting doubt on Stewart=s guilt was withheld or destroyed, that the prosecution in mid-trial switched stories about the setting and method of the crime, that the motive ascribed to Stewart made no sense, and that a media frenzy turned the ideal of Ainnocent until proven guilty@ on its head.

He is convinced that an innocent man now sits in Missouri State Prison, and he has filed an appeal that he believes will ultimately free Stewart.

Welcome to the nitty-gritty of America=s criminal justice system.

The Setting

Saint Charles, Missouri=s original capital, is a suburban community of 60,000, 10 minutes from Lambert Saint Louis International Airport and 25 minutes from downtown Saint Louis. Tourist trolley-buses run along Historic Main Street past well-preserved red brick buildings, many of them serving as antique shops (the city boasts 125); the First State Capitol (always capitalized) and Daniel Boone=s Home are among the tourist stops. The new courthouse, by contrast, is a modern, efficient structure where routine trials involve such crimes as robbery, drug possession, driving-while-intoxicated and, now and then, an odd murder case. But nothing much prepared Saint Charles for the kind of international spotlight the Stewart case drew.

Nothing much in his nine years before the bar prepared Joe Murphy for it, either. After graduation from Notre Dame, where he served as editor of The Observer in his senior year, he earned a law degree at Saint Louis University, worked briefly for a private firm in Saint Charles, spent two years in the Saint Charles County prosecutor=s office, then joined in a loose partnership with Ronald Brockmeyer, a veteran Saint Charles attorney and Purple Heart veteran of the Vietnam War. The two lawyers make a Mutt-and-Jeff pair standing next to each other in the courtroom: Murphy is short, Brockmeyer tall.

The hideousness of the alleged crime attracted a level of media attention that gives rise to the phrase media circus. Local TV, national TV, newspapers, wire services, TV shows and checkout-counter tabloids all converged on the Saint Charles County Courthouse and on Murphy=s office, six blocks away. The case also aroused unusual media interest in Britain, and journalists from that country swelled the pack.

Predictably, the case also caught the attention of a fair number of unstable members of the public. Throughout the trial Murphy was accompanied by a bodyguard, and in the courtroom three bailiffs were deployed between him and the onlookers. He was the target of insults in public places and received a few death threats. One day last December he got a package in the mail with a label that read: AScrew You, Joseph I. Murphy.@ Bomb squad X-rays revealed wires and a long object that turned out to be an electric screwdriver, a Christmas present from a Saint Louis business firm.

Murphy did not enter the Stewart case as a court-appointed attorney; he was retained by Stewart=s family. He took the job because he believed C still believes C in Stewart=s innocence. Would he have taken the case if he believed Stewart committed the crime?

Probably not, he says.

Missouri v. Brian Stewart

In 1996 Stewart=s son, then 5, was diagnosed with AIDS, launching an investigation by the Saint Charles County sheriff=s department and the Missouri Department of Health. No evidence was found of two common sources of HIV transmission in children: blood transfusion or sexual abuse, although an expert trial witness would testify that he could not rule out sexual abuse with 100 percent certainty. The police concluded that Stewart was the culprit. Two years then passed, during which no work was done on the case, before Stewart was arrested in April 1998 and charged with first-degree assault. A preliminary hearing in May resulted in the case being bound over for trial.

The trial was conducted in early December. The boy=s mother, identified in court and in the press only as Jennifer in deference to her request for privacy (the child was known only as BSJ), testified that when she returned to the hospital room that day in 1992, her baby was screaming in terrible pain, the kind of pain that the presence of incompatible blood in his body might cause. Stewart, she said, claimed not to know what was wrong with the child.

Some months later Jennifer and Stewart separated, and Stewart was said to have objected to paying child support, claiming he was not the baby=s father. Jennifer testified that he forecasted BSJ would not live past the age of 5. Stewart also was said to have talked about the boy=s disease before it was diagnosed, suggesting guilty foreknowledge.

The prosecution=s case is easy to sum up: Stewart had the knowledge, the opportunity and the motive to infect his son:

Knowledge: He worked as a phlebotomist, a specialist who draws blood, in a Saint Louis hospital, though not the one where his son was being treated for a respiratory disease. He was skilled at using syringes.

Opportunity: He could easily have spirited HIV-infected blood out of the hospital where he worked. He spent 20 minutes alone with the baby in the child=s hospital room.

Motive: He didn=t want to pay child support.

These things add up to circumstantial evidence, at best. There were no witnesses, no physical evidence.

But a lot of cases revolve around circumstantial evidence, and the jury required just eight hours of deliberation before returning a guilty verdict late last December 5, a Saturday night. A month later Judge Ellsworth Cundiff, following the jury=s recommendation, sentenced Stewart to life in prison. The judge said he struggled with the recommendation because he thought the defendant deserved a more severe sentence.

The Defense Objects

Joe Murphy is convinced his client would have walked free if the prosecution had been Amore honorable.@ He talks almost obsessively about the holes he saw in the prosecution=s case and the aggravating instances of missing or incomplete evidence. That doesn=t mean he was surprised by the jury=s verdict. The climate created by the hideousness of the alleged crime and what Murphy considers media bias was such, he says, that the burden was on the defense to prove Stewart innocent, not on the prosecution to prove him guilty beyond reasonable doubt.

He shakes his head about the blown-up photo of BSJ that was displayed in the courtroom C a photo of a boy in the wasting stages of a dreadful disease, a sight designed to arouse strong emotions in the jury box. But if he had objected to the photo, it might have opened the way for the prosecution to bring the child himself into the courtroom, and no defense attorney would prefer that.

Murphy notes the nurses at a station only 14 feet from BSJ=s hospital room on the day of the alleged crime testified they weren=t aware of the hysterical screaming Jennifer testified to. And he recalls testimony that there was no physical evidence that the baby had been injected C no bruises or puncture wounds. The prosecution=s response was to theorize that Stewart must have taken the child into the bathroom, closed the door to muffle his screams, and injected the blood through the baby=s navel where evidence would be virtually impossible to notice.

Murphy wonders why the jury didn=t scrutinize the alleged motive for the crime. AIf you wanted to get out of paying child support,@ he asks rhetorically, Awhy would you do it by injecting a disease that takes 10 years to kill?@ And he wonders why the jury shrugged off the fact that two IV drug users lived in Jennifer=s house, or that a convicted child sex offender lived in BSJ=s grandmother=s house, where the boy often stayed. The drug users testified that they were very careful to keep needles out of BSJ=s reach. AYeah, right,@ Murphy rejoins. AThey were stoned but they never tossed a needle in a wastebasket where a toddler might find it?@ All these people were tested for HIV and found clean, the prosecution declared. But the defense was denied an opportunity to conduct tests of its own under conditions that would eliminate possible tampering with the results.

Murphy concedes the prosecution was successful in spinning theories and playing on the jury=s emotions. ABut theories are not facts, and a tragedy is not a crime,@ he declares.

After the Trial

On every one of the 80 post-conviction days Brian Stewart remained in the Saint Charles County lockup before he was transferred to the Missouri State Prison at Potosi, Joe Murphy visited him. Even on Christmas Day. Murphy continues to visit him in prison, although not as often C Potosi is a three-hour round trip by car, more when traffic is heavy.

Murphy badly wants his client to keep two things in mind: He=s not finished with this case, and he still believes in Stewart=s innocence. AI=ve seen nothing that tells me he committed this offense,@ says Murphy, Aand there are dozens of pieces of evidence that point to his innocence.@

Although the state=s case was prosecuted by a deputy prosecutor, Murphy=s animus is directed at the elected prosecutor, Tim Braun, Murphy=s former boss. It is Braun he refers to when he says the trial was politically motivated to boost re-election chances. As it turned out, Braun was defeated in last November=s election, and that, at least, gives Murphy a little consolation. Many political observers in Saint Charles County think Braun=s strategy of trying the case in the press may have won him a conviction but cost him an election.

Murphy is not alone in doubting the justice of Stewart=s conviction. The case attracted widespread attention in the legal community, and it=s not hard to find attorneys who think it fell short of being proved beyond reasonable doubt. Most believe it goes without saying that Braun's real goal in the case was his re-election. And the general impression among trial lawyers is that Murphy did as good a job as anyone might do, given the handicaps he encountered.

There is no love lost in either direction between Murphy and Braun. In response to pre-trial complaints by Murphy that the prosecutor contaminated the potential jury pool by trying the case in the press, Braun was quoted in the Saint Louis Post-Dispatch: AIf some lawyers take the tactic of trying to divert attention from their client to the prosecutor, then so be it.@ Murphy still believes he lost in part because of Braun=s eagerness to cozy up to a press morbidly fascinated by the case; among other venues, the prosecutor turned up on the Today show. In contrast, Murphy avoided the media limelight; this story represents the first time he has consented to being interviewed about the case.

Now he wonders if reticence was the smart tactic.

Who Did It?

Joe Murphy doesn=t claim to know how BSJ was infected with HIV-tainted blood, or when, or even if. He=s convinced, though, that Brian Stewart didn=t commit that act in 1992 in his son=s hospital room. He is equally convinced that the prosecution purposely avoided exploring alternative explanations, among them the child=s contact with known intravenous drug users and a convicted child molester. And he questions the validity of tests showing those people to be HIV-free.

He suggested during the trial an alternative theory, albeit a bizarre one. There is a medically accepted entity called Munchausen Syndrome by Proxy (MSP), a form of child abuse in which a parent or adult caretaker fabricates a physical disorder in the child as a way of winning sympathy as the child=s protector. In such cases, a mother may claim her child is sick, or may even cause a sickness. The Adevoted parent@ then continually seeks medical treatment for the child, basking in the sympathy others have for her Aordeal.@

Murphy points out that Jennifer, like Stewart, had a job that gave her access to samples of blood. Though he stops short of suggesting that Jennifer was the real cause of her son=s AIDS, it is another of the alternative explanations that, he says, should have been pursued by the prosecutor=s and sheriff=s offices. One characteristic of an MSP parent, he observes, is a constantly sick child, and BSJ was in and out of hospitals and doctors= offices virtually from birth C as an older sister had been before BSJ was born.

At this writing, the Brian Stewart file remains open in Murphy=s office. The motion for appeal is on record and transcripts of the trial are being prepared. The best guess is that the appeal will be heard late this year.

Meanwhile, BSJ is still alive, though perhaps not for long. Jennifer, despite her insistence on privacy before and during the trial, subsequently has appeared on national television under her full name to talk about the case.

As for Murphy, he=s not sure he=ll continue to practice law when the Stewart case is finally behind him. Sometimes he is a bit dazed at where life has deposited him a mere dozen years after graduation from Notre Dame C and a bit uncertain that he wants to spend the rest of his life defending DWI clients.

One thing he has learned about the criminal justice system is that the middle word in that phrase is an elusive thing, because a lot of non-textbook considerations affect any prosecution C the political fortunes of the courtroom players, the quality of police work, the race and socioeconomic status of the defendant, and even physical appearance (several veteran court observers described Stewart as looking somewhat sinister).

And he has become an unapologetic opponent of the death penalty, not so much out of religious or moral convictions as because he is all too aware of how innocent persons can wind up in prison, and even on death row.

Brian Stewart, he insists, is one of those innocent persons. AIf I had any suspicion he did it,@ Murphy declares, AI wouldn=t be pushing this thing any farther. But it=s a simple matter of justice. And I=m mad.@

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