Janice Ophoven flew to the Southern Tier of New York State from the heart of a Minnesota winter on January 14, 1994, and remarked how deadly cold it was. It was one of the things she and a number of others would remember about this pivotal day in the unearthing of the truth about the children of Waneta Hoyt.
Bill Fitzpatrick was too excited to notice the weather. He would recall driving down to Owego with Pete Tynan, walking into a meeting room of the best hotel in Tioga County, the fifty-eight-dollar-a-night Treadway Inn, surveying the assemblage of police investigators, prosecutors, and out-of-town forensic pathologists, and thinking how wonderful it was that all these people were gathered for the purpose of pursuing a case he’d thought about for seven years, and never stopped believing in.
There were sixteen people in all, which probably made this the largest and most momentous strategy session on the subject of crime in Tioga County since the infamous Apalachin Conference in 1957. Simpson brought in his three part-time assistant district attorneys. The senior assistant, George Mundt, a soft-spoken lawyer in his mid-fifties, happened to live and work in Newark Valley and knew the Hoyts. He had once drawn up a will for them, though they never came in to execute it. Mundt also had a memory of Tim Hoyt arriving at his house with a road crew after a prodigious snowstorm in the early eighties and drinking coffee on the porch after the work was done. The Hoyts seemed like nice people to Mundt, though he could not say he knew them well. He made no effort to conceal his shock and sadness about the accusations.
The police were there in force. Courtright called in John Sherman, Sherman’s new partner, Bill Standinger, and three more investigators, two men and a woman, recruited from other parts of Troop C for the expanding investigation. Sitting in for Captain Pace, who was spending these months in Massachusetts working on the widely publicized abduction and murder of a little girl named Sara Anne Wood, was one of the troop’s BCI lieutenants, Larry Jackmin.
Hearing about this case in detail for the first time, some among the group found it unnerving. They had questions—a lot of questions. The answers would come from Janice Ophoven and Michael Baden, and how the doctors responded, in style as well as in substance, would go a long way toward determining where this case went from here. For Bob Simpson, it was the moment of truth. Ultimately it was his call. And he still had the same dilemma that had troubled him from the first: How could the doctors be so sure, with neither conventional physical evidence nor witnesses, that these children were murdered? How could they be sure they hadn’t had some undetected genetic disease? Even if Baden and Ophoven felt the medical records indicated the children were normal and healthy before their deaths, why did that rule out SIDS? Wasn’t that what SIDS was—the sudden, unanticipated death of a healthy baby? These doctors seemed to be making accusations by exclusion, a concept that made some people in this room uncomfortable. The investigators were trained to be suspicious by nature, but they were also trained to seek evidence that was positive and physical, not conceptual. For now, therefore, it was necessary for them to direct their skepticism not at the supposed perpetrator but at her accusers. One thing was clear: If it took all day, which it would, Simpson wanted the meeting at the Treadway to end in resolution. Either the group would buy homicide or the case was over. And if they did buy it, the next step would be an extraordinary one. There would be no turning back.
Four long tables were arranged in a square so that the participants could see one another. At the front of the room was a blackboard; a fireplace flickered in the background. Baden was late, which was not unusual for him, so Ophoven would be the first of the medical experts to speak. She came in knowing she had some persuading to do, but she was unworried. She understood the dynamics of the relationship between forensic science and criminal science. As she scanned the faces of the investigators and prosecutors in the room, she could almost read their minds. The look she saw was the kind she’d seen a hundred times before. It said: Prove it to us. Tell us why it would be a responsible thing to go up to this little town in the hills, look Mrs. Waneta Hoyt in the eyes, and ask if she is a mother who killed her babies all those years ago.
OPHOVEN: It was really a police thing. It was like Simpson was chairing a committee that was going to decide whether or not there was anything here that would provide the critical mass to do this amazing investigation. They wanted to know what I thought, and I told them. Then they just started firing questions at me: “Are you telling me twenty-five years later that you could go into a court of law and testify that these people were murdered? On what basis?” For them it had to do with learning about apnea and about this thing where people kill their kids and pretend they have disease. And there was a lot of skepticism, either real or affected. The questions became quite pointed. And what I said was in my years of evaluating the deaths of children, there is one underlying concern that, when it presents itself, is very worrisome, and that is when there is a dead child and the story doesn’t make sense. And that is as compelling for the diagnosis of foul play as if I were to find cancer cells. When the answers do not make medical sense then you would be making as serious a mistake not considering the possibility of foul play as it would be to say, “Oh, I just really don’t want to call this cancer. Just think about how the family’s gonna feel.”
Here, of course, were not one but five dead children, and in Ophoven’s judgment the stories given for at least four of them made no medical sense. In the weeks before the meeting, she had performed the final tasks that confirmed her original diagnosis. She had peered into her microscope at sections of tissue taken from Noah’s and Molly’s organs—their hearts and lungs and kidneys, the thymus, thyroid and parathyroid, the trachea, aorta, spleen, liver, esophagus, appendix, large intestine, stomach, pancreas, adrenal glands, ureter, bladder, muscle, spinal cord, lymph nodes, bone marrow, and skin—and found no evidence of any lethal disease. Put together with the narratives of the autopsies found in the files at Upstate and Wilson Memorial hospitals, the tissue sections provided as accurate a look at the babies’ bodies as if Ophoven herself were in the pathology labs on the afternoons of June 5, 1970, and July 28, 1971. A central precept of autopsy requires that the body and its organs be methodically, thoroughly, and neutrally described so that a hundred years later, it would be possible for a pathologist to make a diagnosis, even a diagnosis different from the original, based on that objective description. This was a point Ophoven, and later Baden, stressed: Taken with all the other circumstances, the autopsies, if competently described, could allow them to rule out natural causes.
As she said she would, Ophoven had also showed the voluminous Upstate records to an infant apnea specialist in Minnesota, Dr. Stephen Boros. He had found no evidence that either Noah or Molly had an apnea problem. What he saw was that for weeks on end, the nurses and doctors, including Steinschneider, kept meticulous medical diaries of babies who were utterly normal.
OPHOVEN: The histories for Molly and Noah reported very devastating episodes of apnea, precipitating emergency reactions, that were never validated in the hospital. Neither baby had episodes of anything that remotely resembles true apnea. And they both ended up dead. And then with the other three having no explanation, the probability is that all these children died for the same reason. One of the investigators said, “Well, how would you counter all these death certificates?” And I said, “They’re not right. And you may want to think about revising the death certificates, because based on today’s world, a couple of them, James and Julie, just don’t make any sense at all. And you might want to revise Molly’s and Noah’s as well.” Both of their autopsies had suggested there was something wrong with their lungs. This was based on the tissue sections, which did have descriptions around the lungs. But neither one of them described a fatal pulmonary disease. You could tell they were reaching when they filled out the death certificates. In those days it was not uncommon to just sort of pick the thing that was most wrong and call it that.
What I wanted to get across was that this was a different set of dynamics and different kinds of folks than you find in the traditional chronically tortured or habitually abused child. This is just a much more complex, smarter kind of deal. It takes a pretty crafty individual to outsmart everyone—to understand and use the medical dynamics to get people to draw conclusions about your child when it goes against the actual facts. And it made sense when you read the charts. If you looked at the history as it was being given, it got increasingly sophisticated over the years. In the earlier years it was a little bit primitive, kind of simple explanations, and then by the time you got to Noah, the history seemed to be fairly full of complex things. You could take the point that she figured out what Steinschneider needed and gave it to him. Traditionally, the by-proxy form of child abuse is very sophisticated, very compelling, very believable. If you get into the Munchausen literature it’s amazing the kind of stuff that people are willing to do to children. And the part that’s so hard is we become an instrument of abuse. Oh, Lord, we put a child in a sterile environment, we stick needles in him, we test him, we do operations on him. I had a case where the child had been admitted to the hospital something like 220 times by the time he was eight years old, and he had literally dozens of operations on his head and his nose, and there was nothing wrong with him at all. It’s an amazing dynamic. I told the police at this meeting about the tapes we had seen, surveillance tapes of children being suffocated by their parents while in the hospital. And the police were saying, “Are you kidding? You’ve actually seen people do this in the hospital? You’re not making this up?” I think until you see one of these tapes, it’s really hard to believe. So that’s why I thought they needed to know what kind of person she was. That was going to be an important piece. Is she of reasonable enough intelligence to have the capacity to pull this off?
Baden came into the room like a gust of wind, momentarily drawing attention away from Ophoven. Courtright had made a point of calling both medical examiners some weeks before to let them know the other was involved. But he hadn’t made Ophoven’s special credentials clear to Baden, or perhaps Baden, forever distracted, wasn’t paying attention and only heard something vague about a doctor from Minnesota. So as she spoke, Ophoven sensed that Baden was a little edgy at first, looking at her as if skeptical of who she was and what qualified her to be here. “To the point,” she recalled, “where I felt Simpson had to interrupt and kind of say, maybe we need to redo the introductions here: Dr. Ophoven is a forensic pediatric pathologist, trained with Dr. Coe in Minnesota. And then Baden kind of went, Ohhhh. I think he thought I was a pediatrician coming in and talking about pathology. He lightened up and pretty soon we were a team.”
BADEN: I drove up from the city, and I remember snow. It took me a long time to get up there. There was a very supportive feeling that Ophoven, from her perspective, and I from mine, had both independently reached the same conclusions. Second opinions are just as needed in forensic pathology as in surgery or internal medicine. I think I prefer that, especially if you have an expertise in that area. What sometimes happens is you get a dermatologist coming in as a friend of the family to see if the autopsy is done right. I was impressed with Ophoven, so I had no turf problems. I knew that before the district attorney was going to proceed he had to be satisfied in his own mind he really had a case, and that it was a provable case. I thought Ophoven gave a very good presentation and analysis of the whole thing. Simpson was listening—everybody was listening.
FITZPATRICK: I had kind of taken for granted that everyone was as convinced as I was, and I began to realize that this was not the case. And you’re certainly not going to find a more favorable audience than a roomful of law enforcement people. Jan Ophoven did a magnificent job of very quietly, patiently explaining why these were murders. And I thought: Bob’s come up with a real diamond in the rough here. She’ll be very effective in front of a Tioga County jury. She’s not Madison Avenue Mike Baden. Baden’s like me, from New York City, and I just love listening to the guy talk. He always looks like he’s just run a marathon. But you’re talking about country folks, people who might know Waneta Hoyt, might even have known about the deaths of the babies. I mean, every time a waitress would come into the room, we’d be quiet. And you think, geez, it really is a small community. You don’t know who the waitress might be related to.
Baden and Ophoven each went through the lives and deaths of the five children, hoping to impart, as clearly and specifically as possible before moving on to the next point, why they thought each one had been murdered. They used the blackboard as a visual aid.
Eric: Dies suddenly at three months. Interviews with the parents during the care of Molly and Noah reflect conflicting stories: “no apnea” and “episodes of apnea,” and died with blood coming from his nose. Death was attributed to congenital heart disease but this was never medically evaluated and no autopsy was performed. Viewed in the context of the other four, Eric’s death is highly suspicious.
Julie: Dies suddenly at two months. Death attributed to “choking” on milk or rice cereal. This is not an adequate explanation for cause in an otherwise healthy infant—children don’t die of strangulation from a bottle feeding. Rather, they would aspirate the food. No autopsy was performed.
James: Dies suddenly at two years after “calling out.” Autopsy, though not available, reported in later records to have found no cause of death. This child is also reported to have blood coming from the nose and mouth, indicating trauma and likely suffocation. Age and circumstances—including its timing just three weeks after Julie died—make this death especially suspicious.
Molly: Dies suddenly at two months, the day after discharge from hospital. Death certificate lists “acute interstitial pneumonitis” and “coarctation of aorta,” but examination of autopsy report and tissue slides refutes these conditions as causes of death and fails to provide any medical explanation for the death. Review of medical records does not confirm a life-threatening apnea problem and is more consistent with “factitious” apnea, or Munchausen syndrome by proxy. Reports of cyanosis, or turning blue, are not consistent with SIDS.
Noah: Dies suddenly at two months, also the day after discharge from hospital. As with his sister, there is no evidence of a life-threatening medical condition, nor would the hospital have sent either baby home with a serious infection. (Infections of the sort described on the death certificates, even if present, could not have killed so rapidly.) Autopsy does not provide a medical explanation for the death. Once again, cyanosis is more consistent with suffocation than with SIDS.
There were a couple of other things both doctors wanted the police and prosecutors to understand. If these deaths occurred now, the absence of autopsies and/or full-scale investigations would preclude the SIDS diagnosis. And finally, there was the big picture: The odds against five infant deaths in one family in six years, with no suggestion of a genetic condition, were virtually incalculable.
OPHOVEN: What they needed to do now was a competent death investigation. That was the missing piece. If I’m the medical examiner and I’m looking at these cases, I need a death investigation and I need it now. You need to ask clear and detailed questions about the health and well-being of the kids, get details of their lives and details of the events and get the stories from the parents. Because you need to know that I’m very worried that without additional information the only plausible explanation is homicide.
SIMPSON: I was absolutely fascinated with Baden and Ophoven and what they had to say. And we hammered away at the issue from all sides. There was a lot of skepticism there: How do you know this? How do you prove it? Why couldn’t it be something else? We talked about all these things you don’t look at until somebody force-feeds it to you. We talked about SIDS, what it is and what it isn’t. And we talked a lot about apnea, and that apnea is normal. If you read the medical record you say, My God, these kids had apnea, how did they live so long? And once these doctors explain to you what these medical records mean and don’t mean, then you’re looking at them and saying, Why in the hell didn’t somebody figure this out twenty-five years ago? Well, probably the climate wasn’t right for an investigation. Even when I got into this, I’m thinking, who am I to question Dr. Steinschneider? Who was Floyd Angel [the county coroner who signed Molly’s death certificate] to question Steinschneider? Hell, back in the seventies, just think about what would have happened if somebody became really suspicious. Steinschneider would have taken care of them in a hurry.
Steinschneider. He was the unseen but pervasive presence in this case, at this meeting. Who was Alfred Steinschneider? What were his responsibilities? What were his motives? Did he know more than what he had put on paper? All the key players on the Hoyt task force had seen the influential 1972 article—it had been included in everybody’s package of records—and though they were far more concerned with its subject than with its author, for some the heart of the matter always came back to Steinschneider, and to the inevitable question of how two murders could have occurred virtually under his nose. Given what came later, did he benefit by failing to notice?
Fitzpatrick, for one, wasn’t sure whom he reviled more, the mother or the doctor. Linda Norton’s reading of the 1972 paper had always left her with the conviction that Steinschneider bore some responsibility for allowing the last child, probably the last two, to be killed—the casual “isn’t that curious?” attitude taken to appalling extreme. Fitzpatrick embraced this view passionately. The language and methods of Steinschneider’s study suggested he saw himself more as a research scientist than as a doctor with patients, and to Fitzpatrick this raised questions of basic medical obligation. “I always felt that M.H. and N.H. were the most egregious because now they are under the care of a doctor,” he said. “And I’m a new father. And what’s going through my mind as I’m reading the medical records is I want to reach back in time and save them. I had thought about Noah for a long time. I had every day of his life in front of me. He was the one who didn’t have to die. Who shouldn’t have died. Steinschneider may have thought he was doing great research, but his responsibility was to his patients. And his patients are dead.”
From her first reading of the hospital records, Janice Ophoven also felt that Noah could have been saved. “The fact that Molly’s case never validated these apnea episodes and she ended up dead left the devastating awareness—because I have these two cases sitting here—that Noah’s death was clearly preventable. And that’s made me sad.” She tried to be charitable. She wondered if Steinschneider, intrigued by SIDS and confronted by a family with an arresting history, had gotten a little overexcited at the prospect of solving one of the great mysteries of medicine—of cracking the code. Perhaps he saw in the H. family not a cause for alarm but an opportunity for science—a regrettable but honest misjudgment.
But then Ophoven reminded herself that Steinschneider had gone on to become a classic name in SIDS. He now ran the American Sudden Infant Death Syndrome Institute, a clinical research center he founded in Atlanta in 1983. He knew what SIDS looked like. He had to have seen that the children in this family were dying in all kinds of strange ways. Was it a case of a zealous researcher’s naïveté, or something more disturbing? Ophoven found troubling evidence in the comparison between Steinschneider’s article and the hospital records. “The paper has a slightly different slant than you’d get from reading the medical records,” she said. “We pride ourselves in giving a clinical history that’s based on a neutral assessment of the facts. This paper just doesn’t feel so unbiased. It’s very biased toward these being very sick kids. And when you look at the cases, they just don’t look like very sick kids.”
Like Linda Norton, Ophoven found herself absorbed by the medical and scientific undercurrents of the Hoyt case. The apnea theory that Steinschneider put forth in his paper had profoundly influenced the way the world viewed SIDS for two decades. The paper itself had been quoted nearly four hundred times in research and medical journals, and the thriving industry of home apnea monitoring had been conceived as a result. Now, a roomful of doctors, detectives, and prosecutors were discussing whether the babies who started it all actually stopped breathing more often than any other babies. It was science that the Nobel Prize—winning biochemist Albert Szent-Györgyi was thinking about when he remarked that “discovery consists of seeing what everybody has seen and thinking what nobody has thought.” But his observation could be applied to crime as well as to science—and now to both at once. It was not the purpose of this investigation to probe the methods and consequences of medical discovery, but it was intriguing to consider the ramifications of the day, nearly twenty-four years before, when the research doctor and the young mother from the rural hills first crossed paths.
When the subject of Steinschneider came up, Fitzpatrick told the group about the phone call he’d made to Atlanta six months before. He had made a careful record of the conversation.
“This is Dr. Steinschneider.”
“Doctor, I’m the district attorney here in Syracuse, your former hometown. I’m calling about a case that you may be able to help us with. Do you remember the Hoyt family?”
“I’m sorry. I can’t discuss patients without their permission.”
“Well, can you talk to me about the family you wrote about in your article in Pediatrics in October of 1972? The H. family?”
“I can’t tell you the name of the family in the paper.”
“Do you have any notes that you saved, relative to your interviews with the family?”
“No, that would be confidential. Who did you say you were?”
“I’m the district attorney of Onondaga County.”
“This was thoroughly reviewed back then.”
“I was just calling to see if you had any additional information.”
“They were a very nice couple, very supportive of each other, as I remember. I think he worked in construction and she was a housewife. These were all very tragic occurrences.”
“Well, didn’t it seem a little peculiar to you, five children dying one by one?”
“First, let me say, there is a lot of evidence that SIDS recurs in families. All these cases were thoroughly reviewed, and the autopsies on the last two babies revealed no evidence of foul play. The last child had several life-threatening episodes while under observation in the hospital. And after he died, I believe they went on to adopt a baby.”
“Are you familiar with Munchausen syndrome by proxy?”
“Yes.”
“And?”
“I’m familiar with it.”
“Didn’t it strike you as odd that all these things happened to all five of these children only when their mother was around? Don’t you think some-body else would have seen episodes of breathing difficulty?”
“As I said, the babies I studied had life-threatening episodes in the hospital.”
“Is that right? Well, didn’t it seem strange that they all died in the presence of their mother?”
“There’s only three possibilities. It would happen in the presence of the mother, or the father, or both.”
Hearing Fitzpatrick describe Steinschneider’s defensiveness, there were few doubts among those at the Treadway what role the doctor would and would not play in this case. Though in all likelihood he knew more than anyone except the Hoyts themselves, Steinschneider was probably the last person the investigators could count on for help. Then as now, it seemed, he had his interpretations—his agenda. For them, however, Steinschneider’s attitude was beside the point. What mattered was that these cases were now indeed being “thoroughly reviewed.” The momentum of the meeting was shifting. A hurdle had been cleared, a line crossed.
OPHOVEN: There was a great deal of feeling in there about what they were getting ready to do, and concern for the family. It’s not like they wanted to run in there and raise this question to a family that could have suffered five horrendous tragedies and had this very difficult life. I had the strong impression that they felt that, even though they had the authority to go in and ask questions any time they wanted to, if there was any way not to do it, that’s what they wanted to come out of this. But by the end I think they had what they needed. It’s interesting how the police do this. It’s like they almost have two personalities in these cases involving parents and children. The first one is “I’m skeptical. Let’s not accuse people of things we shouldn’t.” But once they believe that murder is likely, they move into a different way of thinking. It’s a bit more peaceful, like they’re getting ready to move. And near the end, Bob Simpson wanted to be absolutely sure and he said, “Let me get this straight one last time. Give me the cause and manner of death in each of these cases.” And he would say each of the children’s names and Mike and I would sort of say it together, in a very clear and dramatic way:
Eric: Homicide.
James: Homicide.
Julie: Homicide.
Molly: Homicide.
Noah: Homicide.
SIMPSON: I asked a few questions, but I didn’t say a whole lot. I just listened. And what they had to say made so much sense to me when taken in conjunction with the medical records that I was convinced that Mrs. Hoyt had suffocated these children. And I decided by the end of that meeting that we were going to go ahead with the prosecution. I don’t know how a big-city D.A. would look at it, but sometimes you make decisions that you just know are right. I think of it more in terms of what do I think of myself, not what the voters are going to think of me. I think the five kids deserved that.
The meeting broke up into the bar at the Treadway, one of the cozier spots in Tioga County in this harsh winter of 1994. In the darkness beyond the windows at the far end of the bar, the headlights of the cars and pickups traveling Route 434 across the freezing Susquehanna River passed like searchlights in the pitch-black night. Fitzpatrick, Tynan, Ophoven, and some of the state police investigators had a few beers at the bar, and as they talked and drank, there was an undercurrent of relief and anticipation. Fitzpatrick felt a kinship with Ophoven. He liked the strength of her convictions. “Fascinating cases like this don’t come along that often,” he’d say later. “It’s exciting, and that’s what we do.” Though the two of them had no small stake in what was to come, they also had the luxury of detachment. They neither lived nor worked in this county; in this case they were advisers, instigators. Ultimately, though Fitzpatrick wished it were otherwise, he was a spectator.
Bob Simpson and Bob Courtright, meanwhile, went home that frigid night and thought about what lay ahead. They lived here. Before the spring thaw, they knew, their actions were likely to change a good number of lives, in Tioga County and far beyond.