by Jessica Lussenhop, and photography by Sarahbeth Maney

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In court, Dr. Nancy Harper comes across as professional and authoritative. Often she begins her testimony by explaining her subspeciality: child abuse pediatrics, which focuses on the diagnosis and documentation of signs of child abuse. Her role, she often reminds judges and juries, is solely medical. Whether or not to remove a child from their home, terminate the parent’s rights or, in the most serious cases, charge a caregiver criminally is not up to her.

According to Harper’s testimony, she and her team at the Otto Bremer Trust Center for Safe and Healthy Children in Minneapolis handle about 700 cases of suspected abuse each year. She has testified that 10% to 20% of those wind up confirmed for physical abuse, although it is difficult to determine if these figures are accurate since child protection cases are not public.

When Harper, the center’s director, and her team diagnose abuse, parents and caregivers often struggle to challenge those opinions. By Harper’s own estimation, she’s never been wrong.

“I don’t think I’ve ever had a case where I thought it was abusive head trauma and the other specialist didn’t,” Harper testified in 2023, in the case of a day care provider charged with the death of a child in her care.

The defense attorney in the case pressed her: “Have you ever incorrectly diagnosed a child with abusive head trauma?”

“Not currently to my recollection,” she answered.

But in a handful of cases, judges and juries have found day care providers and parents not guilty of crimes after Harper has testified that abuse occurred, though a verdict cannot necessarily be interpreted as a repudiation of Harper or any other expert witness’ determinations or credibility.

Additionally, two federal lawsuits filed recently accuse Harper of ignoring or even concealing alternative explanations for children’s injuries. And, more broadly, medical and legal experts are increasingly questioning a leading child abuse diagnosis, shaken baby syndrome, which is also known as abusive head trauma.

Harper did not respond to requests for comment. She has yet to respond to either lawsuit. In past court testimony, Harper has said that both shaken baby syndrome and abusive head trauma are considered scientifically valid diagnoses by the mainstream medical community. Any controversy, she has said, exists primarily in the legal world rather than the medical one.

Kathleen Pakes, a former prosecutor who now specializes in the forensics of child abuse cases for the Office of the Wisconsin State Public Defender, said Harper’s claim of never making an incorrect diagnosis strains credulity.

“There is no other specialty in medicine that has zero error rate. None,” she said.

Below are four cases in which Harper concluded there was abuse but courts or juries determined otherwise.

On July 12, 2017, an 11-month-old boy named Gabriel Cooper collapsed in his high chair at the day care that Sylwia Pawlak-Reynolds operated in South Minneapolis. Paramedics took him to Hennepin County Medical Center, where he was declared brain dead a day later.

Harper reviewed Cooper’s medical records and wrote that “in the absence of a well-documented consistent severe accidental injury, non-accidental trauma or abusive head trauma remains the primary diagnostic consideration.” The child, she wrote, was essentially shaken to death. Before any criminal charges were filed, Pawlak-Reynolds boarded a plane for her native Poland to care for her ailing father, according to her attorney. In February 2018, prosecutors charged Pawlak-Reynolds with two counts of second-degree murder, citing Harper’s diagnosis.

According to her husband, Will Reynolds, they did not realize Pawlak-Reynolds was pregnant when she boarded her flight to Poland. She remained there to give birth to their third child, who is now 6, while Reynolds remained in Minnesota with their two older children, who are now 13 and 16. Reynolds said he and his wife have no confidence that she will get a fair trial, and that she fears she will lose custody of their youngest child if she reenters the country. The family has now been separated for eight years.

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