Eli H. Newberger, M.D. 92 Evans Road Brookline, MA 02445 Telephone 617-232-7908 Email: newberge(almassmed.org FAX 617-731-1897 May 30, 2011To whom it may concern:Re: Mila Malenko (date of birth 11/29/2006)I am Eli H. Newberger, a physician licensed to practice in the State of Massachusetts, AssistantProfessor of Pediatrics, Harvard Medical School, and Adjunct in Pediatrics, Childrens HospitalBoston.My Curriculum Vitae is attached to this affidavit.The expertise that I bring to this matter derives from my four decades of practice and research asa pediatrician at Childrens Hospital Boston, where I organized its first child protection team inSeptember 1970 and served as its medical director for 3 decades. Important in my consulting rolewas distinguishing inflicted or abusive injuries from congenital conditions, including birthmarks.I also founded and directed the principal out-patient clinic for victims of abuse and neglect atChildrens Hospital, the Family Development Clinic, from November 1972, to December 1999.Over the first decade, this clinic became a principal referral source for the Massachusetts Probateand Family Courts for interdisciplinary assessments of child abuse, child sexual abuse, anddomestic violence in the face of custody conflict. In the subsequent two decades, we receivedapproximately 20 referrals for assessments of the validity of disclosures and examinationartifacts suggesting child physical and sexual abuse from the family and criminal courts andchild protective services agency offices across the State of Maine.Apart from my current teaching at Harvard Medical School, I am often called on to teach onchild development, and the clinical diagnosis of child abuse, and child sexual abuse at local,state, and national conferences. In Maine, over the course of 40 years, I have presented at leastfive keynote addresses at regional and state conferences on child abuse and pediatric andobstetric grand rounds at Maine Medical Center in Portland and Eastern Maine Medical Centerin Bangor. The obstetric conference focused on the frequency with which child abuse anddomestic violence co-occur and the elevated risk of physical and sexual child abuse jf a mother isa victim of domestic violence.My colleagues and my research on this issue was propelled by multiple clinical encounters withmen who abused both children and their mothers. It led us in 1986 to start in my clinic the firsthospital-based battered womens advocacy program in the U.S., called AWAKE (for advocacyfor women and kids in emergencies). This program continues at Childrens Hospital Boston and
is recognized as a regional service model by the New England Conference of Child WelfareConmlissioners and Directors and as a national model by the U.S. Department of Justice. It hasprovoked both advances in medical and hospital diagnosis and women and childrens protectionand, pertinent to Mila Malenkos case, efforts across the region to incorporate into childprotection work supporting battered mothers to protect themselves and their children.This experience also led me to write my book, "The Men They Will Become: The Nature andNature of Male Character." (Perseus Books, 1999) The book has been favorably received byprofessionals and parents alike and remains in print in a paperback edition.I have reviewed extensive materials related to Mila Malenkos health and behavior, includingpediatric records and conesponding photographs of injuries, the evaluation of possible sexualabuse by my colleague Lawrence Ricci, M.D., and his associates at Maines renowned Spurwinkprogram, and the affidavit dated May 26, 2011, by Carl Baum, M.D., the director of the Yale-New Haven Childrens Hospital Center for Childrens Environmental Toxicology on thesignificance of the Milas urinary methamphetamine level of 56 ng. per ml. on April 6, 2010.It is my understanding that a high-level conference is to take place tomorrow to review the statusof Milas case. I was asked to provide pediatric diagnostic support to the decision-making at thismeeting by Milas mother, Lori Hanrahan and by her retained private investigator, StephenPickering., a retired Maine State Police Detective. Because of the press of time and the abundantcorpus of previous expert recommendations, I will focus my opinions on Milas recent headinjury observed and photographed on March 27, 2011, and the aforementioned history ofmethamphetan1ine and domestic violence exposures.The head injury, characterized that day by an emergency room physician as "a small ecchymoticbruised area on the center of the forehead with no obvious hematoma," is evident on the sixphotographs I have reviewed. The term "ecchymotic" refers to the presence of blood beneath theskin. The term "hematoma" refers to a collection of blood in a tissue swelling that can beperceived visually and/or by palpation.In order to receive such an injury, the skin must be suddenly compressed from the outsideagainst the hard bone beneath. Such a forcible process is necessary to squeeze blood from thetiny vessels within and beneath the skin. Here, there is a consistent quality of discoloration thatdoes not confornl to any specific inlplement. It is, however, entirely consistent with Milasdisclosure that she was struck on the forehead by a frying pan wielded by her father, IgorMalenko.In recorded conversation with her mother about this injury, Mila disclosed that she was told tosay that the injury was a "birthmark:"Lori: "What was the thing on your forehead?"Mila: "It was just my birthmark."Lori: "Did someone think it was something different?"Mila: Shakes head no.Lori: "No?"
Lori: "Did somebody tell you to tell me that?"Mila: "No but it was just my birthmark. Poppa told me it was just my birthmark."Lori: "Poppa told you what was your birthmark?"Mila: "The ... remember that thing I told you about with the metal panTLori: "No. Can you tell me again. I cant remember."Mila: "When I said that Poppa hit me with a metal pan."It is my understanding from an email communication with Ms. Hanrahan, that Mr. Malenko hasseized on her seeking an assessment of thjs injury to terminate Milas visitations with her, inorder to protect Mila from further "false allegations."Opinions:With regard to the urinary methamphetamine findings, I concur with Dr. Baums [mal statement(pp. 3 - 4): "In conclusion, based on my experience, knowledge, and expertise in evaluating,diagnosing and treating children exposed to illegal drugs, this childs methamphetamine levelwarrants an in-depth investigation by Child Protective Services and perhaps also by the localpolice. Indeed, Child Protective Services should have initiated an investigation when this reportwas received over a year ago."To Dr. Baums strong comment, I would add that current knowledge on the effects ofmethamphetamine use on adults protection and care of children, as methamphetaminecommercialization and use wreaks havoc on families and communities in a broad swath of thecountry, pertains directly to Mila. In a few words, the pertinent finding is this: the disinhibitingeffects of the substance on men is frequently expressed in physical and sexual violence againstchildren and women. Sexual and angry impulses that might otherwise be controlled arechanneled into direct attacks on intimates and others, often with severe impacts on the victims.There is also frequent concurrent abuse of other disinhibiting substances, including cocaine.What is more, as the manufacture, distribution, sale, and use of methamphetamines involve thetrade in toxic chemicals and the drugs themselves with others in the drug subculture. The risks tochildren extend beyond physical exposures to chemicals and methamphetamine smoke tovictimization by individuals with violent proclivities that are unleashed by these drugs.With regard to the head injury, I believe that it is highly likely that this is an artifact of bluntinflicted trauma, as Mila describes. I say this because of its appearance to the examiningphysician, its photographic appearance, her disclosure of how she received it, and her ownwords. This injury, in my opinion, is clearly not a "birthmark." Birthmarks should never beconfused with ecchymoses or bruises. Where the former are consistent and lillchanging indiscoloration, bruises heal and typically disappear.Mila alleged that her father told her to say that the injury was a "birthmark" if she were askedabout it. It appears that he manipulated his daughter to cover up his assault on her. Milasdisclosures take on additional significance, because of the personal abuse risk that 1 believeapplies to her because of her own and her mothers past abuse. This is by way of saying that theinjury itself should not be examined and interpreted in isolation. Neither should a protectiveservices investigator confuse it with a congenital skin discoloration.
At tIllS critical juncture, it is necessary to rethink the entire scope of Milas treatment by herfather and her mothers own victimization at his hands. The concurrent abuse of her mother andthe apparent co-occurrence of methamphetamine abuse, in my opinion, yield tremendousadditional risk that Mila will be abused again.Please do not hesitate to contact me if needed. Eli H. Newberger, M.D Assistant Professor of PediatTics Harvard Medical School Adjunct in Pediatrics Childrens Hospital Boston