A former Harris County associate medical examiner accused of botching an autopsy that led to a young mother's imprisonment has come under scrutiny in several other cases in which her conclusions were later contested or revised. The work of Dr. Patricia Moore, who now performs autopsies in Montgomery County, is the focus of renewed debate since officials recently reclassified one of her 1999 autopsies from "homicide" to "undetermined." The cause of 2-month-old Daniel Lemons' death is at the center of an appeal by his mother, Brandy Briggs, who is serving a 17-year prison sentence and has asked a judge to recommend her release. A Houston Chronicle review of county records reveals at least two other cases in which Moore's supervisors revised her findings in autopsies on children. She was admonished once for appearing to show a bias in favor of prosecutors, and criticized for "not understanding the objectives of neutral medical-legal investigation." In a sworn affidavit last week, Moore acknowledged concerns about her autopsy report in the Lemons case. "I still believe that my initial opinion as to the cause of death and the manner of death of this 2-month-old boy are most likely correct," she wrote. "But since there have been other views on this matter ... I feel that another opinion from an outside expert would be of utmost importance." Her finding of "shaken baby syndrome" reinforced the case against Briggs, who pleaded guilty to child endangerment in 2000. But the county's chief medical examiner, Dr. Luis Sanchez, testified July 9 that there is no evidence of shaken baby syndrome. He recently changed the official manner of death. Briggs' attorney, Charlie Portz, has asked state District Judge Mary Lou Keel to recommend reversing the conviction, saying there is no longer evidence that the death resulted from a crime. Keel has not made a ruling. Doesn't add up During her time in Harris County, Moore attributed infant deaths to shaken baby syndrome at a rate considerably higher than the rate at which it happens in the general population, according to a study by a doctor and defense attorney who worked on a case involving one of her autopsies. "She may be biased toward the district attorneys instead of playing it straight," said Portz. "And that means the defense doesn't have an even playing field." Moore has declined to comment to the Chronicle since Sanchez's testimony. She resigned her Harris County job in July 2002, citing a need to spend more time with her child. In nearly six years with that office, Moore was widely respected by the legal and law enforcement communities. Records show she conducted up to 500 autopsies a year and had special expertise in pediatric pathology. Moore received a doctorate in osteopathic medicine from Southeastern University of the Health Sciences in Miami. She currently works in Conroe for the Southeast Texas Forensic Center, which contracts with Montgomery County to provide autopsy services. Sanchez, who became chief medical examiner after Moore left her Harris County post, said he has little reason to doubt her competence and could not recall any instance other than the Lemons case in which her findings were revised. Similar case But a claim similar to Briggs' was made by another woman earlier this year, after the medical examiner's office changed the cause of death of 7-month-old Trevor Seber from "homicide" to "undetermined."

DR. PATRICIA JEANNE MOORE • Age — 42 • 1984 — Received a bachelor's degree from the University of West Florida in Pensacola • 1989 — Received a doctorate in osteopathy from Southeastern University of the Health Sciences in Miami • 1990-92 — Resident in pathology at Baptist Medical Center, Birmingham, Ala. • 1994-96 — Fellow of pediatric pathology at Baylor College of Medicine • 1996-2002 — Associate medical examiner in the Harris County medical examiner's office • 2002-03 — Associate medical examiner with the District 5 Medical Examiner Department in Leesburg, Fla. • 2004-present — Medical examiner with the Southeast Texas Forensic Center in Conroe Source: Harris County medical examiner's office

In October 2002, prosecutors charged the infant's mother, Ruth Ann Gilliam, 22, of Pasadena with reckless injury to a child, punishable by up to 20 years in prison.

"I was thinking, 'Oh, my gosh, I've lost my son and now they are charging me with my son's death?' All I ever did was love my kids," Gilliam said recently.

She spent nine months in jail before posting bail. During that time, her parental rights were terminated and her other child was adopted.

In preparation for trial, another medical examiner, Dr. Dwayne Wolf, reviewed Moore's autopsy and disagreed with her homicide ruling. Sanchez concurred and the ruling was changed, county records show.

Prosecutors then offered to let Gilliam plead guilty to a lesser charge and receive a sentence of time served, meaning she would not go back to jail. She refused.

"I guess they wanted their little plea or whatever," she said. "But I told my lawyer, 'Absolutely not. I'm not pleading to something I didn't do. I'm fighting my case all the way.' And then the DA backed out."

The case was dismissed in March.

"That's not to say we don't believe a crime was committed," said Assistant District Attorney Charles Thompson. "It just becomes more difficult to prove."

Gilliam's attorney, Ernest "Bo" Hopmann, contends that Moore tried to match her findings to law enforcement investigations.

"I think that once a detective on the scene or some other law enforcement officer made the original analysis that a possible crime had been committed, then she did her work from that standpoint and tried to substantiate those allegations with medical conclusions," Hopmann said.

Butting heads

Moore was criticized for handing in paperwork contaminated with blood and making written requests for X-rays on paper towels. One employee review calls her "headstrong."

Carter reprimanded Moore in 1999, saying she seemed biased in favor of the prosecution.

"Dr. Carter reminded Dr. Moore that our office is neutral and that we are not doing cases for the DA's office. We need to be open to both the prosecution and the defense," states a July 19, 1999, memo by Alex Conforti, the chief administrative officer at the medical examiner's office.

The remark stems from the death of 10-month-old Christina Dew. Doctors suspected shaken baby syndrome, but the precise time of the fatal injuries was unclear.

That left prosecutors unsure whether to pursue charges against the mother or the baby sitter, who said she found the child semiconscious shortly after the mother left for work.

Moore's initial report indicated that the baby must have become unconscious right after the injury, a finding that would point to the baby sitter as a suspect.

But after police said the mother had failed a lie-detector test that the baby sitter had passed, authorities focused on the mother, county records show.

Shortly afterward, Moore met with a prosecutor and other doctors. The autopsy report was then changed.

After learning of this, Carter confronted Moore.

"You stated your opinion of who the guilty party was. I responded to you at that point to say you were overstepping your boundaries," she later told Moore in a memo. "We as medical examiners should not opine as to who did what, if we are to remain neutral."

Carter followed up with a note in the case file.

"It remains impossible to gauge a thirty minute time frame as to precisely when the fatal injuries occurred to this young and unfortunate victim," Carter wrote. "So as not to impede the legal process, the new version is now signed after careful review. The prosecutor was reprimanded as to the serious risk of collusion when changes are made to a public document."

The baby sitter, Trenda Kemmerer, was tried in 2000 on a charge of injury to a child.

The jury deadlocked, but in 2001, Kemmerer was convicted and sentenced to 55 years in prison.

Assistant District Attorney Kelly Siegler, who prosecuted Kemmerer's second trial, said autopsies usually are contested in this type of case because defense attorneys often claim the child died of natural causes.

"It's always the main thing in a shaken baby case," she said.

Siegler said she had no concerns about Moore's work.

Second-guessing

Questions about Moore's autopsy on a Fort Bend County child led prosecutors there to drop capital murder charges and give a man probation on a lesser charge.

Frank Chavez was accused of killing his 2-year-old stepdaughter, Hallie Lohner, after Moore concluded the child was beaten to death in 2000.

The Harris County medical examiner's office was providing autopsy services to Fort Bend County at the time.

After Moore testified about the autopsy at a civil court hearing on custody of another child, prosecutors decided to have an expert review the case before taking Chavez to trial in criminal court.

That expert suggested the death had resulted not from blunt force, but from illness. Prosecutors later had the capital murder charge dismissed.

The case ended in 2003 when Chavez agreed to plead guilty to failure to seek medical attention. He faced up to 10 years in prison, but got probation.

A statistical examination of Moore's work suggests a trend of finding shaken baby syndrome as a cause of death, said Dr. Jim Bromberg, a physician and defense attorney who worked on a shaken-baby case in which Moore performed an autopsy.

Based on numbers from the U.S. Department of Health and Human Services, Bromberg estimated that Houston's metropolitan area should see one or two fatal cases of shaken baby syndrome each year.

Moore, however, cited it as a cause of seven deaths in one 18-month period.

"The numbers suggest one should look into whether this is being overdiagnosed," Bromberg said.

District Attorney Chuck Rosenthal said he has worked with Moore on many cases and sees no reason to question her work.

"She acted pretty middle-of-the-road," Rosenthal said. "I thought she did them pretty much as she saw them. She didn't come across as a biased state witness on any of the trials I had."

Child fatalities that raise suspicions of abuse or neglect have received more scrutiny in recent years, said Assistant District Attorney Denise Oncken, longtime head of the district attorney's child-abuse division.

"Years and years ago, people felt so bad when somebody's kid died that nobody wanted to look for any foul play," Oncken said.

But Bromberg said the pendulum has swung too far in the opposite direction.

"This is a politically sensitive area of medicine. They all want to protect children, but they are using incomplete science," he said.

"I don't think there is malice. I don't think there is collusion. But I do think there were scientific errors that have created legal errors."

andrew.tilghman@chron.com