False Alarm: The failed promise of Apnea Monitors ...
Part 3

This is a lengthy article published electronically on the Syracuse Online electronic newspaper. It is very interesting to read. The third part starts below.

Please honor the copyright of the article. Thank you to Timothy D. Bunn, Deputy Executive Editor, The Post-Standard, tbunn@Syracuse.com, for allowing this reprint.

Syracuse Herald American
Sunday, May 5, 1996
BYLINE: By Todd Lighty, Charles B. Hickey and John O'Brien Staff Writers

NURSES QUESTIONED RESEARCH
HOSPITAL WORKERS SAY THEY SUSPECTED WANETA HOYT
WAS KILLING HER BABIES.

There was a time in 1970 when nurse Polly Geer thought working with Dr.
Alfred Steinschneider would make her famous.

Fresh out of nursing school and still in her 20s, Geer landed a job on a
pediatric research project at Upstate Medical Center in Syracuse.

The project eventually involved five apparently healthy babies from
three families who were referred to Steinschneider after their parents
said the children suddenly stopped breathing and turned blue.

Steinschneider suspected these life-threatening episodes were a
prolonged form of apnea - the involuntary pauses in breathing many
infants experience during sleep. He had noticed that each of the babies
experienced brief apnea spells in the hospital's sleep laboratory. And
he theorized that this might be a warning sign for sudden infant death
syndrome, or SIDS. At the time, the mystery killer claimed about 10,000
babies a year.

"I really thought he was onto something," Geer said.

When Steinschneider published the results of his study in 1972, he
expressed his gratitude to Geer in his acknowledgments. And while that
didn't exactly earn Geer fame, it made her a footnote to medical
history.

Steinschneider's groundbreaking study led to the widespread practice of
wiring babies to apnea monitors in hopes of preventing SIDS. The idea
behind the machines was simple: They monitored respiration and sounded
an alarm if the infant stopped breathing for a set period, at the time
usually 15 seconds.

Nobody foresaw how easily murderous parents could turn these electronic
baby sitters into accomplices. But there was evidence from the
beginning.

Polly Geer saw it in 1970.

Geer's doubts surfaced when she saw what happened to one of the babies
in Steinschneider's study - Molly Hoyt.

Although Molly appeared normal in the hospital, she suffered a
life-threatening spell each time Steinschneider sent her home on an
apnea monitor. Four times, the mother said, the baby stopped breathing
and needed resuscitation.

Geer wondered about the mother, Waneta Hoyt.

"She was not what I considered to be an attentive, eager-beaver mother,"
Geer said. "I just remember her not hugging Molly or holding her really
close ... She wouldn't sit in the rocker with her."

Geer also knew that three other children in the family had died.

The third time Molly went home from Upstate Medical Center, she died,
too. Her death was attributed to SIDS.

At the time, Steinschneider saw Molly's death as evidence that apnea was
part of the mechanism that caused SIDS. And the death of Molly's
brother, Noah, under similar circumstances the following year seemed to
reinforce that theory.

A quarter-century later Geer's worst fears were confirmed: Waneta Hoyt
was convicted of murdering Molly, Noah and her three other children.

Steinschneider "just believed in his research, just as we all did," Geer
said.

"We were all 100 percent involved in the research, and I think when
you're that involved, your focus is on proving what you're proving ...
the denial, then, becomes pretty high."

Research in Syracuse

The seeds of Steinschneider's research were planted in the 1950s at
Upstate Medical Center, now called SUNY Health Science Center.
Pediatricians there had started using respiratory monitors to study
breathing patterns in newborns.

One of the doctors' chief concerns was apnea - a frequent and sometimes
grave problem in premature babies. Preemies who haven't developed the
reflex to resume breathing on their own sometimes need full-blown
resuscitation to snap out of an apnea spell.

To address that problem, Dr. Earle F. Lipton, an associate professor of
pediatrics, came up with the idea of a respiratory alarm. He wanted a
machine that would not only keep track of an infant's respiration, but
sound an alarm if the child suddenly stopped breathing.

Using Lipton's specifications, engineers in the medical school's
bioelectronics laboratory cobbled together what many believe was the
world's first apnea monitor. If a baby stopped breathing for a set
period, usually less than 25 seconds, the monitor would trigger an
alarm.

"It probably has had lifesaving consequences in some instances," Lipton
wrote in announcing the invention in 1964.

The apnea monitor's lifesaving potential soon captured the imagination
of Steinschneider, a Lipton protege. Steinschneider would later be
hailed as the father of the apnea monitor, but then he was a
little-known pediatric researcher at Upstate Medical Center.

Steinschneider already had a doctoral degree in psychology from Cornell
University when he arrived at Upstate as a medical student in 1957.
After completing his residency in 1965, he joined the faculty as an
assistant professor of pediatrics.

Working with Lipton and other doctors, Steinschneider studied the vital
functions of newborns, trying to learn how emotional stresses in infancy
contributed to the development of psychosomatic disorders such as
asthma, ulcers and breath-holding. The apnea monitor was a
state-of-the-art tool in the laboratory where Steinschneider looked for
the elusive factor that caused newborns to develop one psychosomatic
illness rather than another.

Steinschneider never found the "X" factor, as he called it. But his
basic research on newborns earned him an invitation in 1969 to the
Second International Conference on the Causes of Sudden Death in Infants
near Seattle.

The invitation came from Dr. Abraham Bergman, a Seattle pediatrician who
had studied under Steinschneider at Upstate Medical Center.

Like most pediatricians at that time, Steinschneider knew little about
crib death. The conference, instigated by a group of Seattle-area
parents who had lost children to the mysterious malady, was about to
change that.

Parents push research

By the 1960s, crib death had become the shorthand term for a parent's
worst nightmare: The sudden and unexplained death of an apparently
healthy baby.

Crib death struck without warning. Typically, a parent would put a baby
down for a nap and return to find a lifeless body.

Death was silent; the parent heard no cry of distress. The parent might
see telltale signs of death - a pink froth from the buildup of fluid in
the lungs, a loss of muscle tone - but many victims looked normal.

Because crib death had no symptoms, its victims went straight to the
morgue, bypassing clinical researchers like Steinschneider. But
autopsies of crib death victims never revealed evidence of fatal disease
or injury, leaving coroners and medical examiners powerless to answer
the question that haunted grieving parents: "How did our baby die?"

The question left many parents wracked by guilt. Blunt questions from
prosecutors and medical examiners trying to rule out homicide sometimes
added to the parents' pain.

Many parents became outraged at the medical establishment's neglect of
the problem and the insensitivity of authorities who investigated their
children's deaths. In the early 1960s, parent-support groups started to
pop up independently around the country.

The movement had two goals: to find the cause and cure for sudden infant
death, and to make sure that parents who lost children received
sympathetic treatment from the authorities.

The emphasis on absolving parents of guilt set a pattern that eventually
obscured more disturbing explanations for some cases of sudden infant
death.

A tailor-made theory

Participants in the 1969 Seattle conference adopted the term "sudden
infant death syndrome," or SIDS, to describe a fatal disorder that
seemed to have increasingly distinct characteristics.

SIDS struck most often among babies between 1 and 4 months of age.
Babies with a low birth weight seemed more susceptible. A mild
respiratory infection often preceded it.

Dr. J. Bruce Beckwith, a pediatric pathologist who helped organize the
conference, defined SIDS as "the sudden death of any infant or young
child, which is unexpected by history, and in which a thorough
post-mortem examination fails to demonstrate an adequate cause of
death."

The definition, experts said, failed to account for a crucial factor: It
is virtually impossible for an autopsy to distinguish between SIDS and
intentional smothering.

"We sort of deliberately adopted a non-suspicious attitude in 1969,"
Beckwith said. "We wanted to get some progress. And if we had said,
`Well, a certain unknown fraction of these are homicides,' you're going
to progress a lot more slowly toward humanitarian approaches."

Beckwith would later try to tighten the definition to exclude smothering
and other causes of death. But for years, authorities blamed an unknown
number of possible homicides on SIDS, often without autopsies.

The conference also revealed a new line of inquiry that seemed
tailor-made for Dr. Alfred Steinschneider. Several participants
mentioned sleep apnea might be related to SIDS.

"Individuals presented information to suggest that there were babies who
were apparently healthy who would have a sudden cardiac-respiratory
arrest," Steinschneider said last year. "They would suddenly be found by
their parents not to be breathing, would turn cyanotic (blue from a lack
of oxygen), pale, (and) would be resuscitated.

"And the notion was that these babies might, in point of fact, be at
increased risk to die of SIDS. In fact, the term that they were using at
the time was the term near-missing or near-miss SIDS. And as a
clinician, that was a very intriguing notion, because it meant that
there may be babies out there in our community who were described in
just that manner, that might help us."

Steinschneider returned to Syracuse and set up a research protocol to
investigate the connection between sleep apnea and SIDS. He told
colleagues he was looking for babies who had experienced the kind of
life-threatening spells described at the conference.

That's how he met Tim and Waneta Hoyt.

The Davis Hollow couple

On March 18, 1970, Waneta Hoyt, 23, gave birth to a girl in Tompkins
County Hospital in Ithaca. She and her husband, Tim, a 27-year-old
laborer, named the baby Molly.

According to her medical records, Molly was normal four days later, when
her parents took her home. They lived in a trailer in Davis Hollow, a
remote settlement in Tioga County, 70 miles south of Syracuse.

About a week after coming home, Waneta Hoyt said, Molly started having
trouble breathing.

The baby would stop breathing and turn blue when she went down for a nap
after feeding, Hoyt said. Twice she had to revive the baby with
mouth-to-mouth resuscitation, she said.

The Hoyts took Molly to the Ithaca hospital twice, but doctors there
could find nothing wrong. Still, Molly's medical records show her
pediatrician, Dr. Roger Perry, was concerned. The Hoyts had lost their
first three children to sudden, unexplained deaths.

Eric, their firstborn, died at 3 months. Their second son, James, was
almost 2 1/2 years old at the time of his death. The couple's 1 1/2
-month-old daughter, Julie, died three weeks before James.

In each case, the child had died at home, alone with Waneta Hoyt. And in
each case, the coroner took her word for what happened. The first two
children were not autopsied; James' autopsy proved inconclusive. There
is no record of a police investigation of any of the children's deaths.

Nor is there any record that Perry suspected the children had not died
of natural causes when he made arrangements for Steinschneider to see
Molly at Upstate.

On April 15, Steinschneider admitted 28-day-old Molly to the Children's
Clinical Research Center at Upstate. Doctors could admit children for
specific research projects and the federal government would pick up the
cost.

Waneta Hoyt told Steinschneider that Molly often held her breath during
bottle feeding, then resumed breathing when her mother took the nipple
out of her mouth. She also told Steinschneider about the deaths of her
first three children.

"Eric ... had recurrent cyanotic `passing out' spells during which he
would gasp to get air `like he couldn't get his breath,"' the doctor
wrote. "These episodes tended to occur about one hour after being fed
while asleep. It was intended that further studies be performed to
evaluate for possible congenital heart disease. He died suddenly on
1/26/65.

"Julie ... on 9/5/68 during bottle feeding she suddenly `seemed to
choke,' turned blue and died.

"James ... on 9/26/68 appeared well. However, following breakfast he
suddenly called out, `Mommy,' bled from nose and mouth and died
suddenly."

Steinschneider's tests showed Molly was healthy, except for some
diarrhea. He gave nurses instructions to check Molly's vital signs every
four hours, record room temperature, note her skin color and weigh her
periodically.

The next day, Steinschneider studied Molly in a sleep laboratory.
Machines recorded the baby's heart rate, eye movement and brain waves
during a nap. Apnea monitors kept track of her breathing.

On the basis of this first study, Steinschneider concluded Molly
experienced frequent apnea during sleep.

"Although none of the apneic episodes were of sufficient duration to be
associated with clinical difficulty," Steinschneider wrote, "I believe
similar breathing could relate to the problem described by the parents."

Steinschneider made a distinction between apnea, which lasted as little
as two seconds, and prolonged apnea, which he defined as a spell that
lasted longer than 15 seconds. Research had shown that children didn't
start experiencing difficulty, such as a drop in heart rate, until they
had stopped breathing for about 30 seconds.

The first test of Molly in the sleep lab recorded no prolonged apnea
spells. Nor did the second test five days later. But Steinschneider said
he detected more brief apneic episodes. He told the Hoyts he wanted to
keep Molly in the hospital until the spells decreased, and the couple
agreed.

An aloof mother

The Hoyts visited Molly in the hospital on weekends, driving from Davis
Hollow and back each day. Nurses noted the parents' visits in Molly's
medical records, along with how much the baby ate, the consistency of
her stools, when she was bathed and when she was rocked to sleep.

As Steinschneider made his scientific observations, the nurses started
recognizing some patterns of their own.

Nurses noticed that Waneta Hoyt never asked how Molly was doing, and
never cuddled the baby.

"My observation was that when she held the baby, she did not hold the
baby like I've seen most mothers hold babies - in her arms, cuddled to
her. She held the baby away from her," recalled Thelma Schneider, the
research center's head nurse.

Steinschneider also noted Hoyt's behavior. He said he believed Hoyt
feared becoming attached to her daughter because she already had lost
three children.

Following Steinschneider's instructions, the nurses kept Molly wired to
an apnea monitor. The alarm was set to beep if the baby stopped
breathing for 15 seconds.

According to Steinschneider, the apnea monitor's alarm went off 15
times, indicating that Molly had suffered prolonged apnea spells. But
the nurses' notes made no mention of such episodes. Nurses wrote that
they tapped Molly's foot on a few occasions to make sure she was
breathing, but the monitor often sounded when there was nothing wrong.
Molly's color looked good, her heart beat solidly and she breathed
normally.

"They were fairly new," nurse Corrine Dower said of apnea monitors.
"They would go off if the leads were tangled up or the baby moved or
something ... If you get Molly's chart and look at it, most of the time
the thing went off it was from malfunction of the equipment, not the
kid."

Monitoring at home

As Molly's hospitalization started to stretch into a third week, Waneta
Hoyt began to ask questions, Steinschneider told a group of SIDS
researchers several years later.

"I had the baby on a monitor and the mother said to me, `Why can't I
learn how to use it?' And I said, `I guess you can,"' Steinschneider
said.

"She finally convinced me that what we were doing in the hospital at a
distance from home for her, she could do at home, providing we taught
her how to use the machine and how to resuscitate."

On May 8, Molly Hoyt became the first baby in the world to be sent home
on an apnea monitor.

Steinschneider told her parents to call immediately if there were any
problems, and to bring Molly back in a week for follow-up studies. The
apnea monitor sounded frequently the first day home. After the alarm
went off 20 times around supper time May 10, Hoyt called Steinschneider.

Molly had been cranky with a runny nose and a mild cough, Hoyt said.
Then, Molly stopped breathing, and Hoyt said she had to resuscitate her.

The first experiment in apnea monitoring at home had lasted a little
more than a day.

Nurses grow suspicious

Steinschneider tested Molly in his lab again that day and readmitted her
to the research center. Back on the ward, the apnea monitor was again
set to detect 15-second interruptions of breathing.

Whenever the alarm sounded, the nurses checked to make sure Molly was
breathing. They said, and their records indicate, that they usually
found she was breathing shallowly, and they occasionally tapped her foot
to make sure.

After nine days, Steinschneider sent Molly home again, telling the Hoyts
to bring her back in two weeks. She returned 20 hours later in an
ambulance.

This time, Hoyt told Steinschneider she had fed Molly in the morning and
put her in the crib. About 40 minutes later, she said, the monitor's
alarm sounded. When she checked, Hoyt said, Molly had turned blue and
stopped breathing.

The Hoyts said they had found a propane gas leak in their trailer, and
Steinschneider asked a public health nurse to make sure the leak hadn't
caused the baby's breathing problems.

The nurses had their own concerns. They said they found it odd that no
one ever had to resuscitate Molly in the hospital the way Hoyt said she
had at home. That point would come back to haunt Steinschneider, who
said Molly required resuscitation in the hospital as well.

"She was doing really well," Geer recalled. "There was no sign of any
cold or any problem ... so I was just very suspicious.

"I remember distinctly wanting to go home with her ... I wanted to see:
What's going on? What's she reacting to? Why is it she would do so well
here and then go home and have a problem?"

Nurses noticed that Molly had become listless, her cry was weak. Some
nurses wondered if the child had been smothered, then revived.

"Child has a dull appearance. Does not relate well to nurses or
surroundings," Schneider, the head nurse, wrote in Molly's medical
charts May 29.

Molly's flat expression haunted Schneider. "Child has little or no
affect," she wrote June 2. "Looks to the left most of the time during
care. Does not smile at people. Has been noted to smile at mobile, or
once while sitting in the swing."

Dower, a nurse for 30 years, became so concerned about Molly that she
spoke to Schneider.

"Thelma, something's going to happen to Molly," Dower said. "If you send
that baby home, that woman is gonna smother it or kill it."

Schneider said she carried her colleagues' concerns to Steinschneider.
"I said, `She's doing them in,"' Schneider recalled. "He sort of
shrugged it off."

Steinschneider said he does not recall any nurses bringing concerns
about Hoyt to him.

Schneider noted her talk with Steinschneider in Molly's permanent
medical records.

"I discussed my concern for this baby with Dr. Steinschneider this
a.m.," she wrote June 4. "The interaction between mother and baby is
almost nil."

But Steinschneider had decided to send Molly home again that evening.

The Hoyts arrived at the hospital about 7 p.m., and Steinschneider gave
the mother final instructions by phone: Keep Molly on the apnea monitor,
let her sleep on her back, keep her room cool, bring her back in two
weeks.

Joyce Thomas, a licensed practical nurse, put a pink dress on Molly,
then carried the baby outside and put her in the Hoyts' car for the trip
home. When Thomas returned to the ward, she cried.

Dower kept looking at her wristwatch that night. "Well, Joyce," she
said, "do you think she's still alive?"

A death at home

"I was the one that took the call when Mrs. Hoyt called the next
morning," Geer said. "She just called all alarmed, saying Molly stopped
breathing.

"I was all by myself ... I just remember keeping her on the phone, and
once the EMS (emergency medical service) got there, then I hung up. I
don't recall when we found out that she had actually died. But I
remember being devastated."

The other nurses learned about Molly's death as they showed up for their
shifts. Most cried.

Molly had lived 54 of her 79 days in either Tompkins County Hospital or
Upstate Medical Center, and medical records never indicated she suffered
an apnea spell in the hospital that required resuscitation. The crises
occurred only at home, and only Waneta Hoyt had said the baby needed
resuscitation.

"We used to talk about it, and we just said we're sure something's going
on," said Thelma Schneider. "It didn't make any sense to me because we
hadn't had any problem while she was in the hospital. It just didn't add
up."

But Schneider and the other nurses had nothing but suspicions to go on.

"It was the doctor's patient," Schneider said. "It was his
responsibility to do something if he thought it was deemed necessary."

Steinschneider asked for an autopsy, which failed to show how Molly
died. There was no police investigation. Steinschneider didn't ask for
one, he said, because he assumed police had investigated each Hoyt
child's death.

Molly's death seemed to confirm to Steinschneider that SIDS victims were
afflicted by a subtle abnormality and that apnea was part of the fatal
chain of events. He did not see her death as a failure of home
monitoring.

"The baby died with an apnea monitor in the home," Steinschneider
explained a few years later. "People who misread that would read that as
meaning that the baby was on an apnea monitor when the baby died. That's
not true."

Waneta Hoyt "disconnected the baby from the alarm. Why? Because she was
going to put a new dress on the baby because Grandma was coming. She
disconnected the alarm, bathed the baby, put the baby in the crib and
left for a moment. When she came back, the baby was dead."

Like the doctors who had dealt with the deaths of Hoyt's first three
children, Steinschneider took her word for what happened. He would do
the same when Molly's brother, Noah, arrived at Upstate the following
year.

A baby boy

Waneta Hoyt gave birth to Noah at Tompkins County Hospital on Mother's
Day 1971. Although the baby seemed healthy, he stayed in the hospital
several days. Dr. Roger Perry, the pediatrician who had treated Molly,
gave the reason in Noah's records:

"Sudden deaths 4 siblings, age 4 weeks to 2 1/2 years not explained by
clinical and autopsy findings. This baby being transferred to Upstate
Medical Center for evaluation."

The Hoyts brought Noah to Upstate Medical Center May 13, 1971. Federal
funding for the research center had been cut, so Steinschneider had the
4-day-old baby admitted to the pediatrics ward.

Steinschneider ordered a medical course similar to Molly's: Keep Noah on
an apnea monitor set to trigger an alarm at 15 seconds, and watch him
closely.

According to his medical records, Noah breathed normally on the ward and
his color looked good. He slept soundly and steadily gained weight. His
medical chart was remarkable only for the number of times it noted
malfunctions of the apnea monitor.

May 15: "Patient continues to do well. We are having trouble with the
apnea alarm on the monitor."

May 16: "Condition unchanged. Patient supposedly had one apneic episode;
but on close questioning of the nurse, it appears that there was a
malfunction of the monitor."

May 17: "Status quo except that the monitor malfunctions more frequently
now ... No documented apneic episodes yet."

Although Noah appeared normal on the ward, Steinschneider concluded from
studying him during naps in the laboratory that the baby experienced
frequent but brief episodes of apnea during sleep and seemed to have
trouble coordinating breathing during bottle-feeding.

The feeding problem disappeared, and Steinschneider took Noah off
research status by early June.

The Hoyts took the 1-month-old baby home for the first time June 15.

The next day, an ambulance brought Noah back to the hospital.

Hoyt told Steinschneider that she was in the kitchen when the monitor
sounded. Noah was lying in his bassinet, pale and not breathing, but he
perked up when she shook him. She told Steinschneider that when she
tried to call the hospital, Noah fell asleep in her arms and turned a
dark blue.

Once again, she claimed to have saved one of her children's lives with
mouth-to-mouth resuscitation.

Steinschneider ordered more tests, which showed Noah was in good health.
He took Noah back to the sleep lab, where the heat was turned up to see
whether room temperature had any impact on the frequency of apnea.

Noah remained on an apnea monitor in the pediatrics ward. Clinically, he
appeared fine, according to nurses' notes. But Steinschneider said he
had documented 15 spells of prolonged apnea.

However, there are no entries in Noah's medical records to support
Steinschneider's assertion that the baby suffered a total of 28
prolonged apnea spells during his two hospital stays.

Steinschneider said in the discharge summary, for example, that Noah
suffered a prolonged apnea spell on May 25, but notes the nurses made
that day show the monitor only recorded brief spells lasting three to
four seconds. The same day, nurses noted that the monitor's alarm went
off twice when the machine recorded no pauses in breathing.

Steinschneider sent Noah home after a second month in the hospital. He
told the Hoyts to bring the baby back in a week, but Noah returned to
the hospital the next day.

This time, Hoyt told Steinschneider that she had been feeding Noah when
he began to cough, turned blue and stopped breathing. She said he
started breathing again after she made him gag.

Another death

The nurses who witnessed Noah's return to the pediatrics ward began to
form the same suspicions that had troubled Molly's nurses. Like Molly,
Noah never needed resuscitation in the hospital, only at home.

Gail Pfeiffer, then a 21-year-old nurse's assistant, couldn't understand
Hoyt's lack of interest in Noah, a rosy-cheeked baby who seemed to take
delight in being around people.

"You'd walk in the room and he'd look at you when he could, as soon as
you were in his sight," she said. "He'd lay there and want attention."

Pfeiffer recalled that Hoyt stiffened when the nurse's assistant tried
to hand her the baby. When the mother finally took Noah, she held him
away from her body, Pfeiffer said.

Julia Evans was one of the few nurses who took care of both Molly and
Noah. Knowing what had happened to Molly, she watched Noah more closely
and became concerned about Hoyt's pattern of indifference.

"I saw that there was no warmth between the mother and her babies,"
Evans said. "I would try and give the mother the bottle to feed the
babies and she would never take it. The father would always take the
bottle and feed them."

Evans had known Steinschneider since he was an intern and felt
comfortable taking her concerns to him. But when she told the doctor
Hoyt neglected her babies and did not appear to love them,
Steinschneider told her she couldn't prove Hoyt was doing anything
wrong, Evans said.

Steinschneider said he does not recall nurses telling him Hoyt might be
a threat to her children.

Steinschneider had noted only one prolonged apnea spell during Noah's
week at the hospital, but he decided to test the baby again in the sleep
laboratory before sending him home on July 27, 1971. The Hoyts left the
hospital with Noah at 7:30 p.m.

Evans said she bet Steinschneider a quarter Noah would not come back.
Steinschneider said he did not recall any bet. Evans said he laughed at
her and shrugged it off.

The next morning, Noah was dead. He was 78 days old.

Case closed

Waneta Hoyt said she was in the bathroom when she heard the muffled
sound of an alarm, Steinschneider explained years later. By the time she
got to the baby, he was blue and she could not revive him.

"The machine worked," Steinschneider said.

Steinschneider learned about the baby's death when Dr. John Scott, the
Tioga County coroner, called him from the Hoyts' trailer. Steinschneider
explained the background of the case, the previous deaths of four
children in the family, and asked to have Noah's body sent to Upstate
Medical Center for autopsy.

The hospital's pathologists found traces of bronchiolitis, a mild
respiratory infection, but there was no obvious cause of death. Scott
attributed the case to SIDS. After all, the baby had been on an apnea
monitor.

The case was closed without a police investigation. No officials noted
that Noah, like Molly, had never suffered a life-threatening apnea spell
in the hospital, but needed resuscitation each time he was at home,
alone with his mother.

"I looked at it as ... a medical problem, which seemed to be evident
with the appearance of the body and the medical electrodes, the fact
that the child had been in the hospital for respiratory problems right
up until shortly before he died," Scott said. "The other four (deaths)
certainly pointed toward a crib death."

At Upstate Medical Center, nurses cried when Steinschneider told them
another Hoyt baby was dead.

Evans said she told Steinschneider, "I told you so."

Steinschneider saw the striking similarities between the deaths of Molly
and Noah Hoyt in a different context. Molly and Noah were part of a
study involving five "very, very important babies," Steinschneider later
explained.

Like Molly and Noah, the other three were apparently healthy babies who
had been referred to Steinschneider after they suffered episodes in
which they stopped breathing and turned blue. In each case, he diagnosed
the problem as sleep apnea and eventually sent them home on monitors.

But these children - another brother and sister, and a premature baby
from a third family - all survived. By dying, Molly and Noah Hoyt gave
Steinschneider the evidence he needed to show that sleep apnea was a
warning sign for SIDS.

In 1972, Steinschneider told the world.

Next: Silencing the critics.