Eli H.

Newberger,
92 Evans Road

M.D.

Brookline, MA 02445 Telephone 617-232-7908

Email: newberge(almassmed.org FAX 617-731-1897 May 30, 2011 To 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, Assistant Professor of Pediatrics, Harvard Medical School, and Adjunct in Pediatrics, Children's Hospital Boston. 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 as a pediatrician at Children's Hospital Boston, where I organized its first child protection team in September 1970 and served as its medical director for 3 decades. Important in my consulting role was 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 at Children's 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 Probate and Family Courts for interdisciplinary assessments of child abuse, child sexual abuse, and domestic violence in the face of custody conflict. In the subsequent two decades, we received approximately 20 referrals for assessments of the validity of disclosures and examination artifacts suggesting child physical and sexual abuse from the family and criminal courts and child 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 on child 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 least five keynote addresses at regional and state conferences on child abuse and pediatric and obstetric grand rounds at Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor. The obstetric conference focused on the frequency with which child abuse and domestic violence co-occur and the elevated risk of physical and sexual child abuse jf a mother is a victim of domestic violence. My colleagues' and my research on this issue was propelled by multiple clinical encounters with men who abused both children and their mothers. It led us in 1986 to start in my clinic the first hospital-based battered women's advocacy program in the U.S., called AWAKE (for advocacy for women and kids in emergencies). This program continues at Children's Hospital Boston and

is recognized as a regional service model by the New England Conference of Child Welfare Conmlissioners and Directors and as a national model by the U.S. Department of Justice. It has provoked both advances in medical and hospital diagnosis and women and children's protection and, pertinent to Mila Malenko's case, efforts across the region to incorporate into child protection 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 and Nature of Male Character." (Perseus Books, 1999) The book has been favorably received by professionals and parents alike and remains in print in a paperback edition. I have reviewed extensive materials related to Mila Malenko's health and behavior, including pediatric records and conesponding photographs of injuries, the evaluation of possible sexual abuse by my colleague Lawrence Ricci, M.D., and his associates at Maine's renowned Spurwink program, and the affidavit dated May 26, 2011, by Carl Baum, M.D., the director of the YaleNew Haven Children's Hospital Center for Children's Environmental Toxicology on the significance of the Mila's 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 status of Mila's case. I was asked to provide pediatric diagnostic support to the decision-making at this

meeting by Mila's mother, Lori Hanrahan and by her retained private investigator, Stephen Pickering., a retired Maine State Police Detective. Because of the press of time and the abundant corpus of previous expert recommendations, I will focus my opinions on Mila's recent head injury observed and photographed on March 27, 2011, and the aforementioned history of methamphetan1ine and domestic violence exposures. The head injury, characterized that day by an emergency room physician as "a small ecchymotic bruised area on the center of the forehead with no obvious hematoma," is evident on the six photographs I have reviewed. The term "ecchymotic" refers to the presence of blood beneath the skin. The term "hematoma" refers to a collection of blood in a tissue swelling that can be perceived visually and/or by palpation. In order to receive such an injury, the skin must be suddenly compressed from the outside against the hard bone beneath. Such a forcible process is necessary to squeeze blood from the tiny vessels within and beneath the skin. Here, there is a consistent quality of discoloration that does not confornl to any specific inlplement. It is, however, entirely consistent with Mila's disclosure that she was struck on the forehead by a frying pan wielded by her father, Igor Malenko. In recorded conversation with her mother about this injury, Mila disclosed that she was told to say 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 panT' Lori: "No. Can you tell me again. I can't 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 has seized on her seeking an assessment of thjs injury to terminate Mila's visitations with her, in order to protect Mila from further "false allegations."

Opinions:
With regard to the urinary methamphetamine findings, I concur with Dr. Baum's [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 child's methamphetamine level warrants an in-depth investigation by Child Protective Services and perhaps also by the local police. Indeed, Child Protective Services should have initiated an investigation when this report was received over a year ago." To Dr. Baum's strong comment, I would add that current knowledge on the effects of methamphetamine use on adults' protection and care of children, as methamphetamine commercialization and use wreaks havoc on families and communities in a broad swath of the country, pertains directly to Mila. In a few words, the pertinent finding is this: the disinhibiting effects of the substance on men is frequently expressed in physical and sexual violence against children and women. Sexual and angry impulses that might otherwise be controlled are channeled 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 the trade in toxic chemicals and the drugs themselves with others in the drug subculture. The risks to children extend beyond physical exposures to chemicals and methamphetamine smoke to victimization 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 blunt inflicted trauma, as Mila describes. I say this because of its appearance to the examining physician, its photographic appearance, her disclosure of how she received it, and her own words. This injury, in my opinion, is clearly not a "birthmark." Birthmarks should never be confused with ecchymoses or bruises. Where the former are consistent and lillchanging in discoloration, bruises heal and typically disappear. Mila alleged that her father told her to say that the injury was a "birthmark" if she were asked about it. It appears that he manipulated his daughter to cover up his assault on her. Mila's disclosures take on additional significance, because of the personal abuse risk that 1 believe applies to her because of her own and her mother's past abuse. This is by way of saying that the injury itself should not be examined and interpreted in isolation. Neither should a protective services investigator confuse it with a congenital skin discoloration.

At tIllS critical juncture, it is necessary to rethink the entire scope of Mila's treatment by her father and her mother's own victimization at his hands. The concurrent abuse of her mother and the apparent co-occurrence of methamphetamine abuse, in my opinion, yield tremendous additional 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 Children's Hospital Boston