When Is Crib Death a Cover for Murder?

By Anastasia Toufexis

In the cruel roulette of life, Waneta Hoyt seemed to be an especially tragic loser. Nearly 30 years ago, she lost her first child, Erik, suddenly and inexplicably. The mother tearfully told doctors that she found him barely breathing in his crib and could not revive him. He was three months old. Waneta's second child, James, was a little over two when, according to his mother, he called out after breakfast one morning and expired. A daughter, Julie, died at 48 days; her mother was feeding the child when the infant choked, turned blue and died. Another daughter, Molly, died at home in bed at three months, and a similar fate befell another son, Noah, who was her last- born child.

Doctors were mystified and intrigued. A pediatrician who had closely monitored the last two children wrote up the family's history in a 1972 medical journal as a classic example of how sudden infant death syndrome (or SIDS) can run in families. As for Hoyt, she went on to adopt a son, who is now 17. But she never forgot her dead offspring. She kept their photos throughout the house and laid flowers on their graves every Memorial Day. "She'd say, 'I miss my children. They all died on me -- you know, that crib disease,' " recalls Martha Nestle, a family friend. "Then she'd cry."

Now it looks as if the bereaved mother may have been getting away with murder. Last week the 47-year-old Berkshire, New York, housewife sat in court charged with suffocating all five of her children. Authorities accuse her of smothering three with pillows, one with a bath towel and another by pressing its face against her shoulder (the specifics are based on a confession that Hoyt has now recanted). Says District Attorney William Fitzpatrick of Onondaga, New York, who initiated the investigation of Hoyt: "We have brought to justice a killer who preyed on her own children."

The Hoyt case is not an isolated instance. In Waukegan, Illinois, this month, Gail Savage, who is accused of smothering her three babies, goes on trial for a child's death. In Garden City, Kansas, last June, Diane Lumbrera was convicted of fatally suffocating her son; she had already pleaded no contest in Texas to killing a daughter. Across the country, authorities are taking a harder look at SIDS deaths. According to medical examiners, police and prosecutors, SIDS is a label that is too readily affixed to mysterious deaths. They say that anywhere from 1% to as many as 20% of the 7,000 to 8,000 U.S. babies who die of SIDS each year actually expire of other causes, including murder. Generally the killer is the mother. Sometimes she slays for insurance or from frustration, and sometimes in a twisted bid for attention and sympathy. These sympathy junkies, says Vincent Di Maio, medical examiner of San Antonio, Texas, "usually keep killing until they're caught or run out of children."

One reason the murders go undetected is that suffocation, the usual method of these infanticides, is virtually indistinguishable from SIDS on autopsy. As a result, single deaths don't raise much suspicion. Nor should they. But red flags should snap up when several apparently healthy babies die in one family. "Two SIDS deaths is improbable," observes Di Maio. "But three is impossible." Another sign of possible foul play: repeated bids for medical attention for the children before they die. "Often there's a long medical record of these babies being brought barely breathing to hospitals by the parent who says they have a history of turning blue and losing consciousness," explains Dr. Michael Baden, director of the forensic-sciences unit of the New York State police and an expert witness at Hoyt's preliminary hearing. "This isn't the pattern for SIDS, where babies have no serious prior problems and are suddenly dead in their cribs."

But even such strong signals get missed. Doctors and police may be unaware of a family's history, or they may be blinded by pity for the bereft parents. Marybeth Tinning of Schenectady, New York, won only sympathy as, one by one, her nine youngsters died of SIDS and other vague natural causes between 1972 and 1985. Doctors and friends suspected some rare genetic defect was to blame, even though one of the victims was an adopted son. (Tinning was finally convicted in 1986 of murdering her last child.) "We have prejudices about what killers look like," says D.A. Fitzpatrick, "and they don't look like nice middle-class moms from the suburbs who would do this for no reason."

Psychiatrists say the killers commonly suffer from a variant of Munchausen's syndrome, a bizarre mental condition that impels people to feign or induce illness in order to get care and nurturing from doctors and hospitals. In Munchausen's by proxy, people injure their children in their place. They may inject the youngsters with poisons or drugs, or mix blood in their urine. Parents have even been caught by surveillance cameras attempting to smother their offspring in their hospital beds.

Hoyt escaped suspicion for years. What finally led to her arrest was the two-decades-old medical article in Pediatrics. Fitzpatrick first read the paper eight years ago while preparing an infanticide case in order to familiarize himself with possible causes of SIDS. In the report, Dr. Alfred Steinschneider, now president of the Sudden Infant Death Syndrome Institute in Atlanta, proposed that a genetic defect could cause prolonged apnea, or breaks in breathing during a baby's sleep, and lead to SIDS. He bolstered his thesis with detailed accounts of the death of five babies in one unidentified family. Medical examiner Linda Norton, who passed the paper along to Fitzpatrick, ! offered an intriguing remark: "She said, 'By the way, when you read the article, you may decide you have a serial killer here.' "

Fitzpatrick agreed and began digging. The article referred to the family only as "H." But Fitzpatrick searched county medical records and eventually came up with the Hoyts. Much of the incriminating material in the case comes from the extensive research records kept by Steinschneider. "For Molly and Noah Hoyt," says Fitzpatrick, "we can account for virtually every day of their lives."

Since the Hoyt case and similarly suspicious ones form much of the evidence for Steinschneider's theory that SIDS runs in families, that theory is being called into question, and along with it, the value of so-called apnea monitoring in preventing SIDS. Steinschneider's findings have supported the idea that families who have lost one baby to SIDS can avoid losing subsequent children by hooking up sleeping infants to devices that set off an alarm when the gaps between breaths become too long.

Cases like Hoyt's and Tinning's, as well as the increasing awareness of child abuse in the U.S., have led law-enforcement and medical authorities to call for a more aggressive approach to investigating infant deaths. Most states now require an autopsy for all babies who die unexpectedly. Before a diagnosis of SIDS can be made, an examination of the scene of death and a review of the child's medical history are made. SIDS experts are calling for standardized protocols to guide such investigations.

While all this may serve the interests of justice, it will doubtless cause greater pain to parents already stunned by the loss of a child to crib death or some other natural cause. Now, in addition to enduring their grief, they will face more intense questioning from officials. But SIDS parents are among the most fervent supporters of stricter investigations. "The truth," notes Thomas Moran, president of the SIDS alliance, "is that bias and confusion will disappear only when people are really sure why every baby in this country dies."

With reporting by David Bjerklie/New York, Elizabeth Taylor/Chicago and Sarah Tippit/Orlando