Hello Dr. Holick,

I got your contract information from the Fractured Families support group on Facebook. We are from Olmstead, Arkansas.

My mother (a retired elementary school teacher), my husband Zachary, and I took our 3 month old son to the E.R. on March 22, because he was throwing up, not gaining weight well (he had gained an ounce that week), and seemed to be in pain while eating. This was his second E.R. visit for eating problems. His doctors were unconcerned at that time and increased his Zantac dosage from 0.6 ml to 2.0 ml. We were told to schedule a follow up with our pediatrician for the next day and sent home.

The next day, we met with our pastor to plan our son’s baptism. We left about 1:30 for the pediatrician’s office. Our son was asleep and nothing seemed out of the ordinary. We arrived at the doctor a few minutes before our 2:30 appointment time. No one anything wrong while we were in the waiting room, or as we were called back to the exam room. He began to cry a little when I undressed him for his weight check. After the weight check, I sat down next to my husband with our son on my lap. The nurse practitioner came in a moment later and placed him on the exam table. Zachary heard a loud pop as she took him and the baby screamed and began to cry much more than normal for him. A few moments later, the nurse practitioner turned to us and said, “something’s really wrong here.” He was taken for x-rays there in the clinic, which did not show any fractures. Because his arm was swelling and he wasn’t moving it, we were sent back to Arkansas Children’s Hospital. We took him in immediately.

At the E.R., they asked to redo the x-rays. I gave my permission for them to x-ray his left arm again. I was not aware that they also did a skeletal survey or a CT scan until brought the results: in addition to his elbow, he had a skull fracture above his left ear, chronic subdural hematoma with a small amount of sub acute layering, several posterior rib fractures, a fracture on the left side of the pelvic bone, at least one femur fracture, and bi lateral tibia and fibula fractures all in various stages of healing. Several times the fractures on this list appear, disappear, and multiply. With the exception of his left elbow, none of these fractures swelled, had bruises associated with them, or seemed to be causing him any pain.

We were asked only a few questions about our family medical history, including if we had a history of osteogenesis imperfecta (we don’t), if we had a history of broken bones (only a few), if I had any joint problems (yes, and I demonstrated and explained a few of the many). My joint problems weren’t recorded in his medical records. Shortly afterwards, the hospital’s child abuse specialist wrote a report that his history and initial labs didn’t indicate a medical cause for his injuries. An hour later, my husband was arrested.

We were told that you might be able to help us. I have all of his records so far, as well as his scans if you’d like to look them over. Thank you for your time and we hope to hear from you.

Sarah & Zachary Culp

Dr. Holick’s Evaluation

I and my team saw Sarah and Quincy in our Ehlers Danlos Clinical Research Program in July. Based on a careful medical history, family history and detailed physical examination I concluded that Sarah has the bone genetic disorder Ehler Danlos Syndrome Hypermobility type. I also concluded that based on his medical history, family history and physical examination where he demonstrated intense blue sclera, significant joint hypermobility among other physical findings that he had acquired this genetic bone fragility disorder from his mother. He also likely was vitamin D deficient since his mother did not take any vitamin D supplementation during her pregnancy and he was solely breastfed and not receiving any vitamin D. Thus, Quincy had two causes for his bone fragility that were the likely explanations for his fractures rather than due to non accidental trauma i.e. child abuse. I explain these conclusions to Sarah and Zachary an provided an expert report that was helpful in having Quincy returned to them.

Follow-up from Zachary

Dear Dr. Holick,

I hope you are having a great day. I am Mr. Zachary Culp, husband of Sarah Culp and father to Quincy.

I would like to again thank you for seeing my wife, Sarah and my son, Quincy during July 4th weekend of 2018.

Since then, I saw you testify at my court trial and you were quite the saint.

With Quincy being almost 2 and a half years old, he still exhibits blue sclera, doughy hands, being ambidextrous, and lean body and short stature for his age.

He has several developmental delays, and we are currently working on those struggles.

Because of the visit in July 2018, Sarah and I are thoroughly convinced you saved Quincy’s life. Only after seeing you did Quincy start to get on the right track.

Respectfully,

Zachary A. Culp

Follow-up from Dr. Holick

As a result of their horrific and terrifying experience, they went to their state representative and senator and finally had a law passed, know as Quincy’ s Law which now includes a variety of metabolic bone disorders including Ehlers Danlos Syndrome and vitamin D deficiency rickets as potential causes for infantile fractures. A summary of the law is below:


Stricken language would be deleted from and underlined language would be added to present law. Act 976 of the Regular Session

State of Arkansas
As Engrossed: H2/8/21 H3/29/21 H4/7/21

A Bill

93rd General Assembly 
Regular Session, 2021
By: Representative Brown 
By: Senator A. Clark 

“Differerential Diagnosis Accountabilty Act” TO BE KNOWN AS: “Quincy’s Law” Regular Session, 2021 HOUSE BILL 9999 By: __Child Welfare System_Committee

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ARKANSAS:

Exert from the Bill;

(3) A third-party panel that has neither affiliation nor employment with neither the accusing institution or any of its satellite campuses shall be constructed
that has physicians from each of the following fields that has a subspecialty to
practice in a Pediatric setting, if applicable:

  1. Endocrinologist
  2. Gastroenterologist
  3. Geneticist
  4. Hematologist
  5. Neurologist
  6. Neuroradiology
  7. Neurosurgeon
  8. Orthopedic Surgeon
  9. Pediatrician
  10. Radiologist

in which the following who specialize in identifying unique health conditions, including, but not limited to, shall look objectively for the following health conditions:

  1. Rickets, including all phases and types of Rickets from pre-birth to adulthood
  2. Ehlers-Danlos Syndrome;
  3. Benign Enlargement of the Subarachnoid Spaces (BESS or BESSI);
  4. Benign Extra-axial Collection of Infancy;
  5. Retinal Hemorrhages;
  6. Menkes Disease;
  7. Hydrocephalus;
  8. Macrocephalus;
  9. Osteogenesis Imperfecta;
  10. Osteopenia of Prematurity; (11) Stickler Syndrome;
  11. Vitamin D deficiency; and
  12. Other similar metabolic bone diseases or connective tissue disorders, or any other unexplainable or listed symptomatic disorder.

All findings from each of the panel members shall be produced and distributed within a business day of all completed work of the physicians to the agreed upon parties. A two-thirds majority will be the standard for of the alleged victim has a health condition(s) or suspected child abuse or neglect.