(2 of 3)
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."