By Brenda Wintrode for Wisconsin Watch.
Broadcast version by Jonah Chester for Wisconsin News Connection reporting for Wisconsin Watch-Public News Service Collaboration

Stacy Hartje's quest to clear her name took eight years.

In 2007, the 22-year-old mother of one was providing child care for several children in her Mauston, Wisconsin, home. One day after eating his lunch, a 3-year-old boy collapsed in front of her.

"He didn't fall to the ground because I was able to catch him," Hartje said. She called his parents, then called 9-1-1. She rode in the front seat of the ambulance that took him to the regional hospital.

The boy was transferred to American Family Children's Hospital in Madison, where doctors performed a lifesaving craniotomy to relieve pressure on his brain. And because his brain trauma was unexplained, a pediatrician trained in identifying child abuse examined him.

Dr. Barbara Knox called Hartje the next day. Although distracted while visiting the zoo with some children from her home day care, she answered the doctor's questions for about 15 minutes. Knox would later tell a jury Hartje's answers during their call deviated from the answers she gave to police, which Knox described as "a red flag to me for child abuse."

Hartje's saga was among a dozen cases Wisconsin Watch found in which Knox's assessment of child abuse was rejected by the criminal justice system, child protective services officials or other physicians.

But in Hartje's case, that process took nearly a decade as she watched a county prosecutor issue and then drop charges due to a lack of evidence - only to later face two trials on revived state charges. The case relied heavily on Knox's contention that nothing other than physical abuse could have caused the child's injury, even though the trauma left no clear external mark or broken bones.

Knox formerly led the UW's Child Protection Program in partnership with American Family Children's Hospital. She resigned from the position in 2019 after being placed on leave for allegedly bullying colleagues. She is facing similar complaints as medical director of Alaska CARES, a statewide child abuse forensic clinic that has seen a mass exodus of staff, many of whom lodged complaints about Knox's behavior and diagnoses.

Knox did not return calls and emails requesting comment.

Charges filed, dropped and filed again

The week after the boy collapsed, a detective came to Hartje's home and interviewed her for two hours. Juneau County Sheriff's Detective Tim Andres later said in court that the only conversation he had before he knocked on Hartje's door was with Knox.

Hartje agreed to let Andres question her "because I had no reason not to talk to anybody," she told Wisconsin Watch.

Andres told Hartje the boy was in grave condition and had undergone emergency brain surgery, according to the interview transcript. He said he had spoken with Knox on the phone, and described her as "an expert in child injuries."

Knox had told him the boy's injury happened within an hour of Hartje's 9-1-1 call and had taken severe force to inflict - as if the boy had fallen out of a two-story window or hit the windshield in a high-impact car crash while unbelted, he said, repeating what Knox had told him.

"That's why I had to come and talk to you," Andres told Hartje. "There's just no way that anything could have happened to (the boy) unless you were involved in it."

He warned her not to lie. "I understand that you're afraid, but I can also tell you that it's not going to be any better by lying to me," he said, according to the transcript.

Hartje wracked her brain for an answer. She recalled a recent incident in which the young boy had slipped on the stairs and hit his head. Could that have caused the episode? She told Andres she had never hit this child or any child in her care.

Andres kept talking. "There isn't anywhere else to go with this Stacy ... Something happened with you and (the boy), and I need to know what it was."

Six months passed and Hartje heard nothing, but officials were still considering whether to level charges. That December, a cadre of state and county law enforcement visited Knox in her Madison office. The doctor told them physical abuse, specifically "blunt trauma," inflicted within the hour before Hartje called 9-1-1 caused the boy's injuries.

Then in January of 2008, a sheriff's deputy knocked on Hartje's door and handed her a letter containing a list of criminal charges. The news hit days after Hartje learned she was pregnant with her second child.

"You're frustrated, sick to your stomach - and then, the thoughts of: If I go to prison, where's my kid going to go?" recalled Hartje. "It's every emotion you could possibly think of besides happiness."

The office of Juneau County District Attorney Scott Southworth had filed four charges against her, alleging she intentionally and recklessly caused bodily harm to the toddler and showed "utter disregard for human life" - only to drop the charges nine months later due to a lack of evidence.

But Juneau County Sheriff Brent Oleson wanted to go forward, asking Southworth to allow the state Department of Justice to look into the case. The state agreed and in 2012 charged Hartje with three counts - first-degree reckless injury of a child, physical abuse of a child and first-degree endangering the safety of another.

She pleaded not guilty.

Knox: 'These are violent injuries'

The first trial didn't start until 2014, seven years after the boy had collapsed. On the trial's third day, Knox took the stand and told the jury how she diagnoses child abuse. She said she examines the child, looks at his or her medical record, rules out bleeding disorders and genetic disorders and confers with other doctors working on the child's case. She speaks to the parents and caregivers.

Although the boy's mother had epilepsy, Knox testified the incident was "absolutely not" a seizure.

"My starting presumption is I don't know what this is, and I want to objectively look at an entire differential diagnosis of what may explain head trauma," she told the jury.

Assistant Attorney General Richard Dufour asked Knox if it was her job to affix blame. She replied, "Absolutely not," then proceeded to do just that, insisting that the injury was inflicted just before the 9-1-1 call - laying the blame firmly on Hartje.

She rejected the idea that the bump experienced during the child's slip and fall on the plastic steps could have caused brain bleeding. "We wouldn't survive as a human race if you had a little minor bump to your head and then you had a catastrophic head injury," she testified.

"These are violent injuries," Knox said.

She said the boy's brain had shifted to the right, meaning something must have impacted the left side of his head. But there were no injuries to the left side of his head. She pointed out a bruise on the right side of the child's forehead but said she could not determine if it was related to the brain injury.

She compared the boy's head injury to a fall from a horse followed by "violently striking their head on a rock."

Knox drove her point home with another grizzly scenario - one that bore little resemblance to the facts in Hartje's case.

"I had a mother who was upset with her three-year-old child and violently, violently impaled the child into the wall. That child immediately went down, and the child slowly started to get up. She slapped the child again, and the child died of massive head trauma. So that is a clinical scenario of how that happens."

Dufour asserted in his closing arguments that Hartje "bashed this little boy in the head and almost killed him." Knox had ruled out other diagnoses, he told the jury; child abuse was the only logical conclusion.

After eight hours of deliberation, the Juneau County jury deadlocked, and Judge James Evenson declared a mistrial. But that was not the end for Hartje.

The state announced the following week it would try her again. Hartje learned of the development while watching the local news.

Second trial ends in acquittal

In that second trial, Hartje's lawyers argued that the state ignored its own evidence to support their allegation.

"It was not a process of elimination. It was a process of justification," attorney Stephen Meyer said in his closing arguments.

A medical expert for the defense, Dr. Lawrence Hutchins, a Marshfield Clinic neuroradiologist whom Meyer said had never before testified on behalf of a defendant, wrote in his report he found no brain swelling, no skull fracture and no soft tissue swelling - no evidence of direct trauma to the brain.

A second defense expert, pediatric neurologist and epidemiologist Dr. Joseph Scheller, wrote in his report: "Children who are the victims of abuse typically have external injuries and broken bones. They can have retinal hemorrhages and neck injuries. (The boy) was not found to have any of these."

Scheller said an accidental fall likely caused the injury. And while Knox contended an injury as severe as the one in question would have elicited immediate symptoms, Scheller disagreed, saying such injuries can take hours - or even days - to reach enough pressure to cause symptoms.

A jury found Hartje not guilty of all three charges in October of 2015.

But nearly $250,000 in legal debt lingered. Hartje and her husband Ned gave their house over to a bank to pay a relative who offered a loan. They have about eight years of payments left.

Sitting on a picnic table in August outside the Sauk County Courthouse in Baraboo, Hartje, now 37, remains puzzled and angry about her legal ordeal.

"How in the world could I have caused this injury, and there's no other mark on this child's body?" she asked.

In an interview, Meyer said the state "hitched their wagon to Knox" and "went out and found other people to support their original erroneous assumption."

"Stacy and her family went through hell," Meyer said. "(The boy's) family was ... certainly convinced by people in authority that Stacy had harmed their child. And how do we repair that? How do we put it back together? We can't."

Brenda Wintrode wrote this article for Wisconsin Watch.


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A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.

Despite a recent policy victory, Wisconsin labor leaders still express concern about the current environment for shielding young teens from unsafe work environments.

Gov. Tony Evers this month vetoed a bill which would have expanded the elimination of required work permits for those younger than 18. The bill's language applied to 14- and 15-year-olds, several years after the state did away with parental permission for 16- and 17-year-olds.

Stephanie Bloomingdale, president of the Wisconsin State AFL-CIO, said the recent debates are policy fights advocates thought they won decades ago when minors often worked in dangerous conditions. She cautioned there is a strong push to chip away at protections.

"We are seeing a growing movement from different, unscrupulous employers that want to put kids back in the workplace, and not have the kind of oversight that is needed," Bloomingdale contended.

The Economic Policy Institute said rollbacks have been approved in a dozen states in the past few years. While current efforts are thwarted in Wisconsin, Bloomingdale worries about similar debates in future sessions.

Meanwhile, violations are trending upward, with the U.S. Labor Department reporting an 83% increase in financial penalties. Backers of the Wisconsin bill said the goal was to reduce red tape for families.

Bloomingdale countered taking away another layer of protection does more to trample on the rights of parents and guardians. And with higher consumer prices placing more pressure on household budgets, she added some kids might feel the need to bring in additional income.

She emphasized the current law helps the whole family make an informed decision.

"It's important for kids to get a good work ethic," Bloomingdale acknowledged. "But at the same time, these kids need to make sure that they are getting enough sleep, that they are able to participate in their school, and really making sure that balance is there."

The Economic Policy Institute report showed amid the push in many states to weaken laws, several other states have advanced bills to strengthen protections. There have been bipartisan bills in Congress which, among other things, would crack down on violators.


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