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Daunting And Condescending Testimony Exhausts Jury

Yolo-Count-Court-Room-600by Jane Fitzsimmons, Marya Alloo, and Antoinnette Borbon

 With still weeks of testimony to go, the jury in Department One has seen its fair share of medical testimony, which seems to be dragging them in circles.

Quentin Stone is the father accused of “shaking” his two-month-old baby, which potentially may have caused the baby’s death. The trial, which started last week, involves the contention that three-month-old Samuel Stone died from injuries that included bleeding in his brain, retinal hemorrhages and fractured ribs, and has left many questioning the charges at hand.

Today the trial continued, with the return of Doctor Coulter, the chief of pediatrics at UC Davis Medical Center. Coulter, who has examined more the 1,000 child abuse cases and has testified in over 200 cases as an expert in child abuse, felt that two-month-old infant Samuel’s death was not an accident.

When baby Samuel arrived at the ER at UC Davis Medical Center, a specialist in optometry examined the infant’s eyes. The eyes, Coulter stated, are examined to rule out any retinal hemorrhages that are commonly found with head injuries. When the retinas of the infants were examined, multiple hemorrhages were located on multiple layers of the retina.

When asked by Deputy D.A. Robin Johnson about how retinal hemorrhages occur, he stated that “retinal hemorrhaging can occur when there is increased pressure in the brain which pushes on the head of the optic nerve.” Johnson, who seemed to quickly brush Coulter’s response aside, began questioning Coulter with an emphasis on the idea of “shaking baby syndrome.”

Shaking baby syndrome, according to the chief of pediatrics, is associated with retinal hemorrhaging. When a person is being shaken, the gel in their eyes also will be moving. With the repetitive movement of the gel, swelling of the optic nerve can occur, and can ultimately lead to retinal hemorrhaging. Oddly, later on in the testimony Coulter seemed to contradict himself by stating “I do not feel retinal hemorrhaging is associated with abuse.” Many of the jurors’ faces were left puzzled as the testimony continued.

It is interesting to note that Coulter’s first response to the reasoning behind retinal hemorrhaging was that it could be associated with increased pressure in the head. A CT scan done at the ER at UCD Medical Center showed that the two-month old infant did have a tremendous amount of fluid causing pressure in his head. When asked later in the testimony what doctors would do to relieve the pressure associated with fluid in the head, Coulter responded with the first thing doctors would do would be to drain the fluid by inserting a needle into the head, which could ultimately lead to saving the person’s life. When asked if draining of the fluid in the infant’s head was something doctors were considering the day before, Coulter responded, in a questioning tone, that “Neuro felt it was unnecessary?”

After what seemed like a never-ending cycle of questions, the jury was released for a recess to take a break from the mind-boggling testimony.

Coulter’s testimony continued after the break, with cross-examination done by Deputy Defense Attorney Martha Sequeira.

Sequeira, who seemed intrigued by the fact that Dr. Coulter has testified as an “expert” in assessing child abuse, questioned Coulter about his certification. In recent years, the Medical Board has certified specialists to assess child abuse cases by taking an exam. Coulter, who emphasized that he has the qualifications of being a child abuse consultant, stated that he has not taken the exam and was instead “grandfathered” into the position, due to his years of dealing with abuse cases.

When questioned by Sequeira of how validation of child abuse is given, a hesitant Coulter responded by saying “literature and speaking to others in the field.” Sequeira fired back, “So there is no way of validating?” Coulter responded with a reassurance to Sequiera’s question, that there is no way to truly validate that child abuse has taken place.

Defense then presumed to question Coulter with many different scenarios and hypotheticals, which led Judge Richardson to ask the defense to narrow down to the subject matter. Sequeira, clearly upset, responded to Judge Richardson’s request by stressing that she has the right to cross-examine and that she feels that her client’s rights were being violated.

Sequeira then cut to the chase by asking Coulter if it was possible that someone else could have inflicted these injuries on the two-month-old infant. An agitated Coulter responded by saying, “I never said it was the defendant that shook the child, but somebody did!”

The jury has now had multiple ideas thrown at them for possible causes of the baby’s death, and will continue hearing several “expert” medical testimonies as the trial continues. Cross-examination of Coulter will continue by the defense in the morning.

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22 comments

  1. Wonder how much he was paid to testify.

  2. “Coulter responded with a reassurance to Sequira’s question, that there is no way to truly validate that child abuse has taken place.”

    For this portion of the trial, there appears to be reasonable doubt.

  3. I would like to speak to the complexity of medical testimony and how it may be confusing to laymen without actually being contradictory. I have not heard, or reviewed the full testimony in this case and so cannot speak to the actual testimony since what we have here are only partial quotes. But I will use what we have to illustrate the point.

    ” “retinal hemorrhaging can occur when there is increased pressure in the brain”
    ““I do not feel retinal hemorrhaging is associated with abuse”.

    On the surface these two comments sound contradictory, but we would have to consider the entire testimony to determine if this is the case.

    While retinal hemorrhaging can occur when there is increased pressure in the brain, this is not the only possible cause of retinal hemorrhage. A fist to the eye will also cause retinal hemorrhage. Bleeding from a small retinal vessel because of an inherent weakness in that particular vessel will cause retinal hemorrhage and may have nothing to do with increased pressure in the brain. The fact that the witness cited one cause does not preclude others and hopefully this will be pointed out to the jury if it has not been.

    It is very hard to assess the context of the second quote and we are not given the exact question the witness was addressing when he stated “I do not feel that retinal hemorrhaging is associated with abuse”. Did he mean in general, did he mean usually, did he mean always, did he mean in this particular case ? Since we are not provided with context, we cannot really tell whether or not this is a contradictory statement.

    I am raising these points not to criticize your reporting which I greatly appreciate, but rather to demonstrate the difficulties faced by the jury in trying to understand the physiology involved, the potential causes of injury, and where the truth lies when alternative explanations are presented in an adversarial fashion with drama introduced by each side to attempt to sway the jurors opinion rather than simply presenting the facts in an unemotional, non prejudicial fashion, which is surely what “getting at the truth” should be based on.

    • Elizabeth Bowler

      It is the job of the medical expert to take complex medical information and explain it in terms that the jury and other laypersons can readily understand. The failure to do so is a failure on the part of the expert, not a lack of understanding on the part of the laypersons.

      • I agree that the jurors are in no way at fault. The medical expert however is also limited in what they can present by the questions that are asked of them and the context in which they are asked.

    • Elizabeth Bowler

      The very title of this article highlights the failures of this expert. Medical testimony should never be “daunting” or “exhausting” and no testimony should ever be “condescending”. The facts of the testimony itself become lost among the unpleasant ambiance created by the expert, and this ultimately hurts the prosecution’s case.

      • I am not sure if everyone is aware that the authors often do not choose the title of an article.
        Sometimes yes, sometimes it is chosen by David. I do not know in this case, but when words such as “daunting”, “exhausting” and “condescending” are used, they are sometimes more an expression for dramatic effect than an accurate reflection of the actual circumstance covered by the article.

        This I know because I have on occasion asked for a revision of a title that I found either non – representative or unnecessarily inflammatory.

  4. at T a yes there were parts of our notes that were mistakenly left out of this article so I want to clarify a couple of those points to answer your question about the retina yes Dr culture testified that the retina scan also be harmed by high blood pressure

    also, he appeared to at the end of the day yesterday be forced to form an opinion that the baby in fact had died of shaken baby syndrome person his medical reports and consultations with other doctors.

    • Thanks for getting back to me with the additional information.
      I think this must be a difficult case for you all to cover, just as it is difficult for everyone else involved.

  5. Dr Coulter stated, that in looking at the cats cans an
    compound injury to the infant,
    that he concluded it could have only come from blunt f orce trauma on the brain and sure that was a cause of death however, he did not state that he knew who shook the baby.

    I believe most of his testimony was pretty clear and pretty explanatory along with pictures and the result of this several CT scans along with the results of the MRI. He said he concluded his report due to the compound injuries, which in his expertise and years of examining children of abuse, these injuries were consistent to forced trauma and non accidental. I believe though, he wad asked the same questions too many times but there may have been a strong.point to DDA doing this…just a hunch. Some was a.bit contradictory but again, by the end kf the day, defense was finally able to push him for a straight forward answer.

    It seemed tedious for both counsels but I am sure they are just wanting direvt answrrs. Understandably, there are misdiagnosis and error in medicine, for sure.

    I apologize for the mistakes in the responses..trying to type without my glasses

    But I do hope I have cleared up a few things.

  6. but in my opinion, I do believe the medical doctors in this case failed the family. I don’t believe they did all that they could have done to save this baby’s life, no matter how he sustained those ..

    also, and testimony yesterday defense brought out the fact that the family had requested a second opinion, but the doctors at UC Davis told them it would take too long to get a second doctor in there to look at everything and possibly make other decisions.

    I pray for this family and their healing through this tragic event it matter what the outcome it’s never going to be enough nor will it bring back this baby who died innocently…..and still believe there was negligence on the doctors part. I think before the focused on the abuse factor, they should have focused more on saving his life. So far from testimony, signs were ignored, no matter how he sustained the injuries, to me, he was failed.

    But I do understand the flopside, the doctors believing they acted appropriately, considering some were given very little info on the serious signs and not wanting to take medical risks…but look at the results of not taking the risk may have ultimately caused. Albiet, from the injuries initially. However they came about. More than one set of hands had their part in this tragedy….just saying.

    • Elizabeth Bowler

      I certainly agree that it appears that the various medical professionals failed this family, beginning with the prenatal care that the mother received, assuming that she received any. When an 8 week old infant has a low Vitamin D level (as testified by Dr Coulter) it is due to low maternal levels and indicates that the mother was not adequately monitored during pregnancy. Given that infantile rickets is 25 times more common in twin pregnancies, such a lack of monitoring is completely unacceptable in this day and age.

      I would be cautious about using words like “injuries” when describing the baby’s symptoms including brain bleeds and retinal hemorrhages, until we hear from the defense experts. I assume that we will be hearing about various metabolic conditions that can cause these symptoms without the presence of injury, either intentional or non-intentional.

  7. UCDavis’ Neurology dept has had massive problems. There was extensive reporting on their 2 doctors who were experimenting on terminal patients with brain tumors, without permission and required protocols, using medications that were never approved to be used on humans. One was the dept. chair and both were forced to leave or else UCDavis would have lost accreditation. I’ve seen 4 of their neuro doctors and none were totally competent.
    Dr. Coulter is probably being very careful not to lay blame on neuro docs at UCDavis, his employer. He likely doesn’t want the parents to fill a civil suit for negligent care.

    I believe the prior reporting was that the baby was examined by Dr. Patel, in ophthalmology, not optometry; Dr. Patel is in training in this field.

    It’s very sad to think the baby’s injuries and trauma might have been due to the toddler’s actions. We can hope this aspect is handled very carefully by his parents as he grows older.

    • Robert Canning

      TJ: I believe that was the Dept. of Neurosurgery – not neurology. There is a big difference. Neurologists are not surgeons . You might want to check your facts before making such a damning statement.

      Elizabeth Bowler says: “It is the job of the medical expert to take complex medical information and explain it in terms that the jury and other laypersons can readily understand. The failure to do so is a failure on the part of the expert, not a lack of understanding on the part of the laypersons.”

      It is also the job of attorneys to prepare expert witnesses so that their testimony aids the triers of fact and not confuse them. Simply blaming the expert obscures the ability of the attorney to question in such a way that allows the expert to assist the judge or jury. Don’t blame the expert for an attorney’s poor line of questioning.

      • Elizabeth Bowler

        “Don’t blame the expert for an attorney’s poor line of questioning.”

        Robert Canning, you are referring to information which I have not read, as I have seen nothing to suggest that the prosecutor engaged in a line of questioning that was ineffective and/or improper. What I have read, however, is that the demeanor of the witness was condescending, and that his testimony was daunting, exhausting and confusing. In my experience, an expert is almost always given a lot of latitude on direct examination in order to thoroughly explain his findings and opinions, and the failure to do so in a coherent and understandable manner is rarely the fault of the attorney doing the direct . Condescension and confusion have no place in a matter such as this. It seems to me that the prosecutor was doing the best job he could with what he had .

        • Elizabeth Bowler

          and my apologies to the prosecutor, Robin Johnson, if I have used the incorrect pronoun

        • Hi Elizabeth

          I have had the good fortune to never be a participant in a court case despite an almost 30 year career. I am wondering what your experience is with court cases.

          • Elizabeth Bowler

            Tia, I have testified as an expert in hundreds, probably thousands of cases over the years over the years. I have always found the intersection of medicine and the law to be particularly fascinating.

      • “I believe the prior reporting was that the baby was examined by Dr. Patel, in ophthalmology, not optometry; Dr. Patel is in training in this field.”

        “UCDavis’ Neurology dept has had massive problems”

        “I believe that was the Dept. of Neurosurgery – not neurology”

        These three statements illustrate just how easy it is to make mistakes in a general sense and more specifically to mistakenly make false associations and accusations in assessing medical contributions to adverse outcomes. I think it is especially important in a highly emotional case such as this one to ensure that our comments reflect the facts at hand and do not make loose references to broad groups of people who may have had no relationship to this situation at all.

  8. I agree, Robert, it is their job. But in withholding the parts of testimony, disagree, Elizabeth, we are there to write about exactly what we hear, short of what David will allow. Once.defense gets their shot, sure then we will have another side to this story.

    • Elizabeth Bowler

      Indeed, I completely understand the position you are in. I appreciate the thorough reporting and am very much looking forward to reading the other side of the story.

  9. Thank You Elizabeth, we will certainly try to do the best that we can.

    yes I’m looking forward to the other side of the story as well. thank you so much for reading and commenting.

    we certainly appreciate it.

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