Expert Testimony Leads to Heated Response by Defense in Infant Death Case

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

As the prosecution’s “case-in-chief” comes near an end, it has been bringing forth a deeply emotional surge of outbursts from Deputy Public Defender Martha Sequeira. Ms. Sequeira’s intense emotion throughout this case goes as far back as the beginning of the trial. But today, things spiraled out of control between her and the prosecution’s expert witness, Dr. Omalu.

Judge Paul Richardson often had to pose as referee to the shouting match between the doctor and defense counsel Sequeira.

Dr. Omalu has also testified as an expert for Deputy Public Defender Dan Hutchinson, in the case against James Mings. In fact, it was his testimony that would narrow down the exact cause of death along with the elements and factors which led to the decedent’s last breath. It was at the request of Hutchinson that the brain stock was tested, thus getting defense an acquittal on the charge of second degree murder in the case against Mings.

Today, Dr. Omalu testified for the prosecution’s case.

Dr. Omalu received his MB, BS [M.D.] degree from the University of Nigeria in 1991. He received his MPH [Masters in Public Health] degree in Epidemiology from the University of Pittsburgh in 2004. He also received his MBA [Masters in Business Administration] degree from Carnegie Mellon University in 2008. Dr. Omalu holds four board certifications in Anatomic Pathology, Clinical Pathology, Forensic Pathology and Neuropathology. Dr. Omalu was the first to identify, describe and name Chronic Traumatic Encephalopathy [CTE] as a disease entity in football players and wrestlers.

Dr. Omalu testifies in court 60-70 times/year. He has little faith in the accuracy of predictions by CT scans and MRIs; he prefers sophisticated neuronal tests that can zoom in on the brain 1,000X or more. These tests are conducted postmortem and are invasive.

In 2012, Dr. Omalu conducted a neuropathology test of Sam Stone’s eyes and brain.

He stated that, as a neuropathologist, “we use differential diagnosis, meaning we assume the person has all diseases and then begin a process of elimination.”

At first glance, Omalu stated, “Sam’s brain was normal upon initial, external inspection — there were no genetic abnormalities, but there were contusions at the poles of his brain and the brain was in a state of shock.”

Raising his tone, Dr. Omalu emphasized, “I found MULTIPLE contusions in the brain!” Along with the finding of the contusions in the brain, Omalu also discussed that he found “congenic swelling, meaning the brain had become flattened out or attenuated, which indicated head trauma was caused by force without immediate death.”

On top of all those findings, Omalu also underlined the fact that “There was bleeding between the halves of Samuel’s brain and blood on top of the corpus callosum that came from a tear in a blood vessel. We call this pathognomonic of non-accidental, traumatic brain injury. There was bilateral and dorsal hemorrhaging.”

“There was evidence of angular rotational acceleration-deceleration, to which the midbrain is particularly susceptible. This type of acceleration-deceleration destroys fibers of the brain and causes leakage in cell membranes. There was excitotoxic injury, which is seen after severe trauma.”

“Differential densities between the skull and brain at different ages are important. The brain of an infant has more water, therefore is more resilient following head trauma.”

Shockingly, Omalu testified that “A yellowish discoloration of Samuel’s brain (dural matter) indicated more than one bleeding event, or more than one episode of traumatic head injury.”

“CT scans and MRIs showed a likely hypoxic-ischemic injury in Samuel’s brain, meaning his brain was deprived of oxygen or glucose. However, we can see this is not correct by opening up the brain. He did not experience hypoxic-ischemic injury and his spinal cord was not injured, which we would usually see.”

Omalu then took individual slices of the brain and had them put into microscopic slides for him to further examine the matter of the brain. He explained, “I examined microscopic slides of different regions of Samuel’s brain and found a presence of white blood cell infiltration, signaling axonal damage. There was evidence of a disruption of the tubules transmitting proteins anterograde and retrograde to the brain. Proteins gather around this disrupted area and it is severed. This was apparent in Samuel’s autopsy.”

Omalu reiterated that “Unresponsiveness, respiratory system interruption, brain swelling, and seizures are all secondary to the primary injury that initiates this cascade of events.”

Along with the examination of the brain and dural matter, Doctor Omalu also examined the eyeballs of the infant. His findings indicated, “Samuel’s eyes showed findings with evidence consistent with traumatic brain injury. There was bleeding into all 6 layers of the retina — globule hemorrhages. The
blood began at the optic papilla, then the equator of the eye, to the anterior end of the retina. There was traumatic retinal detachment, meaning forceful separation. I was able to see bilateral hemorrhages.”

The doctor yesterday narrowed the cause of this bilateral hemorrhaging in Sam’s eyes down to trauma or coagulopathy. Dr. Omalu, today, ruled out the latter. “Coagulopathy does not cause retinal detachment and this detachment cannot occur postmortem. We can rule out any causes other than traumatic head injury.”

Throughout questioning, Dr. Omalu failed to answer questions briefly and gave information beyond what was asked. He was countlessly reined in by the defense’s sustained objections on the grounds of narrative.

DDA Mount asked, “Are you aware that [another] doctor found abusive trauma in the form of fractures of Sam’s posterior ribs?”

Omalu responded, “Yes. The ribs of a 3-month-old have a certain amount of give; they can sustain movement without injury, especially the ribs closer to the outside of the body. However, a violent compressive injury squashes the ribs on the spinal column.”

Mr. Mount then speculated, “Could Sam’s ribs have been fractured at the same time as his other injuries?”

Omalu reiterates, “Callouses mean the injury was about 2 weeks old, so it could have happened at the time of the older head injury. But there was no way this infant could have lived with such severe brain injuries for weeks” He asserted that the labored breathing happens “within minutes of the injury sustained but no longer than one to three hours.”

With the ever so present idea of subdural hematomas being a possible cause of death in Samuel Stone’s case, Omalu was asked by Mr. Mount to elaborate on the presence of subdural hematomas in infants. Dr. Omalu explained “50% of babies have subdural hemorrhages due to vaginal delivery, but they are
of no forensic consequence. They heal and are not typically bilateral or dorsal.”

When asked if a subdural hematoma in an infant can re-bleed, Omalu responded, “In re-bleeds, new blood vessels that have formed have thin walls and are more likely to rupture, but one blood vessel cannot be on both sides of the brain. Samuel’s brain had a bilateral re-bleed, and the only possible explanation is acceleration-deceleration trauma. A fall almost always causes unilateral injury.”

Asked by Mount to restate the cause of death, Omalu reassured to the court room that, “Sam’s injuries were not sustained from a fall. It was non-accidental. An infant’s motor abilities are very small and the injuries incurred would require a lot of mass and energy.”

The injuries present on/in the infant, in Omalu’s terms, “are the worst internal injuries a 3-month-old can have without any external injury. It was very severe. If it was an accident, we would expect to see significant abrasion or bruising. A fall could not generate enough force — it would have to be violent force.”

Omalu stated that it was important to note that “a child’s neck is more susceptible to rotational movement. The neck is not strong enough to resist, as when a baby is being violently shaken. From my examinations, I concluded that Samuel’s injuries were caused by adult-induced, non-accidental head trauma.”

In cross, Ms. Sequeira, in an attempt to steamroll the witness, bombarded Dr. Omalu with abrasive questions, spat out too fast and loud for him to understand, but they all ended in a determined, “YES?”

She went so far as to ask, “You charge however much you can milk from whoever is hiring you, yes?”

Shocked, Dr. Omalu answered her questions evasively – even contemptuously. He attempted to elaborate on everything, and in no time the defense and doctor were having a shouting match. Judge Richardson had to interrupt, repeatedly, to remind the professionals how a courtroom works.

In wrapping up what was heard in the afternoon, Sequeira continued with the same type of “yes or no” questions. At this point, a very emotionally charged Sequeira began questioning the doctor about his previous cases. In a previous case that Dr. Omalu had testified in, a dismissal took place due to a plea, because Omalu had proved that the child had been thrown with violent force, after being shaken.

Sequeira, questioning the doctor stated, “How can you manage how violent the shaking is if it’s unnoticed?” Sequeira, continuously badgering the doctor, focused on the doctor’s reasoning behind the death by saying, “But in your opinion, it was your opinion.”

An agitated Omalu stated, “This is not my opinion, it is a scientific fact, I studied the brain, I got degrees, I tested everything. These are not opinions!”

Sequeira then responded by saying, “But do you know that people disagree with your findings – Dr. Coulter disagreed with what you are saying.”

Omalu emphasized that what Coulter stated was based off of an MRI and CT scan, which are not very elaborate. By dissecting the brain and its dural matter, Doctor Omalu has the ability to further diagnose the cause of death.

Next to testify was, Detective Matthew Jameson. Matthew Jameson has been a Woodland Police Officer since 2005. He currently is a Yolo County Deputy Sheriff, and has been for the past 4.5 years. Jameson was asked to show a layout of the Stone’s house, and what was examined.

From his examination, Jameson had taken measurements of the height of the bed which the infant had supposedly fallen off of. His examination indicated that the bed to the wood floor came to “2 ft and 10 in.”

Deputy Public Defender Monica Brushia asked Detective Jameson why they would cut out the section of wood floor where the baby was said to have fallen.” He replied, “Well, we thought we may have needed it but we didn’t.”

“So you never tested the wood for DNA, blood, anything?” asked Ms. Brushia. “No, not after Stone told us his statement and we knew we weren’t looking for blood.”

After a day of intense and informative testimonies, the case wrapped up for the day.

About The Author

The Vanguard Court Watch puts 8 to 12 interns into the Yolo County House to monitor and report on what happens. Anyone interested in interning at the Courthouse or volunteering to monitor cases should contact the Vanguard at info(at)davisvanguard(dot)org

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17 Comments

  1. Tia Will

    WesC

    I think that you are misunderstanding what is being claimed here. There are some things in medicine that are fact.
    A collection of blood in the subdural space is a subdural hematoma by definition.
    A placenta lying completely over the opening of the cervix is a placenta pre via by definition and a baby cannot be delivered through it. This is fact, not opinion.

    However, what one decides to do about the hematoma, or the exact timing of a Cesarean to maximize the health of the baby while protecting the well being of both mother and baby are the “art of medicine”. It takes years of study and experience to know what, how and when to do the optimal intervention.

    There is both science and art involved in medicine and this is true whether one has, or has never been involved in a court proceeding.

  2. WesC

    I find it interesting that whenever a MD is on the witness stand they state their testimony of what they found is based on scientific fact which should not be questioned , but when the MD is a defendant being accused of malpractice, medical care and treatment very quickly becomes the “the art of medicine” and not an exact science.

  3. Antoinnette

    Amen! Tia!

    Yes, I am often to trusting…but would like to give Dr. Omalu the of the doubt. Yes, agree, abuse can be hapoening without anyones knowledge, trust me, I speak from personal experience!

    As my intern pointed out in the latest article, “no one knows what goes on behind closed doors.”What we cannot deny is the pathology, and facts laid out by three doctors. These are not just mere opinions…as we could see with our own eyes, the photos of the injuries. If those tests results and /or injuries can be be defined as something else, I would lose all faith in any scientific fact and all doctors.

    1. Antoinnette

      oops….sent too soon.

      Because we know from parts of the brain having a yellowish discoliration, we know he had been injured more than one time from the recent. The yellow us a sign if healing, per Dr. Omalu.

      If the toddler is responsible, he must have hurt the baby on more than one occasion and with great force.

      Is it possible? Maybe….but likely?

      In past testimony of a character witness, it was said defendant never drank…..yesterday, the neighbor testified to ,”the boys having a few together on the porch,” she said. I am pretty sure she was not talking about the baby boy twins. If mom was gone, who was attending the children? Just raises a question….

  4. Tia Will

    Davis Burns

    “If the baby could not have lived more than a few hours after the injuries that killed him were inflicted, when will they talk about who had access to him in the hours that preceded his death? Is all the other testimony about the fall off the bed, the first trip to ER, the visits to the doctor,emails to the doctor, vomiting and going limp completely irrelevant? I thought I had read all the articles about this case but don’t recall anything about on going abuse, pattern of abuse, etc.”

    I am going to preface my comments by saying that what I am going to state is speculation intended to present another way of interpreting this information. I am in no way suggesting whether or not there was abuse in this case. I am merely presenting what I know to be possible from 30 years of practice.

    It is estimated that an abused woman will deny abuse an average of 7 times before she will gain enough trust to admit that the abuse is occurring. A 3 month old has no way to provide input into what is actually occurring at home. Some injuries are not readily visible. Abuse is frequently a series of events which escalate over time.
    So if a baby were being abused, it is entirely possible that this could have been occurring over time in gradually increasing severity of episodes. If this were the case, it would not be unusual or in any way negligent for doctors to miss early signs given that they had only the verbal reports of the parents and the baby’s physical status at that time to go on.

    One point of agreement with your comments. The issue of who had access to the baby during the relevant time intervals will be critical to the issue of reasonable doubt.

  5. Antoinnette

    Jackson…..I am one of the reporters…lol Dont think you knew that?

    Agree, the brain suffered injuried, thats what we have heard but not condusive to a fall…agree, there should have been xrays taken on that first day but according to docs, he was fine?

    I hope more will become clearer by closing of this case.

    Stay tuned, Jackson….and thanks for your comments.

  6. Antoinnette

    Tia….well said! I agree, it is unfair to make the jury believe he is money motivated…seems silly since he is more than likely wealthy?

    Tok, when he testified in Mings case, he charged a very low amount…the DA has paid more because they probably have more? Unsure?

    Jackson…..at what point is Pathology important? Even if you disagree in “how,” the injuried were sustained..s.how in the world can you deny what is in front of you,i.e. Brain matter that shows blood in all the spots that indicate trauma? Are the test results wrong?

    I have not heard any of three doctors disagree on the injuries stemming from trauma, not sure where people are getting that from? In fact, so far, we have not heard a doctor from defenses case yet.

    The only thing Dr. Omalu disagreed with wad the xrays having limitef ability to show everything in detail and/ or causation. Also, about the brain being deprived if oxygen. But they were not actual disagreements as they were clearly explained once the brain wad cut open and evidence of injury was found and matter was tested.

    A good example: When the MRI of my sons showed fluid in the subdural, surgeons had no idea how much there was until they cut into his skull to get to the subdural to remove it, it was at that moment they told me they were shocked at how much more infection filled fluid was present.

    It was removed, in time and he survived. My point, as the Dr. stated too, is that xrays are limited.

    1. Jackson Scott

      No one is denying the fact that there is brain damage. I see that, I am agreeing there is brain damage. And that is what took the life of baby Sam. What I am saying I have an issue with is WHAT CAUSED these injuries. If they were really caused by Sam falling off the bed then this trial is pointless and disappointing. And If you read the other reports by the Vanhaurd you will see the Doctor (DA’s witness) say the injuries may have occured a month ago (which matches when Sam fell) We also know the no MRI or test was done after he fell to see if there was brain damage.

    2. Tia Will

      Antoinette

      “seems silly since he is more than likely wealthy?”

      Thanks for the smile. I wish I were still this trusting. No, I believe that many wealthy people are capable of acting unscrupulously in order to gain more money, or build their reputation as an expert witness, or just because
      they enjoy the process of being in the limelight speaking about their area of expertise. However, just because some people will do this is no statement whatsoever that this is what is motivating Dr. Omalu. For me, this kind of innuendo and emotional badgering has no place in a court of law which is supposedly about establishing fact and arriving at the truth.

  7. DavisBurns

    “But there was no way this infant could have lived with such severe brain injuries for weeks” He asserted that the labored breathing happens “within minutes of the injury sustained but no longer than one to three hours.”

    If the baby could not have lived more than a few hours after the injuries that killed him were inflicted, when will they talk about who had access to him in the hours that preceded his death? Is all the other testimony about the fall off the bed, the first trip to ER, the visits to the doctor,emails to the doctor, vomiting and going limp completely irrelevant? I thought I had read all the articles about this case but don’t recall anything about on going abuse, pattern of abuse, etc.

    If the baby’s doctor thought there was no cause for alarm after the fall off the bed, do we assume she is an expert and no other experts have said the injury happened a month prior to death therefore the events of the month prior to his death showed no abuse?

    1. Jackson Scott

      Based on the info from this article and others they are not talking about who had access to the baby before, because they can not say, with out a doubt, that Sam could not have lived with those injuries. Other Dr.’s have said the injuries could have occurred a month before. In another article by the Vangaurd, they had an ER doctors testimony that says the injuries could have happened within the past three months. Sam was only three months old. They DONT know when these injuries occurred. Thats the whole issue, I think.

  8. Jackson Scott

    I find it amazing how the Dr. never actually answered the question about it being his opinion. He says its not his opinion its facts based on his degree….. Excuse me but thats still your opinion, just your opinion based on fact. That doesn’t make in any more valid then the Dr. that disagreed with him. And that fact that he was paid differently tells me that his opinion could be bought! This whole case is interesting…. I have been following it for weeks now, I don’t see how this is anything other then expert against expert… Either way I dont see how ANYONE could find Stone guilty especially beyond a reasonable doubt. Curious to see what happens next, would love to have seen this in court.

    PS. i would love to see if the outcome of this and Dr. Omalu’s testimony will play into his NFL arguments. hmmmm makes you think a lot.

  9. Tia Will

    ““You charge however much you can milk from whoever is hiring you, yes?”

    This is one kind of comment that I think exemplifies the point that I have been attempting to make about the presence of theater with attempts to demean the testimony of a witness. If the defense wants to make a point about whether or not a witness is being paid to testify, simple questions such as ” Are you being paid to testify here today ? And if so by whom ? would establish the facts without casting aspersions on the integrity of the witness. The question as asked is clearly an attempt to appeal to the jury’s emotional response to the suggestion that the witness is only motivated by money with the implication that he would lie for money being very thinly veiled. This is an effort to defame an individual, not to seek the truth of what happened.

    1. Elizabeth Bowler

      I think it is unfair to criticize the attorney for doing her job, which is to attempt to discredit and undermine the witness and his testimony on cross-examination. That is one way it is done, by bringing up the money issue, and the witness should have been prepared for that line of questioning as much as he is in court. It certainly should not have deteriorated into a shouting match and that sort of behavior might very well negatively affect the impact of the witness’s testimony in the jury’s eyes. But both sides do it, you will see the prosecution do exactly the same thing when they cross-examine the defense experts at that point in the trial, and they will certainly bring up the money issue as well. As uncomfortable as it might seem, that is how our system works and I don’t know of another system of law that is better. I have enormous respect for our legal system, warts and all.

      By the way, I don’t know if you have been watching any of the cross-examination of Oscar Pistorius and other witness in that trial, but South Africa makes our system look very subdued and civilized compared to theirs! Even I have been surprised by some of the tactics, especially on cross.

    2. tj

      Sad to say, but expert witnesses like this doctor testify to help the party paying them.

      Sometimes he’s hired by defendants, sometimes by prosecutors, often times it depends on who signs him up first.
      The fact that he testifies sometimes for one side, sometimes for the other side, is really irrelevant.

      His demeanor is very strange! An expert witness who testifies in court 60 to 70 times a year would usually not be so easily rattled or so undignified.
      Makes one wonder just how uncomfortable he is in making the claim that Mr. Stone is guilty.

      If I understand the reporting above, the doctor is full of conclusions, but can’t back his conclusions up with clear facts, clear demonstrations from the slides, that substantiate his “facts”.

      I hate to say it, but doctors like this one are essentially prostituting themselves for the side paying them.

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