By Julienne Correa and Carla Arango
During the morning of October 3, 2016, the case of the People v. Darnell Dorsey resumed, presided over by Judge Paul Richardson. Pursuant to Cal. Penal Code sections 273a and 273ab, Darnell Dorsey is charged with assaulting and causing fatal injury to his girlfriend’s 20-month-old child, Cameron Morrison, in January of 2014. Deputy Public Defender Martha Sequeira represented Darnell Dorsey, while Deputy District Attorney Michelle Serafin represented the prosecution.
The first witness called to the stand was a fifth-year resident from the UC Davis Medical Center, “Dr. AE.” She worked Cameron Morrison’s case two years ago as a second year resident during her pediatric service. She explained how she performed a tertiary examination, which occurs when the patient is mostly stable and serious injuries have been taken care of. She noted that the child had coarse and abnormal breathing sounds, as well as some indication of fluid in the lungs.
The prosecution continued to ask Dr. AE questions such as when she performed the exam. The doctor mentioned that Cameron was brought to the UCDMC emergency room at 3:03 am, but she did not see him until a few hours later, at the Pediatric ICU. Dr. AE noted that Cameron’s condition was the lowest number on the Glasgow Coma Scale (GCS). This test measure’s an individual’s movement, voice, and eye movement to assess the impairment to consciousness. In addition, he was intubated and, when performing a head-to-toe visual exam, the doctor noticed “darkened skinned coloration” on the child’s posterior. She also reviewed imaging from radiology results and noted her findings for further examination. In addition, his blood count was stable and there were few unexplained injuries.
The next witness, accepted by the court as an expert witness for the defense, was Dr. Roland Auer, a scientist and neuropathologist from the University of Saskatchewan in Canada. He has studied the brain, living and dead, as well as performed biopsies on matter such as tumors. He has studied mechanisms of damage in the brain, such as nerve cells being excited to death, called excitotoxicity. Low blood sugar can lead to positive death of neurons, by events such as strokes, trauma and epilepsy. Other medical terms he mentioned were hypoxia (low blood oxygen) and ischemia (lack of blood flow). These conditions can lead to enlargement of an area that may trick doctors into diagnosing a fracture.
His knowledge of shaken baby syndrome is published in his book of forensic neuropathology. The diagnosis may include retinal hemorrhages and subdural hematoma, both of which can be caused by various factors. The doctor then explained the process of blood flow to the brain and the process of using glucose for energy.
After the morning recess, the defense showed images of brain development into adulthood. Dr. Auer mentioned that over half of the blood is commonly in the brain in children around the age of two years. If the pressure increases on the brain, blood goes into the eye. If a blood clot develops, hemorrhage occurs and can have catastrophic consequences. The doctor then explained the mechanisms of pneumonia as a failure of the immune system to keep viruses and bacteria from the lungs. Puss then develops, generated by white blood cells. Pneumonia can result in respiratory distress, leading to cardiac arrest. Other organs can become affected and infarct appears, a localized area of dead tissue resulting from failed blood supply, thus, ischemia creating necrosis.
According to the doctor, he reviewed all the information in regard to the case, however he “can’t look at the slide, need the global picture,” for providing reasonable certainty. He also mentioned abnormal lab values when Cameron Morrison was first admitted, such as increased lactate and glucose levels. Within two minutes, one or two neurons are lost, and at four minutes, a number of neurons are lost. Cameron’s condition on the day seemed to be consistent with respiratory arrest, according to the doctor.
Both parents’ actions did not cause serious injury to the child, as they did what they could. However, the absent gag reflex and the child’s gasps for air indicate that his brain was in trouble and losing consciousness. The day before, there were indications that Cameron had a flu-like illness, and images of his lung tissue indicated instances of pneumonia.
Defense Direct Examination Of Neuropathologist
By Carla Arango
On October 3, in People v. Darnell Dorsey, the defense called to the stand Dr. Roland Auer, a neuropathologist with expertise in adult and pediatric brain damage. Deputy Public Defender Joseph Gocke began his direct examination of Dr. Auer, who confirmed he looked at different tissue samples, lab levels, and observed vitamin D levels as they pertained to Cameron Morrison. Mr. Dorsey is charged with assault on a child resulting in death, after Cameron Morrison, who was under Mr. Dorsey’s care, was pronounced dead on January 25, 2014, at the age of nearly 20 months.
Dr. Auer has more than 30 years of experience in his field and worked at the Sainte-Justine children’s hospital in Montreal, Canada, for almost five years, where he examined children’s tissue from biopsies and autopsies to determine disease.
Mr. Gocke presented scans that depicted Cameron’s optic nerve and brain hemorrhages. During the examination, Dr. Auer said it would indeed be difficult to have a hemorrhage in the optic nerve due to trauma. Mr. Gocke asked Dr. Auer to explain what he saw, and Auer responded that there was a massive amount of hemorrhaging in the retina behind the eye. The doctor said Cameron had a “perfectly normal retina with minimal lesion.”
Mr. Gocke asked Dr. Auer what can cause hemorrhaging in the retina behind the eye. Auer explained that an increase in spinal fluid increases pressure which can cause retinal hemorrhage.
Next, Mr. Gocke showed images of Cameron Morrison’s neurons. Dr. Auer pointed at dead brain cells in the cerebral cortex and explained they can be recognized by their pink color. Dr. Auer confirmed that the brain stem, cerebellum, and spinal cord all contained dead brain cells and hemorrhaging. When he was asked about the significance of having dead brain cells in so many areas, the doctor said it’s not a result of trauma.
Mr. Gocke then proceeded to show spinal cord images. Dr. Auer identified a reperfusion hemorrhage, which may have occurred after cardiac arrest and which is a sign of something that happened to the whole body. The doctor said it was likely to have been produced from leaking blood vessels after efforts to revive the child increased pressure on the vessels. A reperfusion (reoxygenation) hemorrhage occurs when blood supply normalizes after a period of ischemia (oxygen deprivation), causing inflammation and tissue damage instead of restoring normal function. Dr. Auer said this happened when the child’s heart was restarted.
Global cerebral ischemia occurs due to lack of blood flow to different areas of the central nervous system.
In addition, Mr. Gocke questioned Dr. Auer about Cameron Morrison’s vitamin D level. Dr. Auer said Cameron’s vitamin D level was 14 nanograms/milliter. A healthy vitamin D level ranges from 30 ng/mL to 100 ng/mL.
A level of 20 ng/mL to 29 ng/mL is considered Vitamin D insufficiency, and anything under 12 ng/mL is vitamin D deficiency. Vitamin D is essential to strong bones because it helps retain calcium.
Mr. Gocke also asked Dr. Auer if Cameron’s scans revealed indications of rib fractures at different stages of healing, and Dr. Auer concurred.
When Mr. Gocke asked if that meant with certainty that the fractures were a result of trauma or abuse, Dr. Auer said it did not. Dr. Auer made it clear that, depending on how brittle the bones are, fractures can occur while a child’s diaper is being changed or by hitting a table.
Dr. Auer continued to explain that human beings produce vitamin D from their exposure to sunlight and, as a result, vitamin D levels vary throughout the year. Dr. Auer emphasized that it is common for people to have low levels of vitamin D. Dr. Auer also agreed that, during the cold winter months, vitamin D levels are lower than usual. “We tend to cover up everything except our faces in the winter,” Dr. Auer stated.
Dr. Auer said kids have undiagnosed rickets, a softening or weakening of bones as a result vitamin D deficiency. The medical records of “JC,” Cameron’s older brother also revealed vitamin D deficiency.
“It doesn’t matter what I believe. The vitamin D levels are low, those kids get lots of fractures,” Dr. Auer said in response to the defense’s inquiry. Mr. Gocke asked Dr. Auer to confirm if similar fractures can result from playfully tossing a child into the air and catching the child. Dr. Auer said yes.
Mr. Gocke asked Dr. Auer if performing cardiopulmonary resuscitation (CPR) on a person can result in broken ribs. Dr. Auer responded that “CPR often breaks bones.”
Dr. Auer confirmed that there is a higher likelihood of CPR resulting in rib fractures in people with rickets, which Cameron Morrison was diagnosed with. He continued to explain that, when people are desperate to save a person’s life, like at the scene of a car accident, CPR is performed outside of a hospital. Dr. Auer said rib fractures are common among people who receive CPR before coming into the hospital.
Mr. Gocke asked Dr. Auer if CPR injuries are more or less common in children. Dr. Auer said kids’ bones are more flexible, therefore severe fractures are less common in children. Dr. Auer described children’s injuries as “greenstick fractures,” where a bone is bent rather than completely broken.
Judge Richardson announced that the trial would reconvene on October 4, 2016, at 9 a.m.