More Medical Testimony about Child Rib Fractures in Dorsey Trial

YoloCourt-12by Julienne Correa and Mariel Barbadillo

On the morning of October 5, 2016, the case of the People vs. Darnell Dorsey resumed with Judge Paul Richardson presiding. Mr. Dorsey was represented by Deputy Public Defenders Martha Sequeira and Joseph Gocke, and Deputy District Attorney Michelle Serafin represented the prosecution. Dorsey is accused under Penal Code sections 273a and 273ab of assault causing fatal injury to his girlfriend’s 20-month-old child, Cameron Morrison.

Medical testimony was given on this day by a pediatric forensic pathologist, a witness for the defense. Most of the doctor’s experience came from examining children under the age of two and she has 30-plus years of work under her belt. She also helped developed a child abuse program by coordinating and bringing physicians together.

The defense asked her about medical terms, and her experience working as a forensic pathologist to educate law officials about the meaning of the manner of death and interpretations of medical findings. She evaluates past medical history, details of the event, paramedic information, ER and lab reports, and the details of the postmortem.

According to her observation of Cameron Morrison’s history, there was an indication that the child had been sick for two to three days due to fever and vomiting. Through X-rays, it was determined that there was mucus and puss all around the lungs. Records from Sutter Davis showed results of pneumonia as well as tan secretions with  mucus plugs, material in the airway leading to respiratory failure. In addition, evidence of dehydration appeared and contributed to the lack of oxygen exchange.

Lab results showed that Cameron had elevated creatinine which indicated loss of circulation and impaired kidney function, and dehydration indicated underlying sickness. Tests showed gram-positive cocci (bacteria like Staphylococcus which give a positive result in a gram stain test), with more evidence of Staphylococcus aureus because of an abundant culture. The doctor reviewed tissue samples and slides, as well as taking pictures on her own. The picture of the lungs showed the plugs and neutrophils, white blood cells that are a first line of defense but cause a lot of destruction in the tissue. As a result, this can interfere with vital functions such as breathing.

Pneumonia is a lethal condition that affects children and the elderly more than the average adult. However, it stops and starts depending on the progression of the disease in the individual. Respiratory arrest can contribute to no longer having the ability to circulate blood within the body. A progressive process and multiple system consequences affect the quality of oxygen, and a system of oxygenic failure results in cell death and failure of the capillary refill.

In this instance, Cameron Morrison had pneumonia before he got to the hospital, per test results. According to the doctor, Cameron had bacterial pneumonia with a history of illness. The defense offered hypotheticals similar to this case, asking questions, and the doctor answered that there was abundant evidence that the child was ill with pneumonia and his health was diminishing. The doctor also suggested that Cameron had vitamin D deficient bone disease, which weakened the bones and made him more susceptible to fractures. There is also strong possibility, with weakened or damaged bones, that the child’s rib fractures were a result of CPR administered.

Medical Expert Testifies Child’s Ribs Fractured during CPR in Dorsey Trial

By Mariel Barbadillo

After the lunch break, the pediatric forensic pathologist returned to complete her testimony regarding the death of Cameron Morrison.

Deputy District Attorney Michelle Serafin began cross-examination by asking the witness about her process of reviewing Cameron’s case. The witness said she capped her review at 13 paid hours, but the entire review lasted approximately 30 hours in total.

The witness examined audiotapes of conversations as well as medical records, including as Cameron’s MRI (magnetic resonance imaging) and CT (computerized tomography) scans. Ms. Serafin asked the witness if she used any information other than the material provided to her. The witness said she only used what was given to her; she did not interview Cameron’s family members or consult with other medical experts.

The prosecution then asked about the witness’ findings concerning Cameron’s blood work. The pathologist said Cameron had a metabolic bone disease, which she said is a general consideration of abnormal bones that could be attributed to a variety of causes. Specifically, Cameron had a metabolic bone disease related to vitamin D deficiency, which meant he was not absorbing adequate amounts of calcium. The witness said low levels of vitamin D have become common among children in recent years.

Based on the evidence, the witness said she could not assume Cameron had normal bones at the time of his death. She could not exclude the possibility that Cameron had abnormal bones and, therefore, she could not conclude with reasonable certainty that Cameron’s rib fractures resulted from child abuse.

Ms. Serafin turned the discussion to a book in which the witness had written a chapter about skeletal injury. In the chapter, the witness had said that fractured ribs in young children are diagnostic of child abuse. The witness admitted that is what she believed in the 1990s, but that is not what she believes now. When she had written the piece, medical practitioners at the time would assume such injuries were the result of child abuse without pondering further explanations. Nowadays, doctors are more likely to consider other reasons for bone injuries in young children, such as metabolic bone disease.

The witness said she has seen 10 or more babies with rib fractures due to metabolic bone disease. She described a case of triplets who were found to have rib fractures. The parents were accused of child abuse, but it was later found that the children, as well as the mother, were deficient in vitamin D, which caused them to have fragile bones more susceptible to fractures.

The prosecution asked if the witness had seen the X-ray of Cameron’s ribs. The witness said she had, but she could not recall how many fractures were present in the X-ray. The prosecution stated there were 18 fractures in total, some of which were healing and some of which were more recent.

The pathologist said she has treated children with displaced rib fractures and, in her experience, some children are unaware of their injuries. Patients have gotten X-rays for other reasons and discovered the rib fractures by chance.

The witness asserted she is “one hundred percent” certain Cameron’s ribs were fractured due to CPR. There was no blood found in Cameron’s chest or abdomen during the autopsy, so the rib fracturing must have occurred when he no longer had a heartbeat. If the ribs had been fractured while his heart was still beating, there would have been blood leaking into his pleural cavity, the space between the membranes that line and surround the lungs.

When asked if the fractures could also have been caused by child abuse, the witness said that was possible, but she does not believe that happened in this case.

Ms. Serafin then asked if contusions and hemorrhaging on Cameron’s lungs could be attributed to child abuse. The witness disputed that, saying the appearance of contusions and hemorrhaging on Cameron’s lungs in the X-ray was actually pus from pneumonia, not blood.

Ms. Serafin stated that none of the nurses or doctors at Sutter Davis diagnosed Cameron with pneumonia. The witness countered that they were wrong. When Cameron arrived at the emergency room, he had Staphylococcus aureus bacteria and mucus plugs, accumulations of mucus blocking the airways, in his lungs.

Analyzing the tissue under the microscope was the “final test” and when the witness did that, she found that the substance in Cameron’s lungs was pus, not blood.

The witness went on to say there is no evidence of traumatic brain injury occurring as a separate event from Cameron’s pneumonia and cardiac arrest. She said that both global cerebral ischemia (insufficient blood flow to the brain) and subdural hematoma (bleeding between the brain and the dura mater, the membranes that cover the brain) found in Cameron’s brain could have been caused by cardiac arrest.

The prosecution then questioned if the constellation of Cameron’s injuries (new and old rib fractures, brain injury, liver laceration) could be attributed to child abuse. The witness responded that it could be, and she said it is understandable why child abuse was assumed to be the cause of the injuries.

However, she said her job is not to “make a story” and go back to make the evidence fit that story. Rather, she meticulously studied the evidence prior to coming to a conclusion about the reason behind Cameron’s injuries. She said that she, too, would have jumped to the conclusion of child abuse if she had not taken into consideration the mucus plugs in Cameron’s lungs indicating pneumonia, the vomiting, the dehydration, and the vitamin D deficiency.

Moreover, the witness said that it is often more obvious when children die of blunt force trauma because the region where the force was applied is typically visible.

Ms. Serafin questioned the witness about the bruise behind Cameron’s ear and if that could be considered a sign of child abuse.  The witness said pressing the area behind the ear is a common method to test a child’s response to pain and it can bruise easily if a child is susceptible to bleeding. Therefore, she did not consider bruising behind the ear to be indicative of child abuse.

About The Author

The Vanguard Court Watch operates in Yolo, Sacramento and Sacramento Counties with a mission to monitor and report on court cases. Anyone interested in interning at the Courthouse or volunteering to monitor cases should contact the Vanguard at info(at)davisvanguard(dot)org - please email info(at)davisvanguard(dot)org if you find inaccuracies in this report.

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