Testimonies of Pediatric Radiologists at University of California, Davis, Med Center in Sacramento
By Samantha Brill
Deputy DA Michelle Serafin asked Dr. Chirag Patel, pediatric radiologist and musculoskeletal radiologist with UCD Med Center in Sacramento, to define his line of work. He explained that, although he has never done specific research involving child abuse, such cases are a part of his daily practice. Also, through many years of schooling he has learned to examine X-rays, ultrasounds and MRI (magnetic resonance imaging) scans, and learned how to use them to diagnose injuries to the bones and detect possible diseases/injuries in organs. Darnell Dorsey is being prosecuted for allegedly assaulting and inflicting deadly injury upon his girlfriend’s 20-month-old son, Cameron Morrison, on January 22, 2014.
The prosecution continued to elicit more specifics about January 23, 2014, the day Dr. Patel examined a series of X-rays of Cameron Morrison’s skeletal structure. While looking at People’s Exhibit 13, which were images of the exams that had been conducted of Cameron on the 23rd of January, Dr. Patel explained his findings. He observed several rib fractures that showed up in the X-rays, and he noted a suspected fracture in the lower bone of the upper right arm.
Based on what he reviewed he was able to decide that Cameron did not have rickets, in his professional opinion.
The defense cross-examined the witness, asking how long Dr. Patel had reviewed Cameron’s scans, but he did not recall. Dr. Patel also clarified that there were no injuries to the thoracic or the lumbar spine and, in order for such an injury to appear it would have to be caused by a motor vehicle accident. He added that motor vehicles tend to be more powerful than people.
The defense had no further questions, and Ms. Serafin resumed her questioning for the prosecution.
She asked Dr. Patel how many times he reviewed exams, and he explained that he reviewed them more than once to make sure that he wouldn’t duplicate anything in future scans, in order to avoid excessive radiation exposure to Cameron.
Dr. Patel continued to explain that he would not exclude accidental injury from a child with multiple rib fractures of varying ages, but that Cameron’s scans rose suspicion of non-accidental child abuse trauma.
The prosecution had no further questions and the court excused Dr. Patel.
The prosecution called Dr. Thomas Sanchez, a pediatric radiologist with the Children’s Hospital at the UCD Med Center in Sacramento. She asked Dr. Thomas to explain his background in the field of pediatric radiology. He explained that he has been in his field for eight years and is certified in diagnostics and pediatric radiology to diagnose injuries in CT (computerized tomography) scans. He has also done research in child abuse and childhood trauma that resulted in the publication of several articles and book chapters.
Ms. Serafin established People’s Exhibit 128 to determine some medical terms involving different kinds of rib fractures. First, acute fractures are defined as a rib fracture that has just happened within one to four days. Next, subacute fractures was defined as a fracture that happened from one to eight weeks prior, identified with the visibility of a callus. Finally, the term chronic fracture was defined as a bone that has started to remold and is pretty much healed, after eight to 12 weeks.
In his expert opinion, Dr. Sanchez explained that, according to his research, 48 percent of posterior rib fractures are caused by child abuse. He has only experienced one case where a 3-month-old patient had two fractured ribs as a result of CPR, and those ribs were not posterior rib fractures, as seen in Cameron’s scans.
Ms. Serafin confirmed that Dr. Sanchez was working the day of January 23, 2014, and did in fact review Cameron’s chest CT scans, as well as the child’s skeletal survey. But he did not review scans from any outside hospitals.
Reviewing the scans in court, Dr. Sanchez identified that there were 18 rib fractures shown on Cameron’s scans, nine of which were identified as acute and nine subacute. Further, eight of those were posterior and 10 of those were lateral.
He explained that all of these injuries were consistent of the potential squeezing of a child – which could have also resulted in the puncturing of the lungs, which was identified in the scans as Cameron suffering from pulmonary contusions with suspected hemorrhaging.
There were also lacerations inside the liver, resulting in hematoma (blood escaping from the liver and collecting at the top of the liver). Dr. Sanchez strongly believed that all these injuries were a result of the fractured ribs, which also caused damage to Cameron’s kidneys.
The prosecution then moved to create People’s Exhibit 127, and has the doctor label a diagram of the rib structure to match the injuries that he observed on Cameron the day of January 23, 2014.
Dr. Sanchez then told the court that he did not observe any injuries to Cameron’s spine.
Ms. Serafin rested and Deputy Public Defender Joseph Gocke proceeded with the defense’s questioning.
The defense had Dr. Sanchez make it clear to the court that Cameron was older than the children in the studies he referred to earlier in his testimony, and explained that those studies excluded children with vitamin D deficiencies.
Mr. Gocke asked Dr. Sanchez to clarify to the court that, even though Cameron’s injuries do indicate abuse, there is no way that the scans can determine who the abuser may have been.
Darnell Dorsey Trial Resumes
By Ryan Gonzales
Following the afternoon break, Deputy District Attorney Michelle Serafin began redirect examination of Dr. Thomas Sanchez, a pediatric radiologist at the UC Davis Medical Center.
Ms. Serafin asked multiple questions regarding Dr. Sanchez’s professional history. In response to the prosecution’s question of whether or not Dr. Sanchez had read 8,000 hours of medical journals, the doctor stated that he engaged in many hours of research, and had also published his own paper in 2010 that examined “pseudo fractures.”
Then, the prosecution inquired if the research articles that Dr. Sanchez had studied were related to child abuse incidents. Dr. Sanchez explained that the articles involved general research of pediatric radiology.
Continuing with the evaluation of Dr. Sanchez’s profession, Ms. Serafin questioned if Dr. Sanchez considered himself a specialist in child abuse and accidental fractures. He stated that “well, compared to my colleagues, I’ve published more work” in those fields of research.
Next, the prosecution discussed Dr. Sanchez’s research study of rib fractures. Ms. Serafin inquired why Dr. Sanchez excluded patients who were diagnosed with rickets. He explained the disease affected the durability of bones and the levels of vitamin D, thus would delay or lengthen the healing process. However, when the prosecution questioned if he was aware of to what extent a vitamin D deficiency disease would delay the process, Dr. Sanchez was unsure.
In the case of Cameron Morrison, Dr. Sanchez testified that he did not see any signs of rickets in the victim’s scans and that indications would be visible if a patient did have the vitamin D deficiency disease.
Ms. Serafin questioned more about vitamin D deficiency and whether or not it increases the probability of fractures. Dr. Sanchez stated that it is possible, if the fractures are located near extremities, such as the wrist, that fractures can be secondary to the rickets disease.
Ms. Serafin then asked Dr. Sanchez to explain the statements made, in examination by Deputy Public Defender Joseph Gocke, that he (the doctor) would not review records or previous diagnoses because he wanted to remained unbiased. Dr. Sanchez stated that in some cases, such as vitamin D deficiency, diagnoses can be subjective and he did not want those diagnoses to influence his observation. When Ms. Serafin asked if he maintained an unbiased observation when reviewing Cameron Morrison’s radiology scans, he stated, “Yes, I reported objectively on what I saw and did not look at history.”
Mr. Gocke conducted a rather short re-cross examination of Dr. Sanchez. Mr. Gocke inquired whether a child, who suffered from a vitamin D deficiency, had fallen without preparing for impact could possibly cause harm to bones other than at the extremities. Dr. Sanchez responded affirmatively. Mr. Gocke ended the re-cross exam with, if this hypothetical situation should occur, it could possibly cause liver damage, secondary to damage caused by a displaced rib. Dr. Sanchez responded affirmatively.
Ms. Serafin, on final redirect, asked Dr, Sanchez if he had seen any loss of bone density on Cameron Morrison, to which he answered no.
Dr. Sanchez was excused from the court.
The prosecution’s next witness was Dr. Rachel Hight, a trauma surgeon. Dr. Hight, who is actively serving in the United States Air Force, was part of the trauma response team that received Cameron Morrison in the early hours of January 23, 2014. Dr. Hight testified that her main job as a trauma surgeon was to assess and operate on any life-threatening injuries. Ms. Serafin inquired whether Dr. Hight found any life-threatening injuries on Cameron Morrison. The doctor said no, that there was only a moderate concern for head trauma.
Ms. Serafin then questioned if the witness suspected abuse. Dr. Hight stated yes, however, she also stated that it was not an independent analysis, as she was part of a trauma response team.
Mr. Gocke conducted a short cross-examination of Dr. Hight and inquired about the inconsistency of reports from Sutter Medical Hospital and the UC Davis Medical Center. However, Dr. Hight was unaware of any inconsistencies.
Ms. Serafin ended her re-cross examination by questioning Dr. Hight about whether Cameron Morrison illustrated symptoms or injuries of abuse. Dr. Sanchez stated that he showed both abuse and accidental injuries.
Dr. Hight was excused and the trial is set to resume on October 3, 2016