How Much Force Is Necessary to Cause Petechiae?

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Witnesses Testify in Child Abuse Case with Attention to Rash on Victim’s Face

By Grace Jung

According to child abuse and neglect expert Dr. Angela Vickers, there has not been any research conducted quantifying how much force must be applied to cause significant injuries to a child, because of the moral and ethical issues of carrying out such experiments for medical purposes. In Department 7, three witnesses were called to the stand to testify about the alleged child abuse victim, and a commonality found in their testimonies was the visible rash on the victim’s face.

The jury trial for Brian A. Miles, the defendant charged with child abuse and corporal injury on a child, resumed as the first witness of the day was called to testify.

An emergency room doctor working at Kaiser in Sacramento testified that she evaluated the alleged victim after the child was transferred to a private room in the ER. She noticed a petechial rash underneath the eye and around the side of the cheeks, as well as two scratches on the nose and cheek.

When asked about any other symptoms she recognized, the doctor testified that she did not identify other symptoms like upper respiratory symptoms or nausea.

Strangulation was a prevalent topic in the trial, as both the prosecution and defense wanted to clarify the potential concerns of strangulation in respect to child abuse. The doctor confirmed that strangulation could cause damages such as fractures around the larynx and bruising around the neck. The doctor further testified that the patient did not report any symptoms of a sore throat or loss of control of bodily functions.

In order to establish an accurate foundation of the causes of petechial rashes, interchangeably known as petechiae, the doctor articulated that other causes of petechiae include the rupturing of capillaries, sneezing hard, crying hard, and infections.

The doctor testified that if petechiae were caused by trauma, they would appear within the time frame of 5-15 minutes after the contact.

She also mentioned that petechiae is a “non-specific finding,” which means it is not something you can point to and say it came from a specific diagnosis. However, as an ER doctor, she stated that the worst-case scenario is assumed, to make sure that follow up is done with patients.

To conclude her testimony, the doctor noted that she evaluated the victim more fully around 11:04 p.m. on Dec. 4, 2017, when the petechiae was brought to her attention.

The second witness was the child abuse/neglect expert, Dr. Angela Vickers, who is a Medical Director of BEAR (Bridging Evidence Assessment & Resources) Clinic Sacramento at Sutter Health, and was called by the prosecution.

Specializing in child abuse and neglect, she explained that the purpose of the child abuse program is to evaluate cases of suspected child abuse from a medical standpoint which can include medical evidence, records, and photographs. Moreover, she stated that the purpose of the BEAR Program is to provide additional resources for victims ranging from newborns to 90-100 years old, who were abused as children.

To establish her credibility as an expert in this field, the first part of her testimony included medical terminologies and setting up the foundation of symptoms of strangulation.

Dr. Vickers stated that strangulation is pressure applied to the neck which causes compression of the blood getting supplied to the brain. In addition, she mentioned that “acutely after strangulation” someone can pass out, feel like they are dying, and if the strangulation causes a brain injury, the patient could possibly never recover from such an incident.

Secondarily, she explained that tissue damage in the neck, pain when swallowing, external and internal neck pain, soiling in the pants and urine loss are all possible symptoms that could arise from strangulation.

Dr. Vickers further described that, after strangulation, there could be injury to the voice box, fractures to the larynx, injury to carotid arteries, and bruises.

Additionally in strangulation cases, she added that petechiae becomes apparent minutes after the contact and becomes more apparent after a couple hours.

To shed more light on petechiae, Dr. Vickers explained they are dots that are essentially tiny bruises which form when pressure is applied to the surface of the skin, obstructing the blood supply from going back. This, in turn, causes the capillaries to pop. Since the blood supply cannot return, the tiny dots appear above the ligature.

She stated that petechial rash and allergy symptoms can be differentiated because allergic reactions are usually itchy, while petechiae are bruise-like.

For clarification purposes, she explained that the difference between suffocation and strangulation is that suffocation is blockage of the airway while the latter is compression.

Dr. Vickers testified that her clinic conducts forensic medical consultations which include reviewing patients’ past, social, family, and developmental history to ensure a more accurate diagnosis.

She testified that the alleged victim’s developmental history was normal for her age, and her diet was also normal for a child her age. The doctor stated that the victim had no allergies to any medications and mentioned that the victim’s parent indicated she was allergic to certain foods, including tomatoes.

However, Dr. Vickers stated that a tomato allergy would not cause that type of rash on the victim’s face.

According to her physical findings from the ER visit on Dec. 4, 2017, the doctor mentioned that the victim’s physical exam results indicated she was overweight, even though she walked around fine. She communicated that the physical findings are important because they “help substantiate the type of mechanism” that may have caused the injury.

Furthermore, Dr. Vickers claimed that a doctor who examined her had noticed petechiae dots on the check and along her hairline. She also noticed the victim had tiny cuts on each side of her nose.

She testified that the victim told her that her father had put his hand over her hands and nose and wrapped his legs around her and squeezed.

Dr. Vickers did clarify that the cuts she identified on the victim’s nose could be nonspecific injuries, but testified that the victim’s description of the incident could indicate fingernail marks from someone putting their hands on her nose.

Additionally, Dr. Vickers stated that she did not personally speak with the medical professional who examined the victim, did not speak with the victim’s mother in person, nor did she ever interview the victim directly.

Dr. Vickers clarified that, depending on how the compression occurred, it may not have produced any injuries – as the victim’s petechial rash was subtle since they looked like freckles on the photograph. However, she explained that, while freckles remain even after a long period of time, petechiae disappear after a week or two.

The third witness was called to the stand to testify as to her observations of the alleged victim at The Bounce Spot, where she was working on Dec. 4, 2017.

The Bounce Spot is a huge warehouse with bounce houses, slides, and obstacle courses designed for kids, and the alleged victim was a kindergartner in her class at that time.

The witness testified that the victim was present most days, and, although she doesn’t recall the specific day, she did observe some red marks on her face.

She testified that Child Protective Services called her on Dec. 6, 2017.

Even though she observed the red marks on the victim’s face, she testified that she was not particularly alarmed because she mentioned “kids get scratches all the time.”

She noticed the red pimples when the victim arrived at The Bounce Spot, before she started playing with the other kids. When asked about the red marks the witness observed on the victim’s face, the girl responded that they “seemed like pimples?”

“Sometimes she would be sad, just about random things.”

Since the victim did not want to talk about what was on her mind, the witness testified that they just redirected to play time.

The witness testified that she remembers asking the victim where the bumps came from and the victim responded that they were from tomatoes. She added that she just disregarded her statement because it seemed like something kids would say.

The court is expecting more complete evidence tomorrow, as the jury trial for Brian A. Miles will resume in Department 7 at 1:30 p.m.


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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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