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DAY 6: Doctor testifies in murder trial

Seattle doctor says fatal injuries to 4-month-old Juneau infant were caused by child abuse

Posted: June 1, 2013 - 7:56pm  |  Updated: June 2, 2013 - 12:12am
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Dr. Naomi Sugar, a pediatrician of Seattle's Harborview Medical Center, answers questions from Assistant District Attorney Angie Kemp via teleconference in Juneau Superior Court on Friday in the trial of David J. Paul for the murder of 4-month-old Rian Jambi Orr.  Michael Penn / Juneau Empire
Michael Penn / Juneau Empire
Dr. Naomi Sugar, a pediatrician of Seattle's Harborview Medical Center, answers questions from Assistant District Attorney Angie Kemp via teleconference in Juneau Superior Court on Friday in the trial of David J. Paul for the murder of 4-month-old Rian Jambi Orr.

A Harborview Medical Center doctor who examined 4-month-old Rian Jambi Orr before she died, testified Friday in the ongoing murder trial against the infant’s father that Orr died from injuries caused by child abuse.

“My opinion is that she experienced actions that resulted in brain injury, that this occurred at the hands of another person,” said Dr. Naomi Sugar from Seattle via a two-way video conference in Juneau Superior Court.

“Inflicted injury?” Assistant District Attorney Angie Kemp asked.

“That’s correct,” Sugar replied.

A member of the Harborview’s Suspicion of Child Abuse and Neglect (SCAN) team, Sugar was asked by the attending physician to examine Orr on Aug. 10, 2010, five days before Orr died, and to offer a diagnosis. The baby was seizing and had recent head injuries (cerebral swelling, and bilateral subdural hematomas, which means bleeding on both sides of the brain). She also had older injuries including bruising on her chest, fractured ribs and a thigh bone fracture, Sugar said.

“A diagnosis in a medical sense is to look at all the symptoms or signs a patient had and see if they fit together,” Sugar said under direct examination from Kemp. “In this case, the baby had several findings that were highly consistent, very highly consistent, with abusive injury. And if we don’t even think about the head injury ­— she then had a head injury also highly consistent with abusive injury. All of those findings led me to the conclusion that there was a diagnosis of child abuse.”

Assistant Public Defender Eric Hedland, the defense attorney for the defendant Juneau resident David J. Paul, 24, pushed back on the notion that the prior injuries were evidence of prior child abuse. Sugar conceded under cross-examination that the rib fractures could have been two months old, but that she still associates those fractures with the head injury. Hedland also established that the baby’s mother, Jaki Orr, told Sugar at the time that the baby had bruises on her chest on and off for her entire life. (That’s also contrary to what Orr testified to on the witness stand last week, which is that she only first noticed the bruises at 3 months of age.)

Through Sugar, prosecutors introduced their theory that Orr may have died from being shaken. They charged Jaki Orr’s live-in boyfriend Paul, who is not the baby’s biological father but raised her as his own, with two counts of second-degree murder and one count of manslaughter under that theory in July 2011 about 11 months after Orr died.

Sugar said Orr had no signs of external injury to her skull (such as a knot on the head or a skull fracture), leading her to believe that there are two theories as to what could have caused such injuries: being thrown onto a soft surface such as a pillow or bed, or being shaken.

“I have to say that this is not proven, we haven’t demonstrated it in animals and certainly we haven’t demonstrated it in humans, but the primary theories are that this — her brain injury, bleeding were not external injury (sic). It’s caused by either the baby being thrown onto a soft surface like a cushion, a bed, a pillow, so that there’s no injury to the scalp or to the bone, but there’s injury inside. Or due to shaking, that is the baby is held and shaken, and so there’s no impact at all,” Sugar said to one of Kemp’s questions.

Under cross-examination, Sugar agreed that the viability of Shaken Baby Syndrome (SBS) theory, which is now referred to as Abusive Head Trauma, has evolved over time, is disputed and has been disavowed by many of its early supporters and pioneers. She also testified under cross that the later discovered fact that Orr did not have retinal hemorrhaging, one of the triad of symptoms associated with SBS, did not change her opinion that Orr could have died from being shaken.

“I thought that was not sufficient to explain the child’s injuries,” Sugar told Hedland.

She said retinal hemorrhaging is absent in 10 to 15 percent of children with abusive head trauma.

Sugar agreed with Hedland that prolonged seizures can result in brain damage. She conceded that it is unknown how long Orr was seizing for before her parents noticed and took her to Bartlett Regional Hospital the morning of Aug. 9, 2010. (Orr was having both seizures that could be observed and ‘subclinical seizures’ that could not be observed, Sugar noted.) Orr was medevaced to Harborview that day, and she died there a week later on Aug. 15, 2010.

Hedland tried to establish that Sugar rendered her diagnosis, which she reiterated during a grand jury proceeding in 2011 nearly a year after Orr had died, without having a full medical history. Sugar testified under cross that she did not review medical records from the mother’s physician regarding the mother’s pregnancy and early baby check-ups until January 2012. Information contained in those reports, including the fact that infant was not eating well or gaining weight initially, did not change her diagnosis, she told Hedland. (Sugar could not recall when she received the autopsy, which confirmed the infant did not have retinol hemorrhaging.)

Hedland has also suggested mother Jaki Orr was not taking her prenatal vitamins during her pregnancy, which could have affected the baby’s medical condition. Jaki Orr testified on the stand last week that she didn’t like taking the pills, but she took them anyway; however jurors heard an audio recording of Jaki telling police that she did not take them.

Prosecutors say they expect to rest their case on Tuesday. The defense says it will likely take another week to put their case on before it goes to the jurors.

Testimony is slated to resume Monday with Juneau Police Department Det. Elias Joven on the witness stand. Joven interviewed David Paul while he and Jaki Orr were at Harborview. On Tuesday, the mother’s Juneau physician Dr. Valentine is expected to testify, as is Dr. Richard Harruff, the chief medical examiner for King County, Wash., who ruled who ruled Orr’s death a homicide.

If convicted, Paul could be could be facing up to 99 years in prison for second-degree murder, plus another 20 years for manslaughter.

• Contact reporter Emily Russo Miller at 523-2263 or at emily.miller@juneauempire.com.

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