David C. Patkins v. Shawn Hatton
Filing
5
ORDER SUMMARILY DISMISSING PETITION FOR LACK OF SUBJECT MATTER JURISDICTION; REFERRING THE PETITION TO THE U.S. COURT OF APPEALS PURSUANT TO NINTH CIRCUIT RULE 22-3(A); DENYING A CERTIFICATE OF APPEALABILITY by Judge Dolly M. Gee: Pursuan t to Ninth Circuit Rule 22-3(a), the Court refers the habeas Petition to the U.S. Court of Appeals for the Ninth Circuit for consideration as an application for leave to file a second-or-successive habeas petition. This action is dismissed wit hout prejudice for lack of subject-matter jurisdiction pursuant to Rule 4 of the Rules Governing Section 2254 Cases in the United States District Courts. LET JUDGMENT BE ENTERED ACCORDINGLY. A certificate of appealability is denied. Case Terminated. Made JS-6. (copy of petition and Appeal form 12 attached) cc:9th Circuit (Attachments: # 1 Petition-part 1, # 2 Petition-part 2, # 3 Appeal form 12) (jm)
LODGED
PETITION
HABEAS CORD
AO 241 (Rev. 5185)
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name
dAv(~ G. PATKII`~$'
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Place of Confinement
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etitioner)
Name of Respondent ~auihonzed pe
Name of Petitioner (include name under which conviciedj
e Anomey
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PETITION
I. Name and location of court which entered the judjment of conviction under attack
F f~l,
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«L~fc Rn((A~ Go urJT}' ~~ ~'r JF~SI DE, ~//Oo M~I~ ST , ~iVER S~ bE, C A . ~'Z SO
Z. Date ofjudgment otconviction
3. Length of sentence
~/
Q~-T.
~, zon z--
~~~n ~ ~ 7 ~'
4. Nature of offense involved (all counts)
L~ FE
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f~
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5. What was your plea? (Chec4: on
(a) Not guilty
-~
(b) Guilty
(c) No10 contendere
U
If you entered a guilty plea to one count or indicm~enl, and a not guilty plea to another count or indictment, give details:
G. If you pleaded not guilty, what kind of trial did you have? (Check one)
(j~/~
(a) Jury
(b) Judge only
J
7. Did you testify a~ the trial?
Y es ~ No r~7/
$. Did you appe;il from thejudgmcnl otconviction?
Y es ~ti' No
(~)
AC 24 i (Rev. v/051
J. If you aid appeal, answer the following:
o~ ~~QEA~-S~ '~~'~~ q~P. P~sT~I~T, Di~l(,f' lorl Z
(v) Name of court Cl~• Ccu(ZT
(bj Resuli
D E►J I E D,
~ I~ S E r10 . ~ c~ z 7~ 7
(c) Dale of result and citation, if known
(d) Grounds raised
(►JST2c1~-TI N ~~~'of~ ~ £~le-o~ I~ ~1(~~"L~TT~l~G PR~a~ ACTS
,
rnr~~,2QE c r ggsTR ~c'- aF a-~~( r~ F►sT .
slate court, please answer the lollo~~~ing:
(ej If you soughs further review of the decision on appeal by a higher
( I) Name of court
(2) Result
Cf~ L IF~~~~ Fl
DEN(E~ ,
CI~SF
(3) Date of result and citation, if known
(4) Grounds raised
ScJ ~~~MF Cav~T
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E~(Zo~' r►/ /~D~^r1TINCr PR~ok
/~cTS
please answer the following with respect to each
(~ if you filed a petition for certiorari in the United States Supreme Court,
direct appeal:
(1) Name of court
(2) Result
(3) Dale of result and citation, if known
(4) Grounds raised
filed any petitions,
1 0. Other than a direct appeal from the judgment of conviction and sentence, have you previously
to thisjudgment in any court, state or federal?
applications, or motions with respect
Yes~No`;
1 1 . If your answer to I O WAS "yes," give the following
for~~aUo
U►JIYE~ ST~T~S CovRT~ c.E~rT(Z^~ DIS'r• o~ ~n~~~o/~r~r,~
t i Iv meofcourt
~a
(2) NaWreofprocceding
(3) Grounds raised
N~6Fns ~cjZp~s
«SF nlo. FDed• o'/.~Iz~f pM(~ (~tM~
(~E~~~~TI`~~` ~fSI S7nNC~ off- T~~/IL Col,~rJSEL; ('RofEe~~o~Q~~L
M r S~aI'~(jJG'r~ r/~1 ~ ~-'~~ T~ P~c,~'Er(Y I~sT2V~-T,' INSvf —F~~EN'~
~s~
AO 241 (Rev. 5/B5)
~cTS ~ ~ni1'TRvcTtcN
~vrpE~c~~ ~k2vR ~n~ ~tDµi ~~ ~NC PRr~~ t~n0
f`~Z~.2.0~~~'
E~Qo~ ~~A~T~c
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on your petition, application or motion''
(4) Did you receive an evidentiar~~ hearing
Yes — No
(5) kesull
'~FN~~~
(G) Date of result
~ — 1 y `~ ~ (~
or motion give the same information:
b) As to any second petition, application
(
(1) Name of court
2)
( Nature of proceeding
(3) Grounds raised
petition, application or motion?
4)
( Did you receive an evidentiary hearing on your
Yes -' No
~5) Result
6)
( Date of result
ation or
n,
jurisdiction the result of action taken on any petitio applic
(c) Did you appeal to the highest state court leaving
motion?
Yes ~; No ~
(I) First petition, etc.
Yes ;~ No ~
petition,
2)
( Second
you did not:
any petition, application or motion, explain briefly why
d) If you did no! appeal from the adverse action on
(
y the jugs
that you arc being held unla~~~fully. Summarize briefl
.
! Slate concisely every ground on which you claim
nal grounds and jucls supporting same.
pages stating additio
supporting each ground. If necessary, you may attach
rilY first exhaust vour available state court
In order to proceed in the federal court, vote must ordin~
CAUTIOI~:
the federal court. If 1'ou fail to scl forth all grounds in this
t action bl'
remedies as to each ground on which you reques
nal grounds at a later date.
petition, you may be barred from presentin~ additio
(4)
I
A0247 (Rey. 5/85)
raised grounds for relief in habeas corpus
wing is a list of the moss frequently
raise ~n~•
For your information, the follo
ate eround for passible relief. 1'ou may
preceded by a letter constitutes a separ
proceedings. Each statement
state coup re medies with respect io them.
sted your
other than those listed if you have exhau
base your
grounds ~~~hfch you may have
ting to this com~fction) on which you
peti(ion a!! nvailahle ~rnunds (rela
ver, you should raise in phis
Howe
in custody unlawfull}~.
, you must allege facts. The
alleeations that you arc being held
one or more of these grounds for relief
of these listed grounds. if you select
Dv nog chec{; any
of these grounds.
one
merely checl;(a) throu~,h Qj or any
ing of the
petition will be returned to you if you
induced or not made voluntarily with understand
plea of guilty which was unlawfully
(a) Conviction obtained by
quences of the plea.
nature of the charge and the conse
coerced confession.
(b) Conviction obtained by use of
stitutional search and seizure.
evidence gained pursuant to an uncon
cj Conviction obtained by use of
(
~ful arrest.
evidence obtained pursuant to an unlav,
(d) Com~icuvn obtained by use of
ion.
of the privilege against self-incriminat
to
(e) Conviction obtained b~~ a violation
to disclose to the defendant evidence favorable
l failure of the prosecution
iction obtained by the unconstitutiona
f) Con~~
(
the defendant.
ardy.
tion of the protection against doublejeop
(gj Conviction obtained by a viola
and impaneled.
which was unconstitutionally selected
of a grand or petit jury
(h) Conviction obtained by action
of counsel.
(I) Denial of effective assistance
of appeal.
j)
( Denial oC right
I~ D C- E ►`f C F C L A I l~
A G T v A 1— I N
Ground one:
A.
CU~NS~I~~
~FFCTI~/F Afs' I .rT~I~CE aF
—AG/1iNST EQRv12r DBE T~ (NE
ut citing cases or law)
Supporting FACTS (state brief]j~ witho
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~~s-soii
April 21, 2014
Mr. David C. Patkins
Prisoner ID T-73612
P. O. Box 705
Soledad, CA 93960
Re: David C. Patkins
v. Ricnara J. Subia, ~Varaen
No. 13-8654
Dear Mr. Patkins:
ed case:
lowing order in the above-entitl
The Court today entered the fol
i is denied.
The petition for a writ of certiorar
Sincerely,
.
~~
Scott S. Harris, Clerk
Riverside Police Department
CA0331300
SUPPLEMENTAL REPORT
~~28-01 ~ 0920
,
18. Type o! Place
..Address of Occurrence (Street No. -Name - Cily -Zip)
Residence
1370 Via Vista Dr., Riverside
19. ID:
=Other
For ID USE' V =Victim, I =Informant, W = Wi ess, 0
f Business)
-Middle (Firm
20. Last Name -First
27. ID.
(909) 780-2401
N/A
W
P1 Garofano, Margie Ann L
s
P
E
~
T
45S
U
S
P
E
43. Arrested
Yes ~ "° O
03-24-65
BRN
44. Address -Clothing -Other Marks r Identifying Characteristics
BKG #200114482
1370 Via Vista Dr., RV 92506
Juv. Ct.
Prob.
Juv: Other
2
~
(
Dis - Juris.
46. Last Name -First -Middle
~
~
Wilhi~
1
~
Dell_
5
49. HL
47. Race -Sex 4B. Age
6
Detained
50. WL
51. Hr.
(
)
1
2
)
(
Not Detained
54. Arrested
53. DOB or ID
52. Eyes
Yes ~
-
No
55. Address -Clothing -Other Marks or Identifying Characteristics
C
T
56.
39. WI.
42. DOB or ID
41, Eyes
40. Hr.
G-02 220 BRN
36
W- M
Patkins David Charles
38. HL
37. Age
36. Race - Sex
%
l
35. Last Name -First -Middle
34. Bus. Phone
(909) 780-2401 (909) 985-2811
San Antonio Community Hospital, Upland
1370 Via Vista Dr., RV 92506
09-13-59
- F
33. Home Phone
32. Business or School Address
37. Resdence Address
S
30. DOB
29. Race -Sex
i Business) ~
28. Last Name -First -Middle (Firm
26, Bus. Phone
25. Home Phone
24. Business or School Address
1370 Via Vista Dr., RV 92506
10-25-OU
- M
W
i
23. Residence Address
22. DOB
21. Race -Sex
Patkins, Erik James
V
7
16.
Additional O
15. Additional
Adults Arr. O
14. Type Conl.
13. Type Clr.
12. Dale /Time Inv. Term.
/
11. Date /Time Inv. Start
-/
10. Date I Ti me Assigned
9. Day
04-28-01 ~ 0600
G08
626
P3-01-118-065
6. Crime-CL
5. Crime-CL
4, Dist.
"~ d. OH. ID
2
1. Origfna! File Na
Date Prepared: 04-29-01
B. Dale /Time Occurred
/F Crime-Cl
Jw: Other
Dis ~ Juns.
~
~
Juv. Gt.
Prob.
z
~
(
5
Within
De t.
(
~
6
Detained
(
)
1
)
(
Not Detained
2
BELOW
ORIGINALLY REPORTED DOLLAR VALUES ARE CHANGED AS SHOWN
Cat.
PS
Currency
A Notes
$
Clothing
C Furs
Jewelry
B Prec. Met.
$
$
E
OfFice
Equip.
F
-~ V. -Radio
Cameras
$
$
G Firearms
$
H
Household
Goods
$
Consum.
Goods
~
$
Livestock
~
K
Misc.
$
$
PR
Stolen
Auto
61. Original Offenses Changed to (Code -Crime)
~ ~ ~ Incident Report
SB.
~ ~ ~ 273a(a) PC
60. Originally Reported Offenses (Code -Crime)
59. Inuto
( 2)
(Z)
Reporting Officer
M. Bartholomew
62. Narrative of Supplemental Report
Reviewed By
FOR FURTHER,SEE PAGE 2
VCLO (
APB Senl
APB Cancld.
APR Senl
APR Cancld
DOJ - NCIC
Entered
Candd.
Riverside Police Department - Supplemental Report
)
ARTI~Y
~' RIV~KSIDE POLIO DEP
Coutinuatiou Page
Page 7 of S
04-29-01
273a(a) PC
~~~1T
Filc No. P3-01-118-065
M. Bartholomew #626
collected
ted a search of the residence and
tographs, Det. Masson conduc
After the pho
supplemental report for details).
ier
several items of evidence (see his
1'S, iilZ CClu, if~e rnas
i~w~i ~Oiii0il Oi tiiE Sii11
C I21GaSuiciil~ili5 vi ti1~
i tGOI
measurements were
chair in the baby's room. All
room bed, the office bed, and the
bed
e.
taken with a standard tape measur
upper floor
ay between the ground floor and
The lower portion of the stairw
roximately 7"
dle landing. each step was app
of seven steps, ii~icluding the mid
consisted
ep 7) was 3'2'/4" iti
d 11" in width. The lauding (st
in height and between 10 ~i "an
to landing).
of the stairwell was 5'(from floor
The height of the lower portion
peted
width.
The stairwell appeared to be car
6 were approximately 3' wide.
Steps 1 through
g).
the house (off-white pile carpetin
with the same carpet as the rest of
Stairs:
Master Bedroom Bed:
by 6'11" long;
standard king size bed, was 6' side
The bed, what appears to be a
bed,
Mattress to the floor was 26". The
height of the bed froiii the top of the
the total
bed between the
roxi~nalely 5" gap at the foot of the
which has a wood frame, had an app
wood
gap Uetween the mattress and the
s and the end board; there was a 2"
mattres
located on the right
tely 9" from the wooded dresser
headboard. The bed was approxima
side of the bed.
Crib:
as
was wood-colored. It stands 3'6" tall
The crib (possibly "~r~uilclin" brand)
. The sliding rail
the headboard acid is 4'6" iii length
measured from the door to ilie top of
ven slats. There is an approximately 3
is 2'3 %2" in height and consists of ele
on the crib
" in width.
of the crib was 4'S" in length by 2'4
~
/4" gap between each slat. The interior
ss pad was
rail (raised) to the top of the mattre
distance between the top of the sliding
The
found to be about 11".
Chair near crib:
m was 39" tall, 28" wide (from front of
The blue upholstered chair in V-Erik's roo
17" front the floor.
the seat to the back rest, and the seat vas
Office ~3ed:
ed 3'6" wide by 6'2" long by 28" tall.
The bed found in the upstairs office measur
lying
d or footUoard. A baby pad/play toy was
It had a standard medal frame with no hea
on the top of the bed.
~
Follow-up:
a message to call Riverside Community
Prior to the end of the search, I received
ays and
a radiologist had reviewed V-Erik's X-r
Hospital. "Yolanda" advised me that
each femur.
found what was thought to be a fracture in
Pagc8of8
04-29-01
~ RIVERSIDE YOLICL DEPARTI~~ `.1T
Co~ltinuatioii Pagc
File No. P3-01-118-OGS
M. Bartholomew #626
273a(a) PC
cal Center Pediatrics LIZ. I
I was also asked to call Loma Linda University I~Tedi
based on
not believe the fractures did existr
spoke with an ER doctor who told me they,did ...._ ..,,. ~ ,. a .__
a
~ icvcuicu «~creaseu ~r~ssu►-e u~ -~ri - s
~
a .~. F ..,.... ~T ~CaiiS iluu
~.i
t~iCii n-iaj%S. 1 WuS ~~lu ~i►d~ i~~w
ure. Sonic type of
to be inserted iii au altcmpt to relieve the press
brain; a tube was going
also, which is consistent with past
old diffusion (old injury) was seen in the CT scan
a to the head was observed; all the
bleeding due to an older injury. No obvious traum
head. The injuries were unlikely to be
multiple injuries were observed inside V-Erik's
the circumstances of the injury.
consistent with the story provided by S-David of
of the scene, it was
Based on the medical infornlatioii, and the inspection
~~ere consistent with abuse. As S-David
determined that the injuries sustained by V-Erik
was arrested for the listed charges
was the pri►nary caregiver at the time of the injury, he
ntal report).
and booked into RCJ (see Ofc. Dorado's suppleme
to LLUMC to check the
Det. Masson, Sgt. DcLaRosa, D.D.A. IIu~;hes, andI went
iewed in the family
status of V-Erik and to contact P1-Margie. She was interv
further, refer to Det. Mason's
consultation room in the Pediatric ICU (Unit 5700). For
supplemental report.
Disposition:
Office for filing
Case to be referred to the Riverside County District Attorney's
consideration.
NOT TO BE PUBLISHED
IN OFFICIAL REPORTS
ified for
not
relying on opinionsifiedcert publication or
for
and parties from citing or
97T~a~, prohibits courts by rule 977(b). This opinion has not been cert
California Rules of Court, rule d, except as specified
publishe
~ubtication or ordered purposes of rule 977.
ordered published for
ATE OF CALIFORNIA
AL OF THE ST
Ili' THE COURT OF APPE
STRICT
DI
FOURTH APPELLATE
DIt~ISION T`~~'O
THE PEOPLE,
E032757
Plaintiff and Respondent,
Sup
( er.Ct.No. RIFa96844)
OPII~'ION
DAVID CHARLES PATKINS,
Defendant and Appellant.
'. Patrick F. It~agers, Judge.
of Riverside Count}
APPEAL from the Superior Court
Affirmed with directions.
endant and
nt by the Court of Appeal, for Def
tme
S}~aron ?~;. Jones, under appoin
Appellant.
Robert R.
BiII Loc~.yer, Attorne}~ General,
Assistant
General, Gary W. Schons, Senior
Anderson, Chief Assistant Attorney
Attorney General, Gil P. Gonzalez,
nt, Senior Deputy Attorney
eral, and Garrett Beaumo
Supervising Deputy Attorney Gen
General, for Plaintiff and Responden
t.
er (Pen. Code, ~ 187)1 (count
A jury found defendant guilty of second degree murd
1), child abuse resulting in death (§ 273a)(count
2), and possession of brass knuckles
found true that defendant
§
( 12020, ssbd. (a}). The trial court thereafter
had pr~ unti
en he
he, he, he, th
tlieri, ~~nd then
hii~~ up. Ind
. . ...
d he would like
~~lay with him an
w ould cr.y, T
u
th you dan't yo
"I wanner be wi
..
. ... . . . . . . .
lie says "Cause
m . . .. . . . . .. . ."
erstand what I'
und
u ]{now I don't
ught "Well," yo
crying." I Llio
he's
, so I thought
every single: time
r picl~c l~iii~ up
w anne
d like, like
r a few momentU an
cl let iL go Lo
I, I'
RGIE Ai~TN GAROFANO
INTERVIEW WITH MA
P3-01-118-065
Page 99
ab him
I always could gr
ttle bit, before
cry a li
geting a
inking that he's
me, you know, th
all the ti
I didn't wanna,
w, more aware, so
little older no
my m~md. But, I
thinking that in
you know, I was
go "Oh, come here
m up finally, T'd
would go pick hi
him, then he'd,
him up and cuddle
honey" or pick
tes and he'd calm
one or two minu
give him about
my arms and just
st pick him up in
down. Like 1 ju
he, and he, then
room and then, and
walk around the
MASSON:
y.
know, rather rapidl
he'd calm, you
day or two where
was like this a
Y just mean he
you'd--
GAROFANO:
MASSON:
GAROFANO:
MASSON:
No.
me from work,
from work, you're ho
--he'd comma homE,
to sleep all
reason he won't ga
and for whatever
irritable
and he's agitated or
y, and he's crying
da
. .. ... . .
kept you awake .. ...
l day, and the baby
al
s, Eric,
was like that. He wa
ere was a day that
Th
nds, and
of the day doing erra
id was gone most
Dav
day, a
dn't sleep good that
s crying and I di
he wa
he was
. . . . . .. ... . . and I thought
day. . . . . . . .
full
active
more
being
and
up
growing
just
. . . . . . .. . . .
... . . butand I'm not . . . . . . .
Page 100
FANO
INTERVIEW WITH MARGIE ANN GARO
P 3-01-118-065
GAROFANO:
Yeah.
MASSON:
GAROFANO:
It was, it was,
that
this
past
there was a couple of days like
but
why
know
you
because
thought,
so,
or
week
I
know,
just
I
I,
he,
how
uh
I
up in bed and then set
thought that, cause if I sat
him
in
my
lap
and
.... . . . . . .. . . ....
then
he's
something
all
then
he
like
bright,
stopped,
and
this time his toys
he's like u-u-u-u- .. ...... ...
y. As soon as I did
and looking around and he's happ
I kept him in bed
that, that was ah-h-h, you know,
r ....... . ...
like a .. . .. . . . .. . . . . . . You know olde
can't
do
that.
Laying
in
bed,
you
know,
mommy
thing.
MASSON:
Right.
GAROFANO:
level
Now we're transen, transcending to the next
~'1/ .'S
~
where
he
gotta
have
more
activity
time.
And
I
a playpen
know, it's coming you know. I have uh um
in the
my doctor said, I said "Should I put him
an hour
playpen now for an hour in the morning and
in the afternoon." Haven't
quite done
cause he has . .... ... ... . ... . . . . . ...
that
yet,
I didn't
. . . .. knew he'd just be
want any. . . . . . .. . . . . . . . .. . .
all emotional he likes being with me, so, I just
~ _ `. 4
Hospital
Riverside Community
4445 Magnolia Ave
Riverside, CA 92501
400
PHONE #: 909-788-3
909-788-3194
FAX #:
.,
NAME: PATKINS,ERIC
PHYS: Sonne,Alan C
AGE: 6M 3D
DOB: 10/25/2000
: A.D.ED
ACCT: A.D0203105879 LOC
TUS:
EXAM DATE: 04/28/2001 STA
RADIOLOGY NO:
UNIT NO: AD01105349
SEX: M
~
~
BRAIN WO CONTRAST
EXAMS: 000224422 CT
HOUT CONTRAST:
CT OF THE BRAIN WIT
HISTORY:
Trauma.
PROCEDURE:
d Advantage CT
e make with the GE HiSpee
iguous 5 mm slices wer
Cont
scanner.
FINDINGS:
i ~ 5~~~
rEu,
ago
al lobes
right temporal and left pariet
,~~..~5+
are fractures of the
n of blood
lectio
There
depression. A 3 mm thick col
poral region'"'`
without significant
skull in the right frontotem
the inner table of the
ntotemporal
along
al hematoma. A small left fro of the
consistent with an epidur
le
is
inner tab
lection is noted along the
low density fluid col
~°E "~°
skull.
with a
ion in the left frontal lobe
a 2 x 1 cm low density les
n,
ent portio
There is
sity material along its depend
tiny amount of high den
defined.
No midline shift is
consistent with blood.
torium and
S~'. N
material is noted along the ten
Some increased density
d density are noted in
lar zones of diminishe
posterior falx. Irregu
the occipital
es bilaterally, particularly
the cerebral hemispher
ebellum.
sity is also noted in the cer
lobes. Diminished den
MPRESSION:
I
.
1
DURAL HE2iATOMA.
SMALL RIGHT TEMPORAL EPI
.
2
SKULL FRACTURES.
BILATERAL NONDEPRESSED
.
3
X AND TENTORIUM.
ED ALONG THE POSTERIOR FAL
SUBARACHNOID BLOOD NOT
4.
AL SUBDURAL HYGROMA.
SMALL LEFT FRONTOTEMPOR
L LOBE,
C DENSITY IN THE LEFT FRONTA
A 2 X 1 CM PORENCEPHALI
.- s ~ ~ .,~
. c ~ ~~ ,
UNT OF BLOOD
CONTAINING A SMALL AMO
(CONTINUED)
PCI
Signed Report Printed From
PAGE 1
.
5
_.,
~~
y Hospital
Riverside Communit
e
4445 Magnolia Av
e, CA 92501
< - ~ Riversid
3400
PHONE #: 909-788.909-788-3194
FAX #:
NAME: PATKINS,ERIC`
PHYS: Sonne,Alan C
SEX: M
AGE: 6M 3D
DOB: 10/25/2000
LOC: AD.ED
ACCT: AD0203105879
2001 STATUS: DEP ER
EXAM DATE: 04/28/
RADIOLOGY N0:
UNIT N0; AD01105349
ST
CT BRAIN WO CONTRA
EXAMS: 000224422
AND
NSITY IN THE CEREBRAI~
NES OF DIMINISHED DE
IRREGULAR ZO
.
NSISTENT WITH EDE'1~iA.
6
HERES BILATERALLY CO
CEREBELLAR HEMISP
MPLETELY EFFACED
TH SMALL BUT NOT CO
NO MIDLINE SHIFT WI
NS.
.
7
FISSURES AND CISTER
VENTRICLES, SULCI,
ABNORMALITIES
TER OF THESE VARIOUS
TRAUMA
LTIPLICITY AND CHARAC
HE MU
T
PEATED EPISODES OF HEAD
E POSSIBILITY OF RE
TH
NDED.
CERTAINLY RAISES
RRELATION IS RECO1~1E
PERIOD. CLINICAL CO
TIME
OVER A PROLONGED
~~
kover M.D. **
gned by Raymond P. Sa
**
** Electronically Si
on 04~28~2001 at 1155
ver, M.D.
**
by: Raymond P. Sako
Reported and Signed
C. Sonne, M.D.
GENCY PHYS GRP; Alan
CC: CALIFORNIA EMER
Enomoto, CRT
TECHNOLOGIST: Mark
IME: 04/28/2001 (1109)
TRANSCRIBED DATE/T
HIMMK
TRANSCRIPTIONIST: AD
BATCH NO: 5495
05/01/2001 (1020)
TED DATE/TIME:
- ~ PRIN
From PCI
Signed Report Printed
PAGE 2
-
~ ~~~
~ ~
~~
Riverside Community Hospital
4445 Magnolia Ave
Riverside, CA 92501
i
PHONE #: 909-788-3400
FAX #: 909-788-3194
NAME: PATKINS,ERIC
PHYS: CALIFORNIA EMERGENCY PHYS GRP
AGE: 6M 3D- SEX: M
DOB: 10/25/2000
ACCT: A.D0203105879 LOC: AD.ED
EXAM DATE: 04/28/2001 STATUS: DEP ER
RADIOLOGY NO:
UNIT NO: AD01105349
EXAMS: 000224430 ABDOMEN 1V / KUB
PORTABLE KUB:
The bowel gas pattern is not remarkable.
density is defined.
No suspicious soft tissue
Incidentally noted are zones of periosteal reaction of the femoral
shafts bilaterally consistent with prior trauma.
MPRESSION:
I
SUBACUTE TO CHRONIC PERIOSTEAL REACTIVE CHANGES OF BOTH FEMURS
PROBABLY RELATED TO PRIOR TRAUMA.
** Electronically Signed by Raymond P. Sakover M.D. **
**
on 04/28/2001 at 1324
**
Reported and Signed by: Raymond P. Sakover, M.D.
CC: CALIFORNIA EMERGENCY PHYS GRP
TECHNOLOGIST: Alecia Curtis, CRT
TRANSCRIBED DATE/TIME: 04/28/2001 (1207)
TRANSCRIPTIONIST: ADHIMDMD
BATCH NO: 5495
~ PRINTED DATE/TIME: 05/01/2001 (1020)
PAGE 1
Signed Report Printed From PCI
,~
~I
.,
~
pital
Riverside Cozyunity Hos
4445 Magnolia Ave
Riverside, CA 92501
PHONE #: 909-788-3400
FAX #: 909-788-3194
~.,
,~
NAME: PATKINS,ERIC
PHYS: Sonne,Alan C
AGE: 6M 3D - SEX: M
DOB: 10/25/2000
ACCT: AD0203105879 LOC: AD.ED
: DEP ER
EXAM DATE: 04/28/2001 STATUS
RA.D IOLOGY NO
UNIT NO: AD01105349
AL SPINE 1V LATERAT,
EXAMS: 000224424 CERVIC
NE, LATERAL PROJECTION:
PORTABLE CERVICAL SPI
nor bone
n of fracture, displacement
ere is no definitive sig
Th
soft tissues of
d adenoid hypertrophy. The
struction. There is mil
de
suggestion of
demonstrated, but there is a
neck are not optimally
the
prevertebral swelling.
MPRESSION:
I
SPINE SERIES IS
ALITY. A COMPLETE CERVICAL
NO DEMONSTRABLE ABNORM
TO COOPERATE.
IENT IS BETTER ABLE
RECOI~IENDED WHEN THE PAT
Raymond P. Sakover M.D. **
** Electronically Signed by
**
on 04/28/2001 at 1324
**
d P. Sakover, M.D.
mon
Reported and Signed by: Ray
S GRP; Alan C. Sonne, M.D.
CC: CALIFORNIA EMERGENCY PHY
, CRT
TECHNOLOGIST: Alecia Curtis
DATE/TIME: 04/28/2001 (1205)
TRANSCRIBED
MD
TFZANSCRIPTIONIST: ADHIMD
BATCH NO: 5495
: 05/01/2001 (1020)
.PRINTED DATE/TIME
.
l
Signed Report Printed From PCI
PAGE 1
~#
I.
~,
Riverside Community Hospital
4445 Magnolia Ave
Riverside, CA 92501
PHONE #: 909-788-3400
FAX #: -909-788-3194
NAME: PATKINS,ERIC
PHYS: Sonne,Alan C
AGE: 6M 3D - SEX: M
DOB: 10/25/2000
ACCT: AD0203105879 LOC: AD.ED
EXAM DATE: 04/28/2001 STATUS: DEP ER
RADIOLOGY NO:
UNIT NO: AD01105349
EXAMS: 000224423 CHEST 1 VIEW
0
PORTABLE CHEST, SUPINE:
the appearance of the heart and
A frontal view of the chest reveals
ts for this portable technique.
mediastinum to be within normal limi
ular markings are essentially
The lungs are clear. Pulmonary vasc
of bone structures for
normal. There is no major abnormality
image is not a detailed examination
the patient's age, although this
of thoracic skeletal architecture.
MPRESSION:
I
Y IS DETECTED ON PORTABLE CHEST
NO ACUTE CARDIOPULMONARY PATHOLOG
RADIOGRAPHY.
ver M.D. **
** Electronically Signed by Raymond P. Sako
**
on 04/28/2001 at 1324
**
P. Sakover, M.D.
Reported and Signed by: Raymond
Sonne, M.D.
CC: CALIFORNIA EMERGENCY PHYS GRP; Alan C.
TECHIVOLOGIST: Alecia Curtis, CRT
TRANSCRIBED DATE/TIME: 04/28/2001 (1203)
TRI~NSCRIPTIONIST: ADHIMDMD
BATCH NO: 5495
-., PRINTED DATE/TIME: 05/01/2001 (1021)
PAGE 1
Signed Report Printed From PCI
unity Hospital
Riverside Comm e
Av
4445 Magnolia
92501
..
Riverside, CA
9-788-3400
PHONE' #: 90
8-3194
FAX #: 909-78
ERIC
NAME: PATKINS,
nne,Alan C
SEX: M
PHYS: So
AGE: 6M 3D
DOB: 10/25/2000
.ED
5879 LOC: AD
ACCT: AD020310
US: DEP ER
/28/2001 STAT
EXAM DATE; 04
RADIOLOGY NO:
1Q5349
UNIT NO: ADOl
IEW
436 CHEST 1 ~I
EXAMS: 000224
/28/2001:
VIEW - 04
CHEST, SINGLE
of fluid.
sulci are free
e costophrenic
iothymic
The card
clear. Th
The lungs are
ly distributed.
els are normal
ss
pulmonary ve
al.
houette is norm
sil
MP
I RESSION:
.
RADIOGRAPH. _
NORM~iL CHEST
ee M.D. **
.Donald R. Mass
**
ally Signed by-_
** Electronic
at 1046
on 05/06/2001
ee, M.D.
R. Mass
**
gned by: Donald
Reported and Si
~,.
__
e, M.D.
P; Alan C. Sonn
ERGENCY PHYS GR
EM
CC: CALIFORNIA
T
ecia Curtis, CR
TECHNOLOGIST: Al IME: 05/04/2001 (1132)
/T
__~_.____--- -- ____~
TRANSCRIBED DATE ~A:DHIMMK_~-___.___~___.~.__~...__._
---_TRANSCRIPTIONIST:BATCH NO: 5662
0}
05/06/2001 (113
IME:
PRINTED DATE/T
CHART COPY
— PAGE 1
The
•
,~, . ~
~~
PATIENT:
DOB:
ITr1L
TY ~HILDREN'S ~[10SP
L0~lIA ~I~VDA UNIVERSI
PATKINS, Eric
r r23a nnd~norr sr~«t
~
ia 923.14
Loma Lin~lo, Californ
10-25-2000
909
( )8?S-K1DS{54.?7/
MR:
:
DATE (7F CONSULTATION
REFERRING PHYSICIAN:
CONSULTING PHYSICIAN:
:
PATIENT IDENTiFiCATIQN
75543 25
4-28-01
Dr._Slaughter
Rebeca Piantini, MD
ity
from Riverside Commun
was transfeRed to LLUCH
who
s:
This is a six month old male
altered level of consciousnes
h closed head injury and
Hospital on 4-28-2001 wit
S:
ES
HISTORY OF PRESENT ILLN
while
under the care of his father
chart. The patient was
the
erring hospital is that he
The history is obtained from
tory to paramedics and ref
's his
and
mother was at work. The father patien# and tripped and the pafient fell from his arms
h the
ed to
irs are report
was walking uQ the stairs wit
t 5:30 to 6:00 AM. The sta
io call 911.
stairs. This happened abou
rolled down the
rk, said that he needed
AM.
called the mother at wo
be carpeted. Father
the home at about 6:46
about 6:38 AM and arrived at
medics reported that the
Paramedics received a cal!
y Hospital at 7:15 AM. Para
unit
erside
They arrived at Riverside Comm
s agitated upon arrival at Riv
ing when they arrived but wa
patient was alert and cry
turing with eyes deviated
ir exam, the patient was pos ient was intubated and
the
Community Hospital. On
tching. The pat
pital
ly and the right arm was twi
ownward bilateral
d
CT done at Community Hos
antin and Valium. Head
eric subdural hematoma
stared on phenobarbital, Dil
dural hematoma, interhemisph
d sub
parietal skull
showed new right epidural an
e, and there were bilateral
her
c subdural versus hyperacut
and evidence of chroni
erred to LLUCH for a hig
. The patient was then transf
fractures, per preliminary report
level of care.
PAST MEDICAL. HISTORY:
unds 10
Pa. Birth weight was 10 po
vaginally to a 41 year old G7
Patient was born full term
e was meconium, however,
re used on delivery. Ther
s we
d sitting.
ounces. Suction and forcep
lopment: Patient has starte been
nt home with mother. Deve
There have
patient did weft and we
re no medications at home.
the bed a
known medications. There we
There are no
ions. Patient has fallen off
by
ergies, no il9ness or hospitalizat
n v reported drug all
the incidents were reported
by a primary physician after
unizations. family
couple of times and was seen
eived two and four month imm ther reported that,
has rec
mom. immunizations: Patient
icant disease. Mo
d
history of seizures or signif
y: There is no family
histor
d asked father what ha
small bruise~on the jawline an
on one occasion, she noted a
t had Palle' m~the bed.
happened and he said the patien
,
~
t
TE ~y%~1~'r~2~04
PRIIiTED BY: padikuon DA
ve"tutlnftitution
Aprii 28, 2001
RE: PATKINS, Eric
MR: 155 43 25
Page 2
PSYCHOSOCIAL HISTORY:
nity Hospital. Father is
Mother is 4i years old, is an RN and works at San Antonio Commu
not married.
36 years old and is a painter.. The parents live together and are
PHYSICAL EXAMINATION:
intercranial pressure
Temperature 96, pulse 163, respirations 20, blood pressure 123157,
percentile) and head
60, estimated weight 7 kg (25 percentile), length 70.5 cm (75~'
l, the patient is intubated,
circumference 45 cm (around the 80~' percentile). In genera
area. There is an
sedated. There is an intracran~al pressure monitor in the right frontal
leads on the scalp.
external ventricular drain catheter in the left parietal area and EEG
pressure monitor bolt on
Head: Anterior fontanel is~bulging and tense with an intracranial
with some Betadine
the right side and EDV on the left. There is dried blood on the scalp
. Head appears
aver the area where the monitor bolt and drains were placed
are bilateral extensive
macrocephalic. Eyes: Pupils are fixed and about 3 mm. There
There is no
retinal hemorrhages. Sclera is white. Ears: Tympanic membranes are clear.
the Hares.
hemotympanum and no bruises. Nose: There are small abrasions around
d. There is an
There is an NG tube in place. Mouth: The lips are dry and cracke
There is no
endotracheal tube in place. Upper and lower frenulums are intact. Neck:
with symmetric
crepitus or bruising. Lungs are clear to auscultation and ventilator sounds
no murmurs.
air movement. Heart is regular rhythm. He is tachycardiac. There are
disten#ion, no
Abdomen is soft. Bowel sounds are present. There is no abdominal
ties: There
hepatosplenomegaly aid no masses. There is no abdominal bruising. Extremi
ary to
are femoral lines bilaterally for 1V access. There is a bruise on the left wrist second
is circumcised Tanner
IV access attempt. Pulses are 2+ and equal. Genitalia: Patient
is a
stage 1 with testes descended bilaterally. Anus is within normal limits. Skin: There
is a small
small amount of hemorrhage on the nails of the first toes bilaterally. There
appreciated. The
bn.~ise on the left wrist from the {V attempt. There are no o#her bruises
nt of the
skin is not hyperelastic. There is a slightly red area on the right lower quadra
gical
abdomen where tape has been placed for dressing of the right femoral line. Neurolo
exam: Patient is sedated.
DIAGNOSTIC DATA:
platelet
WBC 19,000, hemoglobin 10.4, hematocrit 29.1, neutrophils 80, lymphocytes 15,
4, creatinine 0.3,
count 433,000, sodium 144, potassium 3.8, chloride 116, CO2 18, BUN
glucose 12i, alkaline phosphatase 398, AST 74, AL7 34. UA noted specific gravity 1.025,
no leukocytes, trace protein, 500 glucose and small ketones.
PRII~~TED BY: padikuon DATE 09/15/2004
Page 3
April 28, 20fl9
ic
RE: PATKlNS, Er
M R: 155 43 25
stamy
approach ventriculo
atus post left frontal
LLUGH was st
morrhage along the
28: Head~CT done at n of the ventricles. There is air and he
A pril
e was
mpressio
frontal lobe. Ther
placement with deco traparenchyrrzal hemorrhage in the left d/or infarction, bilateral
w in
ema an
shunt tract and ne
extensive cerebral ed rebellum.
Intraventricuiar
nsity consistent with
stent low de
left and ce
is a
persi
than
hemorrhage. There
res, right greater
cerebellar hemisphe ural hemorrhage, and right parafalcine
bd
hemorrhage, right su herniation.
rial
downward transtento
al bane
region of the pariet
the posterior superior r.
ey showed fracture of acture of the right femu
April 34: Sone surv
fr
on indicating probable
and periosteal reacti
ood flow
normal cerebral bl
BF study noted ab
an vascular flawIC
April 30: Brain sc
nt cerebral blood flow.
consistent with abse
ES:
RI
SUMMARY OF INJU
ant cerebral edema.
signific
ural hematoma with
ed head injuries, subd
Clos
ousness.
Altered level of consci
ly.
Skull fractures bilateral
rrhages.
Bi~akeral retinal hemo
1.
.
2
.
3
.
4
IMPRESSION:
ma th
with abusive head trau
is asix-month-old male
This
S:
RECOMNIENDA710N
1.
.
2
.
3
and photographs to
Ophthalmology consult ed.
volv
Law Enforcement is in tion.
na
Mother wishes organ do
r
~
V
~
Gv
Rebeca Piantini, MD
atrics
pivision of Forensic Pedi
RP/alel5-'I4
on DATE ~9/1.5/2C~04
PRIt•ITEI? BY: padiku
at resulted in death.
rrhages.
document retinal hemo
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LOMA LINDA UNIVERSITY MEDICAL CENTER PdTKI ;iS, ERIC
bD 042801
~
CONSULTATION REPORT
PRIC~TED BY: padik~.~c>n DATE 09/15/2004
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015543250000
PATKIPIS, ERIC
#431795
7:04/30/2001
D:04/29/2001
07950
44/29/2()01
DATE OF ADMISSION:
onth-old boy who
S: This is a 6-m
d over a dog. He
THE PRESENT ILLNES
HISTORY OF
his father trippe
the stairs after
n
rside after
reportedly fell dow
intubated at Rive
Riverside. He was
s
om
g. The patient wa
was transferred fr
decorticate posturin
. A
ng decerebrate and
arbital and Dilantin
showi
ven phenob
ry and the
seizures and was gi
ju
beginning to have
an intracranial in
showed evidence of
uation.
scan was done that
CT
her eval
erred here for furt
patient was transf
or
us focal weakness
: rro known previo
. RESPIRATORY:
EMS: NEUROLOGICAL
ia
REVIE~J OF SYST
ension or arrhythm
SCULAR: Na hypert
inder of
seizures. CARDIOVA
diarrhea. The rema
GI: No vomiting or
a or cough_
No dyspne
r as is known.
s is negative as fa
the review of system
Y:
PAST MEDICAL HISTOR
Negative.
Y:
PAST SURGICAL HISTOR
None.
MEDICATIONS:
ALLERGIES:
Negative.
NONE KI~IOWN.
SOCIAL HISTORY:
t.
Unknown at this poin
:
PHYSICAL EXI~MTNATION
:
VITAL SIGr1S
HEENT:
NECK:
CHEST:
HEART:
EXTREP~ITIES:
ABDOI"IEN:
PELVIS:
EXTREMITIES:
74,
, blood pressure 120/
Temperature is 98.4
weight is 7.2 kg.
heart rate 100 and
osed.
e fontanelles are cl
Normocephalic. Th
reactive to
ual, round and
E yes, pupils are eq
ral
are intact. No scle
light. The EOr~is
mbranes are - clear
mpanic me
icterus. Ears, the ty
hemotympanum.
rIo CSF otorrhPa. No
bilaterally.
ons.
lacerati
Face, no step offs or
or thyromegaly_
DIo masses
lly.
r and equal bilatera
Heart sounds are clea
y.
rIo chest wall deformit
murmur. Normal
rate and rhythm. No
Regular
PMI.
lly.
4 extremities bilatera
The patient moves all
ation in all 4
Apparently normal sens
extremities.
No evidence of
Soft. No distension.
wel sounds.
tenderness. Intact bo
Stable.
y.
edema and no deformit
Lo~rer extremities, no
7GAL CFdYTER
.Obi.4 LINDA UMVERSIIYMED
I
~uvn.
~
'"~E
~,
#
~
r
~~srr.
~trD Cx~n~v'S HosPrrnL
~
HISTORY and P}II'SICAI~
~
09/ ~
ED E3Y: padikuon DATE
~~
_
deformity.
ema and no
ies, no ed
emit
Upper extr
r blood.
nderness o
rdo te
.
e or rashes
P10 petechia
RECTAL:
14.5
cell count
SKIN:
or
ite blood
, wh
of fracture
in is 10.1
e hemoglob
no evidence
th no
normal wi
DATA: Th
-ray showed
x-ray was
DIAGNOSTIC
al spine x
CT scan of
The chest
The cervic
ading.
tion. The
thousand.
iminary re
ary evalua
etal
in
n on prel
a left pari
s on prelim
dislocatio
b fracture
toma and
matoma and
he
ax or ri
bdural hema
t epidural
pneumothor
old left su
small righ
an
owed a
idence of
the head sh
ere was ev
acture. Th
skull fr
fracture.
al skull
left pariet
ntal trauma
non accide
PLADI:
ern for a
actures.
nc
ANTS
l skull fr
y with a co
ASSESSMENT
. Bilatera
nth-old bo
es
6-mo
ma. Left
nial injuri
T his is a
t
ural hemato
w intracra
injury, bu
old and ne
ld left subd
O
with
_
aabdominal
e to
al hematoma
of an intr
ur
evidence
unstable du
Right epid
ent became
There is na
osurgery
ncephaly.
an the pati
pore
CT sc
for a Neur
nal/pelvis
abdominal
Will plan
re.
nit. Abdomi
during the
nial pressu
ive Care U
nd
intracra
the Intens
ld Abuse a
increased
mission to
c
th the Chi
e Pediatri
tion and ad
Consult wi
th th
ble.
consulta
al x-ray wi
ically sta
clin
of the spin
CT if he is
rmal review
t Team. Fo
Neglec
radiologist.
IN, T~1. D.
GERALD GOLL
PHYSICIAI~1
ATTErIDING
r/72
-22-2001
, M.D. On 05
Pri:01
rald Gollin
ed by Ge
A uthenticat
AL CFd~7'F.A
IY~RSST7'YAIEDIG
LOM4 LINDA UN
S H0.SPtTAL
r
~~,gy.
N'
F
~
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r
AND CFIILDRE
SICA.L
H[STORY and PIIY
09/
diku~;n DATC
- ^ ED BY: p~
#~
~~
at 7:48 am
L R.EPOR.T:;
,p
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l
13
0155, ?Snnrl
'
PATKITT~, ERIC
:
D 04/29/2001
nr~R30
#932083
7:04/30/2001
04/29/20Q1
ERY:
DRTE OF SURG
RGEON:
OPERATING SU
ANT:
FIRST ASSIST
SISTANT:
TEACHIrdG AS
S:
VE DIAGNOSI
POSTOPERATI
RFOF2MED:
OPERATION PE
INS, M.D.
JOHN J. COLL
CAPANO, M.D.
MANI7EL R. SA
FSHUTZ, M.D.
JASOTd I. LI
Intracranial
.
hypertension
n.
lumbar drai
Placement of
Local.
ANESTHESIA:
re of 27.
ening pressu
identifying
FINDINGS: Op
consent and
ing informed
tain
the right
IL: After ob
s placed in
URE. IN DETA
e patient wa
s, th
PROCED
aped in the
Eric Patkin
epped and dr
patient was
sterilely pr
the
on and
ar space.
mbent positi
e L2-L3 lumb
lateral recu
shion over th
ical fa
into
s tandard surg
ntly placed
edle was ge
ed through
marl~s, a ne
plac
land
tFieter was
fying proper
e wire was
tified. 7a ca
After identi
and the guid
CSF was iden
ide wire,
end clear
med to
of ~ gu
position,
F was confir
assistance
awn. C1Par CS
le with the
was found,
withdr
the need
e drain, it
needle was
e tube to th
n after the
, it was
ting th
withdraw
At this time
After connec
was patent.
e to flow.
er
continu
eter no long
at the cath
n.
however, th
ocedure agai
the pr
n
d to per_fvrm
s once agai
decide
a needle wa
er once
thdrawn, and
et
tube ~,aas wi
and the cath
e catheter
identified,
ting to
T herefore, th
tion, CSF w<~s
after connec
time,
me posi
into the sa
was
edle. At this
placed
ugh the ne
e, the drain
readed thro
ted. Therefor
again was th
to be aspira
F was able
the drain, CS
Tegaderms.
sition using
3'?<7 ~-rt2
red into po
secu
v~T ~Q~3
~JatlG:lt~
;_81
1Iltrdi~rdil
~Y't3S~.!rZ
tL~~i.(t
21
btic 1t
~;7
i: _i
L~:2
~O'
with CS E'.
was dripping
mbar drain
lu
.
ss than 2 cc
OOD LOSS: Le
ESTIMATED BL
S: rdone.
CUM~'LIC~'1'ION
'}
2 1e
CAP~lNO, h1. D.
NIANIJEL R. SA
INS, M.D.
JOIITd J. COLL
RGEON
OPERATING SU
(H)/r72
05-15-2001
in, t~1.D. Gn
Pri:02
John J. Coll
by
Authenticated
~~c
. ewir.~
F
3
;
~
1
~y
~E
7SERSf7Yi~fEGIr1L
~t7.bL4I.L4~D.4 ~~~
~"S f~OSPITi1L
~1ND CHILD~
OPER:\TI~'E REPORT
ry
r
'-~
`t_~I~ i L:1 ~ Fs Y: rr~~ f
ViER
~~wr~ wu,y
+,~
,
S
~
~
t
~—
I ~~~'1' l~; 1 U / i :-~_-
at 12:15 pm
015543250002
PATKINS, ERIC
D:04/29/2001
DATE OF VISIT:
7:04/29/2001
ENIERGErdCY DEPT H&P
00580
#432058
04/28/2001
ld Caucasian male.
This is a 6-month-o
of stairs per the
was dropped on a set
~IPLAINT: The child
CHIEF COP
father.
history of
t presents with a
ILLNESS: The patien
Team from an
T
HISTORY OF PRESEN
ive Unit Transport
the Pediatric Intens
by
from the
being transferred
The patient arrived
for head trauma_
tics apparently on
outside facility
sedated, no paraly
ty, intubated and
referring facili
board.
ase see accompanying
ility available, ple
m the referring fac
e history from.
History fro
s at this time to tak
there are no parent
history as
above.
Negative, except as
REVIEW OF SYSTEMS:
IDENTIFICATIOT]:
Y:
PAST MEDICAL HISTOR
ALLERGIES:
Unknown.
UNKNOTn7N.
Dilantin and
ed Versed, Norcuron,
: The patient receiv
along with
NIEDICATIOrTS GIVETI
Emergency Department
prior to arrival in our
phenobarbital
1 mg of Valium.
d and intubated.
The patient is sedate
NIINATIOr]: GENERAL:
has a firm
PHYSICAL EXA
ation. The patient
ponse to pain on examin
sgow Coma Scale
There is res
to 2 bilaterally. Gla
tanele. Pupils are 3
ular rate and
anterior fon
aterally. HEART: Reg
NT: TMs are clear bil
aterally.
is 8. HEE
ar to auscultation bil
ill.
No murmur. LUf7GS: Cle
rhythm.
h brisk capillary ref
EXTREMITIES: Warm wit
N: Benign_
AHDOI~
as a level B
: The patient arrived
DdCY DEPARTI~rI'T COURSE
EMERGE
e. Neurosurgery was
gery was at the bedsid
vation and Trauma Sur
acti
and was able to obtain
to examine the patient
patient's
led to the bedside and
cal
d for evaluation of the
ended a CT of the hea
an exam and recomm
intracranial injuries.
orrhage on
re of intracranial hem
referring facility we
blood pressure
Reports from the
c monitor as well as
t was placed on cardia
ced and was
CT. The patien
a Foley and an NG pla
metry. The patient had
ns. A CBC,
and pulse oxi
l as spine precautio
zure precautions as wel
well as the
placed with sei
UDS were obtained as
amylase, lipase and a
formed at the
electrolytes,
n and pelvis being per
d CT of the head, abdome
aforementione
omen and pelvis.
uma Surgery for the abd
recommendation of Tra
.,s..nn.
S
F
~
i
S
4
~
~
CAL CF.Iv'TEA
LObi4 LIN'M UNIVERSTfYI~fEDI
.41vD CRILDREN'SHOSPIT.4L
EMERGENCY DEPARTMENT
,.
~,.~a.
`~,
~~
~
~I'~~ 09/ 1 ~4 _ ..
y
' ..1r~ ED F~~~~STG~P~3~rf~~~''~iyY
~~
ries,
re of the inju
e to the natu
ry
rtment and du
ng Neurosurge
Emergency Depa
see accompanyi
P7hile in the
gery, please
point during
ur
e
aced by Neuros
ely 45, at on
a bolt was pl
ease in
were approximat
l pressures
t had an incr
ia
e patien
consult. Init
s, the.
Department, th
in
e Emergency
with Dr. Coll
his stay in th
iopental
at which time
repeat CT, th
essure to 90
route to
ranial pr
intrac
esent and en
urosurgeon pr
working
a ttending ne
e pharmacist
d dose per th
ende
this time,
as the recomm
gram. During
/kg was given
n mannitol 7
8 mg
so give
tient was al
lated.
today. The pa
ing hyperventi
also be
e patient was
th
single-view
ral femurs, a
of the bilate
d fractures
ray
significant ol
episode an xy of reported
Prior to this
stor
not complete
due to the hi
lf, although,
was obtained
-r
x• ays by myse
Review of the
actures.
bilaterally_
no obvious fr
ture, showed
na
diatric
films in their
ely to the Pe
taken immediat
tient was
hydrocephalus.
nd CT, the pa
e to increasing
From the seco
ricu.lostomy du
ent of vent
ICU for placem
SIONS:
CLINICAL IMPRES
head injury.
1. Closed
.
al hemorrhage
2. Intracrani
edema.
3. Cerebral
nsive Care
Pediatric Inte
mitted to the
ad
ts as well as
tient is to be
ing Intensivis
PLAN: The pa
disposition of
of the attend
care
mate care and
Unit under the
~_irgeon. Ulti
laboratory
diatric neuros
ns. Currently
Dr. Collins, Pe
these physicia
le to be
the hands in
CT were not ab
the patient in
men and pelvis
nding and abdo
itical nature.
studies are pe
e patient's cr
time due to th
is
obtained at th
NIADT, M.D.
D. SHELTON CHAP
YSICIAN
ATTENDIr7G PH
/r72
am
3-2001 at 4:34
n, M.D. On 05-0
Pri:07
Shelton Chapma
by D.
Authenticated
o~„u,rv.
~F
f
~
~;
~
~
Y1tiIEDIC.4L CENTER
LObi9 LlNAA UNIYERSIf
IT.9L
AtiD CAILDREN'SHQSP.
NT
E11~fERGE~NCY DEPARTME
r„~,.
~`~
~y
~,
~~
.~
swN ecnn~antno
;,~ ~/
J
Frank Sheridan, M.D.'
Examiner
pivision of Medical
1 75 South Lena Road
Bernardino, CA 92415-0037
San
909) 387-2561
(
Chief Medical Examiner
Nenita Duazo, M.D., Deputy M.E.
Edward Yaeger, M.D., Deputy M.E.
Steven Trenkle, M.D., Deputy M.E.
Brian McCormick
San Bernardino County Coroner
Autopsy Protocol
Coroner's Case Number: 01-3075GM
Autopsy Number: A-230-01
D.O.B. 10/25/00
Age: 6 months,6 days
ns
Eric Patki
Name:
0745 hours, May 1, 2001
Time of Death: Reported
Time of ~cu~topsy: 1000 hours, May 2, 2001
ty
Place of Autopsy: San Bernardino County Coroner's Facili
Sex: Male
Rice: Caucasian
Deputy: Miller
investigator's report, from information
HISTORY OF DEATH: According to the deputy coroner 6 day old resident of Riverside was
,
received rom hospital and SCOPC personnel, this 6 month
a
University Medical Center on April 28, 2001, at 1030 hours, with
admitted to Loma Linda
mother at home in
his father and
diagnosis of traumatic brain injuries. The baby lived with
not married.
Riverside. The parents are
he vas carrying the baby up some ~s 3
On April 2S, 2001, the father stated that at about 0530 hours
d on his head an a carpeted step of
stairs and tripped over a dog. He dropped the baby who lande
his wife who works as a registered
the stairway. The father became concerned and finally called
told the father to call 911. The
nurse at San Antonio Community Hospital in Upland. The wife
ely.
father called 911 at 0638 hours to report the baby was acting strang
on the father's bed crying. The
When paramedics arrived at 0646 hours, they found the baby
no visible trauma. They arrived at
baby seemed aware of his surroundings and there vas
ency room, the babe began having
Riverside Community Hospital at 0715 hours. In the emerg
head revealed cerebral edema, as well
difficulty breathing and was intubated. ACT scan of the
Linda University Medical Center,
as old and ne~~~ injuries. The baby was transferred to Loma
moving his extremities at that time.
anivin~ on April 28, 2001, at 1030 hours. He was still
al Center, which also showed old
Another CT scan was done at Loma Linda University Medic
and new injuries.
An
ves were administered.
An intracranial pressure monitor was placed and sedati
tent
al retinal hemonha~e, consis
o phthalmologist e;camined the baby and found severe bilater
s neurologic status deteriorated ~~~ith persistent cerebral
with traumatic brain injury. The baby'
ent vas on Nlay 1, 2001, at
edema leading to brain death. The second brain death pronouncem
0745 hours.
old father has a history of
Reportedl}~. Ri~~erside police detectives stated that the 36-yearfrom prison with less than 5 years
conviction for a shaken baby death in 1993. He vas released
iend who is the mother of Eric. The father has been
served. He is currently living with a girlfr
lrrested in regards to this incident.
fallen off of the bed t~~~ice. landing on ~9 3, r
T'lie father reportedly told police that Eric had previousl~~
the carpeted floor.
UED
TOPSY CONTIN
,CATKINS AU
'P
~ AGE 2
~
'q-230-01
r
so
the undersigned, al
procedures and I, , examined the baby
n donation
on procedures
ent to multiple orga
has given cons dersigned, attended the organ donati
Family
. I, the un
ved.
gave permission and visualized the organs when remo
ene FY ~o,
they arrived on sc
prior to surgery
' run sheets stated baby vas alert and
ide paramedics
viewed. The Rivers pine on the father's bed. The
vas
al records are re
ing su
father stated there
Medic
found the baby ly s no loss of consciousness. The
d
g upstairs.
at 0646 hours an to the father, there wa
e baby while goin
dad was holding th
. According
crying
rs. The
ing
18 inch fall to stai
e father vas tivalk
an approximately
Hospital states th ght the baby hit the
e Community
baby. He thou
cord from Riversid
ergency room re tripped over a dog and dropped the The father denies any previous
A n em
clear.
hen he
ft leg
down the stairs tiv carpeted. The time frame was un that was posturing, with a stiff le
cry.
by
re
with a high pitch
stairs, which r~ve Physical examination showed a ba
on of both arms, No obvious bruising
.
significant injuries g of the right leg and hyperextensi poorly reactive.
d
the
in
and rhythmic kick ed to the right, they were 5 mm., an radiographs appeared negative to ,
ural
viat
men
and abdo
g fresh epid
The eyes were de
ne and chest, pelvis
rmalilies includin
en. Lateral C-spi s review. ACT scan showed abno d and other chronic changes
vas se
al bloo
physician'
and
emergency room
old chronic subdur ven phenobarbital and Dilantin
The
actures, possible
gi
cal Center.
bilateral skull fr titive injuries. The child was
a University Medi
tive of repe
by to Loma Lind ute and chronic injuries, bilateral
e ba
sugges
made to transfer th
al, ac
arrangements were ed head injury with evidence of epidur
os
abuse.
impression was cl
suspicion of child
000.
skull fractures, and
platelets were 433,
tocrit 29.1. The
10.4, and hema
,000, hemoglobin
white count was 19 ecific gravity of 1.0 to 5.
The
a
ed a sp
A urinalysis show
ve an impression of
unity Hospital ga tures, subarachnoid
Riverside Comm
skull frac
om the CT scan at
grama, a 2
ral non-depressed
dictated report fr
The
al hematama, bilate all left fronto-temporal s~ibdural hy of blood,
oral epidur
►ount
orium, sm
small right temp
ntaining a small air
erior falx and tent
od noted along post lic density in the left frontal lobe co rebellar hemispheres bilaterally,
blo
and ce
ncepha
lci,
cm. x 1 cm. pore
ity in the cerebrai
faced t~entric(es, su
of diminished dens ift with small but not completely ef normalities certainly
irregular zones
ema, no midline sh and character of these vlrious ab
consistent with ed
s. The multiplicity
fissures and cistern of repeated episodes of head trauma.
y
ts
raises the passibilit
in the femoral shaf
periosteai reaction
the legs was
sion of x-rays of
to be normal.
radiologist's impres prior trauma. A chest x-ray was felt
A
e of
lled
bilaterally, suggestiv
that the baby had ro .
am history states
e incidences
transport te
rsity Medical Center states pediatrician saw baby after thes nsport team
he Loma Linda Unive
T
. Mom
36. When tra
«- times in the past
diffuse
r is aged 41, father
o ff of the bed a fe
to date. The mothe e and decorticate posturing with There
portedly up
closed.
decerebrat
Immunizations re
the fontanelle ti~~as
e baby was both
ed, they noted th emergency room examination stated
2 mm. The initial
arriv
pils tivere 3 mm. to
e initial
ities. The pu
hypenefle:cia. Th
described or deform
no external injuries
tivas
d
pH was 7.4.
r sods, a~~ed 1 1 an
father has ttivo othe nt vas under the
, states that the
k and the patie
ted April 28, 2001
cial worker note da wa. The patient's mother was at ~~-or , except bab}~ rolled off of the
R so
falls
in Io
9 years -old that li~~e e mother denied any other accidents or April ?8. 2001. states the urine
Th
ted
n's note da
physician's
}.
care of the father.
A hospital physicia
normal ~~alues A 28. 2001.
TT 23.5 (these are
couple of times.
bed a
3Q hours on April
PT was 14.6 and P
y is negative. Tlie
vas conducted at 22
toxicolog
ct Team
ld Abuse and Negle
consult from the Chi
TOPSY
~pT'KINS AU
3
~~PAGE-0 l
p-230
CONTINUED
The baby was
length of 70.5 cm.
nce of 45 cm, and a pils were fixed. There were small
umfere
shotived a head circ
. The pu
The exam dated, with a bolt in the right frontal area dried cracked lips. The upper and lover
,
se
i ntubated,
s. The mouth showed
tivas closed head injury
noted around the nare and anus appeared normal. Impression
ry.
abrasions
The genitalia
tent with abusive inju
renula were intact. s, and retinal hemorrhages, trauma consis
f
ture
anges. A
bilateral skull frac
ed global ischemic ch
ates a head CT show ove history. Ophthalmic exam
st
ab
dated April 3D, 2001
A physician's note consult done April 30, 2Q01 confirmed the
ology
pediatric neur
nal hemorrhages.
revealed bilateral reti
hocardiogram
EKG and normal ec
01 included a normal mpromise. An ophthalmology
consult on May 1, 20
Pediatric cardiology and function. No evidence of cardiac co ges «~ith right pi•eretinal heme,
with normal anatomy 01 noted severe bilateral retinal hemorrha ia~es. A pediatric neurology
rl
20
exam dated April 30, ght eye, and many white centered llemor bral blo~~~ flow study on May 1,
a of ri
A cere
1, 2001.
th brain death.
optic disk edem
ncement ~~~as on May
30 was consistent wi
examination on April al blood flow. Second brain death pronou
br
had been
2001 showed no cere
rt, the father stated he
cording to the repo ther said he tripped over their
fa
report is reviewed. Ac
The Riverside police th the baby at the time of the injury. Tlie by fell out of his arms and his
esent wi
l, the ba
When he fel
Detectives
the only one pr
and then called 91 1.
e baby up the stairs.
dog while carrying th Tlie father first called the baby's mother and the ~~~ife slept in the master
head struck the stairs. to the residence. The father stated that he The bab}' had been sleeping
drove the father back by had his o~vn room across the hallway. up in the ni~~ht approximately
bedroom while the bathe past fetiv weeks, although would wake d the fati~er got up sometime
throuch the night for e morning of April 28, 2001, the baby an in a blanket and carried him
once a week. On th d 6:00 a.m. The father wzapped the baby the babti•'s diaper needed to be
an
alized
between 5:30 a.m.
used the father
ttom of the stairs, he re
en they got to the bo At that point, the doQ got in the t~~a~ and ca e baby faced E C,•/ ~,
downstairs. Wh
left arm so that th
around to go up.
shot
changed so he turned . The father vas canyine the baby in his
. As he fell, "the baby
to trip on the first step d to catch himself but fell onto the stairs ther said the baby struck the
ie
fa
the father's shoulder, tr the steps", according to the father. The
rike the ti~~ood
arms into
. The babe did not st . The baby
om the bottom
right out of my
of the baby
e fourth or fifth step fr
mber if he tell on top
carpeted portion of th
e father could not reme pickzd him up and took him upstairs. The
~~. Th
banister or meta! railin ately- after the fall. The father
, I ~ti~as
dn~t kt~ol~~ what to do
d immedi
emed shocke
e father stated. "1 di ized one side of the baby's
se
a "shocked cry". Th
al
baby began to cry in by on the bed in the master bedroom. He re The gather said, "I thought
e side.
the ba
O
the P~!
ly favoring on
scared". He put
-1 ~ minutes, he called
d the baby was definite
dy had `'frozen up" an He was unsure Lvhat to do, but after about lU accident and the mother
bo
an
".
he broke his little neck ork. He told the mother that there had been Sl~illcClllc: ut~cr. -M~~ babe
'
her ~~~
to send
ld them
baby's mother at
then c~fled 91 1 and to
The father
told I~im to call 911.
s. ~p ~
is hurting".
d a couple of accident
father said `'He, he ha nth a~~o. He ~:ets to r9
re, the
e 1 mo
by had been hurt befo
When asked if the ba fe11 off of the bed close to 3 ti~•eeks, mayb d the cabinet there. 1 guess
an
he
One tivith me where e nest thin I kno~ti~ he is between tl7e bed '~. Thz gather described the
er
movin4 around and th s before it happened with her, "the m~th ks do~~n «~ith his hands. He
ek
in
previously a couple we ho did not cra~~~l but rolled and "5~1IiiS'~ th
~i~
bab}~ as an acti~~e body t ~~i(1 fall o~~ei~ it~distracted.
bu
can sit up on (lis o~vn
ther bean to
e baby cry in~T. th~~ fa not after Ise
~tihen he cant stop th
ther said no,
bets frustrated
me
aken the baby'. the fa
~~'hen asked if he ever
asked if he had e~~er sh heard ~f that ti~om }~amphfets brought ho
en
stutter his ans~~er. Wh Babe S`'ndrome~~. He has
en
understood "the Shak
UED
CONTIN
,CATKINS AUTOPSY
PAGE 4
A-230-01
~~
~',
d that the father
this point, it was foun
ing from the past". At He had been arrested, charged and
"just know
Pq ~~,
by the mother and fromson, now 7 years oId, in the past.
father spent "about 4
dest
land, California. The r his release, he and
shaken his ol
Up
had
elty. This took place in s released in 1996. Afte
er
convicted of child cru
attempt and wa
on" for this
w 3 years old. The moth
years of my life in pris ck together and had another child who is no l done and cleared" and
"al
ba
the child's mother got ved to Iowa. The father said that this vas
mo
of those two children seling for the incident.
that he is received coun
r 1, 2000,
e is a visit dated Octobe
rician are evaluated. Therd 10 ounces and a birth length of
private pediat
Medical records from a it. The birth weight vas 10 pounds an
, at aged 2vis
it dated January 5, 2001
aged 7 days, I week
thy child. There is a vis s an abrasion noted to nose 2 days E XH 6,
showed a heal
21-1/2 inches. Exam continued to be breastfed. There wa
y abrasion on t~ie~nose.
by
1 /4 months —the ba oth with rough texture. There teas a healing dr
cl
ago, rubbing on terry
s noted the
4 month check-up. It wa
2001, at 4-1/4 months, dnight for feedinc. The mother
dated March 8,
al.
There is another visit to 5:00 a.m., occasionally up at I2 mi
ical examination is norm
m.
baby sleeps 8:00 p. with hands, lifts head in prone position. Phys
describes laughs, plays
falling off
a visit for evaluation of
the pediatrician recorded
viewed from
None of the records re
the bed.
ent October
pected date of confinem
rn October 25, 2000, ex hours and 38 minutes. Only labor
baby was bo
Birth records show the s gravida 1, para 0. Labor lasted 13
ores were 8
er wa
ginal delivery. Apgar sc
1 1, 2000. The moth
s were used. It was a va material suctioned. The weight was
ng. Forcep
complication was bleedi s. There vas 10 cc. of thick, green
nce 14 inches.
minute
inches, head circumfere
at I minute,9 at 5
s); the length was 21.5 e for gestational age, newborn male
830 gram
10 pounds, 10 ounces (4 inches. Diagnosis was term, larg
g off bed.
nce 14.5
indicate a visit for fallin
chest circumfere
1. None of these records
a 1, para
infant. Mom 41, gravid
75GM.
stigative Report #01-30
o refer to Coroner's Inve
Als
01
2100 hours — lY1ay 1, 20
ating room
vas e;camined iii the oper erapeutic
s,(hospital #01554325)
nb th
follotivi
Eric Patkin
The baby, identified as to prepping for the organ donation surgery. 7'he mouth. There is a
d prior
to the
tube sec~ired
by the undersigne
There is an endotracheal ial bolt in the right frontal portion of the
liances are present.
ran
app
rac
left nostril. There is an int toe. There is a drain in the left mid parietal
naso~astric tube in the
the right great
There is also a drain
oximeter on
scalp. There is a pulse ort intravenous lines in both right and left groin. -ip
scalp, and there are mult
in the lower spine.
t tissues
diffuse edema of the sof
the scalp or face. There is d pink. There is no evidence of
trauma on
There is no overt external
c
mmetric, warm an
t and abdomen appear sy e upper and Lower extremities are symmetri
e face. The ches
of th
ed prior
ge. Th
eous hemorrha
not fully examin
injur}~ such as subcutan
of injury. T'he back is
hemorrhage or evidence s are turned show no acute injuries.
without overt swelling,
ination as both shoulder
to surgery, but a brief exam
nal ova((.
erior chest or abdomi
parent injury to the ant ars intact tivithout injury and.
ns reveal no ap
l ntraoperative observatio thin the peritoneal cavity. The liver appe
wi
There is no hemorrhage eas of hemorrhage or injury.
it1 particular, no midline ar
D
TOPSY CONTINUE
.
~r°~;.-1-I{INS AU
~ ~,c''~A230-01
`
~
~~
are no
of this size and age. There
size and shape for an infant
appears of normal
The thymus ions, areas of hemorrhage or injury.
tus
apparent con
recovery
m and the abdominal organ
h both the heart recovery tea
, thymus,
discussions wit
nal walls, the pericardial sac
Intraoperative
injury in the chest or abdomi
they found no
team confirmed
organs.
sels or any intraperitoneal
great arch ves
ished
ll-developed and well-nour
This is the nude body of awe
ntified
INATION:
of 6 months. The body is ide
EXTERNAL EXAM
sistent with the stated age
earing con
embalmed.
young ma e in ant app
e "01-375". The body is not
tag as "Eric Patkins", cas
by a coroner's
Ciothin
oved.
The clothing.has been rem
ention:
erv
Evidence of Medical Int
er in
oral areas. There is a cathet
lines in both right and left fem
the
enous
There is a nasogastric tube in
There are bilateral intrav
acheal tube taped to the mouth.
an
endotr
r in the right frontal area and
the bladder. There is an
racranial pressure bolt monito d incision in the left frontal area.
int
left nostril. There is an
al area. There is a suture
pubis.
l drain in the left mid pariet
intracrania
l notch down to the symphysis
ation incision from the sterna
re are
There is a sutured organ don er back, apparently at the epidural or subdural space. The
low
There is a drain in the mid
j
r
s.
m ultiple EKG monitor pad
Measurements:
e for
(27-1/2 inches) (75`'' percentil
are taken: the length is 70 cm.
e 45.5
The following measurements
e for aQe), head circumferenc
'
ograms (just above 25`x percentil
age), the weight is 7.365 kil
cm., crown rump length 47 cm.
cm., chest circumference 42
Radiographs:
ietal
the skull shows at least one par
ained. A lateral radiograph of
.
M ultiple radiographs are obt
no evidence of bone deformity
r radiographs of the chest show
or
ities show no fractures
ti•acture. Anterior-posterio
long bones of the upper extrem
es
-posterior radiographs of the
Anterior
g bones of the lover extremiti
posterior radiographs of the lon
on the right side.
periosteal injuries. Anterioron that appears more prominent
~ ~
,
ral asymmetric periosteal reacti
show bilate
Examination:
th and lips. There is
as well as the face, eyelids, mou
s diffuse edema of the scalp,
t is centered 6 cm.
The head show
ision in the left frontal scalp tha
ury. There is a 1 cm, sutured inc
the head. There is a
no definite inj
the left of the anterior midline of
d left eyebrow and 2 cm. to
erior midline and 9
above the mi
d. This is 2 cm. left of the ant
situated. There is
top left parietal portion of the hea
drain in the
s appear normally formed and
level of the left eyebrow. The ear
e are white. There
cm. behind the
a of the sclerae. The sclera
of the eyelids and moderate edem
patent. There is
diffuse edema
e is midline. The nares are
or confluent hemorrhages. The nos
er and lotiver Lips.:
are no petechial
nula of the upp
erate edema of the lips. The fre
no intraoral injury. There is mod
teeth.
are intact. There are no erupted
UED
NTIN
CATKINS AUTOPSY CO
PA
' GE 6
A-230-01
phoid
abdomen is somewhat sca is is
without acute injury. ?he
are symmetric
male. The pen
The chest and abdomen ation procedures. The external genitalia are normal
don
oll
f owing the organ
evidence of injury.
circumcised. There is no
d
well formed and muscle
The right upper extremity is bital fossa and the back of
are symmetric.
rrhage in the antecu
The upper extremities
ity. There is minimal hemo ers. The digits of the right hand are intact
t fracture deform
withou
t with therapeutic maneuv
the right hand, consisten
without apparent injury.
ere is
dence of acute injury. Th
ed and muscled without evi the left ~~Tist, consistent with
is well form
The left upper extremity bital fossa and over the radial artery in
d.
antecu
hemorrhage in the
a of the soft tissue of the han
s. There is moderate edem
therapeutic maneuver
and
ity appears well formed
c. The right lower extrem
are symmetri
The lower Extremities deformity.
cture
m uscled without fra
tufts.
mal pigmentation or skin
ury. There is no unusual derer gluteal cleft. ~'~
dence of inj
The back shows no evi midline of the back,9 cm. above the upp
in the
There is a catheter
ION:
INTERNAL EXAMINAT
at the
and sub~aleal hemorrhage
, there is minimal focal scalp pressure bolt were placed. In
reflected
HEAD: When the scalp is s where the intracranial drain and thz
procedure
3.5 cm. x 2 cm. area of red
site of the surgical
skull is an approximately visible contusion in the skin
d parietal
the midline top of the mi the subgalea. There is no associated
scalp
ing into
adjacent to the area of
hemorrhage extend
no periosteal hemorrhage
n of the scalp
d there is
overlying this area, an terior reflection and deep posterior occipital reflectio
j~emorrhage. Extended anareas of injury.
r
does not reveal any furthe
is
al siitlii•es. When the dura
coronal Iambdoid and saoitt e. `Hie fracture is situated at
n of the
Tlie skull shows separatio older fracture of the mid left parietal bon
ll
healing,
the external table of the sku
reflected, there is a
ure and is not well seen from the skull, the left parietal old
ittal sut
a 90-degree angle to the sag been removed. On the inner table of
. in
iosteum has
inv for approximately 5 cm
until all of the per
ed dural attachments extend subdural I~emorrhaQe in the mid
a of fix
fracture is seen as an are rlies the area of old contusion and
re line ove
right temporal bone, although
length. This fractu
te fractures can be seen in the
No defini
eft
! superior parietal lobe.
ity of the sutures.
there is moderate lax
ll,
to the inner table of the sku
cut
d tight adherence of the dura
al edema an
zes from the
Because of marked cerebr
Markedly softened brain oo
undertaken with difficulty. ge is appreciated as the brain and skullcap are
brain extraction is
definite epidural hemorrha
al membrane is
portions of the dura. No
ted from the skull and the dur al space on the
ve been se
and dura ha
removed. After the brain tely 10-15 cc. of lood and ood clot the subdur present in the
roxima
clot
reflected, there is app
ere, ~.~-ith m~ich of the blood it}~. The blood
d right cerebral hemisp
erior midliile convex
inner aspect of the mi
ending up and over the sup
3 cm. area.
erhemispheric fissure but ext inner dural membrane in an approYimatel~~ 6 cm. x e, present
int
to the
ispher
and blood_clot are adherent oid hemorrhage over the entire left cerebral hem left frontal and
the
arachn
erior portions of
There is extensive sub
cerebral
es and on the lateral and inf
over the superior convexiti oid hem~rrha~e is patclz}~ in areas. O~~er the left
both
arachn
clot or organized blood
temporal lobes. This sub
of subdural blood. but no of subdural hemorrhage
y thin layer
hemisphere, there is a ver right side. There is apprazimatel~ ~ cc.
imately 3 cm. x
iri the
comparable to that seen
nt to thz dura in an approx
richt temporal bone, adhere
nn the inferior base of the
~7
CONTINUED
,CATKINS AUTOPSY
PAGE 7
A-230-01
ferior
nimally over the in
bdural hemorrhage mi bellar hemispheres and
of su
e cere
smaller 2-3 cc. portion
4 cm. area. There is a ere is marked edema and softening of th e brain is quite friable and
of th
. Th
this portion
left temporal lobe
thebrain is removed,
branstem so that as le removal of the brain.
upper
ng gent
, firm,
literally falls apart duri
ea of older brownish
ely 3 cnl. x 2 cm. ar etal lobe adjacent to the
imat
pari
ved, there is an approx
After the Jura is remo morrhage over the left midline anterior rane associated with it.
he
memb
a thick, firm
organizing subdural
area is incised, there is
tal suture. When this
sagit
not weighed.
tal bone
The soft friable brain is
e basilar right occipi
ull, there is a visibl be suture, mi way etween
e sk
pped from the base of th
tal lo
After the dura is stri in a_sagittal plane from the inferior occipi d and the external table of the
ecte
ing
ossly
scalp is refl
fracture line extend
is no associated gr
n magnum. When the
sinus.~nci the forame , the fracture line can be seen. There
the
amined
occipital skull is ex in the associated posterior neck muscles.
rrhage
rd. The
identifiable hemo
vel of the cervical co
area is found at the le n of this drain. The spinal
ar
rtio
aced in the lower lumb
The tip of the drain pl in the region of the cord is at the lumbar inse ce of trauma. The only soft
seen
eviden
There is no
only hemorrhage
a posterior approach.
r lumbar drain.
rd is removed through e sites of the surgical placement ofthe lowe
co
th
obe of
tissue hemorrhage is at
hemorrha;e in the gl
There is no external e he~norrha~e in both right
rough the orbital roof.
iv
The e}'es are removed th the extraocular muscles. There is extens
rrhage in
the eyes or hemo
ths.
chnoid
and left optic nerve shea
ffuse patchy subara
mined. There is di When the brain is serially
.
on, the brain is re-exa
After formalin fixati especially over the left cerebral hemisphere e formalin with the central
present,
n of th
e
penetratio
hemorrhage still
change bilaterally. Th
nal plane, there is poor
tioned through the coro g pink and soft. There is diffuse ischemic ex with a golden brown
sec
in
rt
areas of the brain remain left parietal lobe shows thinning of the co en brown coloration on the
a gold
ry of the
degree there is
area of old inju
morrhage. To a lesser
oration of resolving he oral lobe.
col
t temp
d bone
superomedial mid righ
the tle~k. The hyoi
e anterior m~tsc(es of ly placed with the tip
th
morrhage or injury to
uate
NECK: There is no he are intact. The endotracheal tube is adeq is or tracheal mucosa.
ilage
e epiclott
injury to th
and thyroid cart
e the caring. There is no
ing
roximatel~~ 1 cm. abov
app
ritoneal cavities follow
d in both chest and pe
ere is residual free bloo
BODY CAVITIES; Th ures.
ed
the
the organ donation proc
heart ~~~as removed in
l sac is empt~~. The
rdia
SYSTEM: The perica
CARDIOVASCULAR e.
ur
right
organ donation proced
ed and lobated. The
s are normally form t (ling ~vei~hs 49 grams
ng
T: The right and left lu
The lef
RESPIRATORY TRAC xpected weight for length 69-80 grams). e patent. There is no forei;n
ar
s (e
imal air~~~ays
,
lu~1Q ~~-eiahs ~9 gram
-65 grams). The prox
ioning reveals a firm
ted ~veiQht for length 57 ce of injury or blood aspiration. Sect mboli. There .are no..
e:
( ~pec
eviden
romboe
m aterial. There is no parenchyma. There are no masses or th
ted
modzratel~~ «-ell aera ation.
detinite areas of consolid
,~'ATKINS AUTOPS
s PA
' GE 8
~
, p-230-01
Y CONTINUED
ach contains
roughout. The stom ulate matter
ophagus is intact th
rtic
e es
cus. There is no pa
TINAL TRACT: Th
GASTROINTES . of a mixture of thin, green fluid and mue are no focal lesions or ulcerations.
approximately 50 cc mucosa shows nomlal regal folds. Ther nation procedure. The remaining
c
do
or food. The gastri odenum tivere removed in the organ le appendix arises from the cecum.
rkab
d du
rictures or
. The unrema
The pancreas an
rmal. There are no st
es are unremarkable
l and large intestin of the small and large intestines are no
smal
ntents
The intraluminal co
masses.
e.
gan donation procedur
s removed in the or
pancreas wa
PANCREAS: The
absent
bladder are surgically
: The liver and gall
SYSTEM
absent. The
HEPATOBILIARY
renals are surgically
d left kidneys and ad pty. The prostate is firm, light
em
TRACT: The right an
GENITOURINARY adder are unremarkable. The bladder is us tubules.
fero
d bl
own, semini
distal ureters an
show frm, pale tan-br
e left and
rown. Both testes
tan-b
n-brown colloid. Th
mmetric with light ta.
is sy
rkable
STEM: The thyroid
ENDOCRINE SY rgically absent. The pituitary is unrema
e su
ssection of
right adrenals ar
described above. Di
are skull fractures, as eas of acute or chronic injuries
AL SYSTEM: There
no ar
M USCULOSKELETues of the back, buttocks and legs shotiv riosteum. No acute hemorrhabe is
-,
ft tiss
the pe
the posterior so
ected down to
cal hemarrhabe -Both femurs are dissand chest walls are reviewed, there is fo ible fracture.
or hemonhaje.
sterior peritoneal
liver, suygestin~ poss
seen. When the po ior right ninth and tenth ribs behind the
adjacent to the poster
AMINATIOl'~:
MICROSCOPIC EX
alveoli filled with
cal pneumonia with of consolidation.
~LlilgS show fo
areas
ACT: Sections Of
ns
ere are multifoc~l
RESPIRATORY TR
d macrophages. Th
thin bronchi. Sectio
phils wi
utrophils an
ions showing neutro tent Lvith the presence of an
combinations of ne
bronchitis with sect
ence of
ings are consis
Also, there is evid
ammation. These find
days.
ow submucosal infl e Pediatric Intensive Care Unit for fouc
of trachea sh
ival in th
d surv
endotrachea[ tube an
( submucosa[
gus show minima
,
ctions of esopha
T: Se
e! are unremarkable
le sections of bo~v
ESTINAL TRAC
G ASTROINT
rkable. Multip
e stomach is unrema
inflammation. Th
sal eosinophils.
ominence of subm~ico
other than some pr
Sections of bone
are unremarkable.
effect.
ions of diaphra;m
ere is minimal stress
TAL SYSTEM: Sect
MUSCULOSKELE cellularity tivith normal hematopoiesis. Th
rnan•o~v show 60-70%
site with chronic
a healin~7 fracture
l fracture shoti~
ing Left parietal skul
Sections of the heal negative.
are
ib
f rosis. Iron stains
as well as an
acute l~emarrhaae,
right ninth rib show
morrhagic posterior
Sections tI0111 tiie he
acute fracture site.
ow a layer of
~~s,ie
riostea( reaction sh
om areas of~ x-ray pe d trauma.
right femur taken fr
us inflicte
Cross sections of the
consistent tivith previo
ne~~- bone formation
subperiosteal
111ai1Oi1 and focal
1111COSZI intl~l111
l da}•s.
bladder S110~\ SLII~[
ACT: Sections of
der catheter for severa
GENITOURINARY' TR
e presence ot~ a blad
tivitl~ th
consistent
submucosal liemorrhaQe. rkable.
ma
Sections of testes are unre
ATKINS AUTOPS
~pAGE 9
A-230-01
Y CONTINUED
focal
inflammation and
show submucosal eter for several days.
of bladder
bladder cath
TRACT: Sections
ENITOURINARY ge, consistent with the presence of a
G
rrha
submucosal hemo e unremarkable.
l
stes ar
Sections of te
pituitary show foca
zkable. Sections of
d are unrema
: Sections of thyroi
OCRINE SYSTEM
END
use
micronecrosis.
system show diff
of central nervous of cerebellum show
le sections
a. Sections
S SYSTEM: Multip
NTRAL NERVOU pink-stained neurons and cerebral edemhow acute hemorrhage. There are
CE
th
de -s
hypoxic changes wi . Sections of the dura from the left si ns from the s~ibdural hemorrhage of
on
ctio
rrhage
extensive hemo
temortem clots. Ir
en on iron stain. Se
en macrophages se acute hemorrhage within the dural an
hemosideriri-lad mporal lobe show
the right inferior te
ow
stain is negative.
pheric fistula sh
;
of the interhemis stain is negative
Iron
ge from the region
subdural hemorrha of Zahn. It is not adherent to the fair.
Sections of
hage with lines
nantemortem hemorr
d many hemosideri
extensive gliosis an e right parietal lobe
injury show
der left parietal lobe
ctions from th
Sections from the ol Iron stain is markedly positive. Se also sho«~s anextensive cortical
laden macrophages. sly evident left parietal lobe injury s' of the iron stain. Sections of
ge
os
opposite to the gr and many hemosiderin-laden macropha d edema. Sections from the lower
ges.
hage an
, gliosis
hemorrhage
rin-laden macropha
subarachnoid hemorr
ex show superficial to the dura with a few scattered hemoside
frontal cort
morrhage in
nerve
spinal cord show he
d marked perioptic
inal hemorrhage an rves, are negative.
of subret
show multifocal areas
and optic ne
Sections of both eyes on stains of both eyes, including retina
Ir
sheath hemorrhage.
ATKINS AUTOPSY CONTINUED
AGE 10
:<`
; A-230-01
:
DIAGNOSIS
_
', - ,
I. Abusive head trauma.
ted stairs insufficient to
A. History'of fall from father's arms to carpe
explain severity of injuries.
1. Delay in calling for emergency services. of ~, P y
Shaken Infant ~; v v r
.
2 Father has history of previous conviction for
Syndrome, per Riverside police investigation.
B. Right inferior occipital skull fracture, recent.
C. Right subdural hematoma.
s.
D. Bilateral basilar temporal lobe subdural hematoma
subarachnoid hemorrhage.
E. Extensive left cerebral hemisphere
F. Extensive bilateral cerebral edema.
1. Diffuse spreading of cranial sutures.
and histopathologic).
G. Bilateral extensive retinal hemorrhage (clinical
H. Marked bilateral optic nerve sheath hemorrhage. respirator.
on
I. Survival in Intensive Care UniX for several days,
trachea.
1. Mucosal inflammation of
.
2 Bilateral pneumonitis.
rib.
Acute fracture, posterior right
II.
e
III. Inflicted injury, right femur remot
A. Subperiosteal new bone orm ion. i;s4
IV. Blunt force head injury, unexp fined, remote.
A. Superior left parietal bone fracture, remote.
al cerebral contusions, remote.
B. Left superior bilateral m' p
.
.
C Left subdt~ral hematom remo
V. Status post organ donation p ce re including:
A. Heart.
B. Liver.
C. Kidneys.
D. Pancreas.
above orcans.
E. No evidence of traumatic injuries or dysfunctions of
seen at time of
F. No evidence of intrapleural or intraperitoneal injuries
organ donation procedure.
CAUSE OF DEATH: Abusive head trauma, days.
Sara L. Danville, Deputy D.A.
`
VITNESSES PRESENT: Deputy D.A. Hughes, Deputy D.A.
District Attorney's Office), Detective
George Masson, Deputy D.A. Robert A. Spira (Riverside
Tim Ellis, Riverside Police Department.
Autopsy Completed 1500 hours, May 2, 2001
teven Trenkle, M.D.
Pathologist
Date:
ST:pm
~-s-~
Coroner
no County
San~~ Bernardi
ick, Coroner
Brian McCorm
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front,il c., c. ~~~f thy. frontal lol~c of the c~reht~.~l I~emis~h
- anterior to the r~ntral Sufe~ri~ fi nally, thr entire cortical e.tpan~e
's
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ably auhacute, ~~~ith
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IMPKESSION: Distal ntetaphysea!
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formal~on.
e~~idence of periosteal ne~v bone
0~/10/Z001 OS/10/101
Dictated C3y :FRED SHU P~'
A~,r~•~ :Vith interpretation.
I Re~~iewed f;>>;_.P, {personally and
Signed By : ~:iirvF.L YOUNG r.1D
**** end of result ****
~~
~
l Center
Loma Linda University Medica
en's Hospital
Loma Linda University Childr
munity Medical Center
Loma Linda University Com
CA 92354
11234 Anderson Street, Loma Linda,
796-7311
(909)
PATKINS, ERIC
Name:
01554325
MRN:
Encounter: 015543250002
i oi2sr2000
DOB:
Physician:
Bof 9
Page:
, Pamela
Printed by: Adikuono
L 09/15/04 22:72
rts
dicine Repo
N uclear Me
Exam date/time:
04-221-12135
owlCBF
Brain Scan Vas Fl
Order #:
Exam:
33
04/30/2001 16:44:
Radiology Report
ORDER: 2112135,
EXAM:2309713. .
CASE: 0155432500
02
VERIFIED RESULT
n-accidental
tory of possible no
h old male with his
mont
HISTORY: This is a 6
trauma.
ed IV.
99m v~~as bolus injert
DURE: 15.84 mCi Tc
PROCE
ed for 60
ood flow were obtain
es of the cerebral bl
rior imag
FINDINGS: Serial ante
images.
mediate blood pool
seconds with im
evidence of
is seen. There is no
erial and ~•enus flow
art
FINDINGS: Abonnal
d flo«~.
E3LOOD
or ~•enous cerebral bloo
arterial
SENT CEREBRAL
ISTENT WITH AB
D FLOW CONS
CEREBRAL BLOO
SSION: ABNORMAL
IMPRE
FLOW.
IN CHEN lLiD
Dictated By : BENJAM
With Interpretation.
rsonally and Agrec
1 Revie~+-ed [makes Pe
KIRK MD
Signed By:GERALD
*"
**** end of result **
,,,,,,~ ~
t `t
~`
~
sity Medical Center
Loma Linda Univer
spital
sity Children's Ho
Loma Linda Univer
y Medical Center
sity Communit
Loma Linda Univer
eet, Loma Linda.
1 1234 Anderson Str
90
( 9}796-7311
CA 92354
Name:
PATKlNS, ERIC
01554325
MRN:
ter: 015543250402
Encoun
10/25!2000
DOB:
Physician:
got 9
Page:
0000is
IN THE SUPERIOR COURT
1
L
OF THE STATE OF CALIFORNIA
3
4
ORNIA,
PEOPLE OF THE STATE OF CALIF
5
RSC NO_.. ~RIF-096899
L
~~ U ~ (~~
C
OUNT~'V~pF' ~ CAL~~p
RIVEFSID-
Plaintiff,
6
vs.
7
I
DAVID CHARLES PATKINS,
APR j 7
s
9
2u02
..~
1
Defendant.
10
ii
12
13
PRELIMINARY HEARING
JUDGE PRESIDING
BEFORE THE HONORABLE W. CHARLES MORGAN,
D EPARTMENT 32
MARCH 22, 2002
19
15
16
APPEARANCES:
17
For the People:
18
OFFICE OF THE DISTRICT ATTORNEY
CHARLES HUGHES, Deputy
BY:
4075 Main Street, 7th Floor
92501
Riverside, California
19
20
For the Defendant:
21
22
OFFICE OF THE PUBLIC DEFENDER
STUART SACHS, Deputy
BY:
9200 Orange Street
92501
Riverside, California
23
29
25
~~~g1V ~~
~
26
27
~
28
Reported by:
CONNIE McCUTCH6N, CSR 7027
Official Court Reporter
Riverside Superior Court
1
2
3
4
5
b
7
8
9
10
11
12
13
14
ZJ
1
17
18
19
20
21
22
2?
24
25
26
27
s
~g
1
REBECA PIANTINI,
2
called as a witness 1:>y tt~e People, tiavinq been duly swore., ~das
3
examined and testified as follows:
9
S
DIRECT EXAMINATION
BY MR. HiIVHES:
6
Q.
Good morning, Doctor.
7
A.
Good morning.
8
Q.
What do you c1c~ fc~r a lit~i~1~?
9
A.
I'm a pediatriciaiz.
10
Q.
Okay.
11
12
Can you tell us
4J~lat
type of traini~lg acid
experience you have that qualifies you to be a pediatrician.
A.
I did mediccl sr_liool at Loma Linda University, Sch~:.,1
13
of Medicine.
19
University Medical Center .
15
forensic pediatrics
16
yearly conferences ar~c.3 ~r~Petiiic~s Yor Lorerisic pec:iiatric.i~i~s.
T}iert I dic9 a pediatric residency ~t Lorna Lir~ci~
4J1tIl
Then I got extra training to dc:
Dr. Clare Shericlari~ ~~P,nci I also nT~encl
17
Q.
What does it mean to be a forensic pedi~,tticiari:'
18
A.
It's a pediatrician who does exams on children thnt
19
have been abused.
20
Q.
How long have ycu been doing tt~iese types of exams:
21
A.
Almost 10 years.
22
Q.
And can you dive us a ballparl~ figure of how many
23
examinations of kids you've seen that }lave had injuries?
24
A.
Oh, hu!~dreds.
25
Q.
Okay.
26
Aac}: iii April 2i1~_il, were yuti irivo.lve~ in ~ r
consulted in the treatment u E six-muntli-nlcl Ei i F: Fa tkins ?
27
A.
Yes, I was.
28
Q.
And what. was your role in the treatment. and diagric:,:i
Connie McCntch~n, C,SR ~D27
13
0000ail
of Erik F'atF:ins'?
1
.~
,
•sere
from head trNi~ma, and we
Erik Pa`};ins Iiac.1 s~iffered
q abuecl; his
a po~sil~ility of him Y,ein
consulted because it was
. y°
lt of ahiisive head trailm~+
head trauma being the resu
what cio you do -- in this
Q. When you're consulted,
Pat}:i~~:=."
c~io H~itl~ respect r~~ Eri}:
particular case, what did you
We -lo a
ulted, we take a history.
A. Well, ~rhen we're cons
niee~ir:al
medical records, do a complete
thorough histor•~, review
Ar~~:i i
tests that have beei ~ done.
exam, review the diaquostic
ital,
while tP~ey're in the hosp
continue to follow the patient
whether
then ma};e an opinion as to
follow their treatment, anr]
A.
2
3
4
5
6
7
8
9
10
11
12
ed or not.
we think the child has been abus
Q.
13
Ukay.
ultation role, do
Uo you -- as part of your cons
trying to help the
the treating physicians ~~~h~ are
19
you
15
injured child?
16
17
18
2.C~V15@
test: tc~ get, tc~ `ey
We advise them on what r.iiagno5tic
sive injury ~~r nit, and t~~e
to sort nut why*her this is an al.>u
y just helps iri what is tl~=ir
immediate treatment of. Everybod
A.
f i■
G
nt of what's ~~~,ing to t~~e [!~e
area of expertise to See tYie exte
port life <=end Muff.
in acute management of trying t~:, si_i~~
"'
zf
Have, I:: i:
t::..
You me1_ioneci ycii ~ev.iew u~edicai repoi
Q.
22
medical rece;rds pertaini~~g
reviewed the Loma Lincia Ur~iver5ity
23
to Erik Patkins"?
19
20
29
A.
Yes.
25
Q.
autopsy records
Anil di~~ you also review autopsy and --
?h
Office?
from San Berna•~dina County Cc~rnn~r's
27
A.
's es.
28
Q.
EriF; Fatkins; ~
And yogi, in fact, atten>nity Nc~:;pit~l .
16
a lready intubated, anc:l tip
17
to Loma Linda.
seizures and was sedated acid was broug}lt
He wri~~ ttanspnrt~1
lead been given medicnt i~;r~ for
on
W hen he got to Loma Linda, they felt like leis conditi
18
He was nlready doing movements with hi:-.
19
was very unstable.
20
thought tl~7t he
arms and legs that were very abnormal, and they
21
had a significant injury.
Mk. SA'~HS:
22
23
wt~iat they say.
I'd interpose ~n objection as hearsay ns tc>
Vague ai~icl also lie~rsay.
Well, I'm r~c~t --
29
T HE CO[TRT:
25
I f you'd just -- Doctor, let us know whether or nok
26
27
28
you
anal
'
were told information or you observed the infoin~ation,
if -THE WITNESS:
This is information from tf~~e medical
Connie McCutct~en, CSF 7027
15
000033
1
hin~.
,
records as to wt.at Iia~->pened before I got to see
THE COUkT:
2
3
ohservecl c;r -you'd let us };now when it's something you have
4
5
THE COURT:
C;r,rr~~~t ,
THE WITNEti~:
6
-- you were told by another perty, E~:~r
instance.
7
8
THE COURT:
Correct.
THE WITNESS:
9
And if that status were to c:l~ai~ue,
Okay.
Arid you used this informatiuri in formin~~
your opinion; is that correct? ~~~~=J
That's correct.
10
THE WITNESS:
11
THE CO[IF.T:
12
THE WITNESS:
13
;
So in the emergency room he was noted to I- ave inc:r~3~.~d
You mhy continue.
O}:ay.
They felt it way
14
intrecranial pressure and unstable condition.
1J
important -- the neurc,si;rge~.>ns I ~aci r~, put in ~,i ~ ir~kercr~,i ~i":
16
pressure monitor jt~s1. ,_i
17
head was.
18
h igh.
19
they -- again it was necessary to put in a drain tc clraiu :s~n~e
20
of the fluid to see iY the pressure will derrense in the brain,
21
so they put in ~ drain can his left Side.
22
monitor on the right eicle.
23
side.
24
they again put in a 1i.im1_~ar drdir~ ai~cl catheter- ir. the 1uit~k,-,r
25
spine again to try to decrease the pressure.
26
.
[
L~
A.
26
-- tc> ;,~~~= what 1-.hc= pr~~<.suee in rl i
So they pl~~c.:eci that, ~,nci his pressurF~ was sti]. _1
It was it; the 90s, which is extremely hiyli.
(By Mr. H~t~1he5)
They put in tfie
They came d~:~wn.
1E,Pt
Lr~Y~r
~=o hip hrair~ is sadellir.y?
His hrtir~ is ~;er~!
iiltracra~iial pressiiie.
And then
TI~e~ ~,iit i:~ ~ clrai;: .,r, lii:
His pressures ~~~ere still !sigh.
,~ery
wolleu.
,
TI~~ }:~re:~,.~,ur ,~
Connie M~Cutch=r~, ~5F 70~'"
There is ii ~~ reasec_t
i .; s,; hi~~l ~
~ L~~t }~~ , ~~~r.;i~ ~~r
16
Fle cannot yet
1
~~
profuse his body, because it cannot profuse.
2
in the k~raini
oxygen and blood to his brain because the pressure
3
is higher than the n~:,rmal -- than the blood pressure.
9
t~~ keep
had to also give him medication for the blood pressure,
5
his blood pressure up -- higher doses, you F_now, Che n~axirnun
6
doses, multiple medic:atioris.
7
coma with phenobarbital, agaiiz to keep his i~ltracranial
8
condition -- to try to stabilize it and decrease tk~e
9
intracranial press~.ire.
Sc, they
He was placed in a harhiCurnl
He was actually ~~lacecl in ; barhitural coma; is that
10
Q.
11
right?
12
A.
Yes.
13
Q.
That's to stop brain activity ~~r limit it as much as
19
15
possible?
A.
So that it doesn't. cc~nsumP the oxygen -- that limir,~d
:'.c, they piit the brain ba.~ically at. lest
lh
oxygen that you have.
17
as much as possible to try to decrease the pressure aril to pry
18
x
to decrease the o- .yger~ cc~nsumptian s~, that you c:are do ~~itl~ ,
19
minimum that you can, yoga ~:now, to try r_o l~rir~~.~ thi~tigs bhp-:~:
20
to -- to try to save, you know, the child.
?39 i7>
A t the time that I sa~.~ him, 1~e had already had all the
21
,
He was sedated ~~nc1 he ~ ias hasi~- ally p~,r~lyzed.
Ar. i i
22
drains.
23
saw him just 11ter that cl~~y.
24
didn't have apparent l~ri~ises r,ther than a couple= of bruises in
25
the nails of his toes.
26
ventilator with a tut:~e to Help Mini bceatl,e.
27
He lead the m~~nitor.
28
He had femoral Lines for
His external coricli ti- c:;r~ -- Ise
He didn't -- of course, he was on a
He iiaci tfie a lt-~ ii ~s.
He 1~~,d a catheter. tc, colle<~t }iis uriri~.
T. I. at~cPsS.
Connie McCutch2n, CSF ~~?~'7
Ancl his ~~upils were ~,~er;-
17
T}~at ~r~eans *..IZey don't respc~r~d to light.
1
fixed and ciil~+t~in
13
up because, of course, he was losing t:~looci and lie was bleeding
14
it1 }zis head, acid to -- trying to keep more oxygen -- depositiilcr
15
more.
16
continued to deteric:~r~;te.
But that -- nothing really 1~elped.
His condition
17
Q.
Are you Yamiliar ~.~itli t!~e term "brain death"7
18
A.
Yes.
19
Q.
What noes that mean?
20
A.
It means that although we can keep the liehrt going,
21
because we have medicati~:~ris to keep it goiriq, and we Have a
22
ventilator to E;eep the t~~reatl~iinq quirig, and th~r 't~reatliing is
f►~Cl
only r~oing b~c,~i~ise ref .y veuti.l~,t.cn.
?q
braid-deac:l, yai can't hre~tlie, l~ec:au~e hint's ~ i~r~in r~Yl~<.
25
Basically means your brain isn't working, sq you're dead.
26
Q.
All right.
27
A.
Q.
~
Yes.
?g
Because oi ~r~~ ~;ou're
When dLd that hn~~pen?
Did Eri}~ Pat}.ins reach brain death?
Connie McCutchan, CSR ?0_''
i
18
000036
1
A.
death was
He way declared -- his L"ir>t exam fur l ~*ain
2
y; brain-dead by
actually done on the 30th, and he was basicall
3
exam l iE:~
physician's exam, and then we usually repeat tl~e
4
24 hours later.
S
rie~- larec:i
actually ttie seconri exam wa; done and 11e was
6
brain -dead.
J
And then maybe the 1st is when Iie was --
7
Q.
Is brain death fatal?
8
A.
It's death.
9
Q.
be
Once you're brain-dead, you're no longer going to
10
alive?
11
A.
That's correct.
12
Q.
You can F:eep perhaps r_hP heart Beating =,nd lung5
Yeah, it's fatal.
13
pumping from the mac~iit~es, but yoi_~'11 never recover L`rom that;
14
is that correct?
Only the machine's doing it.
15
A.
That's correct.
16
Q.
When Eri4; Pat~:ins was declared to he bi ~~in-dead, were
17
there surgical procediire~; done tc_, I~arvest orga~~s?
18
A.
Yes.
19
Q.
Whose decision was that, wilettier or nr>t to harvest
20
organs?
It's the family's ciecision.
It's the mother's
21
A.
22
decision.
23
t hen we call t}ie transplant coy-~r~iinator end the team and see
24
if -- then they spea4: tc~ the ntc.~tli2r an~i o~Yer t!r~= E;ossit~ili~y.
25
I believe the 'nom actually brougtir_ it yip even heFc~re ttie~✓ snn}:e
2H
to her, saying that_ site --
When the organs are felr to be in gr,c_,d condition,
27
Q.
Okdy.
28
A.
Sri Margle Girofdn~"~ ncJLee~"1 to Orq<y?
7
A.
Ur. Steve Trer~~:el.
8
Q.
And Dr. Tren4:e1 was a forensic pediatrician before he
9
became a pathologist; is that correct?
10
A.
That's correct.
11
~.
In fact, he tiaine~l Dr. Clare Sheridan, wlio then
12
~, ~ 3
trained you?
13
That's correct.
14
t
A.
Q.
How long has C!r. Trenl:le been a medica] examiner:
15
A.
I don't ;now.
lE
17
lE
Eig11t or nine year's,
sc_,niethiny 1iF:e
that.
c~.
When you wenC to ttie autc:~psy, c:lid you nctuallV see '~Iint
t ypes c->f physical i«~uries Erik Pat.4:ins iia~:l siit lereci :'
1~
A.
Yes.
2C
Q.
Let's talk about ttie new injuries that Erik Patkin=
Whet types of injuries to his head clid you see as a
2]
suffered.
2L
result of viewing the autopsy?
2
.
A.
Well, the m~>~r fital irijitty and the in~i~ries tl~et ~.~re
2~
very acute, he tiad what we c,~ll subciural i~emat<~n~a, whicl~i i~:
2`
bleeding into the covering layer, which is a tf~i.cE_ coverino
2f
layer that goes over tl~e brain in between Y_he brain aril tl~
2"
skull, if you want to -- and there was a lot of t>leedinry,
2f
extensive bleeding.
Ancl the most acute was mostly on tl~e
Contii2 hlcCtrt~.t! ~~i, _'S I: ii).'~;;
20
1111 i
It wd5 t. ~~ t. ~<<= I_>~~cl: c:~f tf ~F
lir~.icl, ~~ ~c9 1* .:',-.s ::i k;~~~~d~- ';.
1
2
the two hemispheres ir. the fissure there.
3
` ,
Iig}lt.
bleeding there.
~T
, 3sa
Had ~ let of
^, v ~
He had also extensive retinal hemorrhages, which were
4
I was able to see that on nay
5
also seen before the autopsy.
6
medical exam, and the ophthalmnloc~ist was able ro see the
7
retinal hemori fiages.
8
confirmed on the autopsy.
9
was that he had optic nerve sheath hemorrhage, which -- this is
They were very extensive.
TV~ey were
What was also seen ors the autops,~
10
only seen when -- at autopsy, because it's not 7omethinc{ tG.~r
11
can be seen if 1:}ie cY~ilc3 survives.
Has to the ~n
12
Q.
So -- I 'm soLry..
13
A.
Then he liaci a.15c:~ sF:ull fry ctiire.
He hn~:i Sri c~cc:~if~i t -,i
It's a s~:ull fracture in the 1.,~_}: of the head
19
s kull fracture.
15
on the right side.
16
examination, they also found that he had ninth rite acute
17
fracture.
~.
18
19
Q.
And when they did n mic:rosc~.,pic
So he had a fracture on his ninth rib.
'tuu cou~it from
the top or the bottom?
20
A.
From the top.
Pi■
.
~.
So the ninth ril:~ down, cotn~Cing clown frc,m the tnp.
xa
~
kight side or left side?
23
A.
On the r_ iglit
29
Q.
kight side.
2J
26
A11 right.
Were there ari.,- olci injutie.;
that were fouricl7
A.
Yes.
27
i~
icle .
hemorrhage.
28
~~h.
Ariei rune other new ir~ji~rV wa=: suk~arachnoi 1
That means bleeding l:incl of liF_e more deeper into
the brain.
Connie McCut~h=n, t,SR 7n~?
21
_...,.
Q.
All rigl~it.
A.
1
Okay.
And the old injuries, he aG~in tiad old sut,c:l~.iral
Arid they E:now they were ulcf becausE oY ttie
3
hematoma5.
9
appearance of the blood and also the stain.
5
the
microscopic examination, they stain it and they see
6
b y-products of the hemoglok:~in.
7
old injury.
8
9
10
11
12
Q.
Okay.
W}~en they c:i~ ~ Yiie
So t11ey can tell that it's yn
Now, ynu had described the new hematomn as
extensive bleeding.
With respect to the old one, by
comparison, was it as extensive'
A.
Not as ?xtensive.
It was -- the old orie was mole c:~~
the left side.
13
Q.
So on the other side?
19
A.
kight.
is
Q.
All right.
16
A.
And then he had are old left parietal fiacture.
~_.
4
Thai's,
17
a gain, another fracture on the head, but it's ors the left side
19
and more in t11i~ area of the Bead (inelicating) ns opposed t',
19
the back:.
20
Q.
How can they tell that's old?
21
A.
Well, because they show already the healing process of
22
the fracture.
23
Q.
All ri7ht.
?q
A.
Yeah.
Were there ally other old injuries n~:_,te~:i?
And then he had ~, right femur Yracture.
25
that, again, they c:~ri t~l l- t_~~ tf~~ }ie~l ing prpc.~ss ~_~f tY~P
26
And
fracture.
27
28
Q.
ar
Based ~~n y~:~ur re view of the medical records, your
actual consultation, and fullowing of the course of treatment
Connie M~Cut~h~r~, i'SF. ?~~,';'
22
~~
'J
1
of Erik Patki~ls aild y~~ur.~ attencl~~iice at t11e autnpsy and tevi~~w
2
O f the autopsy r~Cnrcls, es c>f injuries?
What happens is a baby is shaken vigorc-~tisly.
A.
It's iii
10
acceleration-deceleration, so it's a forward acid back. movement
11
(indicating) of the head that causes the brein to yo bac}: acid
12
forth and causes a lot ~~f intracranial bleeding, a lot of
13
bleeding in the head, c,i~i;;e5 bleeding in the eyes.
14
f requently hav:~ a Frnrr_~~rr, ~9epEnclini~ ~ ~n where rl~e child i .
15
grabbed, how he's field.
~
y
degree of it, they can c7o into a level of unr_onscinusnes ,
17
coma, and deattl.
They cyan
And Y_lt2n, ohvi~,i_is1y, ~Iepe:nding ~~n the
v ~-
18
Q.
You inliicatec:l there cats be a fracti_ire frc>n~ ttie sl~a~:ing
19
and you're mak_incl a m~>rion i~~ith your h:~ncis tog~rher as tl~~~ ,i~yFi
20
holding something in front of ~~c%u; i.=. r_I~iat correcC'
21
A.
Right.
Recati:~e iregiieiitl;% they're held by the ctie :~
22
(indicating), so tioe frequently gee rib fracture:. associar_e~:i
23
with it.
24
Q.
Again you're inclicatinq with your liancln in fionC of you
~J
as though holding son~~~tt~ing the size c,f ~ baby; is tl~~at
26
correct?
27
A.
Right.
28
Q.
Right.
Do yc~~_i have hn opiriiori as to t]~F~ timing of ~~hen
Connie McCutch~t~i, C'3F; 7i~_'
23
1
.
,l
2
ttlese injuries ~dere inflicted iipc:m Eri}: F~atkiri~~:'
A.
3
It clearly h=+rl t<> hhve happened just -MR. SAr}{S:
I tliiri}; I'~t~ going to iriter~~use ai~i
Lack of foundation again, unless she's ta1F_ing
9
objection.
5
about some other doctor --
6
THE COUkT:
7
THE WITrIESS:
Overruled.
Overruled.
And I did to}:e a history Lroir~ tl~~ ❑~c,n .
8
And the child was Pine when she left fur work. rl~e night k~eL >re,
9
was acting normal.
An~i t}ie baby there teas an a~:ute event, wino
10
ends up in deatY~, is clearl;~ witliiri a few tour:; from tire. t.iir~e
11
of presentation to the h~:~spital.
12
13
19
Q.
(By Mr. Hughes).
All right.
And is it your opinion
that these injuries that_ you've ciescribec] to us as resulting
p', y o
f EriF; =~:~tE. ins
from abusive head tr~~>>m,~ r~,ulte l in r!~e ~.ienth
15
A.
Yes.
lh
Q.
Finally, dc> you leave an opinion wl~~ether
these injuries
17
could possibly Have peen caused by a m.~n appro~.imately (~ Ye t.
18
< ,S~'
2 inches ta11 ~~ralY.inq towards a set of carpeted stairs, '
19
tripping while t~ioldinq tl~ie baby up ~,t slloialder level, sn~.I
20
dropping the baby onto tl~e fouit_h or fifth start up ont~~ ~,
& > E'3
carpeted surface?
21
22
A.
At~solutely oat.
23
Q.
Why do }you say that?
29
A.
I've ~~~en many, many children.
-~ -
I also ~.in general E ids
25
who fill a whole rliuht ~:,f stairs an~1 ~~on't Ilav~ tt~~is
?E
Constellation of ~ytnpYom~,.
27
they have d faC~t1 event, or something 1i}.e falling down
28
stairs -- w}iicli is i.isi_ially cement, which rarely t~ ppens -- it's
Connie McCutchzn, CS'R 7i)~7
It's n~;t just one event.
Ancl ~
Zq
_
f
It is nit
l.
jots 1~ave sometklinq fata
from a differe:~t finding
f~~ur~d not ~ ~i:l ~ ii i
~n ~~f syii~E~toms LFiat are
this whole constellalic
1
~
L
at aut~.~p5y.
a clinical exam but also
J
erent injuries Yor that
You'd e;tpect to See diff
Q.
9
mechanism of death?
5
6
Yes.
A.
7
8
THE COiJRT:
Dlothing further.
MR. HUGHES:
Cross?
CROSS-EXAMINATION
9
10
BY Mk. SACHS:
12
touching ~~n your la5c
What }.ind of injuries, -- just
ping t'le
see, for example, i.f drop
response -- you'd expect to
13
eleath a
baby would be the cause of
19
y:
testifying to .his nu~c :iin
11
15
16
17
18
19
20
21
?2
23
24
Q.
A.
Very rarel;~ .
opposed to what yoi.~'re
rd fl~_ ~. .
~~~.~i_r~, F. E~ec~i~_,11~✓ r,n c, ,__ ~peC
-- is a
c}~ilc.i that ends up with a
If wa are talk:inq ah~:>i~t ~
usually
nt stairs heac:lfirst, it's
fatality, that ~alls c.,n ceme
l~l~e~l.
a, and it's an arterial
what we call an epidermal h2rnatom
gnised
it's 1~ecause it's not reco
And, again, most of the time
somPtliinq
gery in timF, hecause it's
and it's not Yak_en to si.ir
An~i, again, it'.=. very rare.
iect.
that usually surgery can c~~z~
We have
n of fir~~lir~ys.
And here we have a constellatio
not
brain in the areas that are
the extensive bleed tliro~igh the
Anil we Have tliF
into ~ :stair .
seen with an a :cideiit<<1 Eall
26
a fricture, and we have also
retinal hemorrhages, ~ncl ~aP have
There w?
we 1~~~~~~ rite tracr~ ix~~,
si_ibarachnoid tl~rnnrrh~,~J~, ;~ iir1
27
have old injuries a~ well. .
25
28
Q.
the .~ial_>dural -Could you distir~iguish -- you said
7
Connie McCutch2n, CSF 70
25
1
in, I guess.
l~le~ding it~sicie tl-~e bra
subdural hematoma is
2
that right?
re'S
u~zc:ier the brain. Ttie
It's bleediil~~ ric~}~t
goe_ ~._~veL -- ~ i ~t~t
t's called a eiura ~haC
covering membrane tha
that -- it's real ly
whir.h is the membrane
over the arachnoid,
ht c>ver tl~e 1_>i~in.
t's going right -- rig
the thin mem~Lane tha
n
ching veins. .Ancl .lie
has li}:e veins -- rea
And that Jura under
er up. They tsar
these veins kind of she
there is this motion,
bleeding. PY3`{ z~ ,
up and cause all this
l~;
~aton~a.
there' 5ul_>.-,racFuioicl f~eti
Q. Now, yuu also said
per region of the 6rair~
tklat bleeding into a dee
That's right
under the arachnoicls.
A. Yes. That is right
A.
3
4
5
6
7
8
9
10
11
12
13
onto the brain tissue.
17
tcina?
bleeding than suheliiral hema
That's rru_~rP extensive
ueni
en,ive k~leecting. Ttie subd
A. They're t:>oth ve~'d exL
~cliizdl and
c. Anc.l wl~2n yc>u leave stil
hematonta is very classi
. shaken t.>.~i ,~
, very c~.~n~u~nly seen witl
s ubarachnoicl, it'.5 very
18
s yndrome.
19
20
ir~ juxy
~atoma is 5i_ich that — are
Subdural -- stib fracture that you made reference
process oP healing:'
ninth rib, you saic.l that was already itl the
Tile rib fracture way ncute.
5
A.
No.
6
Q.
So what you mean, it was recent?
7
A.
It was recent.
8
Q.
It was recent?
9
A.
Riyht.
10
Q.
Could have been i~ontemporaneous with the injury to the
11
head?
12
A.
kight.
13
Q.
And can a bal~~y puffer a rile fracture b~~i falling and
14
hitting their ri.b in tL~t partir_.ular location:
A.
15
Babies that hive rih fractures -- if there's nor ar,
16
adequate histnr~~ tr., explain the ft~~cri~ce -- yeaf~, you caii get y
17
rib fracture, ~3eE~eridiny c.,r~ the lc;~:;tio: ~ oL the
18
fall.
19
it.
20
those rib fractures are due to sha}:inq. `'"
The mechanism has to be stuc:iied.
THE COUF:T:
It's not uizusual.
Just a moment, Mr. Sachs.
I have to take a call Mere.
Beat
,lust a mnmenC.
Jia:;t will be two., minutes.
( E;rief pause in prc~cee~~ings.
23
THE COUF'.T:
29
25
frc~n~ ~~
Rut that's clearly identified, a fall, a: tFie cause ~f
21
22
il;,
I tl~~n}. you for that, P9r. ` .-~.c:hs.
i'ui i it -iv
continue, sir.
26
MR. SAC~[5:
Tlian~:s.
27
THE CO'IFIT:
T}~dt~k_ Vc~u.
28
Q.
(Ry Mr. Sachsl
I'~ri sorry;.
Connie McCutchen, C'SF 702?
'in~i said that was the ninth
28
rib that was fractured, Cu~ctc~r; is tlia~. rigl~t:
A.
Q.
The right -- on the rigf~t side.
t~.
The right si~.l~?
A.
Yeah.
Q.
E
What side was that again?
A.
E
That's correct.
Now, the presence of retinal hemorrhagir~q is, in Ya,t,
something that's consistent with shaken babies; is that right?
c
A.
That's correct.
1C
Q.
As a matter of f1c:t, iuost rinctors, whei~ they See CI ~~
11
presence oI retinal I~emc_,rtt~aginy, autc,n~~ticail~~ essume there's
12
a shaken baby.
Isn't that fair to say?
13
A.
Well, in the absence of a lot of other %:cm ditic~ns, yes.
19
Q.
But thare are other c:onditioiis that c~i ~ cease retir,~l
15
hemorrhaging?
16
17
18
19
A.
There are otter ~_,oricliti-~~ne:, bur tl~iey ].t~,r1.
Q.
Are th=y c~~nsistent with a fall"?
iffererir
too.
ALtei, could a cl;ild
suffer retinal hemorrlia~ing?
20
A.
Riot consistent with a fall, no.
21
Q.
Basically, the presence of retinal hemc,rrliaging is --
?2
just increases'. pressure i~~ithiii the brair~ cause; that; isri' 1:
23
that fair to s;y?
29
A.
Nn.
25
Q.
What --
26
A.
You ca~1 have increased pressure and noY have retinal
27
2n
h emorrhages.
Q.
Aid you cnn 1~~~,v~ iricrense~l E>tessur~ ai~~i n~,t ]~av~
Connie McC[ltch~=ri, CSR %(~_'"'
29
1
-des?
retinal hemorrha~
Is that_ what you're saying'
2
A.
That's correct.
3
Q.
Frequently, if you do leave iricreasecl ~rariial pre~~ure,
4
5
that does cause it?
A.
No.
Oi11y cer~tyin mechanisms.
A lot oT people ~iie Er~~n~
6
motor vehicle ecciderits acid have increased prer,::uie and i ~c~
7
retinal hemorrhages.
8
Q.
What mechanisms are you speaking about?
9
A.
There's occulusiun of the venous return, or the very ~i_i
39, ,!~ 3J
10
outflow, that pauses a lot of retinal hemorrhages.
And, ay~in,
3&
11
the retinal hemorrliages, depending on ~.~hat the~i' ie caused
12
from — but in this cage they're Suspected to tie -- the
13
mechanism is not c.learly understood, what Causes -- whdt
14
specific mechanism it is that causes retinal hemorrhages.
15
they've clearly been seen -- that retinal hemorr}iayes are
16
associated with s11a~;er~ }~al~v and are very rarely seem in m,~t ,t
17
vehicle accidents.
18
there's high speed.
~~ir.h this, I..i~ere' ~ a f:i~tc ,c ✓.
19
report of all [t~is.
It's not joist a rear-end.
20
high-speed motor vehicle accident.
21
22
Q.
3~.it
Tfie iner:hanisn~ seen in motor vehicle,
Thee':: n
It's not a
You had an opportunity to physically e_r~amine tf~e baby
before the baby was declared brain-dead, I guess"'
23
A.
Yes.
29
Q.
Arid thate weie ~i~_~ -- ~~a~.~~~_t~ci ik_ i re Yair ~
25
;;ay tliei~~ Cdr tF~
no visible injuries t~~ the chilci7
26
THE COUkT:
Exter~zal'?
27
MR. SACh'S:
External.
28
THE WITNESS:
N~~ external, other than tine twn little
Connie McCutch~ri, ~'SR %i_)'?
30
1
areas of hemorrt~age that_ I des::eil_~eci c.~u tiffs tor~i ~ails.
(By Mr. Sachs)
There w~ s no redness or bruising c>! ~ the
2
Q.
3
child.
9
A.
No.
5
Q.
And fi.equei~tly ~~lien you see bn~ised children, dc~ yr.a
Is that -air to say?
He :just had an abrasion on -- abrasions.
6
not see the pL~esence of either bruisin~~ or sometimes exr~n~ive
7
external injuries?
8
A.
Sometimes we clo; sometimes we don't.
9
Q.
Now, there is -- a short -- a short fall of a child
f ~l
[
can, in fact, under certain circumstances, cau_ e the I;in~ i - r
11
fatal injury we ]lave t~acl here; isn't that true''
12
A.
Not the ti_ind uf_ i~~Lal ii ijt.iriF~s .ae have !:~rF~, nc,.
13
Q.
What specific_ injuries are you tal}_ing aboi_~t that s,~ ~iilcl
14
preclude -- stripe that.
ZJ
You are aware of a body of lit2rnture that talF:s at,ut
16
short falls can cause fatal injuries in ciiildrer~, dre y~~ii r•: ~t.?
17
A.
Yes.
18
Q.
By a Ur. P1unE_ett, a stiiciy oil
i~:]
hurt falls.
Are you
familiar with that study?
20
A.
Yes.
21
Q.
What particular injuries here are you talking about
22
that would allow the passibility of a fall causing these
2
;
injuries to a cl~ilel?
29
A.
The in~urie:~ r.hnc tl~iis riii_l , h.~
]
aie ~~~.,
.e!i~ive:
25
subdural, subarac:ktinc~i~_l, intexliemi<,pheric~ pressiice.
26
extensive retiila.L hPmc>rrliages and opric~ nerve sheath
27
hemorrhage.
28
fracture.
He Iiys
~15c:;
And he also 1~as a posteri~,r rih fracture, rtcute
He has a combination -- whole lot v1 syniptonis ti.at
Connie McCi~tchen, CSf; 7C?_~?
31
000049
1
are not exE:~la_.ned t>;~ ju:=r_ fallin~_I Er.on~ a father iiclding r!:F
2
child, into a carpeted stair.
3
Q.
the sku11 fracture that you talked about, the new ~.;ne,
B1
I think you said it was in the right parietal regi~~n.
5
right'
6
A.
I '. t'~at
7
8
9
10
No.
Tlie s~_ull rracture that i5 a new c:,ne is in tP~F
back of the head in the occipital area.
Q.
The occipital area.
b y blunt force?
A.
No.
Is that fracture caused normally
Is that caused by shaking as we11?
It -- it's caused Uy impact, having the head I;it
IL
It's what we call frequently -- ce.~ld
S~
be shaken impact syndrunie. Most. of the sha}:en l,abie5 are i ~ ,t
13
just shaken and put duwr~ gently ~:~n t}~e be~l.
19
shaken, then dropped or hit against something.
11
15
against ~ hard surface.
Q.
A int of them ire
Sn in your opinion, it would cause a sufficient -- nave
16
to be a sufficient impact to cause thus type of sE:ull frhi:t~~re,
17
then; is that right?
18
A.
Yas.
19
Q.
Anil Sha}:in~~ tl ~e I]ak>y a1~~>i~e [l~-,e5n't cau P t1~~15 tyK~e
20
,I
~
fracture, as 1 i_~nderstand it?
21
A.
Right.
22
~.
Now, is -- the old injury, the left — one to the left i
23
parietal area, [ believe, is that also the samF type of thing?
24
I t would I~iave tc~ be same impact to that part of
25
hard surf~,c:e?
26
A.
BtiY_ -- yeah.
th~ head wi`h a
But the p~iietal area is less -- tk~e
27
occipital is more sigrlificarit, iri tl~ t it requires me>re Fr,r ~e
28
and that it's very, very diffic:~.tlt to t~reak tYi~ back. of yc~i:r
Conni~~ N1cCutch-gin, i~SF~' ?c%.-'~
32
It's ea~i-er t<~ k,eeaF~ tf~i~ yre~
1
head.
2
parietal is on the sic12.
3
iir~~iicatiriul
Tree
can break easier-.
And the E:>~ri~tnl ere:, i5 a~~ ~-,xe:; _l~at
4
Q.
And again --
5
A.
But it's impact.
6
~.
Sn, again, sha};inq is not going to cause a parietal
7
Has tc~ have an impact.
fracture either, I taE:e it?
8
A.
5liaketz i.mpnct will, t_~ut not shaken alorra, yes.
9
Q.
And was there any attempt to date the age of the
10
11
parietal fracture?
A.
You can't really date fractures on the skull.
All you
12
can Say is that they were already l~eeliny; that t}~ey're r~c~t
13
just recent.
14
can't sav that.
But vn~~ can't s:,y th~e;~~re one weeE:, tw~~ we~lc~.
1
15
Q.
C~oe~ it have calcification --
16
A.
They ha~~e periosteal hP~,ling c, _F the boi~r.
17
Q.
F]ould Vou eXpect to have Sc,[ne symptomdtnlugy frc,n~ t ~i~
18
19
fracture to the parietal to the c:lzilci:'
A.
Usually, but tf~ey r~ar~ lie ver✓ ~niniival.
yn~ptr~rua' ~ ~ i ~~J ,
20
they may ji_ist be fuss;%, cry, or it rtiay nct be very,, -- again,
GL
some shaken baoies are very mild, anr] they doll' t — they ~l~_;;~~' t
22
exhibit the symptoms that will hrir,g the child always to n
23
doctor or bring the c:tiilcl into an intensive care unit.
29
may just he fus~~y ~~x ~i~ay be throwing up.
25
more.
26
think is tl~iat serious for a short period of time.
27
28
Q.
Tliecv
Tl~~e~i u~dy k:~e 51ee~~:i~iy
There Gre different things thi,=~t the people may just. _got
.
R~ell, iri your o~~inioiz, i.=, it the shaY;ii~q of t}1 E },~,f_:~.~ ~,r
is it the lard impact that caused tfie :occipital s};ull fract,ire,
Connie N1cCntchan, CAF. ~0_'"'
33
1
for e;~:;~mplr=, that can~e~ rlie i;~terccyiiial ~~re~r;i;re tc~ bably a combination of t_~otti.
motion of the shaking cn~.ised the most fatal injuries.
Q.
impact?
A.
The motion of sha}_ing, you're saying, as opposed tc rl~e
Is that what yo~,i're saying?
T"E:s.
Because usually ari impact alone, if you just :lave
8
a fracture, doesn't }:ill the t_>ak~y.
9
them.
10
but deTi~~itely the
Q.
A fracture does not 4:i l
It's the other injuries that kill them. Y~
And the most -- ire your opiilioi~, the mo t likely
11
mechanism tc increase the pressure, the interr..r:,nial pressi:re,
12
is by shaking tl~en~; i
13
A.
that cnrre~t
In this c:'as2, ye~~.
19
iHF:-. SA~~HS:
If I m~~~:~ jusY 1iav2 a minute-, K~lease~'
15
THE COfJRT:
You rinv.
16
17
4•
iBy Mr. Sachs)
Are you ramiliar with 1.1ie term ~_,r
rebleeding from existincl hematomas?
18
A.
Yes.
iL•]
Q.
Okay.
`C1~dt'S a
ltuatic:~r~ where you dc7i ~'t rieC:eti~,~t11y
20
have tc; have a clew traurri_i, but an old hematortia Carr star r
21
bleeding egair.'
22
A.
No.
This is trot at.>solt.ttelV what happen.
That's
23
rebleecling, if you have a Space o~~:upyiny ~, le5i~>ii elteaciy,
29
have blr~ncl, yogi Can }~IPPd ii1t~ that.. area easier .
25
usually requirN trat~mr,.
26
doesn' t.: catisa -~ Tathlit.~, c,r a ~~e~tl~ with Llie orl ~er s;%mptr,m::,
27
i t's just <
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