Two physicians who treated 20-month-old Kaedyn Short for severe brain injuries in March 2009 testified Thursday that she was unresponsive and very close to brain death when they attended to her.
Kaedyn died a few days later.
Her mother's boyfriend, James Hilton Parker, now 36, who was watching the little girl the night of March 28, 2009 while Jenifer Short was at work, is on trial for first-degree murder and aggravated child abuse.
Dr. James Strine, who was the emergency room doctor that night at Highlands Regional Medical Center, remembered Parker coming in, carrying Kaedyn in his arms.
The toddler had multiple skill fractures, "very significant bleeding" on the left side of the brain, which had shifted to the right, no spontaneous activity and no response to pain, Strine said.
Her pupils were "dilated and fixed" in response to light, he added, which is part of the criteria for classifying brain death.
"I am assuming she was unconscious?" Assistant State Attorney Steve Houchin asked.
"Yes, that's correct," Strine answered.
The 11-woman, three-man jury heard testimony from three medical practitioners involved in the case, during the first half of the trial Thursday, which is expected to wrap up in a week.
Strine said Parker told him that Kaedyn had suffered a "trauma of some kind several weeks ago."
Strine didn't elaborate but Jenifer Short had testified Wednesday that she had once slammed on her brakes, and Kaedyn had fallen out of her car seat.
That night when he tried changing her diaper, Parker told Strine while he was taking his statement, the toddler "stopped and stared." Parker "'popped her on the butt'" twice, Strine said Parker told him, and she fell.
When he picked her up, she gasped and became unresponsive, Strine said Parker told him.
"Because he was unable to find any response in her, he brought her to the ER," Strine added.
Were her injuries consistent with the injuries that happen when a child falls, Houchin asked Strine.
No, he replied. When a child falls, he or she gets hit on the front or the side, Strine said.
Kaedyn had swelling in the posterior scalp. "Falling backwards would be very unusual," he added. Strine did not observe any "older or pre-existing head injuries," he added.
Public Defender Howardene Garrett asked Strine if an old injury could bleed slowly over time and the "results of the bleeding may not be apparent."
"Possibly," Strine replied.
When Houchin asked if Strine observed "old" or "fresh" blood, Garrett objected, saying it was beyond Strine's medical expertise to answer the question.
Even though Judge Dennis Maloney overruled the objection, Strine refrained from answering, saying it was indeed beyond his medical expertise.
The whole issue of "fresh" blood came up again when the court heard from Dr. Sally Smith, who is Pinellas County's medical director for its Child Protection team, which is a group of specialists that evaluates children when there are allegations of abuse and neglect.
Smith was involved because Kaedyn had to be moved to St. Petersburg's All Children's Hospital, which is in Pinellas.
Smith showed jurors CAT-Scan photos of Kaedyn's head, taken at HRMC and All Children's Hospital, and pointed out areas that she said showed there was fresh blood hemorrhaging in the toddler's brain.
"Not only were there fresh blood clots," Smith said, but the bleeding of the bone indicated the injuries "had occurred just before she came to the hospital."
Smith gave jurors a quick run-down of what the brain's exterior is comprised of and what happens when any kind of impact takes place. The area that experiences blunt force trauma gets swollen, she explained.
Smith said she saw separate areas of swelling on the back of the head, and the left and right sides, leading her to believe there were at least "two separate impacts, probably more but at least two."
When Kaedyn was brought in, she had "raccoon eyes," typical from retinal hemorrhaging or splitting of blood vessels inside the eyeballs, she said.
When retinal hemorrhaging such as she saw in Kaedyn is so "widespread" in both eyes, Smith added, it indicates "very bad injuries" from high blunt force trauma or an acceleration/deceleration type of trauma such as a car crash.
At the trial Wednesday, Jenifer Short testified that Parker had different versions of what happened. Kaedyn fell over a pile of laundry and hit her head. She held her breath until she stopped breathing. A third version, that Kaedyn fell from the top of a bunk bed, and a fourth, that she stumbled on the carpet and hit her head on the laptop.
When Houchin asked if the injuries were consistent with a child falling from bed, Smith replied no.
According to the statements she reviewed, there were varying versions of what happened, she said.
One was that Kaedyn tripped on a pile of clothes and hit her head against a laptop computer, she said. Another, that she tripped on some books.
"I didn't think those explanations made sense," she added. Hitting against a laptop would not lead to such severe injuries, she said, or explain the injuries to the back of the head.
The defense cross-examined Smith after lunch.
Garrett asked both Smith and pediatric neurosurgeon Dr. Arthur Marlin if they knew of the secondary-impact syndrome.
Marlin was the doctor who performed surgery on Kaedyn when she was brought to All Children's Hospital.
Both he and Smith described it as a condition when there is a blow to the head that leads to concussion.
If another impact takes place soon after, before the brain has a chance to heal enough, it leads to a "fatal" swelling of the brain, Smith said.
A second-impact syndrome is associated with concussions and brain swelling, Smith said, never with hemorrhaging, and usually not with brain fractures.
Were Kaedyn's injuries indicative of second-impact syndrome, Houchin asked. Smith said no.
Marlin testified that Kaedyn looked like she had a bilateral stroke. She had a "tremendous" increase in cranial pressure due to the brain swelling, he added. If the pressure was not relieved through surgery, it would have caused her heart and breathing to stop, he said.
He eventually "took off almost half of her skull" to let the brain swell and relieve the pressure, he added. The blood vessels that go into the brain, in particular one vein, was also bleeding, he said.
When questioned, Marlin said in a taped testimony that the toddler's injuries were not a "classic second injury" and were not consistent with minor falls. He described them as typically associated with child abuse.
Part of Kaedyn's brain was dead, he added.
"The prognosis after the surgery was very poor. Three-quarters of her brain was dead and she was likely to be vegetative."