Pathologist testifies in infant homicide trial

Angie Kemp and Richard Harruff

Assistant District Attorney Angie Kemp listens as King County Medical Examiner Richard Harruff answers a question by videoconference during testimony on Tuesday in the David J. Paul homicide trial. Photo by Matt Miller/KTOO News

The prosecution may rest their case on Wednesday in the David Paul homicide trial. A few more follow-up questions are planned for the State’s last main witness before the defense puts their own witnesses on the stand.

Paul is accused of murder and manslaughter in the death nearly three years ago of four-month old Rian Orr, daughter of his then-girlfriend.

King County Medical Examiner Richard Harruff testified by videoconference on Tuesday about an autopsy of Rian Orr started on the day after she died on August 15th, 2010 at Harborview Medical Center in Seattle.

Most of the issues encountered from the first videoconferenced witness last week were resolved, although it was still awkward for witnesses’ consideration of exhibits, and disconcerting for attorneys posing questions or making objections.

“Blunt force injury to the head,” answered Dr. Harruff when he was asked about his determination of the cause of Rian Orr’s death.

Harruff also said it was homicide. But he didn’t use that term as a legal definition of the death, but a description of the manner of death since the injuries appeared to be inflicted by someone else.

I based my opinion at the injuries of the head, and also the associated injuries, provided sufficient evidence that the injury were the result of the actions of another person.”

Dr. Harruff said the 15-pound, 24-and-a-half inch baby appeared to be well-nourished. But she had a bilateral subdural hematoma or pooling of blood outside both sides of the brain, cerebral edemia or brain swelling, evidence of a bruise on the chest, fracture of the femur or right thigh bone near the knee, and three left rib fractures — not two as had been identified earlier. Two of the rib fractures were near the spine and one on the side. She also appeared to have two very small abrasions on the forehead and left temple, but it was unclear whether that was a previous injury or something that happened during her treatment.

The hematoma occurred roughly within the previous six days, but Harruff could not say with any precision when the fractures occurred. He could only say, based on the healing callouses that formed, the fractures occurred much earlier.

The cerebral edemia, for example, can restrict blood and oxygen flow to the brain and lead to necrosis and eventual loss of function, including breathing.

Necrosis is the death of tissue within the living body. And, so, the brain is dead, but it died within the living body.”

Harruff believes the blunt force trauma brain injury may have occurred with the brain violently shaken or moved inside the skull with high inertia. But he didn’t agree with the Shaken Baby Syndrome which he said is not an accurate description of the injuries.

Harruff, while under cross-examination by public defender Eric Hedland, said the shaken mechanism is not accepted by all pathologists as a reasonable cause of death.

“The majority still may think that shaking is a potential cause of fatal brain injury. But there’s certinaly a deivergence of opinions and my own opinion, if it matters, is that I don’t like the term Shaken Baby Syndrome. But that doesn’t mean that I say shaking can’t serious injure a baby and possibly causes death.”

Jurors turned away from autopsy photographs projected in the courtroom and became upset as Harruff testified in detail about Orr’s subdural hematoma. One juror called for an immediate break to regain her composure and the other thirteen jurors either beat her to the door or quickly followed her out of the courtroom.

Superior Court Judge Philip Pallenberg reminded the returning jurors that their job was to properly consider all of evidence. That included carefully listening to the testimony and considering the photos, but they did not have to stare at them.

Assistant District Attorney Angie Kemp made a last-minute paring down of the autopsy pictures shown to the jury and eventually moved on from the offending picture.

And before court proceedings started on Tuesday, Judge Pallenberg issued a rare exception to the local media’s access of court proceedings by prohibiting the publication of the autopsy pictures – which he repeatedly called ‘gruesome’ – to preserve the dignity of the child.