Rehma Sabir (1) who prosecutors claim was murdered by Irish nanny Aisling Brady McCarthy, died as a result of abusive head injuries suffered on the same day she was brought to a Boston hospital, a child abuse medical specialist has told a US court.
Dr Alice Newton testified before Judge Maureen Hogan that her conclusion was based on medical analysis and reports about Rehma’s earlier behaviour from her mother and Ms McCarthy on January 15th, 2013, the day after she was taken to Boston Children’s Hospital.
Rehma was found unresponsive in her cot on the afternoon of January 14th and died in hospital two days later.
Ms McCarthy, of Quincy, Massachusetts but originally from Co Cavan, is accused of fatally assaulting the infant while babysitting her in the family home. She denies first-degree murder.
Her lawyers claim prosecutors have ignored old fractures on the child and Rehma’s previous illnesses and poor health.
Prosecutors say Rehma suffered severe and ultimately fatal bleeding in her brain and from her eyes as a result of acute injuries suffered on the afternoon of January 14th when Mrs McCarthy was caring for her.
Dr Newton, a paediatrician who was medical director of the child protection programme at Boston Children’s Hospital at the time, said Rehma’s mother and Ms McCarthy told her the infant was acting normally when the mother left the family’s apartment in Cambridge near Boston at 10.30am on January 14th.
She confirmed her testimony to a grand jury that she believed Rehma’s brain injuries occurred at between 3.30pm and 4pm that day.
The nanny’s lawyers asked the Middlesex Superior Court to exclude or limit evidence from Dr Newton, a witness for the prosecution, at trial. They argued she failed to take into account a detailed medical history from Rehma’s paediatrician and other medicals specialists, and she did not meaningfully consider any alternative diagnoses.
Dr Newton, a paediatrician and Harvard professor with 15 years experience of child abuse cases, testified that she considered but ruled out other possible causes such as accidental injuries, infection or illness.
Prosecutor Patrick Fitzgerald said Dr Newton's professional experience made her sufficiently qualified to reach the diagnosis she made in the death of Rehma, the daughter of a British entrepreneur.
The paediatrician outlined to the court how at the hospital the child’s mother and nanny described Rehma as appearing normal hours before she was hospitalised. She was playing with new toys from her first birthday, including lifting a tea cup, and when her mother was leaving she cried, made eye contact and reached out for her.
Dr Newton said Rehma later arrived at hospital with “irreversible brain damage and with signs of trauma” which, based on accounts of her earlier behaviour, could not have occurred that morning or before.
“It is impossible for a child with that degree of brain injury to appear normal, playing, drinking, eating,” she told the court. “After sustaining such a severe brain injury there is not an interval or period where children can look normal and then get very sick.”
Dr Newton said she later concluded from the child’s injuries that she died from being “shaken and slammed” and “blunt force trauma.”
“It is my opinion that Rehma was subjected to violent force, violent shaking and blunt force trauma such would be viewed by a spectator to be completely unreasonable handling of an infant,” she said.
The nanny’s lawyers argue that Rehma had suffered from health problems, including eating and bruising disorders and ear infections, and that vertebral fractures discovered on the child after her death were found by another specialist to be five weeks old dating back to when she was travelling with her mother in Pakistan.
Cross-examined by the nanny's lawyer Melinda Thompson, Dr Newton said the existence of old fractures in Rehma's wrist, ankle and vertebrae dating weeks before her death did not change her view that she died from brain injuries suffered on the day she was hospitalised.
Asked why she didn’t take notes at the hospital that night, she said that it was because things happened “so quickly and intensely.”
The doctor told the court that it was common while investigating suspected child abuse cases to rely on the accounts of the child’s care-giver when it came to finding out the victim’s medical history.
Judge Hogan will rule at a later date on whether to exclude or limit Dr Newton’s evidence. The case is due to go to trial on October 14th.
