When a child dies from a head injury, an “undetermined” manner-of-death certification may be seen as an act of cowardice or an act of courage.
Brookelynn Palmer, the 13-month-old daughter of Dorothy Palmer of Westminster, was pronounced dead at Children’s Hospital Colorado in Aurora on May 20, 2013.
According to news sources, Palmer was at her Westminster home May 18. Brookelynn was in another room with Palmer’s boyfriend, Justin Hale.
Palmer heard a “thump” and found Brookelynn sitting on the floor looking dazed. She vomited and lost consciousness. Hale said Brookelynn fell off a 19-inch-high coffee table and hit her head while he wasn’t looking.
Brookelynn had skull fractures and a swollen brain. Doctors believed she’d been abused because her injuries were too severe to be explained by a short fall.
Forensic pathologist Dr. John Carver autopsied Brookelynn for Jefferson County Coroner John Graham. He confirmed the extensive skull fractures and brain swelling reported by the hospital.
Forensic pathologists review medical records and witness statements for context, so Carver knew the opinions of the doctors at Children’s. He also learned that Brookelynn had suffered another injury two weeks before her death – a broken arm.
Brookelynn’s mother had brought her to St. Anthony’s North Hospital and told doctors she’d fallen downstairs while carrying Brookelynn. The radiologist who had examined her X-rays reported no skull fracture.
Doctors rarely can say how a given injury occurred. They can decide only whether an injury could have happened in the way reported by a caregiver.
People do fall while carrying children. A broken arm would be a reasonable consequence of such a fall, so the first injury wouldn’t be particularly suspicious. But a second, more severe injury two weeks later would make any doctor suspect that both injuries were abusive.
There’s also the matter of the boyfriend. It’s my experience – and axiomatic among medical examiners – that abusive injuries to children are most commonly inflicted by unrelated males. When I hear “boyfriend” in the context of a dead child, I’m immediately more suspicious than I am when I hear “grandmother” or “aunt.” We all indulge in profiling.
Carver agreed that Brookelynn’s head injuries were inconsistent with such a short fall. The previous injury and the involvement of a boyfriend suggested a pattern of abuse. Carver concluded that the manner of Brookelynn’s death was homicide – as the doctors at Children’s did, and as I would have.
Hale was arrested and charged with first-degree murder and reckless child abuse. But the case took a disturbing turn when Hale’s attorney, Matthew Beach, hired his own expert.
In an X-ray taken after the fall downstairs, that expert saw a skull fracture missed by both the radiologist at St. Anthony’s and the child protection team at Children’s. In retrospect, everybody agreed he was right.
When Carver learned that Brookelynn had a pre-existing skull fracture, he re-evaluated his opinion.
A pre-existing, healing injury makes tissues vulnerable to re-injury by forces too trivial to damage normal tissue. Anybody who ever picked at a scab knows this.
Because a plain X-ray lacks sufficient detail, Carver couldn’t compare the severity of the original skull fracture with his autopsy findings to determine if the second injury had made the first fracture worse.
He also couldn’t state the degree to which a second blow to the head might worsen the original fracture’s effects on Brookelynn’s brain. We aren’t allowed to fracture the skulls of children and push them off coffee tables at a later time to see what happens.
So Carver reasoned that while a short fall with a bump on the head wouldn’t be remotely likely to kill a normal child, he couldn’t rule out the possibility that a re-injury could kill a child who already had a skull fracture.
It’s tough to change your mind. Our universal tendency to accept new information that supports previously held opinions and to dismiss information that conflicts with those opinions is called confirmation bias.
Carver didn’t dismiss new information that conflicted with his original conclusions. He evaluated the information fairly, realized he was no longer sure and changed his opinion in spite of what people might think and regardless of potential consequences to others or himself.
Not everybody agrees that the previous skull fracture raises reasonable doubt about Brookelynn’s death. Doctors at Children’s Hospital still insisted her injury was proof of abuse. The coroner didn’t change his homicide ruling on the death certificate.
The district attorney was confronted with conflicting expert opinions.
“We had at least two experts who said it took very violent actions on the part of Mr. Hale to result in (Brookelynn’s) death,” 1st Judicial District Attorney Pete Weir said. “We felt justice demanded that it was brought to a jury.”
Defense attorney Beach disagreed.
“It is absolutely terrifying,” he said, “that, once confronted with that evidence … (of Hale’s innocence), they decided to proceed with a first-degree murder case against my client.”
After an eight-day trial and an hourlong deliberation, the jury found Hale innocent.
People expect forensic pathologists to know if somebody has been murdered or not. An “undetermined” certification can easily be viewed as evidence of incompetence or bias, and such perceptions can have career-damaging consequences.
Some people still think Hale is guilty, and perhaps some blame Carver’s lily-livered waffling for the acquittal of a child-killer.
I agree that based on the medical evidence, it’s impossible to know if Justin Hale is a murderer or an innocent man snared by misleading circumstances, missed X-ray findings and misinterpreted injuries.
I admire Dr. Carver’s courage. He did the right thing.
firstname.lastname@example.org. Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.