Editor's Note: The content of this article is based largely on the testimony of medical experts who were involved in or reviewed Kaiden Olea's autopsy. It will be disturbing to some readers.
The jurors in the first-degree murder trial of Joseph Olea heard from two neuropathologists Friday who gave very different medical opinions regarding what caused the death of Olea’s 6-month-old son a little more than two years ago.
Neuropathologists are medical doctors who study disease and disorders of nervous system tissue.
First, Dr. Patricia Kirby, who teaches neuropathology at the University of Iowa Hospitals and Clinics, testified on the state’s behalf. Later, they heard from Dr. Zhongxue Hua, an assistant professor of pathology at the Albert Einstein College of Medicine at Jacobi Medical Center in Bronx, N.Y., who testified on the defense’s behalf.
Hua testified out of order due a scheduling conflict. The state has not yet rested its case against Olea.
Kirby testified as to her credentials, noting she is board certified as a neuropathologist in both her native South Africa and in the United Kingdom. She has been at UIHC since 1996 and is contracted with the State Medical Examiner’s Office as a consulting neuropathologist.
She testified she received Kaiden’s brain and spinal cord from the State Medical Examiner’s Office about two weeks after the autopsy to allow for chemical preservation of the tissues. The container also held the child’s eyes and a gauze bag she said contained blood Associate State Medical Examiner Dr. Michelle Cavalier had collected from a subdural hemmorhage.
Kirby then told Jasper County Attorney Mike Jacobsen she sent the child’s eyes to ophthalmic pathologist Dr. Nasreen Syed, also of UIHC, for her examination. To aid jurors in their understanding of her testimony, Kirby then drew out a picture and explained the structure of the brain.
After that, she proceeded to explain photographs she took during her examination of the child’s brain and spinal cord. One photo of the underside of the dura — a leathery tissue layer that surrounds the brain — she said showed evidence of subdural hemorrhaging, which she said was “not normal.”
Kirby explained possible causes for that bleeding could be the use of blood-thinning drugs, abnormalities in the blood vessels, a skull fracture or brain trauma.
Another photo of the top of Kaiden’s brain was lacking the ridges normally found in a human brain, which she said was indicative of the enormous pressure his brain had been under due to swelling. She noted the brain also was very soft, even after two weeks in the preservative used to transport it to her office, which she said was indicative of necrosis, or dying of the tissue.
Kirby also noted subarachnoid hemorrhages of the brain tissue. Subsequent photos showed additional necrosis of the cerebellum, and bleeding in the pons region of the brain. She also described thrombosis — the clotting of blood in a blood vessel — to the jurors.
During another PowerPoint presentation to the juror, Kirby showed examples of a condition known as sagittal sinus thrombosis, clotting of blood in a vein that transports used blood away from the brain and back to the heart. She said this condition is easy to diagnose, and noted hemorrhaging that would accompany such a condition was not present in Kaiden’s brain.
She testified that when a brain swells, it can eventually cause so much pressure that blood can no longer flow in or out of the brain. This can lead to a secondary thrombosis, which she said was present in the child’s brain.
Showing photos of microscopic slides Kirby took during her examination, she told jurors about the process of recanalization, a defensive mechanism where the body will attempt to restore blood flow through a blood clot in a vessel. She testified she found no evidence of that condition in the slides of Kaiden’s brain tissue.
She also noted she uses similar slides when teaching in the classroom at the University of Iowa.
Kirby also testified she saw no evidence of calcification of the tissue but did note the presence of bone dust from the blade used to open the child’s skull, as well as a few spots caused by the preservative. She said a child would noticably act abnormal if he or she had a thrombosis condition in the brain.
She also noted the presence of axonal spheroids, which she said were bulges in the axons caused by injury. She testified possible causes of axonal spheroids include severe infection of the brain, such as meningitis, stroke and trauma.
Kirby said she believed the axonal spheroids, because of their location, was indicative of a rotational injury. During another PowerPoint presentation, she showed how an angular force applied to the brain could cause it to try to rotate within the skull. Near the center of the brain, this could lead to stretching of the axons, which then leads to axonal spheroids.
During cross-examination by public defender Steve Addington, Kirby said she is not board certified in neuropathology in the United States because she didn’t need to be as a result of her other certifications. She also testified she could not say when the rotational injury may have occurred in Kaiden’s brain.
During redirect examination by Jacobsen, Kirby said the rotational injury occurred before the child was brought to Skiff Medical Center. She also said the secondary thrombosis found in his brain would have formed while he was still alive.
Hua, who also currently serves as the chief medical examiner in Rockland County, N.Y., testified after Kirby. He has a doctoral degree in biochemistry, and after receiving his medical degree, he became board certified in both neuropathology and forensic pathology.
Although he did not participate in Kaiden’s autopsy, he did review Cavalier’s report, as well as photographs taken during Kirby’s examination. But after reviewing the information and photos, his medical conclusion was the child suffered from a rare condition called cortical vein thrombosis, also called cerebral venous sinus thrombosis.
Hua said thrombosis was “extensive” throughout the child’s brain, noting enlargement of the blood vessels surrounding the thrombosis found at autopsy. He said those blood vessels are indicative of clotted vessels.
He then noted there is a “chicken or egg” problem when trying to determine if the thrombosis happened before or after Kaiden’s medical condition deteriorated on Jan. 10, 2012. He said the histories provided by the child’s parents indicated fussiness on Jan. 8, 2012, which he said could be symptomatic of cortical vein thrombosis.
Contradicting Kirby’s findings, Hua said the photographs of microscopic slides showed evidence of both recanalization and calcification, processes he said could only become evident after a minimum of 10 days. He also said cortical vein thrombosis could lead to subdural hemorrhages.
Addington then asked Hua about a photograph Cavalier took during her autopsy, which she said showed a subdural hematoma. He said the photo instead showed two areas of dilated veins, consistent with his own medical finding.
Hua said he had read a study authored by other forensic pathologists published six months prior to Kaiden’s autopsy that suggested an extensive examination of nerves in the neck area in cases where abusive head trauma is suspected. He said he follows that process in his own examinations and he knows of many other pathologists who do as well.
During cross-examination earlier in the day, Cavalier testified she, too, had read the article. She said it was not “standard practice” in forensic pathology to conduct that type of examination and that she knew of no other pathologists who performed that type of exam.
During his own cross examination, Hua told Jacobsen and the jurors the report isn’t comparing abusive head trauma and cortical vein thrombosis and that thrombosis isn’t even a subject of the report.
During redirect examination, Cavalier said it would be “irresponsible” to immediately begin performing the neck examination on the basis of a published article alone.
During his direct examination, Hua also told Addington and the jurors “Shaken Baby Syndrome” or abusive head trauma, was a diagnosis of exclusion. He said he believes Shaken Baby Syndrome exists but feels there needs to be more scientific investigation.
He concluded his direct examination by stating cortical vein thrombosis explained all of the findings in Kaiden’s autopsy.
During cross-examination by Jacobsen, however, Hua frequently went beyond the scope of the questions asked, resulting in District Court Judge Randy Hefner halting his answers, or instructing him to be more responsive.
However, Hua did say abusive head trauma requires a “triad” of evidence, including subdural hemorrhaging, which he said doesn’t exist. If it did exist, however, he insisted it would not change his findings with regard to Kaiden.
He also admitted he is not an ophthalmologist and that he uses an outside consultant in his own investigations. He also noted the sagittal sinus, the vein he said suffered a cortical vein thrombosis, is not directly connected to the veins in the eyes.
Hua, who earlier testified to completing more than 200 autopsies in 2013 alone, said he has never made a diagnosis of abusive head trauma without external injuries evident. He said he was aware of pathologists who have.
He then called Kirby’s medical determination in the case of Kaiden’s death a “bogus diagnosis.” He said there were other causes than trauma for the axonal spheroids she found.
Hua insisted the subdural hematoma found during Cavalier’s examination could not be subdural because it also contained damaged brain tissue and venous blood clots that should be there if it was. He did admit, however, that soft tissue injury cannot be caused by thrombosis.
During redirect examination by Addington, he said the calcification and recanalization he found in Kirby’s microscopic slides were evidence of a pre-existing medical condition.
To start the day, jurors heard Cavalier’s cross-examination by Addington. The associate state medical examiner had concluded Thursday during testimony on the state’s behalf that Kaiden had died as a result of blunt-force abusive head trauma.
Addington first had Cavalier explain what pathology is and had her explain she is not a board-certified neuropathologist. She also said she took both what was found during her examination of the child, as well as what was not found, into account in her medical finding.
Addington asked Cavalier if her examination had ruled out that Kaiden had been suffering from a cold, but she said it was difficult to tell because she had not examined tissue from the child’s nasal cavity. She noted she observed “mild inflammation” of the trachea but said she expected to see more due to the child having had a breathing tube down his throat.
Also during cross-examination, Addington asked Cavalier about the types of movements and amount of force required to inflict the types of injuries found in Kaiden. She said they were the result of shaking, slamming, a blow to the head, or a combination of any of those movements, but she could not say exactly how they were inflicted.
Addington also asked about the lack of broken ribs, which are often found in cases where a child has been shaken. Cavalier said, particularly in younger victims, it is not uncommon for ribs to not be broken because their bodies are less rigid and the bone has not yet fully hardened.
During redirect questioning by Jacobsen, Cavalier said most accidental causes of injury do not result in injuries as extensive or widespread throughout the brain and eyes as were found in Kaiden. She also said she could think of no medical procedure that would have been performed at either Skiff Medical Center or Blank Children’s Hospital that could have resulted in the scalp bruising found during autopsy.
Cavalier also said hemorrhages found at the junction of the child’s brain and spinal cord were indicative of the severity of the trauma the child had suffered. She testified that had those hemorrhages been absent during her exam, it would not have changed her final medical finding.
During re-cross by Addington, Cavalier said she could not say when the bruises on Kaiden’s scalp occurred. She also said she doubted they were the result of emergency care provided at the Skiff Medical Center Emergency Room.
The jurors also heard from Syed, the director of the Floating Eye Pathology Laboratory, which is contracted with the State Medical Examiner’s Office to assist in examinations of eyes removed at autopsies.
She testified she received Kaiden’s eyes Feb. 7, 2012, and performed by a “gross examination” of both, as well as microscopic examinations of tissue samples taken from each. To help explain her testimony better, Jacobsen had her explain a PowerPoint presentation that showed the anatomy of the human eye, as well as examples of both normal and injured eyes.
Syed’s presentation also included photographs taken during her examination of Kaiden’s eyes. She pointed out signs of trauma, including hemorrhaging all around the optic nerves, extensive hemorrhaging of the blood vessels in his retinas and retinal “folding” where the surface of the retina has been pulled, resulting in a “tenting up” of the tissue.
She said the retinas of both eyes did not appear normal. The hemorrhaging was found in multiple layers of the retina and throughout the eye. She said hemorrhaging found closer to the front of the eye is more likely to be the result of trauma.
Syed said brain swelling could cause the optic nerves to also swell, which would result in hemorrhaging. She also testified there are other non-traumatic causes for hemorrhaging, including leukemia, severe infections and blood conditions or genetic disorders, none of which were present in Kaiden at the time of his death.
During her microscopic examination of the eyes, she said she discovered additional hemorrhaging of the sclera, or white part of the eyes. She said this was significant because that kind of bleeding can only occur as the result of a traumatic event.
She said accidental causes for the types of injuries found in Kaiden’s eyes involve crushing injuries to the head, motor vehicle crashes at highway speeds in which the child is ejected, or falls from heights of more than one story. Those events usually result in readily visual external signs and are almost always fatal.
Syed also said the fact these conditions were present in both eyes is significant because it tended to rule out a vein occlusion, which is similar to thrombosis.
During cross examination, she said the injuries could be the result of an accident, and that by looking at the photographs of the eyes, one cannot determine when the injuries occurred. She did, however, say the blood found in the hemorrhages of the sclera could begin breaking down in as little as a day.
At the conclusion of Friday’s trial day, jurors had heard more than 10 hours of testimony. Much of it was from medical experts for both sides.