Matthew's Eappen's Head Injuries example essay topic

On Feb. 4, 1997, Louise Woodward called the police and said that Matthew Eappen was having difficulty breathing. Woodward had been hired by Sunil and Deborah Eappen to babysit their sons in November 1996. When paramedics arrived at the Eappen household, they found that the baby had a two-and-a-half-inch skull fracture. Matthew's eyes were also bulging, a possible sign of "shaken baby syndrome". The baby spent four days on life support before dying on Feb. 9. The autopsy revealed that in addition to his fractured skull, young Matthew was also suffering from a month-old wrist fracture.

Prosecutors said that Woodward admitted to shaking Matthew and to dropping him on the floor and tossing him on a bed. They alleged that Woodward became so frustrated with Matthew's uncontrollable crying that she began shaking him violently to stop the crying. In addition, state medical examiners said Matthew hit the floor with the "force equivalent to a fall from a second-story window". The injuries from the fall and the shaking allegedly caused Matthew Eappen's death.

Woodward was imprisoned without bond after the incident, and that caused controversy. Supporters of Woodward in both Massachusetts and her homeland of Britain had argued that Woodward should not be kept in a state women's prison with hardened criminals because she is only a teenager and was foreign to this country. Woodward supporters claimed she does not understand the U.S. justice system and should have been given the opportunity to be released on bail from prison. Prosecutors countered by saying that Woodward would likely flee from Massachusetts if freed on bail. A Genetic Disorder? The defense had recruited Barry Scheck, the forensics expert who helped O.J. Simpson's defense team during his trial, to help Louise Woodward's defense arguments.

Woodward's defense claimed Woodward's alleged mishandling of the baby did not cause Matthew Eappen's death; instead, a pre-existing medical condition may have killed Matthew. Reportedly, the defense asked for DNA tests on Matthew in an apparent attempt to find genetic disorders that could have affected his bone strength and development or could have caused brain hemorrhages. In addition, according to reports, the defense had also hinted that Matthew's two-year-old older brother, Brendan, may have had a role in the baby suffering his injuries because he was the only other family member home that night. But, prosecutors argued, no two-year-old could have inflicted such physical trauma on an infant. The 19-year old au pair was then sentenced to life imprisonment with the possibility of parole after 15 years. Judge Zabel will hear a three-part motion from the defense on Tuesday, November 4.

The motion consists of: first, setting aside the verdict and dismissing the case; second, setting aside the verdict and holding a new trial; or third, reducing the charge to manslaughter. If the they lose this motion, defense attorneys have stated they will appeal the conviction. October 7 The jury heard opening statements from the prosecution and the defense and saw the prosecution's first five witnesses come to the stand. In his opening statement, lead prosecutor Gerard Leone, Jr. described Louise Woodward as a live-in nanny who was much more concerned with enjoying Boston night life than providing proper care for the sons of Sunil and Deborah Eappen, two-year-old Brendan and the infant, Matthew. Frequently, Woodward had difficulty waking up in the morning to care for the boys after late-night partying with friends. During an incident in late January, Sunil Eappen came home from work one night and allegedly found Brendan and Matthew unattended.

This caused the Eappens to make an ultimatum to Woodward: either do a better job of watching our sons or you " re fired. Five days after the ultimatum, on Feb. 4, the alleged shaking incident with baby Matthew occurred. But Leone refrained from saying that Woodward had planned to kill Matthew. "We are not saying to you that the defendant woke up on February 4 specifically intending to kill Matthew Eappen", Leone told the jury.

"What we " re saying the case is about is that on February 4, the defendant, in a frustrated, resentful, unhappy attitude, slammed the baby into a hard object and shook him, causing his death -- actions that anyone would know would result in death. In this Commonwealth, that is murder". Lead defense attorney Andrew Good responded to the prosecution's opening statement by saying that Woodward never violently shook the baby or slammed his head onto a hard surface. Good told the jurors that he would present head trauma and biomechanics experts who will support the defense theory that baby Matthew suffered a skull fracture prior to the Feb. 4 incident. Matthew's parents were not aware of this injury, which, Good claimed, really caused the infant's death. The state brought two police officers who responded to Woodward's 911 call the night of the incident.

Both testified that they found Matthew lying on his back on the floor, with his arms pointing stiffly towards the ceiling and making periodic jerking movements. Both also said that Woodward told them Matthew had vomited. One officer, Hugh Downing, described Woodward as "detached" from the situation. The other officer, Eric Braceland, testified that Woodward told him the baby would not stop crying the entire evening. Matthew refused to eat his food, had vomited, and at one point was choking on his vomit. According to Braceland, Woodward told him that she had tried to clear the vomit out of Matthew's airway.

Braceland also observed that Matthew's pupils were dilated and that he was breathing hard. Key testimony came from Dr. Kenneth Mandl, the doctor who treated Matthew Eappen in the emergency room at the hospital. He said that the infant was unresponsive and comatose when he arrived in the emergency room. Matthew's pupils were enlarged, fixed, dilated, and there was evidence of retinal hemorrhaging.

According to Mandl, these were all signs of severe head trauma. Mandl was then cross-examined by defense attorney Barry Scheck, who made the doctor admit that he found no evidence on Matthew body that indicated that he had been shaken. Under Scheck's examination, Dr. Mandl testified that he found no bruises on the baby's arms, shoulders, ribs or neck and that there was no swelling on the back of the victim's head. Scheck also asked the doctor whether he observed anything that supported the prosecution's assertion that Matthew's head had been slammed down "with the force of dropping a child 15 feet onto hard concrete".

Mandl responded, "There were no findings to specifically indicate that, no". Mandl also conceded to Scheck's theory that the baby may have suffered from what Scheck called "talk, deteriorate, and die" head injuries. (This refers to instances in which a person suffers a head injury, appears to recover from the injury, but then suffers a rapid decline in health after a later, possibly slight, head injury.) Scheck was trying to build support for the defense theory that the infant really died from a previously unknown head injury prior to the Feb. 4 incident with Woodward. However, despite his concession, Dr. Mandl maintained that Matthew's symptoms that night indicated that his injuries more likely came from violent shaking.

Court recessed soon after Dr. Joseph Madsen, a pediatric neural surgeon who reviewed Matthew's CAT scan, began testifying about the infant's brain swelling, the circumstances that caused the swelling and the surgery that was required to relieve the pressure on the brain. Madsen was scheduled to return to the stand the next morning. Trial October 8 Dr. Joseph Madsen, the pediatric neurosurgeon who performed brain surgery on Matthew Eappen on the night of the alleged shaking incident, returned to the stand. Madsen said that the infant's head injuries had caused his brain to swell "like a loaf of bread rising in an oven". According to Madsen, he and his surgeons were afraid that Matthew would die on the operating table. Based on the extent of the infant's brain damage, Madsen said Matthew's chances of survival were grim.

Dr. Madsen testified that Matthew's brain injuries came from more than a gentle shaking; he also said that the brain injuries did not come from what the defense claims was a prior, chronic head injury. "I think they [the injuries] were non-accidental", said Madsen. "I think there would have had to have been at least two types of mechanism involved, such as a severe blow of the head against a blunt surface and an additional swinging or shaking of the head in some fashion. I think they would have most likely occurred in relation to each other". Defense attorney Barry Scheck challenged Madsen's opinions during cross-examination. Madsen appeared to retreat from his widely quoted analogy that Matthew's injuries were consistent with those suffered during a 15 foot drop onto concrete; he said he had only made that comment in response to a very specific question during grand jury testimony.

Scheck also suggested impropriety on part of Dr. Masden because the doctor did not preserve a blood clot he surgically removed from Matthew's brain for pathological analysis. (The guidelines in Children's Hospital in Boston say that this procedure should have been done.) Masden responded to this allegation by saying that the clot was not salvageable. When asked by Scheck about the defense's theory that Matthew suffered the head injury weeks before the incident with Louise Woodward, Masden agreed that such a head injury could bleed internally and spontaneously hours, days, or even weeks after its original occurrence. And head swelling, crankiness, unusual crying, vomiting, and lethargy are the symptoms of such these kind of head injuries in infants. (Matthew Eappen showed all these symptoms the day of the alleged shaking.) In addition, Madsen agreed that baby Matthew's skull fracture resembled a fracture that could have been suffered three weeks prior to the alleged incident with Woodward. After Dr. Madsen finished his testimony, Dr. Robert Cleveland, a consulting radiologist to the Child Protection Team at Children's Hospital, took the stand and analyzed Matthew's X-rays in front of the jury.

He said that the baby's skull fracture appeared to be no more than three or four weeks old. When asked about an apparent wrist fracture that X-rays also revealed the night of the incident, Dr. Cleveland said that injury was approximately two-and-a-half to four weeks old. The last witness of the day was an expert in pediatric radiology and child abuse, Dr. Patrick Barnes. He explained the brain swelling and other abnormalities the CAT scans detected in Matthew.

Dr. Barnes testimony was scheduled to continue the next morning. October 9 Dr. Patrick Barnes, an expert in pediatric radiology, returned to the stand and testified that Matthew's Eappen's head injuries were characteristic of those suffered by infants through violent shaking. Barnes felt that Matthew could not have suffered the injuries from the a gentle shaking or from being tossed onto a bed. ; he also said that he saw no evidence of a prior head injury suffered by the infant. "The pattern of injury is suggestive of non-accidental trauma", Barnes told the jury.

"My opinion is that this is a classic picture of the acute or hyper-acute shaking impact injury seen in non-accidental trauma". Barnes also testified that he thought Matthew's head injury occurred hours before his CAT scan and that the baby was a victim of shaken baby syndrome. Then, Dr. Barnes examined a mark on CAT scan of Matthew's skull. During the previous day's testimony, he said that the mark was a second fracture suffered by the baby.

However, today he changed his opinion, saying that the mark indicated a stretching of the brain's sutures (the division between the plates of the human skull). This testimony seemed to support the defense's theory that Matthew had suffered a brain injury prior to the alleged incident with Louise Woodward. Defense attorney Barry Scheck tried to undermine Dr. Barnes's testimony about Matthew Eappen's injury when he made the doctor admit that he had not read all the medical reports about the case, including the infant's medical history. Barnes claimed that he did not want his opinions to be influenced by other data. However, Barnes still maintained that the infant suffered the head injuries from being slammed against a surface while being shakened. Still, Barnes would not support the prosecution's theory that Matthew was shakened violently for about a minute.

"I'm saying that this is shaken baby impact syndrome", Barnes said. "I can't say how many shakes and how many impacts". After Barnes's questioning ended, Dr. Gerald Feigin, who performed the autopsy on baby Matthew, took the stand. He testified that he saw no evidence of a prior head injury in Matthew and no evidence of prior bleeding within Matthew's skull.

Feigin said Matthew's skull fracture had very sharp angles, which indicated that his fatal injury had been suffered recently. In Feigin's opinion, the baby died from head trauma and the subsequent swelling it caused in the brain. However, during cross examination, Dr. Feigin conceded that the autopsy findings did not support the prosecution's theory that Matthew was shaken violently for about a minute. (He said it would have been physically difficult to shake a 22-pound baby violently for that amount of time.) Feigin also said that he was mistaken when he had told a grand jury that Matthew's head injury was the equivalent of one suffered from a 15-foot fall onto a hard surface. According to Feigin, the baby's skull fracture could have resulted from a fall of only two to four feet.

Besides the fracture, no other complications, such as brain damage, should arise from such a fall. The last witness to be called for the day was Dr. Umberto DiGirolami, who examined Matthew's preserved brain in March 1997. DiGirolami testified that he found that the baby had suffered from a traumatic head injury. The doctor also found no signs of a prior head injury. Dr. DiGirolami was scheduled to return to the stand the next day.

October 10 Dr. Umberto DiGirolami, a forensic neuropathologist who examined Matthew Eappen's preserved brain on March 11, 1997, returned to the stand. DiGirolami testified that all the bleeding he observed in Matthew's brain had been caused by an injury suffered no earlier than one week prior to the child's death on February 9. The doctor saw no signs of any prior bleeding, lesions, or underlying diseases that could have caused Matthew's death. According to DiGirolami, an older injury would have been a different color than what he observed in the infant's brain. DiGirolami told prosecutor Gerard Leone, Jr. and the court that, in his opinion, Matthew Eappen's death was caused by "the large area of disruption of brain tissue, due to an acute traumatic injury". During cross examination by defense attorney Barry Scheck, Dr. DiGirolami said that he was unable to support the defense hypothesis that Matthew Eappen suffered a head injury two to three weeks prior to his alleged February 4 incident with Louise Woodward.

(The defense claims that a subsequent, much milder head trauma on February 4 caused this theoretical injury to bleed again internally. This, the defense claims, led to Matthew's death.) However, DiGirolami also said that he was unable to support the prosecution contention that Matthew was the victim of violent shaking for about a minute. "You could not come here to the jury today and say 'I have evidence that can corroborate the hypothesis of shaking'? ", Scheck asked the doctor. DiGirolami responded, "I agree with that". Much of Scheck's cross-examination of DiGirolami focused on the defense's allegation that portions of Matthew Eappen's dura (the fibrous membrane surrounding the brain) are now missing.

(These portions might support the defense theory that Matthew had a prior injury that ultimately caused his death.) During a September 24 hearing concerning this issue, Dr. DiGirolami seemed to support that allegation. At that time, DiGirolami recalled that he had cut holes in the dura during his examination of the infant's brain, and that despite a court order that all forensic evidence in the case was to be retained, some of the dura apparently had been thrown away. However, Dr. DiGirolami told a different story during today's testimony. He said that after his previous testimony, he began to wonder about his recollection, and attempted to account for all of the dura specimens. After speaking to his colleagues and attempting to locate all of the samples of Matthew Eappen's dura, DiGirolami concluded, with the exception of some minuscule brain tissue, all of Matthew's dura was accounted for. Under careful questioning by Scheck, Dr. DiGirolami maintained that his testimony during the September hearing was wrong.

DiGirolami even dismissed a defense photo of Matthew's dura that appears to show two large sections missing. He explained that when the dura's sections were fully displayed and pieced together, one could see that no segments were actually missing. Then, Dr. Lois Smith, an opthamologist at Children's Hospital who examined Matthew's opthamology exams, took the stand and testified that Matthew died from shaken baby syndrome. According to Dr. Smith, the retinal hemorrhaging observed in Matthew's eyes was caused by the eye being slammed back and forth against its bone socket. The force of the shaking ripped the retina apart.

"Retinal hemorrhages are thought to be almost pathomonic of [or unique to] child abuse", Smith said. "There are some other conditions in which they can be found, but the degree of retinal hemorrhage indicates the amount of force that is used. The combination of the retinal hemorrhages and this fold [behind the eye] indicate trauma X, or shaken baby syndrome and really rule out any other causes". Smith concluded her testimony for the day by dismissing the defense theories about the cause of Matthew Eappen's death. She told the juror that the infant's eye and brain injuries could not have been caused by what Woodward's defense alleges was a prior chronic head injury, gentle shaking, or a genetic condition.

Dr. Smith will return to the stand for cross-examination when testimony resumes on Tuesday, Oct. 14. October 14 Dr. Lois Smith, the opthamologist who reviewed Matthew Eappen's eye examination and autopsy report, returned to the stand. She continued to maintain her belief that the infant's injuries could not have been caused by anything other than shaken baby impact syndrome. According to Smith, the force of the shaking and the impact with which the infant's head allegedly slammed against a hard surface was the equivalent of a truck hitting an infant in a baby carriage. Smith also said that the injuries that caused Matthew's death were inflicted between minutes and hours before he was admitted to Children's Hospital in Boston. During his cross-examination of Dr. Smith, defense attorney Barry Scheck suggested that a drawing of Matthew's eyes done at the time of his examination does not show the retinal hemorrhaging that Smith had said resulted from violent shaking.

In a major concession, Smith admitted that if this drawing is correct, then her theory about the infant dying from shaken baby syndrome is wrong. However, Smith preferred to characterize the drawing as "incomplete" rather than inaccurate. Then police detective William Byrne, who interviewed defendant Louise Woodward on the day of the incident, took the stand. Byrne quoted Woodward as saying that she had been "a little rough" with Matthew. Woodward also allegedly told Byrne that the baby had been cranky the entire day and that she was angry and frustrated by his non-stop crying. According to Byrne, Woodward said that at one point during the day, she had tossed Matthew on a bed.

Later that day, while preparing Matthew's bath, she dropped him onto a towel on the bathroom floor, and Woodward said that he may have struck his head on the lower side of the tub. In spite of this, Matthew seemed fine when Woodward put him down for a nap. However, Byrne testified, when she checked on Matthew, he was unresponsive and not breathing. Woodward tried to perform CPR on the infant, but then she decided to call 911. Byrne noted that Woodward seemed perfectly calm during her interview and never asked about Matthew's condition. During cross-examination by Woodward's other attorney, Andrew Good, Byrne admitted that during a meeting with his supervisor, he did not mention Woodward's alleged dropping of the infant on the bathroom floor.

Byrne also said he never examined the bathroom floor or towels for any signs (such as Matthew's blood) of the infant's fall. He even suggested to a friend of the Eappens that Woodward may be a "borderline hero" because of her attempt to revive Matthew. After Byrne's testimony, Dr. Stacey Linwood, Matthew Eappen's pediatrician, testified that Matthew seemed to be a normal, healthy baby with no unusual injuries. However, Linwood, who was the baby's doctor since he was two-weeks-old, said that Matthew suffered a subdural hematoma during birth. (A subdural hematoma is a mass of clotted blood that forma in brain tissue as a result of a broken blood vessel.) But, Linwood said, this injury was common among infants, and Matthew's subdural hematoma healed within a month after his birth. During cross-examination, Linwood admitted that she had last examined Matthew when he was six-months-old.

(Matthew was eight-and-a-half-months old when he died.) Linwood was not scheduled to examine the baby again until he was nine-months-old, and she said she did not know what he experienced between his last examination and the time of his death. The day's testimony ended with two family friends of the Eappens coming to the stand. They both testified that Matthew Eappen appeared to be a normal, healthy baby. One friend, Paula McCue, testified that Louise Woodward told her that she panicked when she realized Matthew was not breathing. McCue quoted Woodward as saying, "I picked him up, and I shook him a little bit". October 15 Dr. Eli Newberger, a pediatrician who examined Matthew Eappen at Children's Hospital on the day of the alleged incident with defendant Louise Woodward, testified that he firmly believed that Matthew was a victim of shaken baby syndrome.

Newberger said that the injuries the infant sustained were inflicted and that none of the injuries could have occurred accidentally. "My opinion is that this child was violently shaken for a prolonged period", Newberger said. "This shaking was to such a violent degree that it would have required as much energy as an adult could muster, sustained over a period of time up to or exceeding a minute, possibly delivered in intervals". According to Newberger, Matthew's was grim and that he would have become comatose almost immediately after the infliction of his injuries.

"There was effectively no neurological function... I believe his [Matthew's] condition was irreversible", Newberger told the jury. "I believe that on February 9 [the day the infant was removed from life support] this child was brain dead as a result of neurological trauma. My opinion is that all of the injuries are attributable to child abuse".

Defense attorney Barry Scheck challenged Newberger's theories during cross-examination. Dr. Newberger refused to change his belief that the force needed to inflict Matthew Eappen's head injuries would be the equivalent of a child falling out of a second story window onto concrete. Newberger said that Matthew's injuries occurred shortly before he arrived at the hospital. However, Newberger did admit to Scheck that he is not an expert in radiology, opthamology, or biomechanics. Much of the cross-examination exchange between Newberger and Scheck appeared confrontational, with Newberger at times accusing Scheck of distorting his testimony. And, despite his certainty that Matthew suffered from shaken baby syndrome, Newberger told Scheck that he would change his opinion if there was neuro pathological evidence that the infant suffered from head injuries weeks before his February 4 incident with Woodward.

Then, the mother of Matthew Eappen, Deborah Eappen, an opthamologist, took the stand. Deborah and her husband, Sunil Eappen, hired Louise Woodward as a nanny in November 1996. From almost the beginning, the Eappens and Woodward disagreed over whether Woodward should have a curfew. Mrs. Eappen said that Woodward complained of having to following her previous employers' curfew and that she did not want a curfew. So, the Eappens agreed to give Woodward a one-month trial period without a curfew. However, Mrs. Eappen said, the no-curfew policy did not work; frequently, Woodward would come home late at night after going out with friends and would not be able to wake up on time in the morning to care for Matthew and his brother, two-year-old Brendan.

Mrs. Eappen also claimed that Woodward would seem lazy and unresponsive to her sons. On January 28, the Eappens told Woodward that she would have to follow a curfew if she was to remain employed. Mrs. Eappen said that her baby appeared normal and healthy in the days leading up to the incident. But on the afternoon of February 4, Mrs. Eappen was paged by Woodward, who told her that Matthew was breathing abnormally.

According to Mrs. Eappen, Woodward said that the infant had been "screaming and screaming. She heard him stop crying [after leaving him alone to go into the bathroom], and when she came back, his eyes looked glazed over". Woodward allegedly told Mrs. Eappen that she had not dropped Matthew or treated him roughly. (This testimony contradicts what Woodward allegedly told police detectives.) When Mrs. Eappen saw Matthew in the hospital and examined his eyes with a special instrument, she saw extensive retinal hemorrhaging, a sign of shaken baby syndrome. "I knew what that meant", Mrs. Eappen said.

"I was shocked... I couldn't believe it". The most emotional testimony part of Deborah Eappen's testimony came when she described her son's five days in the hospital on life support and his last moments alive after being removed from life support. "We [members of the Eappen family] all took turns holding Matthew", she said. We played children's music. We lit my grandmother's candle, and we prayed...

And then Matty died". During cross-examination by defense attorney Andrew Good, Mrs. Eappen conceded that she and her husband had a generally good relationship with Woodward and that Woodward seemed in good spirits in the days leading up the incident. Mrs. Eappen also acknowledged that Woodward received a good recommendation from her previous employers. Good suggested to Mrs. Eappen that she prematurely assumed that Woodward was responsible for Matthew's injuries when she asked her about the exact chronology of the day's events leading up to the alleged shaking.

(Mrs. Eappen told Woodward that the hospital wanted to know about the events; the hospital never made such a request.) When asked whether she had misled Woodward with her questioning, Mrs. Eappen admitted, "Yes... I wanted to know how long he [Matthew] had been like that". October 16 Deborah Eappen, the mother of Matthew Eappen, returned to the stand for cross-examination by the defense. She agreed that the notes from an interview she gave to police indicated that her son was crying when she went to work the morning of February 4 (the day of the alleged shaking incident with Louise Woodward). Mrs. Eappen also testified that she had no idea that Matthew had suffered a broken wrist sometime before February 4 and that the baby never showed any signs of the injury. (The autopsy on the baby showed that he had broken his wrist a few weeks before the alleged incident with Woodward.) Defense attorney Andrew Good focused on notes Mrs. Eappen had made when she spoke to Woodward over the phone after Matthew's admission to Children's Hospital.

Mrs. Eappen knew about the extent of her son's head injury and asked Woodward to tell her about the events leading up to his hospitalization. Mrs. Eappen said that Woodward told her that Matthew had taken an unusually long nap that morning and that he had to be awakened for lunch. Woodward also allegedly told Eappen that Matthew had not fallen that afternoon and had not bumped his head on the side of the bathtub during his bath. (This contradicts prior police testimony that Woodward told investigators that Matthew accidentally hit his head on the side of the tub.) However, Mrs. Eappen said that Woodward told her that the baby had fallen over on the stairs the previous day and suggested that he may have struck his head then.

Woodward also never told Mrs. Eappen that she may have been rough with Matthew. Then the prosecution brought Kathleen Sorabella, an avid theatergoer who went to see the musical Rent 40 times during its run in Boston, to the stand. She and her husband regularly saw Woodward standing on a "rush line" for tickets to Rent. (A "rush line" is a special line in which people wait for $20 tickets to extra seats available in the first two rows of the theater.) Sorabella said that on one occasion in December 1996, she and Woodward had a conversation while they were waiting on line, and Woodward told her how much she disliked her job.

Sorabella claimed that Woodward said the Eappens were very demanding and always told her when to come home at night. Woodward also allegedly complained that the boys she cared for were spoiled and constantly cranky. She allegedly described baby Matthew as a "brat". (Sorabella approached police with this story after she had read about the Woodward case in the newspaper this past February.) During cross-examination, defense attorney Good tried to cast doubt on Sorabella's credibility by suggesting that she was a "Rent groupie" who was jealous of Woodward's social relationships with several of the musical's cast members. Good also pointed out several discrepancies between Sorabella's employment and financial history and the information she provided on an application for automobile financing. However, Good did not challenge the specifics of Sorabella's story about Woodward.

Ruhana Augustin, another English au pair and Woodward's best friend in Boston, also came to the stand. Like Woodward, Augustin came to work in the United States as a live-in nanny in June 1996. She went with Woodward to see Rent several times, and they enrolled in a drama class together. Augustin and Woodward went out together every night and had daily phone conversations. According to Augustin, Woodward had an "on again, off again" relationship with Deborah Eappen and that Woodward's biggest complaints about the Eappens was their concerns about her curfew and that they gave her too much work to do. Woodward sometimes complained that Matthew cried a lot and that the infant and his brother annoyed her.

However, Augustin said, Woodward generally liked the boys and would show her friends pictures of them. On the day of Matthew's alleged shaking, Augustin said that she and Woodward spoke on the phone for about an hour and a half. Augustin did not remember hearing Matthew crying in the background. During the evening, after the infant was hospitalized, Woodward allegedly told Augustin that she gently shook the baby after she realized something was wrong with him.

Regarding the testimony of the previous witness Sorabella, Augustin remembered meeting her on the "rush lines". But she did not recall overhearing Woodward talk to Sorabella about her job and the Eappens. Woodward's previous employer, Harris Komishane, testified that he and his wife had hired Woodward to take care of their child when she first came to Massachusetts. Although Komishane was initially concerned about Woodward's lack of experience and confidence in handling his baby, he said that she improved and did a good job. However, the Komishanes' 11 p.m. curfew on Woodward was the reason she left them. Woodward complained that curfew did not allow her to enjoy Boston night life.

(And the Komishanes lived too far from Boston for Woodward to commute conveniently to and from home.) The final witness prosecutors called was Sunil Eappen, an anesthesiologist and father of Matthew Eappen. He mirrored his wife's account of their battles with Woodward over her curfew. "I can't remember a single evening when she [Woodward] was home", Mr. Eappen said. "The mornings after were a problem".

(The Eappens claimed that Woodward's inability to get up to care for their children the morning after a late night out was a constant problem.) Mr. Eappen said that Matthew was behaving normally in the days leading up to the February 4 incident. He tearfully described the day he received the phone call at work telling him that his son was in the hospital. Then, the father slowly described the moment he and his wife decided to take Matthew off life support. "We prayed, got communion, and we decided we'd all hold Matthew", Mr. Eappen said. "And we stopped the ventilator, and just held him. Matthew died while I was holding him".

Mr. Eappen also claimed that he did not know about Matthew's broken wrist that apparently occurred weeks before the shaking. The prosecution rested its case with Sunil Eappen's testimony. The defense will begin presenting its case the next morning Louise Woodward's defense began to present her case today by bringing various character witnesses to the stand. Two of Woodward's former teachers from England said that Woodward was a good student, recognized by her peers as honest and non-violent. In addition, a former assistant at the Children's Museum in Boston (where Woodward sometimes volunteered) said that the defendant was enthusiastic and showed patience while working with children. All these character witnesses characterized Woodward as a gentle, responsible person who could not have caused the head injuries that led to Matthew Eappen's death.

Until today, jurors had seen only the prosecution's portrait of Woodward as a disgruntled teen nanny who was not as responsible as she should have been towards the Eappen boys. According to prosecutors, Woodward was only interested participating in Boston night life. The defense, however, tried to give jurors a different picture. After the testimony of the character witnesses, defense attorney Barry Scheck called forensic neuropathologist Jan Leestma to the stand. Dr. Leestma said that the infant did not die from injuries the prosecution says came from shaken baby impact syndrome.

Describing microscopic photos of Matthew's brain, he testified that the baby suffered from a head injury approximately three weeks before the alleged shaking incident with Woodward on February 4 and that he died from those prior injuries. Dr. Leestma believed that the prior head injury went unnoticed and began to spontaneously bleed within the brain. This led to the formation of the subdural hematoma which put pressure on Matthew's brain. According to Dr. Leestma, this pressure caused Matthew's restless and subsequent comatose state on February 4. Dr. Leestma testified that the alleged shaking incident "did not happen". He said that Matthew's prior injury could have been inflicted but also could have occurred accidentally.

Dr. Leestma also said the infant's skull fracture and subdural hematoma could have resulted from a fall of only 32 inches (as opposed to the prosecution's estimate of 15 feet). During a lengthy cross-examination, prosecutor Martha Coakley tried to refute Dr. Leestma's theories. Coakley asked Dr. Leestma about Matthew's retinal hemorrhages, which is a symptom of shaken baby syndrome. The doctor claimed that the hemorrhages did not change his opinion that the baby's injuries did not come from violent shaking. But, Dr. Leestma said, he had discovered no evidence suggesting the presence of retinal hemorrhaging prior to the alleged shaking incident. Coakley also questioned Dr. Leestma's expertise in child abuse cases.

The doctor admitted that as a neurologist, he has dealt mostly with the tissues of corpses, not living children, and that he is not an expert in biomechanics. Dr. Leestma also admitted to the prosecution that the facts of the Eappen case, as first presented to him, resembled a child abuse case. Under careful prosecution questioning, Dr. Leestma insisted that he had seen and read about cases of children suffering head injuries similar to Matthew Eappen from falls of only three feet. However, the doctor could not specifically name these cases.

Dr. Leestma also conceded that he had never seen or read about other cases where a child suffered retinal hemorrhages from a falls of two or three feet. Dr. Leestma was scheduled to return the stand when testimony resumes Monday, Oct. 20. October 20 Under heavy questioning by prosecutor Martha Coakley, forensic neuropathologist Dr. Jan Leestma continued to defend his position for the defense that Matthew Eappen did not die from injuries caused by shaken baby syndrome. Instead, Dr. Leestma again told the jury, the baby died from the delayed effects of a head injury he suffered three weeks before his death.

(Dr. Leestma said that he could not tell whether the prior injury was accidental or inflicted.) However, in contrast to his testimony on October 17, Dr. Leestma said he could not determine for sure whether the baby's fatal injury was caused by violent shaking. Despite his hesitancy to completely rule out violent shaking, the doctor refused to concede that the infant could have been shaken for even as long as only 20 seconds. Dr. Leestma also believed that it possible for Matthew to not show any signs of his prior head injury before his hospitalization on February 4. Prosecutor Coakley tried to undermine the doctor's theory by saying that his published writings on infant head trauma contradicted his verbal testimony.

The doctor, however, responded that he probably had not stated his theories as well as he should have in his writings. Regarding the retinal hemorrhaging found in Matthew's eyes, Dr. Leestma said that it was caused by a sudden increase in intercranial pressure induced by a rebleeding of the prior head injury, not by violent shaking. (The prosecution claims that the retinal hemorrhaging indicates that Matthew was a victim of shaken baby syndrome.) The defense also brought two more character witnesses to the stand who said that Louise Woodward had a reputation as a law-abiding citizen and generally enjoyed working with children. Testimony today ended with a defense neuro radiologist and head trauma expert, Dr. Alisa Gean, testifying that she could not find evidence that Matthew was a victim of shaken baby impact syndrome.

Dr. Gean based her opinion on that fact that she did not observe any swelling of Matthew's soft scalp tissue at the time of his hospitalization. (A swelling of soft scalp tissue and broken blood vessels are two signs of a recent skull fracture.) According to Dr. Gean, this lack of swelling indicates that the baby's injury could not have been inflicted, as the prosecution claims. Dr. Gean testified that Matthew had suffered a head injury weeks before his admission into Children's Hospital. His condition was caused by pressure on his brain, which was caused by a rebleeding of the prior injury.

Dr. Gean also told the jury that the effects of a head injury on an infant can go unnoticed for several weeks. She also supported Dr. Leestma's earlier testimony about the cause of retinal hemorrhaging in the infant's eyes. Dr. Gean ended her testimony by telling jurors that the clear fluid that doctors observed in Matthew's brain during his surgery was not spinal fluid. Rather, Dr. Gean said, the fluid was really layered remnants of old blood from the baby's prior head injury. Dr. Gean will return to the stand for cross-examination by the prosecution the next day. October 21 Dr. Alisa Gean returned to the stand for cross-examination by the prosecution.

Dr. Gean maintained her theory that Matthew Eappen died from the effects of a head injury he apparently suffered three weeks before the alleged shaking incident with Louise Woodward. According to Dr. Gean, Matthew suffered a skull fracture and subdural hematoma after falling about 32 inches. The baby died from intercranial pressure caused by a rebleeding of the prior injury. Dr. Gean also said that rebleeding in the brain occurs more easily in babies than adults and adolescents. In addition, she told the court that the characteristics of the brain membrane one would indicate a chronic hematoma in Matthew can be easily overlooked during visual examinations. Therefore, Dr. Gean contended, the brain membrane may have been overlooked during the Matthew's emergency surgery on February 4, and the doctors may not have realized that he had suffered a prior head injury.

However, Dr. Gean conceded to prosecutor Martha Coakley that the infant indeed could have been shaken at one point before or on February 4. However, Dr. Gean did not believe the baby's injury came from shaking. Dr. Gean also admitted having no opinion on whether Matthew's injury was accidental or inflicted. Nonetheless, in her medical analysis on Matthew's injury before the trial, Dr. Gean had written that the presence of retinal hemorrhaging left little question about "malicious intent". (The doctor had testified that the retinal hemorrhaging was caused by intercranial pressure, not violent shaking.) When confronted about this contradiction, Dr. Gean said she would have written her medical analysis differently and not insinuated that the injury was inflicted. Dr. Gean admitted that a chronic hematoma can be confused with a recent hematoma but insisted that that mistake did not happen in Matthew Eappen's case.

Then biomechanics expert Dr. Lawrence Thibault took the stand for the defense. A former Chief of the Department of Bio-Engineering at the University of Pennsylvania, Dr. Thibault is the co-author of a 1987 study on shaken baby syndrome (which other witnesses have widely referred to during this trial). He further supported the defense's theory that Matthew's fatal head injury was pre-existing. Dr. Thibault did not think that shaking caused the baby's injury. Rather, the injury could have come from a fall of about 32 inches, not 15 feet like the prosecution originally contended. Dr. Thibault testified that the baby did not have the injuries to his neck and spine injuries that would be present in victims of shaken baby syndrome.

The doctor also dismissed the prosecution's claim the retinal hemorrhaging found in Matthew's eyes came from the back-and-forth movement of the eyeballs within the eye sockets during violent shaking. Dr. Thibault believes that this was not possible. The space between the eyeballs and their sockets are too densely packed with muscle and other tissue to allow such back and forth movement. "The eyeballs couldn't get to the sockets", Dr. Thibault said. "There is no slamming against the orbit". When asked about the broken wrist that the autopsy reports showed the baby suffered shortly before his death, Dr. Thibault said that it was possible that Matthew could have fractured his skull when he broke his wrist.

The doctor explained to the court how Matthew could have fallen and simultaneously fractured his skull and wrist. October 22 Susan Woodward, the mother of the defendant Louise Woodward, came to the stand. She testified that Louise was the eldest among her siblings and cousins back in her home in England, and Louise often had to look after her younger cousins. Louise seemed so responsible that her mother said that she did not feel a need to impose a curfew on her daughter back home. Mrs. Woodward visited her daughter in Boston in December 1996 and said that Louise seemed happy with the Eappens. Mrs. Woodward also said that Matthew Eappen was a beautiful child who seemed normal and healthy.

She did not see Matthew fall at anytime during her visit with Louise and did not see him mistreated in any way. Mrs. Woodward testified that when Matthew was not being held or sleeping in his crib, he normally sat in a "bouncy chair". Mrs. Woodward also said that Matthew's two-year-old brother Brendan played with him while he sat in the bouncy chair. (The defense has not officially accused Brendan of causing Matthew's injuries in court. Defense lawyers so far have only hinted at Brendan's possible aggression during cross-examination on Matthew's mother, Deborah Eappen.) Under cross-examination, Mrs. Woodward admitted that Louise never talked to her about any problems she had with the Eappens, particularly the meeting in which the Eappens gave her an ultimatum (to either start adhering to a curfew or find another place of employment). Mrs. Woodward also said that she told her daughter that she was lucky to work for a family as nice as the Eappens.

The defense also brought two more experts to the stand, neurosurgeon Ayu b Ommaya and pediatric neurosurgeon Ronald Uscinski. Both Dr. Ommaya and Dr. Uscinski testified that Matthew's fatal head injury originally occurred about three weeks before the alleged February 4 shaking incident with Louise Woodward. Both doctors also further supported the defense's theory that Matthew's injury was not caused by shaking. Mirroring previous testimony, the doctors said Matthew did not have the neck injuries indicative of shaken baby impact syndrome. And Matthew's retinal hemorrhaging was caused by intercranial pressure on his brain, not violent shaking.

Dr. Ommaya and Dr. Uscinski also noted that a clear yellow fluid that was present in Matthew's brain during emergency surgery was older blood from the infant's three-week-old injury. The blood had lost its color and indicated that the injury had re bled since its original occurrence. During cross-examination by the prosecution, both doctors had to defend the basis of their theories. Prosecutor Martha Coakley asked Dr. Ommaya about his original contention back in July, that Matthew's injury had occurred only 48 to 72 hours before his hospitalization. Dr. Ommaya denied ever limiting the age of the injury to 72 hours; he said that, based on the evidence he had at the time, he only knew that Matthew's subdural hematoma was an old injury. Dr. Ommaya also said that he did not base his theory about the infant's death solely on research and medical slides of previous defense witness Dr. Jan Leestma but on other findings as well.

Prosecutor Coakley challenged Dr. Uscinski's ability to recognize shaken baby syndrome, saying that its characteristics suggest child abuse. However, Dr. Uscinski refuted this argument, claiming that the characteristics of shaken baby syndrome are "consistent with" but not "diagnostic of" child abuse. The doctor said that signs of shaken baby syndrome are the same in both accidents and instances of child abuse. Dr. Uscinski ended his testimony by saying that an increase in intercranial pressure from Matthew's prior head injury eventually cut off the flow of oxygen-rich blood to his brain. The infant's body shut down, and he died. October 23 Forensic pathology expert Michael Baden further supported the defense's theory that Matthew Eappen's fatal head injury originally occurred three weeks before the alleged shaking incident with Louise Woodward.

Dr. Baden said that the baby did not die from a recent injury inflicted by violent shaking; rather, the infant succumbed to complications from a chronic subdural hematoma caused by a prior head injury. During cross-examination by the prosecution, Dr. Baden was confronted with the fact that his original opinion at the beginning of the case was that Matthew's injury had occurred between 12 and 48 hours before his hospitalization on February 4. However, the doctor replied his opinion was preliminary at that point and later evidence made him revise his original theory about Matthew's death. Then, in a highly anticipated moment, the defendant Louise Woodward came to the stand. Woodward began her testimony by describing her life back in England and how she had joined an au pair (live-in nanny) program so that she could be exposed to American culture. Almost immediately after Woodard began her testimony, her lawyer, Andrew Good, asked her whether she had ever shaken, struck, or dropped Matthew Eappen.

Woodward quietly denied that had ever happened. Woodward proceeded to claim that her relationship with her first live-in family, the Komishanes, was a good one and that the Komishanes thought that she took good care of their children. The only gripe Woodward had with her first employers was that they imposed a curfew on her. This, and the fact that the Komishanes lived far away from the Boston area, restricted Woodward's ability to enjoy Boston theatre and nightlife. Woodward eventually sought employment with another family, and in November 1996, she started working for the Eappens.

In the beginning, Woodward asked the Eappens not to impose a curfew on her. (Woodward had never experienced a curfew back home in England, and she felt her social life would not interfere with her responsibilities as a nanny.) The Eappens agreed to a one-month trial period without a curfew. However, Woodward acknowledged that the arrangement did not work out because of her failure to wake up in time in the morning to care for the children. The most emotional testimony of the day came when Louise Woodward described the day Matthew was hospitalized. Woodward said that the day before his hospitalization, the baby had not moved his bowels at all, and his mother, Dr. Deborah Eappen, had instructed Woodward to feed him fluids.

On February 4, Woodward said that Matthew did not seem to be himself. When Woodward awoke that morning, Matthew was crying. The baby was still crying as his mother left for work that morning. According to Woodward, Matthew remained uncomfortable, crying incessantly. He refused to eat anything. Woodward then said that she decided to give Matthew a bath.

She described how she prepared his bath, and placed him on his back on a towel on the bathroom floor to undress him. Woodward said that Matthew did not strike his head at any time during his bath. However, the bath did not soothe Matthew. Woodward then said she placed Matthew in his crib. After talking with her friend and fellow nanny Ruhana Augustin, Woodward checked on Matthew in his crib. She tearfully testified that the baby seemed unresponsive, his breathing sporadic and his eyes glazed.

"He didn't look right... he was off-color, [turning] kind of blue", Woodward said between tears. Woodward admitted that she panicked, yelled Matthew's name and shook him slightly to see if he would respond to her. The baby also vomited on Woodward. Despite Woodward's actions, Matthew remained somewhat unresponsive. Woodward said she frantically (and unsuccessfully) tried to reach the Eappens before she called 911.

Soon after the call to police, Woodward finally reached Mrs. Eappen and told her about Matthew's condition. According to Woodward, Mrs. Eappen asked her whether Matthew had struck his head at any time in the past two days. Woodward said that Matthew may have hit his head on the stairway the previous day. (Woodward said that she was tending to Matthew's brother Brendan when Matthew tumbled while her back was turned.

Because, Woodward did not actually see him fall, she was not completely sure that Matthew had struck his head. That was only her speculation.) Woodward denied telling police that she had been rough with Matthew. The nanny claimed that she told them that because Matthew was crying during his bath and she was rushing to finish his bath, she may not have been as "gentle as I could have been" with the infant. Woodward concluded her direct examination by her attorney by reiterating that she never hit or slammed Matthew against a hard surface. Prosecutor Gerard Leone, Jr. began his cross-examination of Louise Woodward late in the day and asked her about her motivation to become involved in the au pair program. Leone also asked Woodward about her decision to become the Eappens' nanny and about Brendan Eappen's interaction with his younger brother..