AUBURN — Several doctors testified Thursday that the likely cause of 2-month-old Harper Averill’s injuries and resulting death in 2020 was nonaccidental trauma, although defense attorneys challenged their conclusions.
An intensive care pediatrician at Barbara Bush Children’s Hospital in Portland and the chief medical examiner who consulted on the child’s autopsy were on the witness stand in Androscoggin County Superior Court on the third day of the murder and manslaughter trial of the infant’s father, Trevor Averill, 31, of Buckfield.
The 2-month-old died July 26, 2020, at Maine Medical Center in Portland, four days after an Androscoggin County Sheriff’s deputy responded to the Averills’ home for a report of a 2-month-old in medical distress. Averill told investigators he was awakened after midnight on July 22, 2020, to the cries of his hungry daughter. He took her out of her sleeping area and fed her from a bottle. When he rose her to his chest for burping, she began gagging and stopped breathing.
Deputies and rescue personnel performed life-saving measures before she was transported to Central Maine Medical Center in Lewiston, then flown to the Portland hospital.
At the trial Tuesday, defense attorney James Howaniec said Averill admitted to doctors that he had dropped his daughter while getting up from a couch about a month before.
Dr. Amanda Brownell, a pediatrician specializing in child abuse, said Thursday that Harper arrived at Maine Medical Center hypoxic, a condition in which a person lacks enough oxygen for the body to function, and likely due to a brain stem injury.
Defense attorney Verne Paradie challenged Brownell’s conclusion, asking if it was also possible the infant’s initial distress of aspiration of formula led to hypoxia.
“Yes,” Brownell said. “But it wouldn’t account for other injuries.”
Pediatric Intensive Care Unit Dr. Jillian Gregory said Harper was not responding to stimuli when she examined her. Though her heart rate was regular, her fontanelle, a soft spot on the skull where the bones meet, was bulging, indicating head trauma.
Gregory said overall, the infant suffered a range of ailments, including brain injury leading to subdural hemorrhage, where blood pools between the brain and skull; subarachnoid hemorrhage, where blood leaks between the brain and the membrane covering it; retinal hemorrhage; too much carbon dioxide in the blood; and acute respiratory failure with lack of oxygen.
“She wouldn’t be able to eat or breathe on her own,” Gregory said.
As a result of her team’s examinations and experts weighing in on the symptoms, Gregory’s final report listed nonaccidental trauma as the likely cause of Harper’s death. Gregory notified police and the Department of Health and Human Services.
Dr. Kenneth Mendelsohn, a radiologist at the Barbara Bush Children’s Hospital, which is part of Maine Medical Center, said his imaging of the injuries also discovered collapsed portions of the infant’s lungs, most likely due to awkward placement of the endotracheal tube to help her breathe. He said that while a rib fracture likely occurred sometime before the incident, he suspected that the cranial fracture was due to nonaccidental trauma.
Defense attorney Howaniec questioned how doctors could consider all the infant’s internal injuries as nonaccidental when there were no signs of external injuries to account for them.
“Did you see any external injuries due to nonaccidental trauma?” Howaniec asked.
“I don’t recall,” Gregory responded.
Brownell agreed that the type of rib fracture the infant suffered was not necessarily due to child abuse, and the condition suggested it occurred before the July 22 incident. She also said it was difficult to determine if the skull fracture happened near July 22, the date of the incident, or sometime before.
Vermont Chief Medical Examiner Dr. Elizabeth Bundock, a consultant in the autopsy, also agreed with the state’s witnesses that “numerous findings (were) consistent with nonaccidental trauma.”
In addition to the injuries Gregory mentioned, the infant also had a subdural hemorrhage along her spinal cord and ruptured bridging veins in her brain. There were signs of acute bleeding in the brain as well as chronic bleeding, or bleeding from a prior event, she said.
Bundock said the skull fracture showed signs of early healing, but the dropping incident likely happened much closer to July 22, 2020, than Trevor Averill shared with doctors.
“Taking everything into context, all of these things together can only be caused by trauma,” Bundock said.
Paradie asked if the dropping incident could have caused a skull fracture and brain bleed, which would explain the chronic bleeding found in the autopsy.
Bundock said it could.
He then questioned whether a nontraumatic injury, such as choking on formula, could have triggered an existing clot to burst, causing the cascade of ailments that led to her death.
Bundock acknowledged that prolonged oxygen deprivation — 10 to 15 minutes as first responders and CMMC reported — could cause brain swelling, which could cause a clot to burst.
Justice Jennifer Archer is presiding over the trial, with Assistant Attorneys General Suzanne Russell and Lisa Bogue as prosecutors.
The trial continues Friday and is expected to last into next week.
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