Opinion ID: 2518344
Heading Depth: 1
Heading Rank: 2

Heading: Testimony of Dr. James Ribe

Text: Dr. James Ribe, a senior deputy medical examiner in the Los Angeles County Coroner's Office and the forensic pathologist who performed the autopsy, testified that the cause of death was head trauma. He observed a very large subdural hematoma, which was caused by a violent rotational movement of Adriana's head, probably in a front-to-back, back-to-front direction. He also noted hemorrhaging of the optic nerve sheaths and the retina as well as a spinal cord contusion, both of which are suggestive of shaken-baby syndrome. The sub-arachnoid hemorrhage was caused by a combination of shaking and the violent impact of the back of Adriana's head against a hard, flat surface. The contrecoup contusion above her right eye suggested a fall from a great height or a forcible impact of the back of her head against a hard surface. The length and scope of the skull fractures, as well as indentations in Adriana's skull, indicated a tremendous amount of force must have been used, akin to an auto accident or a fall from the third story of a building. These injuries were probably inflicted by throwing, slamming, or swinging the back of Adriana's head against something hard. Dr. Ribe opined that these injuries were inflicted in a few seconds and that Adriana lost consciousness [e]ssentially instantaneously thereafter. Her eyes would have rolled back. The vomiting could have happened right away or have been delayed 30 to 60 minutes. A seizure immediately following or within minutes was possible. Adriana would have been in a devastated condition from the moment she received these injuries and would not have been able to eat, talk, or walk, nor would she have drifted in and out of consciousness. Without medical attention, she would have survived no more than two hours. Ribe also reviewed the CT scan, which was performed at 12:46 p.m. on the day Adriana was admitted to the hospital. Although the CT scan by itself might support the inference that the injuries were inflicted four or more hours earlier, the pathologic findings confirmed that the injuries must have been inflicted more recently.