Opinion ID: 1057682
Heading Depth: 1
Heading Rank: 9

Heading: Testimony of Dr. Lori Nunley

Text: Dr. Lori Nunley, a pediatric emergency room physician at Children's Hospital, saw S.H. shortly after the full-body x-rays. She described S.H.'s right lower leg [as] very swollen and observed pink, purple, purple-blue bruising. There was also evidence of bruising on the sole of S.H.'s right foot, especially on her great toe, and S.H.'s left lower leg was tender to the touch. Dr. Nunley admitted that it was very difficult to measure pain in a two-month-old child. It was her opinion, however, that fractures of the type S.H. received would cause extreme pain with normal movement. After studying the x-rays, Dr. Nunley, like the other doctors, identified six leg fractures  four on the right leg and two on the left leg  and nine rib fractures. She testified that the leg fractures were corner or bucket-handle types, which are considered to be exclusively [the result of] child abuse. It was her opinion that the fractures were caused by extreme torque-ing action, extreme rotation motion, or the result of S.H. being flail[ed] back and forth violently.... Because the fractures occurred on both sides of the bone, it was her conclusion that the fractures would have to be the result of a hard torque or a rapid flail rather than, as Dr. Roberts had suggested as one possibility, a yank[ing] action. In partial contradiction of Dr. Roberts' testimony, Dr. Nunley opined that corner fractures could be the result of violent shaking, but she also pointed out that a subsequent evaluation by an ophthalmologist indicated an absence of retinal hemorrhages in S.H., which are typically associated with shaken infants. Dr. Nunley specifically observed that the fractures were not consistent with someone falling down when carrying the baby, even if the adult fell on top of the baby. She described the leg fractures as absolutely not the result of an adult lifting S.H.'s legs when changing her diaper. When asked if the fractures could have been caused by an adult picking S.H. up by her legs, Dr. Nunley replied that only forceful twisting accompanied by the lifting of the child could produce such a result. She stated that the pattern of fractures did not suggest brittle bone disease. Her diagnosis was that S.H. was physically abused. Dr. Nunley echoed Dr. Roberts' conclusion as to the cause of S.H.'s rib fractures, stating that an adult squeezing with a lot of force was the only [plausible] explanation. Dr. Nunley found a small, fading bruise on S.H.'s chest, roughly the size of a pinky fingernail; however, she found no indication of pain from the chest.