Defense disputes timing of toddler's fatal head injury

A forensic pathologist for the defense disputed state expert witnesses Monday that said 17-month-old Kamryn Schlitter suffered two possible head injuries, one older and one more recent, and the timing of her injuries.

Dr. Peter Stephens, a former pathologist who practiced in Cedar Rapids from 1985 to 1995 and also a former deputy state medical examiner, said there was no way to determine if there were two different bleeds from looking at the pathologists' reports in this case. Stephens agreed Kamryn's head trauma caused a sub dural hematoma but said it could have been 24-48 hours old.

The timing of the injury is crucial to Amy Parmer, who is charged with first-degree murder in Kamryn's death March 28, 2010. Stephens, testifying for the defense, disputed earlier testimony from at least, three doctors who testified for the state, claiming the recent injury occurred within hours to days of when Parmer called 911 for the toddler on March 21, 2010.

Parmer was taking care of Kamryn that night from about 5 to 7:30 p.m. when the toddler became unresponsive and started posturing – involuntary contraction of the limbs, according to testimony.

Parmer, 29, of Hiawatha, charged with first-degree murder and child endangerment resulting in death, is accused of inflicting the physical abuse of Kamryn, along with Schlitter, 25, of Cedar Rapids, who was convicted in her death last December and is serving 50 years in prison.

Parmer will take the stand 9 a.m. Tuesday in her own defense. The trial may wrap up at the end of the week.

Stephens directly disputed Dr. Gary Baumbach, a pathologist with UI Hospitals and Clinics in Iowa City, who testified last week. Baumbach claimed the recent injury could have occurred within 12-24 hours of Kamryn's brain surgery March 21, 2010.

Baumbach said there was evidence of an older bleed that could have been weeks to months old and a more recent one occurred within 12-24 hours. He said there was evidence the red blood cells hadn't broken down, which indicates it was an “acute event” or recent one.  If it was longer than 24 hours, there would be fibroblast cells in the sub dural hematoma, that starts healing the clot, but those were missing, Baumbach said.

Stephens said it wasn't possible to say if there was fresh or recent bleed. There is evidence of a breakdown in the blood, which indicates the injury could be 24-48 hours old but it's impossible to age a bleeding as less than 12 hours according to literature regarding this kind of injury. He suggested this could have been a re-bleeding, which would be part of an original bleed.

Stephens said Baumbach's report was incomplete because he only had a small sample from the clot.

On cross, Stephens admitted he couldn't say with certainty that there wasn't two bleeding events but then said the recent one could have been the result of the surgery.

First Assistant Linn County Attorney Nick Maybanks asked Stephens if in his deposition didn't he sayd there could be a mixture of two events.

“I should have said there could be,” Stephens said.

In deposition, Stephens said the recent bleed caused Kamryn's collapse, Maybanks said.

“Yes, it's a possibility,” Stephens said.

Maybanks then asked in order to have a re-bleeding, wouldn't the blood have to come from blood vessels but none of the doctors said there was evidence of that.

Stephens agreed there was no evidence.

Stephens on re-direct confirmed the injury was 2 to 3 days old and there's no way to determine two injuries.

Earlier in the day, Tyler Johnston, Parmer's attorney, again renewed his motion for mistrial based on a discovery violation, claiming his medical experts were at a disadvantage because Baumbach changed his testimony from his deposition and Zyriah Schlitter's trial. He claimed the state didn't give him that information.

According to his testimony, Baumbach changed the timing of the injury to 12-24 hours based on additional reading and research he did on brain hemorrhages.

Maybanks argued the state didn't commit a discovery violation. Baumbach didn't change his opinion. He always referenced the possibility of two bleeding events. He did clarify the 12-24 hour window in this trial.

Sixth Judicial District Judge Marsha Beckelman said the defense witnesses were allowed to go down last Friday and talk to Baumbach and look at his slides of the brain injury and bleeding.

“There has been an incredible amount of medical evidence in this case and differing opinions,” Beckelman said. “The state asked Dr. Baumbach if he changed his opinion and he said he didn't.”

Beckelman said it will be up to the jury to determine the credibility of the experts, just like the other witnesses. She didn't believe the state had committed any wrongdoing and denied the motion.

Beckelman also denied the defense's motion for a direct verdict of acquittal.