Experts disagree on timing of injuries
Defense: child may have suffered fatal wounds earlier
BY JENNIFER AMATO Staff Writer
Although experts called by the prosecution and defense agree that 3- year-old Nikolas Chavez was killed by blunt force trauma injuries during a homicide in November 2005, they disagreed about the time those injuries were inflicted upon the boy.

Nikolas Chavez

Frederick DiCarlo, an assistant medical examiner in Middlesex County, testified last week that the North Brunswick boy was beaten to death the morning of Nov. 30 by the child's mother's fiancé, Robert Knutsen, who is on trial for aggravated manslaughter in Superior Court in New Brunswick. DiCarlo conducted an autopsy on Dec. 1, 2005, with a complete external exam and X-rays done before the incisions.

"When I first saw Nikolas, I opened up the body bag and was struck by how pale he was," DiCarlo told the jury. "Either he naturally had a very pale complexion or he had bled out or he had suffered hemorrhage."

He said the only external bruises were from livitity, which is when the blood drains out of the body after death. He said there were no bruises on his back, such as a small bump located there a few days before after the boy fell in his mother's bathroom, except for two parallel postmortem marks. Although he believes the boy was hit somehow in the stomach and in the back, because the abdomen does not have any bony support, the injury would occur to the muscles of the back and would not bruise externally.

DiCarlo said he found 550 milliliters of blood in Nikolas' abdominal cavity, which is a little more than a half-quart, where there should be no blood except for that which normally travels throughout the body. He said that losing so much blood causes hemorrhagic shock, which is when not enough oxygen is delivered to the organs. Eventually unconsciousness and death will occur.

DiCarlo also focused on the intestinal hemorrhage in the mesentery, which is the fibrous tissue that holds the intestines in place. He said these injuries were caused by blunt force trauma which caused the mesentery to be crushed as it moved up against the abdominal wall. The jury was shown several pictures from the autopsy that depicted bleeding near the kidneys, the adrenal glands and the psoas muscle.

DiCarlo also found a fracture in the second and third lumbar vertebrae on the boy's back, with no other fracture to the spine. He testified that since this was a transverse, or horizontal fracture, if the boy tried to stand up, the pressure of the fracture moving back and forth would cause excruciating pain.

"What I saw was a fresh bruise, or contusion, and a hemorrhage … in the muscle underlying the skin in that area," he said. "I now know that this is going to be a homicide. This child died from inflicted injuries. The child was at home. These are not injuries [from a slight fall] … these are severe injuries."

Another note made by DiCarlo was the fact that four to six hours after an injury, red blood cells are the only cells apparent. After that time, a few white blood cells will begin the healing process, with those white cells becoming more prevalent by the 12-hour mark. He said from one to two days afterward, the white cells will reach their peak and then begin to leave as the injuries heal. DiCarlo said he only found red blood cells in Nikolas.

"Given the pathological findings and the clinical findings, approximately an hour or a half-hour before found unresponsive, that was when Nikolas suffered his injury," the medical examiner said. He denied the injuries were caused by a seizure since no lesions were found on the brain, or by 45 minutes of CPR because there were no injuries to his ribs, or because of a bleeding disorder, which would not allow the boy to clot properly. During expert testimony, all three were suggested as factors related to his death.

Renowned investigator doubts

prosecution's findings

Although Knutsen claimed during his call to police that the child was suffering from a seizure, DiCarlo believes that is highly unlikely. Yet Michael Baden, the chief medical examiner for the New York State police and an investigator for the HBO show "Autopsy," testified for the defense that the injuries that caused the child's death could have occurred up to three days prior. He agreed that homicide was the likely cause of death, but neither he nor the defense speculated on who else may have been responsible.

Baden contested that the slip in the bathroom was enough of an impact to fracture the vertebrae without causing too much pain since the spinal cord was still intact, and enough to cause the boy to start bleeding internally, which would coincide with Knutsen's claim that the boy's stomach was hard the night before he died.

"This child could have had this fracture a number of days with nobody noticing it or any signs of paralysis," he said.

Baden said he thinks the abdominal injuries were suffered about 24 hours before the child's death. He said any internal bleeding would irritate the abdominal cavity, and any clots that would form would be aggravated by any type of movement - whether by the boy's diaper being changed, Knutsen picking the child up to snap him out of the seizure or by the administering of CPR - and cause the clots to become distorted.

"The injuries to the abdomen under the microscope show no significant injuries to the blood vessels," he said, stating that the bleeding had to have occurred very slowly.

Baden also disagreed with the freshness of the injuries, stating that although DiCarlo did a "wonderful" autopsy, if he did histological samples of the exterior of a wound, the slides would show fresh blood cells, whereas the middle of an injury site may not receive aid for weeks or months. Also in relation to the blood, Baden said that DiCarlo only tested for iron in the back injuries and not in the abdomen. He said that two to four days after an injury, red blood cells break apart and release iron, and that the test samples from the child's back showed the very beginning of iron formation.

However, called as a rebuttal witness by the prosecution on Tuesday, DiCarlo noted that the iron found in the boy's back injuries was minimal, possibly from an older injury in the same area because iron is not released until eight days after an injury is sustained. He said Nikolas' hemorrhages were "fresh."

In addition, Baden spoke about the boy's gastric contents, which were about three ounces of food from the night before. Baden said it takes about three hours for digestion, so since there was food found in his stomach the digestion had to have stopped the night before, most likely because of irritation to the abdominal cavity.

Defense attorney Robert Honecker once again alleged that the investigators involved with the case completed an incomplete diagnosis, as they did not interview everyone who had been with Nikolas in the days preceding his death before coming to conclusion that Knutsen was responsible, especially based on Baden's revelations.

However, assistant prosecutor Seana Pappas informed the jury that Baden's wife was once Honecker's boss in Monmouth County, and that Baden was paid a reduced fee for his appearance in this trial.

"Do you want us to believe through all this, including [the pediatrician's visit], that the baby had a broken back and bled to death from blunt force trauma injuries?" Pappas asked Baden as her final question.

He replied that the reason for autopsies is because doctors make mistakes.

The case is expected to go before the jury this week.