Injury to eyes the focus as testimony continues in Gipfert trial

On day three of the State of Nebraska vs. Nancy Gipfert, an expert witness explained the injuries to the alleged victim’s eyes and those who saw the infant in the days and weeks before the incident testified to his prior state.

Gipfert is charged with one count of child abuse causing serious bodily injury, a felony for her alleged part in the incidences leading up the hospitalization of an infant who was in her care prior to suffering seizures and brain injury.

Two months old at the time, the alleged victim suffered a subarachnoid hemorrhage and subdural hematoma, as well as retinal hemorrhages, according to earlier testimony. A subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissue that covers the brain and a subdural hematoma is a collection of blood on the brain, according to the National Library of Medicine.

The state’s first witness on Friday was Dr. Justin Cohen, a pediatric opthamologist out of Denver. Retinal hemorrhages occur when the blood vessels in the eye lose integrity and blood spills into the eye, Cohen explained. The retina has many layers and different patterns of hemorrhages in various layers indicate different causes of injury, he said.

Cohen was on call for consultation at Rocky Mountain Hospital for Children during the time the alleged victim was treated there. The infant was hospitalized there following a trip to the Emergency Room in Sidney on Sept. 13, 2011 where he suffered a seizure. Dr. Cohen examined the infant two days after the boy arrived at the hospital in Denver.

“He did have, at the time, bilateral retinal hemorrhages,” Cohen said.

The bleeding was much more severe in the left eye than the right, he added.

Photos taken of the boy’s eyes with a retinal camera were shown to the jury. This camera captures around 70-80 percent of the inside of the eye. The doctor identified areas of what he called significant pre-retinal hemorrhages in the infant’s left eye in two sets of photos taken at the hospital. These sorts of hemorrhages are commonly found with more severe trauma, he said. He identified some of the injuries to the jury as the photo of the left eye was displayed.

“What you see here are numerous hemorrhages,” Cohen said. “They’re fairly widespread.”

Michael Guinan, representing the prosecution, asked why Dr. Cutright who initially examined the infant in Sidney didn’t find these hemorrhages. Cutright used a direct ophthalmoscope, which views about 10 percent of the inside of the eye, while Cohen used an indirect one, which views about 70-80 percent of the inside of the eye, he said.

Cohen acknowledged that birth could cause retinal hemorrhages, but usually resolves within one to five days. Cohen shared his opinion about what caused the injuries to the boy’s eyes.

“It’s strongly suggestive of non-accidental trauma,” Cohen said.

The nature of the hemorrhages, the fact that they’re widespread, coupled with the bleeding in the infant’s brain led him to these conclusions, he said.

Cohen confirmed that retinal hemorrhages can be caused by intracranial pressure, but said there were no signs that in this particular infant the pressure in his skull affected his eyes.

If the pressure caused damage to the boy’s eyes, his optic nerve would be swollen and the pressure would cause splinter hemorrhages directly around the optic nerve, he said. Cohen saw signs of neither of these.

“Widespread, multilayer hemorrhages are just not seen with increased pressure,” Cohen said.

Cohen admitted that no one knows for sure what causes hemorrhages in non-accidental trauma.

During cross examination, Don Miller, representing the defense, asked if it’s true that retinal hemorrhages can’t be dated. Cohen confirmed this.

Cohen listed many other possible causes for retinal hemorrhages at the defense’s request, including high blood pressure and meningitis. Although he confirmed that intracranial pressure could cause some bleeding in the eyes, he said he did not think that was what happened in this case.

Miller asked Cohen if seizures could cause this injury.

“I’ve never seen it,” Cohen said.

Mitch Muhs then took the stand as a witness for the state. Muhs is a physician’s assistant at SRMC and saw the alleged victim for loose stool on Sept. 9, 2011. At this time he checked the baby’s heart and lungs and discussed the possibility that the issue’s cause was a switch from breast milk to formula. The baby did have swollen lymph nodes at that time, he said and a virus could have caused these symptoms.

The state then called many of the alleged victim’s family and friends, some of who had seen the infant the morning of Sept. 13, 2011 or the previous night. The infant’s grandfather testified that everything seemed fine that morning, although he never saw the infant closely.

Ray Davenport, a neighbor of the alleged victim’s family in Peetz, testified that he’d held the infant the night of Sept. 12 and visited with the infant and his family for around an hour. Davenport said the baby seemed normal and was smiling. When Davenport next saw the infant, the boy had changed.

“He wasn’t the same,” Davenport said. “He wasn’t the same.”

The infant stayed in a lethargic state for a significant time period, but is no longer in that state, Davenport said.

Miller questioned many of these witnesses about whether or not they knew if the infant had colic, was hard to console or if he had his days and nights mixed up. Many of them hadn’t heard anything about these problems, but the infant’s mother had spoken to a few of them about these issues.

The trial resumes on Monday and is expected to continue through the end of the week.