October 7

The jury heard opening statements from the prosecution and the defense and saw the prosecution's first five witnesses come to the stand. In his opening statement, lead prosecutor Gerard Leone, Jr. described Louise Woodward as a live-in nanny who was much more concerned with enjoying Boston night life than providing proper care for the sons of Sunil and Deborah Eappen, two-year-old Brendan and the infant, Matthew. Frequently, Woodward had difficulty waking up in the morning to care for the boys after late-night partying with friends. During an incident in late January, Sunil Eappen came home from work one night and allegedly found Brendan and Matthew unattended. This caused the Eappens to make an ultimatum to Woodward: either do a better job of watching our sons or you're fired.

Five days after the ultimatum, on Feb. 4, the alleged shaking incident with baby Matthew occurred. But Leone refrained from saying that Woodward had planned to kill Matthew.

"We are not saying to you that the defendant woke up on February 4 specifically intending to kill Matthew Eappen," Leone told the jury. "What we're saying the case is about is that on February 4, the defendant, in a frustrated, resentful, unhappy attitude, slammed the baby into a hard object and shook him, causing his death--actions that anyone would know would result in death. In this Commonwealth, that is murder."

Lead defense attorney Andrew Good responded to the prosecution's opening statement by saying that Woodward never violently shook the baby or slammed his head onto a hard surface. Good told the jurors that he would present head trauma and biomechanics experts who will support the defense theory that baby Matthew suffered a skull fracture prior to the Feb. 4 incident. Matthew's parents were not aware of this injury, which, Good claimed, really caused the infant's death.

The state brought two police officers who responded to Woodward's 911 call the night of the incident. Both testified that they found Matthew lying on his back on the floor, with his arms pointing stiffly towards the ceiling and making periodic jerking movements. Both also said that Woodward told them Matthew had vomited. One officer, Hugh Downing, described Woodward as "detached" from the situation. The other officer, Eric Braceland, testified that Woodward told him the baby would not stop crying the entire evening. Matthew refused to eat his food, had vomited, and at one point was choking on his vomit. According to Braceland, Woodward told him that she had tried to clear the vomit out of Matthew's airway. Braceland also observed that Matthew's pupils were dilated and that he was breathing hard.

Key testimony came from Dr. Kenneth Mandl, the doctor who treated Matthew Eappen in the emergency room at the hospital. He said that the infant was unresponsive and comatose when he arrived in the emergency room. Matthew's pupils were enlarged, fixed, dilated, and there was evidence of retinal hemorrhaging. According to Mandl, these were all signs of severe head trauma.

Mandl was then cross-examined by defense attorney Barry Scheck, who made the doctor admit that he found no evidence on Matthew body that indicated that he had been shaken. Under Scheck's examination, Dr. Mandl testified that he found no bruises on the baby's arms, shoulders, ribs or neck and that there was no swelling on the back of the victim's head. Scheck also asked the doctor whether he observed anything that supported the prosecution's assertion that Matthew's head had been slammed down "with the force of dropping a child 15 feet onto hard concrete." Mandl responded, "There were no findings to specifically indicate that, no."

	Oct. 7: During the first day of testimony, Barry Scheck, defense attorney for Louise Woodward, cross examines Kenneth Mandl, doctor who treated the infant.

Mandl also conceded to Scheck's theory that the baby may have suffered from what Scheck called "talk, deteriorate, and die" head injuries. (This refers to instances in which a person suffers a head injury, appears to recover from the injury, but then suffers a rapid decline in health after a later, possibly slight, head injury.) Scheck was trying to build support for the defense theory that the infant really died from a previously unknown head injury prior to the Feb. 4 incident with Woodward. However, despite his concession, Dr. Mandl maintained that Matthew's symptoms that night indicated that his injuries more likely came from violent shaking.

Court recessed soon after Dr. Joseph Madsen, a pediatric neural surgeon who reviewed Matthew's CAT scan, began testifying about the infant's brain swelling, the circumstances that caused the swelling and the surgery that was required to relieve the pressure on the brain. Madsen was scheduled to return to the stand the next morning.

October 8

Dr. Joseph Madsen, the pediatric neurosurgeon who performed brain surgery on Matthew Eappen on the night of the alleged shaking incident, returned to the stand. Madsen said that the infant's head injuries had caused his brain to swell "like a loaf of bread rising in an oven." According to Madsen, he and his surgeons were afraid that Matthew would die on the operating table. Based on the extent of the infant's brain damage, Madsen said Matthew's chances of survival were grim. Dr. Madsen testified that Matthew's brain injuries came from more than a gentle shaking; he also said that the brain injuries did not come from what the defense claims was a prior, chronic head injury.

Defense attorney Barry Scheck challenged Madsen's opinions during cross-examination. Madsen appeared to retreat from his widely quoted analogy that Matthew's injuries were consistent with those suffered during a 15 foot drop onto concrete; he said he had only made that comment in response to a very specific question during grand jury testimony. Scheck also suggested impropriety on part of Dr. Masden because the doctor did not preserve a blood clot he surgically removed from Matthew's brain for pathological analysis. (The guidelines in Children's Hospital in Boston say that this procedure should have been done.) Masden responded to this allegation by saying that the clot was not salvageable.

When asked by Scheck about the defense's theory that Matthew suffered the head injury weeks before the incident with Louise Woodward, Masden agreed that such a head injury could bleed internally and spontaneously hours, days, or even weeks after its original occurrence. And head swelling, crankiness, unusual crying, vomiting, and lethargy are the symptoms of such these kind of head injuries in infants. (Matthew Eappen showed all these symptoms the day of the alleged shaking.) In addition, Madsen agreed that baby Matthew's skull fracture resembled a fracture that could have been suffered three weeks prior to the alleged incident with Woodward.

After Dr. Madsen finished his testimony, Dr. Robert Cleveland, a consulting radiologist to the Child Protection Team at Children's Hospital, took the stand and analyzed Matthew's X-rays in front of the jury. He said that the baby's skull fracture appeared to be no more than three or four weeks old. When asked about an apparent wrist fracture that X-rays also revealed the night of the incident, Dr. Cleveland said that injury was approximately two-and-a-half to four weeks old.

The last witness of the day was an expert in pediatric radiology and child abuse, Dr. Patrick Barnes. He explained the brain swelling and other abnormalities the CAT scans detected in Matthew. Dr. Barnes testimony was scheduled to continue the next morning.

October 9

Dr. Patrick Barnes, an expert in pediatric radiology, returned to the stand and testified that Matthew's Eappen's head injuries were characteristic of those suffered by infants through violent shaking. Barnes felt that Matthew could not have suffered the injuries from the a gentle shaking or from being tossed onto a bed.; he also said that he saw no evidence of a prior head injury suffered by the infant.

"The pattern of injury is suggestive of non-accidental trauma," Barnes told the jury. "My opinion is that this is a classic picture of the acute or hyper-acute shaking impact injury seen in non-accidental trauma." Barnes also testified that he thought Matthew's head injury occurred hours before his CAT scan and that the baby was a victim of shaken baby syndrome.

Then, Dr. Barnes examined a mark on CAT scan of Matthew's skull. During the previous day's testimony, he said that the mark was a second fracture suffered by the baby. However, today he changed his opinion, saying that the mark indicated a stretching of the brain's sutures (the division between the plates of the human skull). This testimony seemed to support the defense's theory that Matthew had suffered a brain injury prior to the alleged incident with Louise Woodward.

Defense attorney Barry Scheck tried to undermine Dr. Barnes's testimony about Matthew Eappen's injury when he made the doctor admit that he had not read all the medical reports about the case, including the infant's medical history. Barnes claimed that he did not want his opinions to be influenced by other data. However, Barnes still maintained that the infant suffered the head injuries from being slammed against a surface while being shakened. Still, Barnes would not support the prosecution's theory that Matthew was shakened violently for about a minute.

"I'm saying that this is shaken baby impact syndrome," Barnes said. "I can't say how many shakes and how many impacts."

After Barnes's questioning ended, Dr. Gerald Feigin, who performed the autopsy on baby Matthew, took the stand. He testified that he saw no evidence of a prior head injury in Matthew and no evidence of prior bleeding within Matthew's skull. Feigin said Matthew's skull fracture had very sharp angles, which indicated that his fatal injury had been suffered recently. In Feigin's opinion, the baby died from head trauma and the subsequent swelling it caused in the brain.

However, during cross examination, Dr. Feigin conceded that the autopsy findings did not support the prosecution's theory that Matthew was shaken violently for about a minute. (He said it would have been physically difficult to shake a 22-pound baby violently for that amount of time.) Feigin also said that he was mistaken when he had told a grand jury that Matthew's head injury was the equivalent of one suffered from a 15-foot fall onto a hard surface. According to Feigin, the baby's skull fracture could have resulted from a fall of only two to four feet. Besides the fracture, no other complications, such as brain damage, should arise from such a fall.

	Oct. 9: Dr. Gerald Feigin admits to defense attorney Barry Scheck that his grand jury testimony about the baby's skull fracture being the equivalent of a 15ft fall was incorrect.

The last witness to be called for the day was Dr. Umberto DiGirolami, who examined Matthew's preserved brain in March 1997. DiGirolami testified that he found that the baby had suffered from a traumatic head injury. The doctor also found no signs of a prior head injury. Dr. DiGirolami was scheduled to return to the stand the next day.

October 10

Dr. Umberto DiGirolami, a forensic neuropathologist who examined Matthew Eappen's preserved brain on March 11, 1997, returned to the stand. DiGirolami testified that all the bleeding he observed in Matthew's brain had been caused by an injury suffered no earlier than one week prior to the child's death on February 9. The doctor saw no signs of any prior bleeding, lesions, or underlying diseases that could have caused Matthew's death. According to DiGirolami, an older injury would have been a different color than what he observed in the infant's brain.

DiGirolami told prosecutor Gerard Leone, Jr. and the court that, in his opinion, Matthew Eappen's death was caused by "the large area of disruption of brain tissue, due to an acute traumatic injury."

During cross examination by defense attorney Barry Scheck, Dr. DiGirolami said that he was unable to support the defense hypothesis that Matthew Eappen suffered a head injury two to three weeks prior to his alleged February 4 incident with Louise Woodward. (The defense claims that a subsequent, much milder head trauma on February 4 caused this theoretical injury to bleed again internally. This, the defense claims, led to Matthew's death.) However, DiGirolami also said that he was unable to support the prosecution contention that Matthew was the victim of violent shaking for about a minute.

"You could not come here to the jury today and say 'I have evidence that can corroborate the hypothesis of shaking'?," Scheck asked the doctor. DiGirolami responded, "I agree with that."

Much of Scheck's cross-examination of DiGirolami focused on the defense's allegation that portions of Matthew Eappen's dura (the fibrous membrane surrounding the brain) are now missing. (These portions might support the defense theory that Matthew had a prior injury that ultimately caused his death.) During a September 24 hearing concerning this issue, Dr. DiGirolami seemed to support that allegation. At that time, DiGirolami recalled that he had cut holes in the dura during his examination of the infant's brain, and that despite a court order that all forensic evidence in the case was to be retained, some of the dura apparently had been thrown away.

However, Dr. DiGirolami told a different story during today's testimony. He said that after his previous testimony, he began to wonder about his recollection, and attempted to account for all of the dura specimens. After speaking to his colleagues and attempting to locate all of the samples of Matthew Eappen's dura, DiGirolami concluded, with the exception of some minuscule brain tissue, all of Matthew's dura was accounted for. Under careful questioning by Scheck, Dr. DiGirolami maintained that his testimony during the September hearing was wrong. DiGirolami even dismissed a defense photo of Matthew's dura that appears to show two large sections missing. He explained that when the dura's sections were fully displayed and pieced together, one could see that no segments were actually missing.

Then, Dr. Lois Smith, an opthamologist at Children's Hospital who examined Matthew's opthamology exams, took the stand and testified that Matthew died from shaken baby syndrome. According to Dr. Smith, the retinal hemorrhaging observed in Matthew's eyes was caused by the eye being slammed back and forth against its bone socket. The force of the shaking ripped the retina apart.

	Oct. 10: Dr. Lois Smith, an opthamologist who examined Matthew Eappen's records, testifies that the retinal hemorrhaging she observed in the baby indicates that he died from shaken baby syndrome.

"Retinal hemorrhages are thought to be almost pathomonic of [or unique to] child abuse," Smith said. "There are some other conditions in which they can be found, but the degree of retinal hemorrhage indicates the amount of force that is used. The combination of the retinal hemorrhages and this fold [behind the eye] indicate trauma X, or shaken baby syndrome and really rule out any other causes."

Smith concluded her testimony for the day by dismissing the defense theories about the cause of Matthew Eappen's death. She told the juror that the infant's eye and brain injuries could not have been caused by what Woodward's defense alleges was a prior chronic head injury, gentle shaking, or a genetic condition. Dr. Smith will return to the stand for cross-examination when testimony resumes on Tuesday, Oct. 14.

Read updates from Oct. 14 -17
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