“Isn’t it possible that a newborn’s listlessness and lethargy and poor appetite might be caused by MCADD?” Kennedy asks.
“Yes,” he admits.
“And an enlarged heart—is it potentially a side effect not only of maternal gestational diabetes…but also of this particular metabolic disorder?”
“Yes.”
“Dr. Binnie, did you learn from the hospital records that Davis Bauer had MCADD?”
“No.”
“Had these results come in in a timely manner, would you have used them to determine the cause of death and manner of death in your autopsy results?”
“Of course,” he says.
“What happens to an infant who has the disorder yet has gone undiagnosed?”
“They are often clinically asymptomatic until something happens to cause metabolic decompensation.”
“Like what?”
“An illness. An infection.” He clears his throat. “Fasting.”
“Fasting?” Kennedy repeats. “Like the kind of fasting done prior to a baby’s circumcision?”
“Yes.”
“What happens to a baby who is undiagnosed with MCADD, and who suffers one of these acute episodes?”
“You might see seizures, vomiting, lethargy, hypoglycemia…coma,” the doctor says. “In about twenty percent of cases, the infant can die.”
Kennedy walks toward the jury box and turns so that her back is facing them, so that she is watching the witness with them. “Doctor, if Davis Bauer had MCADD, and if no one at the hospital knew it, and if the medical protocol was to have him fast three hours prior to his circumcision like any other infantwithoutthe disorder,andif an acute metabolic episode occurred in his little body—isn’t there a chance Davis Bauer would be dead even if Ruth Jefferson had performed every conceivable medical intervention?”
The medical examiner looks at me, his gray eyes soft with an apology. “Yes,” he admits.
Oh my God. Oh my God.The energy in court has changed. The gallery is so quiet I can hear the rustle of clothing, the murmur of possibility. Turk and Brittany Bauer are still gone, and in their absence, hope blooms.
Howard, beside me, breathes a single word. “Day-umm.”
“Nothing further, Your Honor,” Kennedy says, and she walks back to the defense table, winking at me.I told you so.
—
MY CONFIDENCE ISshort-lived. “I’d like to redirect,” Odette says, and she gets up before Dr. Binnie can be dismissed. “Doctor, let’s say that this abnormal result had come into the nursery in a timely fashion. What would have happened?”
“There are some abnormal results that require a letter to be sent to the parents in due course—suggesting genetic counseling,” the medical examiner says. “But this one—it’s a red flag, one any neonatologist would consider emergent. The baby would be monitored closely and tested to confirm the diagnosis. Sometimes we send the family to a metabolic treatment center.”
“Isn’t it true, Doctor, that many children with MCADD are not formally diagnosed for weeks? Or months?”
“Yes,” he says. “It depends on how quickly we can get the parents in for a confirmation.”
“Aconfirmation,” she repeats. “Then an abnormal result on the newborn screening is not a final diagnosis.”
“No.”
“Did Davis Bauer ever come in for more testing?”
“No,” Dr. Binnie says. “He didn’t have the chance.”
