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Miller and Urbanski weren't terribly worried about the testimony of the nurses. They knew they had bigger problems ahead. This would be the week when Waneta's statements to the police would be presented to the jury. First, though, Miller would get the chance to do something he relished: tear into the testimony of Simpson's forensic experts. A few minutes after 9:00 on Monday morning, he watched Dr. Janice Ophoven make her way to the witness chair. He could hardly wait to get at her.
Just arrived from Minnesota, Ophoven wore a black skirt and jacket with an orange-and-green print blouse, a pair of glasses nestled in her short, thick hair. She had a midwesterner's plainspokenness, the face and manner of authority. Simpson spent the better part of an hour on her credentials and expertise, working in a thorough explanation of what it is that a pediatric forensic pathologist does, and how it was her job to determine the cause and manner of a child's death based on every bit of evidence, whether physical, circumstantial, or historical. Finally, Simpson signaled the real beginning of her testimony, and his case. "Do you know what SIDS is?" he asked.
Simpson wanted the jury to understand that no one dealt more closely with the intersection of SIDS and infanticide than someone in Ophoven's line of work. And no one could speak with more assurance on the specific medical and legal aspects of the unusual case at hand than a forensic pathologist who had once been a practicing pediatrician. First, he wanted to imbue the jurors with the doctrine of SIDS as random occurrence, not given to repeating itself within families. There is no connection between SIDS and genetics, Ophoven explained, setting up one of the basic tenets of the prosecution's case. The chance of one SIDS in a family was remote enough. Two was cause for alarm, and a serious police investigation. "By the time a third event would occur within a family," Ophoven said, "the SIDS diagnosis is no longer a possibility and an alternative explanation must be identified."
Simpson turned immediately to the alternative explanation being proposed. "Do you generally find signs of suffocation?" he asked, alluding to John Scott's testimony. "Fingerprints, bruises, any external or internal sign?" No, Ophoven said, not generally. "A little person doesn't have the capacity to struggle in a coordinated way in that SIDS age group." What if one arrived at the scene fifteen or twenty minutes after a suffocation? "If a hand was used, or if a hard object was used, maybe. But if the object was soft, then I expect I wouldn't.... Whether it was fifteen minutes or not, if there's no mark, there's no mark." She demonstrated, spreading her hand to cover her own face. The sound of camera shutters snapping echoed through the courtroom; the front page of the next day's Binghamton Press & Sun-Bulletin would be dominated by a large color photo of Ophoven's chilling display.
Simpson was loath to leave the impression that the absence of marks meant the Hoyt children went quietly. Could a two- or three-month-old resist an attempted suffocation? he asked. "Oh, sure," Ophoven said. "Again, those of us who have taken care of little people, if you do something to them they don't like, they let you know instantly. And if it's a big thing they don't like, they arch their back, they get mad right away, they use their muscles, but it's kind of like this whole body reaction, as opposed to a coordinated reaction. But even little, tiny premature infants will struggle if they're uncomfortable or if something's happening that isn't right."
"Would a two-and-a-half-year-old resist differently?" Simpson asked, moving on to the image of Jimmy.
"Oh, Lord, yes.... A small boo-boo or a big boo-boo, they turn the whole thing on. For a two-and-a-half-year-old, to draw blood or to start an IV, you may need two or three people to hold these folks down if they don't like what's happening." But regardless of age, it would take several minutes to accomplish a suffocation. A child, like an adult, would lose consciousness after about two minutes without breath. Death would come another two to four minutes later.
Had she had occasion to actually witness the suffocation of an infant? The question startled some of the jurors, as did the answer. "Yes I have," Ophoven said. "In a qualified way." She described two video surveillance tapes she'd seen in the apnea center at the Children's Hospital of St. Paul. In both cases, mothers were observed suffocating their babies. That's how she knew what a baby fighting for his life looked like.
"Just so we're clear on this," Simpson said, "nobody was watching this so that someone should have rushed in and rescued the child." No, Ophoven said, the tapes were viewed later. It was part of the hospital's method of diagnosing apnea. Sometimes, the camera caught a horrific example of "factitious apnea." There are parents out there, she told the jury, who cause or fabricate reports of life-threatening episodes. And sometimes they go all the way. If they do it in the hospital, she implied, imagine what they do at home. She never uttered the term Munchausen syndrome by proxy.
Ophoven's testimony was at once repellent and riveting to the courtroom spectators. Among them was Gail Pfeiffer, who had decided to come back on Monday morning and resume watching the trial. She found she could not stay away--she needed to see this to conclusion. She sat on a chair in the balcony opposite the jury box, peering down, intent on the testimony. People noticed her, jurors included, and began to wonder about her. Some of Waneta's family glared when they encountered her outside the courtroom.
With Ophoven's lecture on suffocation serving as a prologue, Simpson moved on to what it had to do with the children of Waneta Hoyt. He spent the next phase of the testimony introducing twenty-seven exhibits, handing them up to Ophoven and discussing their meaning with her, one by one. They were birth and death certificates of each child, the various records from the hospitals in Ithaca and Syracuse, and eight autopsy reports--the three performed at the deaths of Jimmy, Molly, and Noah, and the five from the exhumations a few months before the trial. Then he moved to the children. His first piece of business was to refute the original causes of death. "I'd like to start with Eric," he said.
In 1965, Dr. Arthur Hartnagel attributed Eric's death to "congenital anomalies of the heart." Ophoven testified there was no clinical record of such a problem, nor could a coroner come to this conclusion without an autopsy. "It is not the kind of thing where you would make the initial diagnosis without any previous information," she said.
They moved on to Jimmy, whose elusive 1968 autopsy report, missing since the beginning of the investigation, had turned up only weeks before the start of the trial. It happened serendipitously. Late in winter, Miller had subpoenaed Waneta's county mental health records. Sgueglia read them first, then distributed them to the defense and prosecution. Flipping through the file when it arrived at the district attorney's office, Simpson's secretary, Pat Gray, came upon a document that tripped a switch. "Which autopsy did you say is missing?" she asked him. James, he said. "Well, here it is." It was part of the record left by Dr. Mokarram Jafri, the psychiatrist who had requested copies of the autopsy reports for Jimmy, Molly, and Noah after the disquieting incident with the adoptive baby named Scotty in 1971.
Jimmy's autopsy was peculiar, full of findings about the thymus and the adrenal glands and congested organs that a jury of lay people might consider descriptive of a sick child. It had had that effect on Waneta's family in 1968. For Ophoven, it made Jimmy's case more difficult than his brother's to clarify on the witness stand. She decided an anatomy lesson was in order. "The endocrine system is like the body's pony express," she said, addressing the jurors directly, "and the brain stem is like the control panel." Revisiting the autopsy performed by Dr. James Mitchell on the morning of September 26, 1968, she took them on a tour of the thymus gland and explained why its size had nothing to do with the child's death. She explained, point by point, why the autopsy described a normal, healthy little boy whose death could not be attributed to any natural cause--not enlarged thymus, not adrenal insufficiency. For the jurors, it was a long and grueling lecture. "Doctor, try and move it along a little bit," Simpson said at one point.
Julie was next. Hers was a simple case. Babies don't choke to death on rice cereal, Ophoven testified. Pieces of hot dog, peanuts, toys--yes. Rice cereal--no.
Now, Molly. Ophoven read from the voluminous hospital records, first from Tompkins County Hospital, then Upstate Medical Center. Here, the jury heard for the first time that the Hoyts, in giving Molly's history, had told the doctors that blood had been present at the deaths of Eric and Jimmy. Ophoven read all the intake notes for Molly's three admissions to Upstate into the record. "Can you point to any life-threatening event in that hospital record?" Simpson asked finally.
"None," said Ophoven. She evaluated the autopsy in the same detail she had devoted to Jimmy's.
". . . And from your review of the records, the autopsy records, and the slides, did it appear that this young lady had interstitial pneumonitis?" Simpson asked.
"No, she didn't."
"Let's just talk about this pneumonitis for a second. And let's assume for a moment that Molly did suffer from that, would that be noticeable to a caregiver? "
"Oh, yes. If someone's dying of interstitial pneumonia, they progressively worsen, worsen, and worsen. It isn't a sudden thing at all. In the most rapid form it would take days.... She would have been a critically ill infant who would have been rushed into an intensive-care unit and put on a ventilator and given antibiotics. She would have looked like someone who had pneumonia."
"Anything of concern there for the health and safety of Molly?" Simpson asked at the conclusion of her long review of the autopsy.
"No," Ophoven said. What worried her, she said, was how the purported events at home didn't match up with the hospital experience. "The disconnection is an important factor." She repeated the procedure for Noah, whose life and death mirrored his sister's. "You don't die of cerebral edema," she said. Again, it was the discrepancy between his mother's reports and the "observed medical facts" that was of concern to her.
Late in the afternoon, by which point Ophoven was surrounded by stacks of documents that had accumulated during her testimony, Simpson brought her to the payoff. In dramatic fashion, he asked her whether she believed, based on all the evidence before her, that these children had been suffocated to death.
Nothing else could have caused them to die, she stated.
At their corner of the defense table, Waneta and Tim Hoyt held hands, their faces like marble.
Bob Miller stood, walked to the lectern, and asked, "Do you deny there have been forty cases in the last twenty years of multiple, unexplained infant deaths? "
"I know they have been reported," Ophoven replied skeptically.
Miller's first approach was to try to isolate Ophoven's opinion. He called the jury's attention to the traditional wedge between forensic pathologists and SIDS researchers on the question of familial SIDS. Ophoven tried to bring him up to date. "I don't think it's fair to characterize the SIDS people as all believing the genetic theory," she said. "There are a lot of SIDS experts who have the same opinion as the forensic community."
"There's been no medical proof to any degree of certainty regarding that, has there?" Miller challenged her.
"It's just a lot of experience," Ophoven responded.
In arguing the multiple-SIDS idea, Miller was at an interesting disadvantage. Other defense attorneys in his position had had at their disposal the country's most prominent case study: Steinschneider's 1972 paper. Miller, of course, couldn't use it. He decided to go abroad for this line of defense.
"Are you familiar with any of the Norwegian or Australian studies on this very subject?" he asked Ophoven. She said she'd read some of them, but couldn't say she was all that familiar with their case reports or theses. Her tone suggested they weren't worth the effort. Miller let the matter drop, never explaining what the Norwegians or Australians had found.
For the rest of the afternoon, Miller engaged Ophoven in a lengthy debate about the true meanings hidden in the unearthed records of the Hoyt family. He focused on Jimmy. This death was the Achilles' heel of Miller's case--the hardest one to portray innocently--but the autopsy gave him a wide field, and he planned to use every inch of it. Was it plausible, he asked Ophoven, that blood had been present at Jimmy's death, as the prosecution suggested, without its being picked up by the pathologist at autopsy?
"Doesn't surprise me at all," Ophoven said.
"The autopsy examiner is so incompetent in our little county here that he doesn't even make a note of it?" Miller asked, one of several subtly scornful allusions he made during the trial to all the out-of-town experts streaming through the courtroom. "Is that what you're saying?"
"No, that's not what I'm saying. I'm saying I can understand where it would either not be prevalent at the time the autopsy was done . . . or that the injury was inside the mouth and the examination was not done. And it doesn't mean there was an injury."
Miller challenged Ophoven's dismissal of the autopsy findings of congestion of the kidneys, brain, and liver. When she said that none qualified as a cause of death, he asked her what might cause such congestion "in these big, important organs," other than homicide.
"Just about anything," Ophoven replied. "You could have congestion of these organs if you were in a car accident."
"We know that wasn't the case here."
"You could have congestion in these organs if you had a heart attack. You could have congestion in these organs if you had leprosy.... You can get this kind of congestion from anything that can kill you. It is not diagnostic of anything."
"Could you have gotten this type of congestion from some source other than internal? Such as a toxicological reason?"
". . . I think I've answered your question. Anything that can kill you could give you congestion in these organs."
"Doctor, I don't mean to either bore you or irritate you. But a woman is on trial here, charged with ten counts of murder."
At another point, Miller brought up Dr. Marie Valdes-Dapena's name. "I believe you called her Molly," he said to Ophoven. "I believe her legal name is Marie Valdes-Dapena."
"Molly Dapena or Molly Valdes-Dapena is how we refer to her."
"All right, one and the same person, is it not?"
"Only one Molly."