Forensic pathologist: Nathaniel Craver's injuries could not be self-inflicted

"Traumatic brain injury" and "failure to thrive" caused Russian boy's death

By RICK LEE
Daily Record/Sunday News
Posted: 09/07/2011 09:29:04 AM EDT

A close-up photograph of 7-year-old Nathaniel Craver's face as he lay on an autopsy table showed his swollen head.

How extensive that swelling was became apparent when his head was compared to the frailness of his neck.

Dr. Wayne Ross, a forensic pathologist who has performed more than 9,000 autopsies and post-mortem exams, could not keep the astonishment out of his voice as he described the dead boy to the jury.

"His head, virtually his entire head, was swollen up like a balloon," he said. "And I don't mean just a little bit of swelling. The entire skull and head looked like a watermelon. Like an alien."

Ross, who conducts many York County autopsies for suspicious deaths, was testifying on the second day of trial for Michael and Nanette Craver, the Carroll Township couple accused of killing Nathaniel, their adopted Russian son.

Nathaniel died on Aug. 25, 2009 at Hershey Medical Center, five days after Michael Craver, 46, rushed him to the hospital.

Ross was on the witness stand for more than four hours, testifying about the boy's injuries and giving his expert opinion how they occurred. He said Nathaniel died from "complications of a traumatic brain injury" and "severe failure to thrive."

He said he was told before autopsy that Nathaniel's parents said he had a history of injuring himself.

Michael and Nanette Craver, 55, have maintained the boy struck his head on a wood stove in their home. They told police, doctors and child abuse investigators Nathaniel seemed all right except for a mark on his head. They put an ice pack on the mark and put him to bed about 45 minutes later. In they morning, they said, they could not rouse him.

Ross told the jury he began his examination from that aspect.

He said, during his examination, he turned to the police officer observing the autopsy and told him the boy's death "needed to be pursued from the aspect of abuse caused by another person."

Ross said he found evidence of injury to the right side of the boy's brain, a subdural hematoma, from an impact "of hundreds of Gs of force," inflicted about two weeks before he was brought to the hospital in a coma.

Ross said the swelling of the boy's head was the result of "multiple impacts."

Relying on photographs taken of Nathaniel during the summer of 2009, including one of a healthy, well-toned shirtless boy, Ross concluded that six weeks before his death the boy suffered repeated impacts to his head, pulled legs and arms, blunt force trauma to the chest, possibly was bound and was starved.

The doctor also found evidence of a skull fracture on the right side of the head, a healing broken rib, compression spinal injuries, and high enzyme levels confirming liver and heart damage.

The child otherwise was covered with small bruises and abrasions on his chest and back. In a picture of the dead child laying on his back, every rib could easily be counted.

Ross said Nathaniel's swollen brain at autopsy "was a mess."

"It was soft as anything," he said. "It was purple and it was dead. Flat and mushy and just horrible."

On cross-examination, defense attorneys pushed Ross with alternative theories for the injuries, such as fetal alcohol syndrome, self-abuse, genetic disorders and diseases. Ross conceded such theories could account for injuries in some cases but "not in this case."

He said he specifically looked for and did not find evidence of alcohol fetal syndrome in Nathaniel's brain.

When York County Office of Children, Youth and Families placed Nathaniel and his twin sister, Elizabeth, in her foster care at age 5, "They asked me to watch them to see if they injured themselves in any way," foster mother Lori Ferree said.

She testified neither child did while in her care for about two weeks.

Ferree said Nathaniel was an active boy who loved to play but seemed confused about being allowed to play in the dirt and get dirty. She said when she would take the children for supervised visits with the parents, the children would return in more "formal" clothes.

She said Nanette Craver chided her one time for dressing Elizabeth in the wrong shoes for her outfit."

Catholic Charities parent educator Lisa Blake testified that Michael Craver railed against Children, Youth and Families' "interference" in the family's lives.

She said during one meeting with him, he was so verbally abusive, she was happy to cut the session short.

Andrew Blochichak, a family physician and Nanette Craver's brother-in-law, testified he did not see Michael and Nathaniel Craver at any family gatherings the summer of 2009. He said he did see Nanette and Elizabeth. His testimony implied Nathaniel was being kept from sight.

He said he asked Nanette why Nathaniel was not at a July 4th party and a later wedding.

"Nanette said, 'Nathaniel is a handful,' and she didn't want to bring him," he said.

Source http://www.ydr.com/crime/ci_18841999?source=most_viewed

Jury hears details of adopted Russian boy's serious injuries

The Carroll Township couple, which adopted twins, have remained in prison.

By RICK LEE
Daily Record/Sunday News
Posted: 09/06/2011 08:56:57 AM EDT

After Michael Craver rushed his unresponsive 7-year-old son to Holy Spirit Hospital, the first doctor to examine him noticed an unstitched, healing wound on the back of the boy's head.

Beside the boy's frighteningly swollen face, mottled bluish skin, fixed pupils, raspy respiration and deep coma, the doctor wondered about the untreated head wound.

Dr. Nicholas J.T. Baran said Craver told him, "These injuries kind of happen all of the time."

Craver later said, "... it's amazing what you get used to," a York County Child abuse investigator said.

Nathaniel Craver, Michael and Nanette Craver's adopted Russian son, died at Hershey Medical Center on Aug, 25, 2009, five days after he was first taken to the hospital.

Tuesday

(SUBMITTED)in opening statements in the York County Judicial Center, Chief Deputy Prosecutor Tim Barker said the Cravers were charged with the boy's murder for both inflicting the injuries and denying him their parental duty to care for and protect him. Both parents are charged with criminal homicide, endangering the welfare of a child and conspiracy.
Barker told the jury of Nathaniel's uncountable injuries spread "head to toe" over his body. He said there was evidence of repeated physical abuse, "pattern" injuries and binding.

He focused specifically on the boy's swollen face and his underlying head injuries. Barker said he was told people cried when they saw Nathaniel in the hospital and that some described his appearance as "a little monster."

He said the Cravers' contention that the boy's physical and emotional disorders - fetal alcohol syndrome and reactive detachment disorder - and allegations of injuring himself resulted in his death.

"The defendants have used Nathaniel's background .... to cover what was really going on," he said. "There is only one conclusion. he did not self-abuse himself to death."

First Assistant Public Defender Clasina Mahoney argued that is exactly what happened. She said the Cravers "did not sit back and watch it happen, as the commonwealth would have you believe. They desperately searched for help."

They sought answers from doctors and hospitals throughout southeastern Pennsylvania, including Hershey Medical Center and the Children's Hospital of Philadelphia, she said.

She said therapy at a Lancaster facility, where Michael Craver batted balloons with his son and acted like a princess with his daughter, Nathaniel's twin sister, helped the girl who had similar problems, but not Nathaniel.

The first day of testimony focused on Nathaniel's appearance when he entered the hospital. His parents said he had hit his head on a wood stove in their Carroll Township home.

An emergency room nurse at Holy Spirit Hospital said the boy's head, "to me, felt like a wet sponge."

Baran testified Nathaniel registered the lowest possible score on a medical coma test. He also told the jury that a scan of the grotesquely swollen left side of the boy's face showed no subdural fresh bleeding and was the result of an older injury.

Dr. Mark Iantosca, a Hershey Medical Center neurosurgeon who removed part of Nathaniel's skull to relieve the swelling, said he found older blood under the boy's scalp and fresh blood pushing on his brain.

Iantosca also said the injury could have happened the way the Cravers' said it did.

"I think a 7-year-old child, throwing himself with a running start headfirst into a metal object would be sufficient to cause that injury," he said.

He added that the head injury could have been caused by "a closed fist, a blunt object or a car accident ...."

He also agreed with the defense that the child could have appeared uninjured and then suffered bleeding and swelling of the brain during the night.

The trial continues today and is expected to last through next week.

Parents' defense

On trial for murder, Michael and Nanette Craver maintain they never harmed their 7-year-old son, Nathaniel, but that the boy they adopted at 18 months old in Russia had physical and emotional problems that caused him to injure himself.

From the time Nathaniel was rushed to Holy Spirit Hospital on Aug. 20, 2009, to their arrests in February 2010 to the first day of their trial in the York County Judicial Center, they have consistently said the boy struck his head on a wood stove in the couple's Carroll Township home.

According to testimony, evidence and statements presented in court Tuesday during the first day of trial, the jury learned:

Nathaniel and his twin sister were born prematurely in a Russian prison to a mother with substance abuse problems;

Both children were diagnosed in the United States with fetal alcohol syndrome and reactive detachment disorder;

Nathaniel was hyperactive, mentally delayed and had a short attention span;

He pinched and bit himself, pulled his hair and eyebrows out and pulled the skin under his nose until it bled;

He had a high pain tolerance and appeared fearless;

He would bang his head and rock himself to sleep;

The Cravers were reported twice to York County Children, Youth and Families for apparent injuries on the children. The children were placed in foster care but no findings of abuse were substantiated;

After returning from foster care, Nathaniel was distant with his parents;

Nathaniel was distant with children but "touchy-feely" with adults, offering them hugs and kisses;

He would pull the family dog's fur;

He was abusive to his sister;

He frequently wet the bed.

Nathaniel's injuries

The jury also learned Nathaniel's injuries included:

A fresh hematoma, massive bleeding between the skull and the brain;

Older evidence of bleeding between the scalp and the skull;

A boxer's cauliflower ear on the left side of his head;

A ruptured right eardrum;

Evidence of binding;

Pattern bruising to the back and buttocks;

Emaciation and less than one millimeter of subcutaneous fat;

And "head-to-toe" marks, bruising, contusions and abrasions, according to at least two medical witnesses.

http://www.ydr.com/crime/ci_18834019

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