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

Click Here To Read More About This Case

Safety of group homes hard to check

Why wasn't CPS called in on this situation? Why are these "homes" allowed to take children if they are abusing them? Why aren't they more closely monitored (even for the adults) when many of these patients can not defend themselves? Why....? Why..? Why???
---

By JULIE MURPHY, Staff writer
August 28, 2011 12:30 AM

GLENWOOD -- Chris Nicoles sits and draws at the kitchen table while Louise Harwin watches television in the family room.

It's a familiar scenario in homes everywhere, except that Nicoles and Harwin live in a group home for adults with disabilities.

"These houses are supposed to look like any other house in the neighborhood," said Ed DeBardeleben, area administrator for the state Agency for Persons with Disabilities. "These (group homes) are their homes."

Outside of making frequent personal visits, there's little parents or guardians can do to ensure the safety and well-being of loved ones who live in such group homes. Most are left to trust that the system and its safeguards are working.

But are they?

Reviews and violations found on a state website for 57 licensed group homes in Volusia and Flagler counties, as well as for other group homes statewide, are often outdated, with the most recent reports in many cases being more than 3 years old. State inspection reports are often vague, providing few, if any, details about a particular home's overall condition or employees' qualifications.

A recent case of criminal abuse of a disabled Palm Coast teen living in a Palatka group home run by O'Carroll Homes illustrates that sometimes problems slip through cracks.

O'Carroll Homes, which runs several facilities in Palatka and one in Hastings, had its Medicaid waiver agreements pulled by the state after four workers and a former employee accused of burning the 17-year-old girl with a clothes iron were arrested and charged in January.

One of the workers was sentenced to four years in prison earlier this month for his role in the abuse case. Four others have September court dates, according to the State Attorney's Office.

NO EASY FIXES

Many group home providers are paid through Medicaid waiver agreements, according to Agency for Persons with Disabilities spokeswoman Melanie Etters. The waivers pay for care and supplies for adults diagnosed with certain disabilities before the age of 18.

While pulling Medicaid waivers doesn't technically close a home, its residents or their families would have to pay for their care privately. Costs vary widely based on behavioral issues, daily living and medical needs, but can run between $35,000 and $150,000 per year, Etters said.

"In general, APD typically closes about two group homes a month statewide," Etters said. "Generally, there are two main reasons why this occurs. First would be some major incident occurs at the group home endangering the health and safety of one or more individuals. Second would be when a home is continually cited for issues during monthly monitoring and has not corrected any of the issues within a reasonable amount of time, and the agency is concerned for the health and safety of the people living in the home."

After her daughter was burned in January, Jeanette Roscoe moved her to another group home in North Florida and thought she had found an ideal site -- just as she had when she took her daughter to the O'Carroll Homes facility in Palatka 11 years ago.

"The first time I did research, (O'Carroll Homes) were long-standing and had all the credentials," Roscoe said. "I looked at the cleanliness, that she'd have her own room and the ratio of staff to patients."

Roscoe also closely inspected the North Florida facility where she decided to move her daughter, who she said has the mind of a 2- or 3-year-old. Again, Roscoe studied employee folders and resumes, scrutinizing who administered medications and where they were kept.

But again, her daughter suffered serious injuries. This time, she jumped through a window at 5:30 a.m. Aug. 10 and wound up needing more than 100 stitches and staples to close her wounds, Roscoe said.

"It was a 5- to 6-foot drop out the window," Roscoe wrote in an email to The News-Journal that included images of her daughter's injuries. "I thought she had one-on-one supervision, but she didn't. At least she didn't then."

LONG WAIT FOR CARE

The group homes overseen by DeBardeleben's office, which covers Volusia and Flagler counties, include small family-run operations as well as homes owned by large businesses such as Duvall Home, LifeShare, Sunrise Community and National Mentor.

Group home workers are expected to undergo criminal background checks through the FBI, Florida Department of Law Enforcement and local agencies. They must also sign an affidavit that they are of good moral character, DeBardeleben said. "Zero tolerance" training is also required and employees are instructed to treat residents with dignity and respect, as well as to look for signs of abuse or neglect and to report it to law enforcement.

But researching group homes is complicated, said Jim King, executive director for The Arc of Volusia, which provides programs to increase independence and quality of life for adults with developmental disabilities.

"It's not an easy situation," King said. "There (is) a waiting list of people not getting any services. Funding has always been limited and it keeps getting cut. These are all independent businesses -- some big, some small."

DeBardeleben said more than 20,000 people are on the waiting list for Medicaid waivers statewide.

Martin Favis, president of the Duvall Home -- among the largest care providers for the developmentally disabled in the country -- said the challenge is to provide a homey setting for its 160 residents who live in 10 group homes and one larger congregate-living facility. Some pay privately while others have Medicaid waivers.

"Not every individual has a vested parent or guardian," Favis said as he walked through the home where Nicoles and Harwin live. "We want to have compatible homes where people have things in common. This is their home and it should feel that way."

Favis admits things weren't picture-perfect at Duvall before his arrival three years ago.

"We've come a long way in three years," he said. "APD (Agency for Persons with Disabilities) wasn't happy with us. There were funding cuts and financial problems. We had to really mend our relationship."

Group homes are monitored monthly, typically by a two-person team from the Agency for Persons with Disabilities. The exception is "respite homes," those that only take people who need temporary care -- for instance, if a family goes on vacation. They are not inspected if they have no residents during a given month.

"Group homes have their own niche," DeBardeleben said. "We want clients to have a choice so they integrate into the community, and different clients have different needs."

FINDING A NICHE

Some homes have nurses on staff. Others are "intensive behavioral residential habitation group homes," which handle patients who may be a danger to themselves or others.

One Duvall Home niche is that it is an adult-only facility.

"I'm hoping to get (my daughter) placed in Duvall," Roscoe said. "She turns 18 on Sept. 9 and hopefully we'll be able to transfer her that day."

Roscoe, her daughter, her daughter's case manager -- officially referred to as a waiver support coordinator -- and other officials from the Agency for Persons with Disabilities, as well as Favis, are working together to help Roscoe's daughter make the transition.

"I'm waiting for this to all settle down," Roscoe said before breaking into tears.

Roscoe believes her daughter should have been reassessed in January after she was burned. A reassessment is usually done once every three years, with exceptions made for crises.

"That was a crisis," Roscoe said. "I think she was in shock immediately afterward, but I can only guess that because of her limited verbal communication. She wets the bed now and has been self-mutilating. It's post-traumatic stress. And I'm tired. I'm trying to protect her. I'm trying to protect her from other people. I'm trying to protect other people."

Source

http://www.news-journalonline.com/news/local/flagler/2011/08/28/safety-of-group-homes-hard-to-check.html

Newspapers accuse state of illegally withholding child-death records

By Beth Musgrave — bmusgrave@herald-leader.com

Posted: 7:43pm on Aug 17, 2011; Modified: 10:18pm on Aug 17, 2011

FRANKFORT — A lawyer for Kentucky's two largest newspapers told a Franklin Circuit Court judge Wednesday that the state was "thumbing its nose at the law" by withholding records relating to the deaths of abused and neglected children.

"They are acting illegally and they are doing it in a brazen fashion," said Jon Fleischaker, a lawyer representing the Lexington Herald-Leader and The Courier-Journal of Louisville.

Fleischaker's comments came during a hearing about whether the Cabinet for Health and Family Services, which oversees child protection, must turn over records regarding children who died of abuse and neglect while under the state's care. This is the second time in two years the newspapers have sued the cabinet to get such records.

Cabinet officials said Wednesday there were about 44 cases during the past two years that involved children who died or were nearly killed as a result of abuse and neglect while under the cabinet's supervision.

Meanwhile, a convicted murderer and four anonymous women tried to intervene in the case, saying release of the records would harm a legal appeal or violate privacy rights.

Fayette Commonwealth's Attorney Ray Larson also wrote a letter to Judge Phillip Shepherd expressing concerns about the release of child death documents. Larson said it could prejudice a jury if documents were released about the death of Katelynn Stinnett, a 2-year-old Fayette County girl. Brian Crabtree, who lived with Stinnett's father at the time of her death on Nov. 26, 2008, has been charged with rape and murder.

Shepherd on Wednesday allowed Patrick Watkins to intervene in the case.

Watkins and his wife were sentenced to life in prison in October 2008 for the murder of their daughter Michaela Watkins, 10. The Clark County girl's body was found severely bruised and burned on March 11, 2007, at the Watkinses' apartment. She had more than 77 injuries at the time of her death.

B. Scott West, a lawyer for Watkins, argued that Watkins could be granted a new trial and that releasing the cabinet's documents regarding Michaela could prejudice a jury. The state Supreme Court has overturned part of the case against Watkins but the Supreme Court's decision is not final yet.

Scott White, a Lexington lawyer, also filed a motion to intervene in the case on behalf of four anonymous women who say their privacy rights would be violated if the information requested by the media was made public. White said the four women had been investigated for abuse and neglect of their children.

Fleischaker questioned why the women could file to intervene in the case without telling the court who they were. There is no provision in the law that would allow the women to do so, he said.

White argued that their privacy rights would be violated if he revealed their identities before Shepherd ruled on whether they had a right to intervene. Shepherd said he would rule soon on whether the women could file to intervene as "Jane Does."

Fleischaker also argued Wednesday that the cabinet was purposely dragging its feet on releasing records regarding child deaths, despite a previous order by Shepherd that declared similar documents were public. The cabinet has engaged in a series of moves to thwart the media's attempts to get those records, lawyers for the media have argued.

Brent Irvin, a lawyer for the cabinet, said the cabinet was not trying to circumvent the law. The cabinet still thinks federal law prohibits it from releasing some of the records.

If the cabinet releases information that the U.S. Department of Health and Human Services says is private, the state fears it could lose federal child protection funding, Irvin said.

Shepherd asked whether any state had ever lost federal funding because of the release of information about child deaths. Irvin said he was not sure.

Both newspapers sued the cabinet in 2010 to get access to records regarding the death of Kayden Branham, a 20-month-old Wayne County toddler who died after drinking drain cleaner used to make methamphetamine. He and his teen mother had been under cabinet supervision before his death.

After Shepherd made public the documents regarding Branham's death, both newspapers filed requests to get records about other children who have died of abuse and neglect while under the cabinet's care.

The cabinet denied both requests and then filed an emergency state regulation that limited the amount of information it could release about child deaths. The media sued the cabinet again in state court in January, but the cabinet had the case transferred to federal court. A federal court judge later ruled that the case involved state law, not federal law, and returned it to Shepherd's court.

Fleischaker argued that the issues before the court Wednesday were the same as those in the case involving Kayden Branham. The cabinet did not appeal Shepherd's previous ruling, Fleischaker noted.

"They don't care what the law is," Fleischaker said of the cabinet.

Irvin countered that there are still unanswered questions about what should be released to the public.

Shepherd released some of the information involving Kayden's death after he reviewed the file, but he did not tell the cabinet what information he chose not to release, Irvin said.

Shepherd said Wednesday that he released all of the information about Kayden Branham and his mother. The only records he did not release were about another minor related to Kayden Bran ham's mother.

Source: http://www.kentucky.com/2011/08/17/1849003/newspapers-accuse-state-of-illegally.html