The trial of a high-profile sportsman is in its second week. Photo / George Heard
Two doctors told a jury on Wednesday that a baby’s bones were normal and its rib fractures could only have been caused by force, dismissing defence claims of rickets or fragility.
The trial of a high-profile sportsman accused of causing 13 rib fractures to an infant has continued at the Dunedin District Court.
The Crown alleges the injuries were caused by force, while the defence argues underlying bone fragility and deficiency may be responsible.
The court has heard from the infant’s mother, and friends and family of the defendant. All have vehemently argued the infant’s injuries were not caused by the defendant, who is charged with injuring with reckless disregard and assault.
The trial sharpened into a battle of medical opinions, with defence lawyer Anne Stevens KC challenging a Crown witness about whether the infant’s injuries related to a bone disorder.
Professor Ben Wheeler, a paediatric endocrinologist and paediatrician working for the University of Otago and the Southern District Health Board, told the court his review of the infant showed “nothing that supports these abnormal bones … [the infant’s] bones appear to be normal for [its] age”.
Wheeler outlined in his statements that the infant’s fractures showed clear signs of healing, indicating they were more recent rather than congenital.
He told the court he had not been physically involved with the infant but had read hospital notes and imaging after its hospital admission.
He said a repeat X-ray of the infant two weeks after their initial admission showed signs of rib fractures healing, suggesting a more recent issue.
He told the court extensive investigations, including genetic testing for bone disorders, found no abnormalities.
While a mild vitamin D deficiency was identified, he stressed this was common in Otago and Southland infants and did not contribute to fracture risk.
He told the court that without some form of supplementation, more than 50% of babies born in Dunedin would have vitamin D deficiency.
He explained that rickets was the severe end of vitamin D deficiency and can rarely cause fractures, typically only affecting long bones in mobile children, resulting from a fall or such impact.
“They don’t tend to break ribs. If you had rickets, which we don’t have here, a rib fracture would be very unusual. And multiple rib fractures would be extremely, extremely unusual.”
He said if a severe bone disorder was present, further fractures would be expected with normal handling, and “if fractures occurred at birth, [the infant] would have had signs of fractures healing”.
During cross-examination by Stevens, Wheeler again rejected the suggestion that vitamin D deficiency or rickets explained the injuries.
Stevens pressed him on whether rickets could be diagnosed in an infant, putting to Wheeler it was possible rickets could not be diagnosed in an infant of such an age.
“No, you absolutely can,” Wheeler said.
“We’ve looked at that extensively and [the infant] did not have rickets.”
Stevens put to Wheeler the views of overseas radiologist Dr Julie Mack, who is expected to give evidence later in the trial, and suggested Mack had identified rib changes consistent with rickets.
Wheeler refused to endorse that view, saying he would defer to local radiologists rather than the defence’s overseas expert.
“I’d be concerned about Dr Mack... I would want one of our local radiologists to review that, we wouldn’t go overseas for that opinion.
“Dr Mack makes an assumption that because there are so many fractures, and no cause is noted, that this must be due to fragility. In my opinion that is a massive assumption,” he said.
“The pattern and the number of fractures strongly suggested a non-accidental injury with substantial force in my experience,” he said.
In the afternoon, the Crown called Dr Leslie Anderson, a forensic pathologist, who spoke to her experience with rib fractures in babies, including those who had died after bed-sharing with adults.
Anderson told the court that while accidental suffocation can occur in such cases, rolling onto an infant in bed would not typically cause bone fractures.
“An infant’s bones are much more pliable than an adult’s, and with the soft surface of the bed, the pressure of an adult on top of the child would typically not be enough to cause a bone to break,” she said.
She said that in the rare instances where rib fractures were seen, they were usually attributable to CPR attempts.
“From a forensic pathology perspective, in the absence of another explanation such as birth trauma, CPR, high-impact accidental injury or bone disease, rib fractures occurring from an adult rolling onto a baby on a bed is highly improbable,” she said.
Under cross-examination, Stevens pressed Anderson on whether an adult rolling onto an infant could, in fact, cause rib fractures.
Anderson accepted that in theory “under the right condition, you can absolutely cause rib fractures in a child if you were to crush them”.
However, she said she had never seen such injuries in bed-sharing cases and medical literature did not support it as a common mechanism.
Anderson accepted that dating fractures from scans is “not an exact science,” but maintained that posterior rib fractures in particular remain “highly concerning” and, while not definitive, are strongly associated with non-accidental injury.
Anderson accepted that factors such as an adult’s weight, bone pliability or vitamin D deficiency might “increase the risk to some degree,” but said they could not explain multiple rib fractures in a child as young as the injured infant.
She described such breaks from routine handling or physiotherapy as “very rare,” usually involving only a single rib.
“To get the sort of displaced fractures we’re dealing with here, you need more force than that,” she told the jury.
The trial continues.
Ben Tomsett is a multimedia journalist based in Dunedin. He joined the Herald in 2023.