The child abuse specialist at the heart of the ‘Irish nanny’ case took the stand on Friday as her expert testimony was cross-examined by the defendant’s lawyer in a preliminary hearing in which the defense tried to have her ruled out of testifying in the case. The case is set for trial in early October.

Since January 2013, Aisling Brady McCarthy, a native of County Cavan, has been held in jail awaiting trial for the murder of Rehma Sabir, the one-year-old infant in her care.  McCarthy is accused of violently assaulting Rehma on January 14, 2013 at her family home in Cambridge, MA.

Dr. Alice Newton, who at the time of the incident was the medical director of the “Child Protection Program” at Boston Children’s Hospital, diagnosed Rehma Sabir as a victim of abusive head trauma (once called Shaken Baby Syndrome) within 20 hours of the child being admitted to the Intensive Care Unit.

As an experienced child abuse pediatrician, Newton stated that given the constellation of injuries that presented themselves on Rehma and the absence of a history of major trauma, there could be no other explanation for the cause of her death.  The timing of this abuse was also fixed by the prosecution  medical expert as being ‘close on 3-4pm’ on the afternoon of January 14, when the infant was solely in the care of the Irish woman.

She did not take into account many other injuries including spinal bone fractures that had occurred to the child weeks or months earlier, some in time frames times when the defense says it can prove the child was not in contact with the nanny. It was also revealed that her diagnosis of child abuse had been overturned in another controversial case.

On the basis of Newton’s medical opinion, McCarthy was arrested on January 21 before being indicted on first-degree murder charges later in 2013.

On Friday, September 5, at Middlesex Superior Court, MA, Newton took the stand at a pre-trial hearing to undergo a cross-examination of her abusive head trauma diagnosis from the defendant’s lawyer Melinda Thompson.

In the daylong hearing, Newton, who has been a certified child abuse pediatrician since 1999, expressed her  opinion on both the mechanism of Abusive Head Trauma(AHT) generally and as the specific cause of Rehma’s death based on her experience, training, research and review of  medical literature.

Thompson, questioned the paediatrician on wide range of topics including the research and literature that currently exists on AHT as well as her medical notes on this particular case.

“Things happened so quickly & intensely” explained Dr. Newton when she confirmed that she did not take any notes throughout her investigation.

When asked about the timing of the injuries, Thompson, quizzed the doctor  on a CAT scan that was taken soon after the child was admitted to the Children’s Hospital.

According to Newton, the CAT scan showed that the injuries had to have taken place “6-8 hours“ before the x-ray was taken which would place the child alone with her nanny.

However, the CAT scan specialist determined that this time-frame was actually ‘6-12 hours.’

McCarthy’s lawyer stated that this extra four hours could mean Rehma would have been in the care of her parents when the injuries happened.

Thompson asked the child abuse expert “Would this[ extra hours ] be significant in your diagnosis?”

“It could be,” admitted Dr. Newton.

Thompson, then focused in on the methodology of diagnosing AHT which is known as differential diagnosis.

To properly determine the cause of Rehma’s injuries, all the medical records, genetic, social history of the child would have to be accessed and reviewed before reaching a diagnosis.

This would allow Newton, the head of the Child Protection Program, to eliminate all possible alternatives so as to ensure that not only was her diagnosis accurate but to ensure any caregivers are not inappropriately accused of abuse.

To fully complete the diagnosis, the child abuse specialist should access Rehma’s full medical records from birth. In this instance, Newton advised the court, she did not. She admitted relying on information supplied by Rehma’s mother in a “20-30” minute conversation.

“She gave a detailed account. Her mom was one of those meticulous attentive parents,” said Newton

Throughout the cross examination, Dr. Newton admitted that in her pre-diagnosis, in many instances she did not access these necessary records and failed to speak to the primary care-giver on the day, McCarthy.

The doctor determined her AHT diagnosis based on the brief conversation she had with Rehma’s mother, the medical records on the hospital system, the CT Scan & MRI scans that were taken over-night and consultations with specialists during the 20 hours after Rehma had been admitted to Boston Children's hospital.

Newton told the court during the hearing that “it was important to know as much as possible about a child when they are in Intensive Care Unit for unknown reasons.”

Thompson, argued to Judge Hogan that Dr. Newton's failure "of using correct methodology”  meant her expert testimony was based more on “assumptions” than actual fact. She requested  that Dr. Newton's testimony be excluded from the upcoming October trial or at least limited to the scope of her expertise.

The judge took the motion under advisement.