http://media.utsandiego.com/news/documents/2012/08/06/Dr.Melinek_Report.txt
Judy Melinek, M.D
PathologyExpert.com
3739 Balboa Street #102
San Francisco, CA 94121
(415) 850-7056
July 16,2012
Angela Hallier, Esquire
Hallier & Lawrence PLC
3216 North Third Street, Suite 300
Phoenix, 4285012
RE: Maxfield Shacknai
Dear Ms. Hallier,
I have reviewed the following material and conducted the following informational
interviews regarding the above case:
1 . County of San Diego Office of the Medical Examiner Autopsy Report (dated 912111
authored by Jonathan R. Lucas, M.D.), lnvestigative Report, Neuropathology and
Toxicology Report for ME#: 11-1542 Maxfield Aaron Shacknai
2. Coronado Police Department Investigations Division Death Investigation Case
Number 2011-1467 July 11,2011 1043 Ocean Boulevard Coronado, CA Power Point
Presentation.
3 . Statement from Sheriff Bill Gore of the San Diego County Sheriff's Department dated
September 2,2O11
4 . Powerpoint Presentation entitled "Autopsy of Max Shacknai" by Jonathan Lucas
M.D.
5 . Biomechanics advanced report entitled "Expert Report by Mark A. Gomez, Ph.D. Re:
Mr. Maxfield Shacknai" by Mark A. Gomez, Ph.D dated 9119111
6. Photograph of proposed fall mechanism from this report on sdsheriff.net from http://
www. sdsh eriff . net/coro nado/i mag es/msO 1 .j pg
z. Powerpoint Presentation titled "July 13th, 2011" about Rebecca Zahau's death.
B. Pediatric Medical records for Max Shacknai from Camelback Pediatrics P.C.; Laura
Norton Petrovich, M.D.; and Valley Pediatric Triage dated from 6/10/05 to 5126111.
9. Pre-Hospital Care Report for Maxfield Shacknai from the Coronado Fire Department
dated 0711112011 at 10:12 QCS 4192431 Run #: 2011-59527
r0. Sharp Coronado Hospital records for Maxfield Shacknai MR# 00-23-97-92 | from
admit date7l11l2O11
rr . Children's Hospital -San Diego Radiology Repor-ts from Maxfield Aaron Shacknai
dated 7 111 12011 through 7 11612011 .
12 . County of San Diego Office of the Medical Examiner Autopsy Report (dated 912111
authored by Jonathan R. Lucas, M.D.), Investigative Report and Toxicology Report
for ME#: 11-1517 Rebecca Mawii Zahau
13 . Exponent Failure Analysis Associates Draft Reports by Robert T. Bove, Ph.D. dated
December 20,2011 and June 15,2012.
14 . On March 16, 2012 we visited the Coronado Police Department and reviewed in the
presence of Commander MichaelT. Lawton allthe scene photographs in the case
file, as well as photographs of the hospitalízed Maxfield Shacknai. I also reviewed
several police interviews and reports not included in the above files including a child
protective services report and an interview of Xena conducted after the death of the
Rebecca Zahu.Included in the materials was a drawn diagram by the first responder
indicating the positions of Max, Rebecca and the chandelier prior to them being
moved by emergency personnelfor access.
15 . Photographs of Maxfield Shacknai taken in the hospital entitled "Max_back1"
through "Max_back5;" "Max_hospitall" through "Max_hospital5;" and "Maxie_pic1"
and "Maxie_pic2."
16 . Photographs of Maxfield Shacknai taken the day before his death by a family friend,
as well as memorial photo-books belonging to Dina Shacknai.
17 . I have had an opportunity on multiple occasions to personally interview Dina
Shacknai about the circumstances surrounding the death of her son, his physical
abilities and behavior.
1B . Dr. Dean Hawley "Death by Strangulation" 9 pages
19. "Death in a Mansion: Was it Murder" from "People" magazine dated August 15,
2011.
20 . e mail from Nina Romano dated March 1 9, 201 2 about what transpired July 11 ,
2011 documenting her first conversation with Rebecca Zahau after Max's injury.
21 . Phone conversation with Dr. Bove on March 26; approximately 50 minutes
22.Partially
redacted Investigation file of Maxfield Shacknai from the City of Coronado
Police Department.
2 3 . Rady Hospital Medical Records
24 .CD containing photos from the Medical Examiner's Office including scene photos for
Maxfield Shacknai case # 11-01542
25 .27 photographíc prints of Maxfield Shacknai from the hospital, reportedly taken by a
nurse in the Intensive Care Unit
2 6. Entire Coronado Police Department Investigative file with Bates stamp numbers
and associated CDs numbered 1,2,3,8, 10, 11,12,13 (1 of 2),13(2oÍ2),14,17,
18,19,20
21 .Various informational sheets and forum discussions from the internet dated 317112
including : http ://www.scotsdalesoccer.com/Tournament/Max_Shacknai?
index_E.html;
http://www.lefthandedkitten.freeforums.oeg/things-that-are-suspiciousabout-
max-s-death-t7.html;
http://lefthandedkitten.freeforums.org/discrepancies-inrebecca-
s-versions-of-events-tS9.html;
http://lefthandedkitten.freeforums.org/max-sinjuries-
and-cause-of-death-t58.html;
http://lefthandedkitten.freeforums.org/mystery
of -the-benzo-132. htm I
2 B . Various informational sheets from the internet including:
. Aussie Jujitsu: Principles of Pressure Point Application http://
aussiejujitsu.blogspot.coml20ll/03/principles-of-pressure-point.html 712812011
. Brad Parker "The Ten Brazilian Jiu-Jitsu Moves Every Cop Should Know" http://
www. g rapplearts. co m/BJ J -f or-Pol ice. htm 7 128 | 20 1 1
. "Pressure Points" from wikipedia
http://en.wikipedia.org/wiki/Pressure_ point
7128/2011
. "Anatomy of a Choke" by E. Karl Korwai, MD from 8/1 12011 http://
www.o nth emat. com/p rinIlTT I 4
.
http://www.scotsdalesoccer.com/Tournament/Max_Shacknai?index_E.html
.
http://www.lefthandedkitten.freeforums.oeg/things-that-are-suspicious-about-max
s-death-t7.html
.
http://lefthandedkitten.freeforums.org/discrepancies-in-rebecca-s-versions-of
events{59.html
.
http://lefthandedkitten.freeforums.org/max-s-injuries-and-cause-of-death-t58.html
.
http://lefthandedkitten.freeforums.org/mystery-of-the-benzo-t32.html
I am a forensic pathologist who works as an independent consultant in both criminal and
civil matters. My education is notable for my undergraduate degree from Harvard
University, a medical degree (with honors) from UCLA Medical School and pathology
residency at UCLA Medical Center. I trained in forensic pathology at the Office of Chief
Medical Examiner in New York City from 2001-2003, during which time I identified
remains from the World Trade Center terrorist attacks on 9/1112OO1. I have published in
the medical literature on the topics of pathology, surgical complications, transplantation
surgery and immunology. I have been qualified as an expert witness in the fields of
pathology, forensic pathology and cause of death determination over 80 times in
California, New York, Florida and Texas. I am currently licensed to practice medicine in
both California and New York. I am board certified in anatomic, clinical and forensic
pathology and I routinely interpret autopsy reporls, toxicology reports, medical records
and police reports to determine the cause of death and sign death certificates.
After reviewing the above-mentioned sources in this case, and working in collaboration
with Dr. Robert Bove, Ph.D., it is my opinion that Maxfield Shacknai's injuries are not
consistent with the scenario depicted in the biomechanics report generated by Dr.
Gomez. Max's center of gravity would have been too low to go over the banister with the
scooter unassisted, even when taking into account the extra height of the scooter. The
pattern of injury on Max's back is not consistent with an impact/slide against the
descending banister as depicted in Dr. Gomez's scenario, as there is no deep muscle
injury as would be expected from a fall onto the back from a height; the skull fracture
contusion indicates that the primary fall impact was against the top (vertex) of the head,
and not the right front; and the hands have no "dicing abrasions" from grasping at the
chandelier. ln the autopsy photographs, the injuries on Max's back aggregate in a
somewhat "7" shaped angled configuration, more in line with the height and shape of
the banister on the second floor, from whence he fell. The damage to the newel post at
this floor indicate that this is the original site of the fall, and Max's resting position on the
ground immediately below suggests this as well.
The fall alone, in the any of these scenarios, would not account for the abrasions and
contusions along the right forehead, inner eye and lids, the left ala, or the right shoulder
and neck, which are each in additional planes of injury. The more planes of injury, the
more likely that an incident is the result of an assault rather than a simple or even an
complex fall. A fall would not explain injury to a recessed or protected area (as in the
inner right orbit or neck). An unassisted accidentalfall, as depicted in Dr. Gomez's
scenario, does not explain the subsequent resting position of the Razor scooter on top
of Maxfield's leg (where there is no bruising or injury) and the complete lack of glass
shard "dicing" injury to Maxfield's body. The Gomez scenario also does not account for
how a facial impact can cause a frontal fracture and bruise at the midline vertex, or
hyperextension of the neck, if the body has collapsed ahead of the face.
A more reasonable scenario, one that is both consistent with the injuries observed on
the deceased and consistent with the scene measurements. is that Maxfield was
assaulted by another person at the hallway, near the banister on the second floor. The
perpetrator injured his face and shoulder and Maxfield then was pushed against or
backed into the second story railing, causing the patterned injuries along his back.
Then, he was either lifted over the banister or he escaped over the banister, falling
down to the front entryway, below. He landed on the top of his head and collapsed with
his legs following, rather than with his legs first and his face second, as in Dr. Gomez's
scenario. A fall onto the top of the head could cause the cervical contusion from axial
loading, without gross hyper-extension or flexion. The cervical contusion could also
occur if the vertex-impact was followed by gross hyper-extension or hyper-flexion of the
upper neck, as the rest of the body collapsed downward. This assault scenario was
discussed with and supported by the findings of Dr. Robert Bove, a biomechanics
experl, and most importantly, is the only scenario we could come up with in
collaborative consultation that could account for all the planes of injuries and the scene
findings in this case. The presumptive positive benzodiazepine screen of antemortem
specimens might be explained by the administration of Versed in the hospital, but is
more likely a false positive given the lack of confirmation by HPLC, a more specific
laboratory analysis. lt does not support that over-medication of the child in any way was
involved in the assault. Additionally, the location of the injury to the top of the cervical
cord makes it incredibly unlikely that Maxfield would have been able to clearly articulate
the word "Ocean" after the fall, a process which requires intact upper cervical cord
neurons.
My review of all these materials therefore inform me within reasonable medical
probability that while the Medical Examiner's cause of death determination is accurate,
the manner of death is not. lt would be more accurate in my opinion, based on my
review of all this additional information, to certify that manner as a homicide, where
homicide is defined as death at the hand of another. Homicide is a forensic term used
by medical examiners and coroners to indicate another person's involvement in the
death and does not distinguish between legal gradations in intent such as involuntary
manslaughter, criminally negligent homicide or murder. The apparent suicidal death of
the supervising caregiver two days after the incident, combined with the inconsistencies
in her verbal reports about the incident; her comment to her sister that "Dina's going to
kill me;" her knowledge of where Max fell when she spoke to Dina's sister Nina; and the
multiple planes of injury on the child's body all support Rebecca Zahau's direct
involvement. A thorough psychological assessment of her mental state or inquiries into
previous aggressive acts or a pre-existing violent temperament are all notably absent
from the material I reviewed in Max's case file or in the material supplied to me about
Rebecca Zahau's death.
The absence of half of the link from the chandelier, which is clearly visible in the scene
photos but is missing from the evidence collected and photographed at the police
department, may limit analysis of the tensile strength of this link. According to Dr. Bove,
he saw the other half when he examined the chandelier. Photographs alone cannot
accurately convey whether the link would suffer metal fatigue with a yank produced by a
44 pound falling child, or would need the assistance of a greater weight. The difference
in Max's weight between the autopsy report and the pediatric medical records is
consistent with weight gain from fluid resuscitation during hospitalization and organ
procurement with subsequent tissue edema. The pediatric chart dry weight is likely
more accurate. Only metal analysis by a qualified failure analyst can confirm whether a
sw¡nging chandelier could deposit its broken link on the opposite stairway landing, yet
fall downward, only slightly displaced from where it was originally hanging in the
stairwell alcove.
The pertinent facts of the case that lead me to this conclusion are:
1. According to personal interviews with Dina Shacknai, Maxfield was a careful child;
not a risk{aker or dare-devil. She reported that the soccer balls in the photos were
always scattered around the house and it was not unusualto see them there. Both
Dr. Bove and Dina Shacknai described the carpeting of the residence as being a
thick pile carpet, which would make it difficult for Max to ride his razor scooter at a
high rate of speed. Dina Shacknai reported that her sister Nina was told by Rebecca
Zahau that Maxfield had fallen from the second story on the day of the fall, prior to
any police report. She also reported that told
her that Rebecca had a quick temper and knew ju-jitsu. reported incidents
where Rebecca would put in a "hold" and would have to "tap out" to be
released from the hold.
2. Medical records for Max Shacknaifrom Camelback Pediatrics P.C.
documented his height at 45 inches and a weight of 44.1 pounds.
3 . Photographs of the Razor scooter depict white paint on the wheel and side similar in
color and size to the nicks in the upper banister at the top of the second story.
4. Scene photos depict a golden-colored open link, consistent with the chandelier chain
link on the carpeted landing between the first and second floors. Photographs of the
chandelier show a soldered metal loop at the top, but no residual chain. This
indicates that the chain broke at the final loop, where it attached to the top of the
chandelier.
5 . According to the police department interview with Xena, Rebecca Zahau sister,
Maxfield was "smart like a 7 or I year old" and did not ride his Razor scooter near
the edge of the stairs or down the stairs. She said he could not ride fast because the
floor was carpeted. She also reported that her sister told her "Dina is gonna kill me"
when they returned to the house.
6. According to the Coronado Police Department and the Medical Examiner scene,
autopsy and hospital photographs, there is a large subgaleal contusion at the top of
the head, associated with the largest gap in the sagittally oriented skullfracture. The
front edge of the skull fracture is at the midline and does not reach the right lower
frontal forehead area, where the abrasions and contusions begin on the face. There
are healing abrasions on the left thoracic back, some angled, suggesting a pattern:
configured roughly in a figure "7" as the back is viewed in the upright position.
Photographs of the extremities do not demonstrate any sharp force injury or "dicing"
abrasions, typical of glass shard injury. Deep muscle dissection of the back
(130836.jp9 and 130837.jp9) show no deep muscle hemorrhages beneath the
superficial abrasions noted on the back.
7 . From a review of the witness statements it is unclear whether Max was found face
up or face down. When paramedics arrived he was face up but he may have been
rolled over by Rebecca Zahau prior to their arrival.
B . The wet tissue shows sagittal sinus thrombosis and no brain matter contusion at the
vertex, subjacent to the fracture line. There is no grossly appreciable subdural or
subarachnoid hemorrhage. The spinal cord contusion is localized to the upper
cervical segments and there is no epidural hemorrhage. Other organ tissue
fragments are grossly unremarkable.
9. The microscopic slides confirm the presence of a healing abrasion to the right
shoulder, lacking refractile foreign material. The left finger skin has slightly refractile
foreign material on the surface, which have the appearance of fibers, suggestive of
gauze or hospital adhesive tape. The lung sections have a pronounced aspiration
pneumonia with numerous multi-nucleated giant cells phagocytosing foreign
material, including some plant material. The heart sections have scattered areas
with contraction-band necrosis, but without myocytolysis, edema, fibrosis or
inflammatory reaction. The cervical spinal cord segments confirm a recent spinal
cord contusion and associated edema. The brain sections are markedly edematous
indicating an acute anoxic ischemic encephalopathy.
10 . According to Sharp Coronado Hospital records 3 mg Versed was given in the
emergency room at 1146 on7l22l2o01 following endotracheal intubation. Hospital
records indicate an unknown down time and the radiological scans are negative for
cervical spinal fracture. Radiological scans of the head describe a left frontal non-
depressed fracture. Hospital physicians believed the injuries were inconsistent with
the report of an accidentalfall and reported the case to Child Protective Services.
The subsequent report relied on the Medical Examiner's conclusion of the manner of
death that this was an accidental fall and the case was closed.
11 . Medical Examiner Toxicology Report is presumptively positive by ELISA for
bezodiazepines, but this is not confirmed by HPLC.
These opinions are to a reasonable degree of medical probability and are based on my
experience and training, as well as my knowledge of the peer-reviewed medical
literature. I am relying on the information you have provided me at the present time;
thus, my opinions are liable to change if other information is offered to me for review.
I am available to testify to these opinions in deposition or at trial, if necessary. Please
feel free to contact me at the above address and phone number if you have any
questions or need further clarification.
Sincerely,
Judy Melinek, M.D.