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
(*advertiser censored*) XX0-XXXX
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 .jpg
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
10. 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 1161201 1.
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 Michael T. 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 Zahau. 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 personnel for 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.
18. 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 19, 2012 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.
23.
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
26. 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
Judy Melinek, M.D's amazing credentials:
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 inforensic 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 reports, 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 accidental fall, 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 expert, 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 ante mortem 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 swinging 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 risktaker 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 [Who?] told her that Rebecca had a quick temper and knew ju-jitsu. reported incidents where Rebecca would put [Who?] in a "hold" and would have to "tap out" to be released from the hold.
2. Medical records for Max Shacknai from 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 accidental fall 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.