Dr. Andranik Madikians told the court that almost every one of 10-year-old Anthony Avalos' organs were failing when he arrived. He said his eyes were sunken and his body was bruised and burned.
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A CT scan showed bleeding and swelling of the brain. Madikians was one of two physicians who testified Monday that the trauma to Anthony's brain was similar to "shaken baby syndrome."
Earlier on Monday, a detective testified that during their search of the Lancaster apartment in which the boy was found dead, detectives found a corner where the floor's carpet was pulled up.
Anthony's siblings testified that's where they were forced to knee on uncooked rice while holding weights for hours at times - often until their knees bled.
UCLA Mattel Children's Hospital nurse Priscilla Cabunoc told Los Angeles Superior Court Judge Sam Ohta that she has seen hundreds of sick or injured children die while she has been on the job and that Heather Maxine Barron, the mother of the late Anthony, was one of the few who were not present in the hospital room when the child passed away.
In the other cases the parents were out of the area or could not be present for legitimate reasons, Cabunoc said.
The nurse testified that Barron earlier spent about 10 minutes with her son before his death, then asked if she could be excused to the waiting room. Barron spoke with a slur and her concerns for her son seemed feigned, according to Cabunoc.
"To me it looked like she was forcing herself to have some type of emotions,'' Cabunoc said.
None of the boy's relatives were present when he died, although one of his aunts entered his room a short time later, Cabunoc said. Barron did not go back into the room until about an hour and 15 minutes later, according to Cabunoc.
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Barron, now 33, and her ex-live-in boyfriend, Kareem Ernesto Leiva, now 37, are each charged with one count of murder and torture involving Anthony's June 2018 death, along with two counts of child abuse involving two of the boy's half-siblings, identified in court only as "Destiny O.'' and "Rafael O.''
The murder count includes the special circumstance allegation of murder involving the infliction of torture. Over the objection of Deputy District Attorney Jonathan Hatami, the Los Angeles County District Attorney's Office dropped its bid for the death penalty against the two after the 2020 election of District Attorney George Gascon, who issued a directive that "a sentence of death is never an appropriate resolution in any case.''
Barron and Leiva now face a maximum of life in prison without the possibility of parole if they are convicted as charged.
In other testimony, Helen Withers, a forensics services nurse at Antelope Valley Medical Center, told the judge that her facility was the first to which the boy was brought and that he was obviously malnourished and had bruises all over his body.
"His bones were protruding,'' Withers said. "You could count his ribs and they didn't have a lot of fat.''
Withers, reading from her medical report, said Barron further told her that her son had not eaten well the previous three days. Barron also said that Anthony told her he thought he was gay and she said she loved him regardless, according to Withers.
Barron further said that her son fell while playing basketball at school, that he was pushed down while playing basketball, and that he had tumbled on their apartment carpet, according to Withers, who additionally said Anthony was later transferred to UCLA Mattel Children's Hospital.
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Dr. Michael Gertz, the AVMC emergency room doctor on duty when Anthony arrived, testified that the boy had no pulse or cardiac activity, was motionless and that his pupils did not react to anything.
Prior to the former sheriff's Homicide Investigator Omar Miranda taking the stand, Deputy District Attorney Saeed Teymouri spoke to relatives sitting in the front row of the gallery to warn them that a PowerPoint presentation of the boy's autopsy photos would be shown during the testimony of Miranda, who now works in the Special Enforcement Bureau handling tactical operations.
The family members chose to stay and remained poised as the color images, some of them depicting the child's entire body and his injuries, were displayed over a period of about five minutes. Barron and Leiva showed no reaction during the photo display.
Last October, the Los Angeles County Board of Supervisors formally approved a $32 million settlement of a lawsuit filed by the boy's relatives -- two of whom testified last week that they notified the county's Department of Children and Family Services about the alleged abuse. The lawsuit contended that multiple social workers failed to properly respond to reports of abuse of Anthony and his siblings.
The lawsuit cited other high-profile deaths of children who were also being monitored by the DCFS -- 8-year-old Gabriel Fernandez and 4-year-old Noah Cuatro, both of Palmdale -- to allege systemic failures'' in the agency.
City News Service, Inc. contributed to this report.