Apologies for technical difficulties that caused a delay in posting this.

On Tuesday, July 30, Dr. Daniel Selove, a medical doctor Board-certified in clinical pathology, anatomical pathology, and forensics, works with coroners to determine the causes of death. He spoke slowly and looked at the jury often as he gave detailed answers about what an autopsy involves and how he arrives at conclusions. He determined that the cause of Hana’s death in May 2011 was hypothermia, which happens when the body’s core temperature is too cold for the person to survive. He also determined two conditions that contributed to her death: malnutrition and H. Pylori, or gastritis, the inflammation of the stomach lining.

Dr. Selove spent hours going over the conditions that Hana did not have, and did not die from (cancer, AIDS, overactive thyroid gland, parasites, diabetes, schizophrenia, trauma, drugs, drowning, food allergies, anorexia/bulimia, stroke, more).

The prosecutor (Mr. Weyrich) had Dr. Selove review more autopsy photos, noting her the protrusion of her ribs and shoulder blades, her overall thinness, her lack of subcutaneous tissue (the fat under the skin that can keep us warm, if we have enough).

Dr. Selove described what the circumstances that hypothermia occurs in: children and elderly are more at risk, as are thin people; a cold environment, though temps don;t have to be freezing; wet clothes or wet skin, laying on cold surfaces. People dying from hypothermia undergo brain changes, which cause them to stumble and fall. They also engage in what’s called “paradoxical undressing,” taking their clothes off because they have the false sense that they are warm. Hana stumbled and fell that night, and took off her clothes, before she fell unconscious to the ground and later died.

Dr. Selove showed autopsy photos of the many cuts and bruises that Hana apparently acquired the night she died, abrasions on her head, pelvis, elbows, and knees. He also pointed out “striking marks” on Hana’s calves and thigh that Hana had likely received in the hours or days before she died. These injuries were the result of having been struck by a stick-like object; Hana had at least 14 such marks. None of the cuts or the striking marks caused Hana’s death.

Dr. Selove said that the autopsy found no other cause of death besides hypothermia.

The defense attorneys then went over with Dr. Selove, slowly and in great medical detail, the various conditions such as giardia, low organ weight, diabetes, bulimia/anorexia. Ms. Trueblood had Dr. Selove comment on an autopsy photo of Hana’s backside, saying that Hana appeared to have subcutaneous fat under her buttocks and thighs. Ms. Trueblood asked if Hana’s fingernails showed evidence of hypothermia, such as splitting or ridges; Dr. Selove said no. Ms. Trueblood asked about bulimia and anorexia. Dr. Selove said Hana’s esophagus did not show signs of inflammation from vomiting, which is part of bulimia.

The defense attorneys also talked about how conditions like anorexia and bulimia often occur in a clandestine way: that people starve, binge, and purge themselves in secret. I am guessing that they mean to suggest that Hana perhaps covered up her possible bulimia/anorexia, and died as a result of that, rather than malnutrition. This was not a family where privacy was valued highly. Immanuel testified Monday that sometimes he peed on himself because somebody had to go with him to the bathroom, and there wasn’t always somebody around to do that. He and Hana were hosed off outside, or had to shower outside, under the supervision of others.

I’m pretty horrified that the defense is suggesting Hana’s weight loss was from anorexia or bulimia, rather than malnutrition. But I’m more saddened that Hana apparently never received any medical attention after 2009. Both Dr. Chalmers yesterday and Dr. Selove today used Hana’s medical records to look at her weight loss: Hana weighed between 77 and 109 pounds during August 2008 and June 2009. No other medical records apparently exist for her until she was weighed after her death. She was 80 pounds then, at 5 feet tall, in the 5th percentile for girls her age.

The next witness was Gay Knutson, now the Director of Social Services at Adoption Advocates International, the agency used by the Williamses. Ms. Knutson was not personally involved with the Wiliamses’ adoptions of Hana and Immanuel. She testified about various documents that were from the “family file” for Hana and the Williamses: the Welcome Home packet, the child placement papers, the personal data sheets of Larry and Carri Williams, the home study, the post-placement reports. These are all standard adoption agency items.

Ms. Knutson noted that the Williamses were required, like all families who adopt from Ethiopia, to submit post-placement reports every year until the children turn 18. Both the adoption agency and Ethiopia want to know that the children are doing well in their adoptive homes. The Williamses did not submit any post-placement reports after 2009.

Another reason for these post-placement reports is the possibility of the family’s getting help if things are not going well. AAI encouraged families to call if they needed help. They had no record of the Williamses ever calling.

There is a video of Hana taken in Ethiopia by AAI in October 2007, which the prosecution wants to show at some point. Hana said her age in the video, which the defense attorneys challenge. I’m not clear whether Ms. Knutson’s testimony was sufficient to allow the video to be entered and shown. There is another witness who may testify about the video as well, later in the trial.

The final witness was Yohannes Kidane, an instructional assistant with Seattle Public schools, who is fluent in English, Amharic, and Tigrinya. The prosecution hired Mr. Kidane to review adoption-related documents from Ethiopia, to verify that they said the same things in English and Amharic.

Mr. Kidane also explained how the Ethiopian calendar varies from the Gregorian calendar the US uses: the Ethiopian New Year begins in September; the months are all 30 days except for a 13th month which is 5 days; their calendar is between 7-8 years behind the Gregorian calendar. By the Ethiopian calendar, it’s 2005 now. This is important because the dates of events are different on documents, depending whether the Gregorian or Ethiopian calendar is being used.

Mr. Kidane has a bachelor’s degree from the University of Asmara, in Eritrea, and a master’s degree as well. The day ended as Ms. Forde, Larry Williams’ attorney, was asking Mr. Kidane where he went to primary school and high school, over 20 years ago.

The defense attorneys did not ask Ms. Knutson about her education (kindergarten and on), nor Dr. Selove, nor Dr. Chalmers.

Mr. Kidane is expected to testify again Wednesday July 31, probably after lunch break at 1:30. The morning will begin at 9am, with testimony from a Children’s Hospital mental health counselor who was Immanuel’s therapist. The Williamses’ son Joseph could also testify, though the defense lawyers said Joseph’s attorney have told them Joseph plans to take the Fifth amendment on certain items, likely related to the fact that Immanuel had named Joseph as one of the people who hit him. The lawyers and judge were going to confer about next steps regarding Joseph.