Lengthy testimony by St. Louis medical examiner Dr. Mary Case on Wednesday highlighted the second day of the murder trial of Waynesville resident Ryan Evans.

Lengthy testimony by St. Louis medical examiner Dr. Mary Case on Wednesday highlighted the second day of the murder trial of Waynesville resident Ryan Evans.

Evans is charged with second-degree murder in the death of 18-month-old Skyler Barrett on Oct. 23, 2006. He is also charged with child abuse resulting in death.

Skyler’s father Nick Barrett, his paternal grandparents Jeff and Patty Barrett, and his maternal grandparents Robert and Glenda Meyers, wept as Case indicated on projected autopsy photos the bruises on Skyler’s cheek, forehead and scalp that Case said resulted from injuries that killed him.

Under questioning by Prosecutor Susan Boresi, Case said the injuries, in her opinion, caused Skyler’s death and were made by “a very forceful impact.”

Case testified that the injuries could not have been caused by anything else, including shaking the head, a vitamin K deficiency or rough treatment by paramedics or emergency medical technicians.

Case testified that she examined Skyler’s brain about three weeks after he died, and found significant bleeding and major brain damage, which could have been caused only by a forceful impact that caused “differential motion” of the child’s skull and brain, meaning that the skull and brain were forced to move in different directions.

Case, who is the medical examiner for St. Charles, Franklin, Jefferson and St. Louis counties, was accepted as an expert witness by the court before testifying.

During a lengthy cross-examination, defense attorney Mark Prugh questioned Case’s impartiality, suggesting that she had been called by the prosecution to secure a conviction. Case denied this, saying she is not an employee of any public safety agency and that her only role was to give her opinions about what she observed.

Prugh also questioned Case about what she was getting paid to testify, but Case said she was not getting paid anything to testify in this case.

When Prugh asked her if she had seen Skyler’s CT scan, Case replied, “No, but I saw the brain.” Case testified that the subdural bleeding would not have shown up on a CT scan, but she said it was visible when she examined Skyler’s brain.

Two other doctors also testified. Dr. Robert Lynch, who was director of pediatrics at Cardinal Glennon Children’s Hospital when Skyler was brought there on Oct. 23, 2006, testified that he performed an exam on Skyler and determined he was brain-dead. This was indicated, Lynch said, by Skyler’s being totally unresponsive, and a negative blood-flow study. “My determination,” Lynch said, “was that Skyler’s condition was caused by a sudden traumatic injury to the brain.”

Dr. Arturo Montellano, who in October 2006 was a doctor at General Leonard Wood Army Community Hospital, testified that he examined Skyler on Oct. 22, 2006 and found him healthy. He prescribed a suppository and Pedialite and sent him home. Montellano was also on duty in the hospital emergency room on the night of Oct. 23, when Skyler was brought in unresponsive and without a heartbeat. Montellano said he began an IV and administered fluids. Montellano said Skyler’s heartbeat restarted, and he was flown to Cardinal Glennon.

Under cross-examination by Prugh, Montellano said he did not remember a nurse named Jeremy Reynolds being in the emergency room, even after Prugh produced testimony from Montellano’s Dec. 12, 2008 deposition saying that Reynolds was in the emergency room.

Two law enforcement officers also testified. Bill Anderson, who at the time of the incident was the Pulaski County Sheriff’s Department Chief of Detectives, testified that Evans told him that Skyler “got sick” at home after sleeping for 15-20 minutes. Anderson said he never saw Skyler at the hospital.

Donald Hayden, a Pulaski County sheriff’s deputy, testified than he saw Skyler in the GLWACH emergency room before he was flown to Cardinal Glennon. Hayden testified that he saw bruises on Skyler’s left cheek, on his forehead between his eyes and on the back of his head.

The trial was expected to continue Thursday with more state witnesses.