One month ago, 1-year-old Rehma Sabir died of what authorities called abusive head trauma. But her death certificate provides just a one-word description of the cause of death: pending.
While Sabir’s nanny, Aisling Brady, remains in custody on charges of assaulting the child, medical examiners have yet to complete Sabir’s autopsy. Prosecutors say Brady, 34, had sole contact with the child at the time of the injuries, which included massive brain swelling and bleeding behind her eyes.
But without a definitive cause of death, they have not charged her with homicide, creating a thorny legal situation. Brady, through her lawyer, has maintained her innocence.
“The tragic part of this is that you have someone in custody and the government doesn’t even have an autopsy report or the cause of death,” said Michael Doolin, a criminal defense lawyer in Boston, who is not connected to the case. “That’s the part that scares you.”
The Middlesex district attorney’s office, which is handling the case, declined to comment. The prosecutor’s office had previously said it would consider filing murder charges once the autopsy is complete. The medical examiner’s office said it did not have a timetable for when the autopsy results would be available.
Specialists say autopsies involving violent head injuries, particularly in children, can be painstaking, in some cases lasting weeks, if not months. Even when the cause of death appears clear-cut, examiners must perform exhaustive forensic tests to rule out other possibilities and pinpoint when the injuries were sustained.
“Most times, nothing else is going to cause that constellation of injuries besides blunt force trauma,” said Kevin Whaley, assistant chief medical examiner in Virginia. “But you have to run a bunch of tests to play devil’s advocate.”
In some cases, results of toxicology and other specialized tests can take two months or longer, he added.
Frederick Bieber, a pathology professor at Harvard Medical School, said determining the precise cause of brain injuries is a complex, highly specialized process.
“The brain is a more complicated organ,” he said.
In suspected homicides, medical examiners will often call in outside specialists to confirm their findings, those familiar with the process said.
But in cases involving severe abuse, Whaley said, coroners can determine the cause and manner of death before all the tests are back.
“The cause and the manner isn’t going to change,” said Whaley, who was speaking on behalf of the American Society for Clinical Pathology. “I can’t think of anything that would flip me from thinking it was a homicide. As long as it’s pending, you’re sort of handcuffing law enforcement.”
Following an initial autopsy, Rehma was diagnosed as a victim of abusive head trauma, with a specialist concluding that “there is no other medical explanation” for her death. The child would not have appeared normal after sustaining such severe injuries, specialists said.
‘Most times, nothing else is going to cause that constellation of injuries besides blunt force trauma. But you have to run a bunch of tests to play devil’s advocate.’
“Brain injuries are symptomatic immediately,” Whaley said.
Brady’s lawyer, Melinda Thompson, has noted that Rehma was found to have preexisting injuries: bone fractures that appeared to be between two weeks and two months old. She has also noted that the family had traveled extensively without Brady recently.
Last week, Thompson, who could not be reached for comment for this report, filed a motion to preserve a wide range of evidence, including the family’s travel itinerary since last June. She also requested the family computer, Rehma’s medical records, and all communication between Brady and the parents. The motion also included journals Brady maintained at the family’s home in Cambridge about the child’s activities.
Brady is due back in court Feb. 22.
While authorities say the child’s head injuries were acute, inflicted in the hours before she was rushed to the hospital, evidence of preexisting injuries can help create doubt about who was responsible, lawyers say. “That’s powerful stuff for the defense,” said Kevin Reddington, a defense attorney.
Most lawyers interviewed said they were not surprised that prosecutors charged Brady before the autopsy is complete, noting that as an Irish native in the United States illegally she posed a significant flight risk. She was ordered held on $500,000 bail.Andrew Ryan and John R. Ellement of the Globe staff contributed to this report. Peter Schworm can be reached at email@example.com.