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Doctor explains about-face in shaken baby trial

Pallavi Macharla, flanked by her attorney J.W. Carney (left) and her husband, Tony Vahamalla, is on trial for killing 6-month-old Ridhima Dhekane in the spring of 2014 by shaking her violently.
Pallavi Macharla, flanked by her attorney J.W. Carney (left) and her husband, Tony Vahamalla, is on trial for killing 6-month-old Ridhima Dhekane in the spring of 2014 by shaking her violently.Josh Reynolds for The Boston Globe/file

WOBURN — Anna McDonald was a doctor in training in the Massachusetts medical examiner’s office when she performed an autopsy on 6-month-old Ridhima Dhekane in the spring of 2014. It was her first case involving allegations of fatal shaken baby syndrome, she told a Middlesex Superior Court jury on Monday.

The Burlington infant’s former baby sitter, Pallavi Macharla, 45, is on trial for murdering the little girl by shaking her violently.

In testimony Monday, McDonald said her mentor at the time, Dr. Henry Nields, who was then the chief medical examiner, had given her literature that indicated ruptured blood vessels, known as retinal hemorrhages, in a child’s eyes at autopsy were a “black-and-white” sign of shaken baby syndrome.

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McDonald, who now performs autopsies in North Carolina, said the literature affected her original ruling that Ridhima had died of blunt force and injuries to her head by shaking.

“The swollen brain. . . and hemorrhages were portrayed as black-and-white,” McDonald testified. “I didn’t explore, to my discredit, are there controversies about this topic? And what else should I do to arrive at the correct diagnosis?”

Shortly after that autopsy, McDonald left to work in North Carolina and said she began to read medical articles that indicated such retinal bleeding is not always a sure indication of a violent shaking.

“They are not specific and can be seen in a wide variety of conditions,” she said.

“It began the cascade of me realizing I needed to review” the Ridhima case, she said. “I began to doubt myself.”

McDonald said in late 2015 she learned that an expert hired by the baby sitter’s attorney suggested the infant died of cardiac arrest after choking on applesauce while at the baby sitter’s home, and that extensive brain injuries found during the autopsy might have instead been caused by doctors aggressively trying to revive her.

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That knowledge, she said, led her “down the path to admitting I made a mistake.” McDonald said she then reviewed hundreds more documents related to the case and came to a similar conclusion as the defense attorney’s experts.

She said documents indicated Ridhima went nearly 45 minutes without oxygen to her brain. McDonald concluded the massive bleeding found in her head and behind her eyes stemmed from vessels leaking as doctors restored oxygen and blood flow later.

McDonald in 2016 contacted Massachusetts prosecutors, asking to change the manner of Ridhima’s death to “undetermined.”

The change of heart, she testified Monday, “was the right thing to do.”

But McDonald’s former boss, Nields, who had supervised McDonald’s autopsy of Ridhima, disagreed and refused to change the death certificate. He believed the death was a homicide, and the infant died of severe head injuries.

Nields is expected to take the stand on Tuesday.


Kay Lazar can be reached at kay.lazar@globe.com. Follow her on Twitter @GlobeKayLazar.