Prosecution Plans Rebuttal As Twitchell Trial Continues

Defense rests its case after medical expert disputes prosecution's version of cause of child's illness

THE defense rested Thursday in the manslaughter trial of David and Ginger Twitchell. But the case is not yet ready for the jury. Special prosecutor John Kiernan is attempting to present a rebuttal case that could last up to three weeks.

The manslaughter charge stems from the Twitchells' choice to rely on Christian Science treatment instead of conventional medicine during a five-day illness of their 2-1/2 year-old son, Robyn, in 1986. The child died of what was later diagnosed as a bowel obstruction caused by a birth defect.

The defense rested without testimony by Mrs. Twitchell. Defense co-counsels Rikki Klieman and Stephen Lyons also did not call an expert witness to explain the Christian Science religion. Apparently part of the rationale for this was to preserve the defense team's claim that the prosecution's religion-related questions put to Christian Science witnesses were unconstitutional.

The main defense witness last week was Dr. Edward Sussman, chief of pathology at Worcester (Mass.) City Hospital, who disagreed with the autopsy findings of former assistant medical examiner Margaret Greenwald.

Dr. Greenwald, a prosecution witness, found that the obstruction was caused by a twisted bowel. Dr. Sussman, however, gave an entirely different picture. He said that the child had two birth defects, not one, and that the obstruction was caused by entrapment of a section of out-of-place bowel. This led to blood poisoning and a fatal loss of blood pressure. He said Robyn could not have been resuscitated after he died.

Sussman based his findings on a review of the autopsy report, photos, microscope slides he had made of tissue preserved from the autopsy, and the testimony of medical witnesses at the inquest into Robyn's death. He also obtained a history of Robyn's illness from the parents, which prosecution medical experts did not do. ``An accurate history is one of the most important factors in correctly interpreting autopsy findings,'' Sussman said.

Prosecution experts testified that, in their opinion, the obstruction occurred several days before the child died and that the child would have been in great pain and obviously ill. Sussman said he believed the obstruction occurred less than 24 hours before Robyn died. The defense says that the child appeared only to have flu-like symptoms and never appeared to be seriously ill.

Sussman also disputed Greenwald's finding that the child was severely dehydrated at the time of death and said an autopsy test indicated the child did not vomit repeatedly over several days. He said one particular symptom that the prosecution alleges the child manifested does not occur in children and would have been impossible in Robyn due to the location of the obstruction.

Sussman was not allowed to tell the jury about the 10 autopsies he has performed on children, some of whom had been hospitalized, who had died of bowel obstructions. Prosecution witnesses, on the other hand, have been allowed to testify more broadly. Suffolk County Superior Court Judge Sandra Hamlin allowed the prosecutor to state his version of Robyn's symptoms during questioning, while Lyons was not permitted to repeat the defense version.

Because Judge Hamlin has conducted most of the evidentiary discussions at bench conferences or in chambers, the reasons for most of her rulings on evidence are not known. A gag order she placed on prosecution and defense lawyers prohibits them from discussing the rulings with reporters.

OTHER defense witnesses last week were Brenda Chester, personnel record-keeper for a supermarket chain, and Richard Haczynski, general manager of a chain of auto-parts stores. Both testified about the employment of Robert Delaney, a prosecution witness who claimed he heard crying and screaming from the Twitchells' house the weekend before Robyn died, and who alleged that Mrs. Twitchell mistreated the couple's two sons. Mr. Delaney said he was able to observe this because he worked nights and was home days during 1985 and 1986, when he and his wife were the Twitchells' neighbors. Ms. Chester, however, testified that Delaney worked days from March 23 to April 20, 1986. Mr. Haczynski said Delaney managed a store that was open only days during 1984 until October 1985.

The judge refused to allow the testimony of insurance expert Kenneth Zwymer. He stated in a hearing with the jury absent that most major insurance carriers will pay for treatment by Christian Science prayer. Hamlin ruled the evidence ``not probative of the reasonableness of the Twitchells' conduct.''

On Friday both sides wrangled over prosecution subpoenas of the chairman of a Christian Science visiting nurse service in the Boston area and a Christian Science nurse formerly employed by the service. Mr. Kiernan says he is looking for charts made by another Christian Science nurse who visited Robyn the day before he died. The defense lawyers and a counsel for the chairman of the nursing service and the nurse argue that the subpoenas are an improper prosecution attempt to gather information after it has resting its case. The judge is expected to rule tomorrow.

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