BRIANNA MEDRANO-MARTIN - 16 Months (7/2010) - Omaha NE

Doctors were scrambling for answers.

A mother had rushed her 16-month-old daughter into the emergency room — and the little girl was fading fast.

But Brianna Medrano-Martin had no broken bones. No skull fractures.

Nothing beyond a bruise to her forehead. And a recent, seemingly routine illness.

In short, doctors had no idea what was causing her catastrophic injuries.

"Imagine — we're really confused," said Dr. Robert Howell, a Creighton University Medical Center emergency room doctor, who first treated Brianna. "The picture isn't making any sense."

Prosecutors sought to unravel the mystery Thursday as they tried to convince Douglas County District Judge Mark Ashford that the last adult to be with Brianna — her baby sitter, Keny Medrano-Cambara — was responsible for the little girl's death.

Brianna's mother, Adriana Martin, had dropped off her daughter on July 8, 2010, at the apartment of Medrano-Cambara, a cousin of Brianna's father.

Five hours later, Medrano-Cambara called to tell Martin that Brianna was sick and cold. Martin rushed to find her daughter limp and blue and struggling to breathe.

Medrano-Cambara's attorney, Michael Nelson, pointed out that doctors saw no outward signs of abuse — and could not pinpoint when the blunt-force trauma happened that caused Brianna's death.

Nelson also noted that a coroner's physician couldn't conclude whether the blunt-force trauma that caused Brianna's death was intentional.

"It's a blunt trauma, but how that occurred, I don't know," said Dr. Blaine Roffman, a Douglas County coroner's physician. "I cannot differentiate between whether it was accidental or intentional."

Other doctors said they could.

A Children's Hospital & Medical Center physician, and a doctor who specializes in child abuse cases, said Brianna's brain injuries could not have been caused by a typical fall or accident.

Ashford will be left to sort out the dueling doctors as he decides whether Medrano-Cambara is guilty of child abuse resulting in death.

Prosecutors Tressa Alioth and Emily Beller said the symptoms Brianna displayed — vomiting, listlessness, limpness — occur immediately after a child suffers a severe head injury.

Brianna had suffered no major falls or head trauma in the days leading up to her death, according to her parents. The little girl had been battling a lymph node infection, but her parents said she was on new medicine and had turned the corner.

Then Medrano-Cambara called, saying the child's health was spiraling.

Faced with a child with no visible exterior injuries, beyond the small bruise on her forehead, doctors at Creighton frantically tried to figure out what was going on.

They did a CT scan and found brain swelling. They did a spinal tap to see if meningitis was involved. Instead, they found blood in her spinal fluid — an unusual sign.

Fluid was in her lungs — a point that prompted significant debate among the attorneys in the case.

Nelson questioned whether the fluid in her lungs had to do with her ongoing illness. He noted that Medrano-Cambara said Brianna vomited on July 7, 2010, the day before she was taken to the hospital with critical injuries.

Beller, meanwhile, suggested that Brianna vomited because of head trauma — a common occurrence in brain injuries. Any fluid in her lungs was the result of her inhaling the vomit, which is known as aspiration. Such inhalation was a sign that her brain was no longer functioning, that she was unable to cough or otherwise expel the vomit.

After spotting the fluid in her lungs, doctors also checked for sepsis, a severe infection. They found nothing.

Doctors tried to stabilize Brianna, then sent her to specialists at Children's. Doctors there had a hard time initially unraveling the mystery. An MRI showed major trauma to the brain.

"The brain appeared to be dying," said Dr. Suzanne Haney, a child abuse expert and medical director at Project Harmony in Omaha.

By July 10, doctors declared Brianna brain dead. She was taken off life support and died in her parents' arms.

An autopsy found the bruise on her forehead, bleeding on both sides of her brain, brain swelling and bleeding in her retinas.

Medrano-Cambara's attorneys are expected to call a medical examiner to testify that such injuries could have come from an accident such as a fall.

Haney disagreed.

"Children fall all the time, they hit their head, they sustain a bump or a bruise," Haney testified.

"The amount of force in this case was significant. It's way more than what's seen in normal accidents."

http://www.omaha.com/article/20120302/NEWS97/703029910

Omaha Police Sgt. Nicolas Yanez exhausted all of his interrogation techniques with baby sitter Keny Medrano-Cambara.

Yanez told Medrano-Cambara, who is charged in the death of 16-month-old Brianna Medrano-Martin, that there were two penalties for killing a baby: life in prison and the death penalty.

Though the death penalty doesn't apply to child abuse resulting in death, which has a maximum penalty of life in prison, Yanez asked Medrano-Cambara what she thought a child killer should get.

That technique didn't work.

So Yanez overplayed her actions, asking her "how many times" she hit little Brianna.

Then he underplayed her actions, suggesting she never intended to hurt the girl, that it was just a mistake.

He invoked God — telling her she could get God's forgiveness. But first, she had to admit what she did.

He even laid out autopsy photos of Brianna.

Medrano-Cambara never flinched in the interview — which prosecutors recounted Friday as they rested their case.

"I want to know how many times you hit her," Yanez said. "I want to know."

Medrano-Cambara: "To hit a child, I wouldn't. To her, even less. She didn't even bother (me) or nothing."

Yanez motioned to the photo.

"Here she is already dead," he said. "Already dead in this picture. You can see her. You can tell her that, no, you didn't intend to do this to her."

"It's that I never did that to her," Medrano-Cambara said. "I never did that to her. That is impossible."

Yanez: "She's a good girl."

Medrano-Cambara: "Yes, I know."

Yanez: "Pretty. How could you do that, Keny?"

Medrano-Cambara: "I never did anything. Never, never . I never scolded the girl, because she never behaved badly."

Yanez: "So then how did she get the injury on the head?"

Medrano-Cambara: "I don't know."

On and on it went. Yanez pressed. Medrano-Cambara didn't budge.

Her attorney, Michael Nelson, noted that his client remained steadfast in the interview.

"It was consistent and unwavering denials," Nelson said.

Prosecutors Tressa Alioth and Emily Beller had a different spin on her responses. They called her unemotional and cold.

Alioth noted that Medrano-Cambara never once cried, even when presented with autopsy photos of Brianna. Nelson has pointed out that she did cry at Brianna's memorial service — to the point that the victim's mother, Adriana Martin, had to comfort her.

Though Medrano-Cambara wasn't talking, prosecutors suggested the medical evidence was.

Dr. Thomas Hejkal, a retina specialist at the Nebraska Medical Center, described massive bleeding in Brianna's eyes.

Beyond certain diseases, Hejkal said, that kind of bleeding is seen in only two kinds of cases: a severe motor vehicle accident where a child's skull is crushed, and in shaken-baby cases.

Hejkal testified the bleeding in the retina and damage to Brianna's optic nerve would have resulted in "visual impairment."

Prosecutors say Brianna would have been blind immediately after suffering the head injury.

When Martin dropped her off that morning, she had no vision impairment. When Martin returned, she found her daughter cold, limp and blue in her baby sitter's arms.

Nelson, meanwhile, has contended that Brianna was sick the day before she was taken to the hospital and that illness could have contributed to her death.

Douglas County District Judge Mark Ashford refused to dismiss the state's case after prosecutors rested Friday. He is expected to render a decision after the trial concludes next week.

http://www.omaha.com/article/20120303/NEWS01/703039883

Baby sitter not guilty in toddler's death

By Todd Cooper, WORLD-HERALD STAFF WRITER
Published Saturday March 10, 2012

Adriana Martin was already hollow, already reeling after losing her only child, 16-month-old Brianna, nearly two years ago.

Then came Friday.

After a two-week trial, Douglas County District Judge Mark Ashford acquitted the woman who Martin and prosecutors believe was responsible for Brianna's death: baby sitter Keny Medrano-Cambara.

The judge's loud declaration of "not guilty" — which followed a one-hour, far-reaching and at times rambling discourse — led Medrano-Cambara's supporters to erupt in prayers, applause and hugs.

It simply left Martin empty.

"I don't understand the judge," Martin, 27, told The World-Herald. "Did he need a witness? Well, there's only two witnesses who know what happened: Keny and my daughter. And my daughter is dead.

"I'm just in total disbelief. There's just an absolute disrespect for my daughter's life. I can't comprehend it."

She wasn't alone. Douglas County Attorney Don Kleine said he "respectfully disagrees" with Ashford's decision.

"In these cases, the only people who know what happened are the child and the perpetrator," Kleine said. "What tells you what happened is the medical evidence. And the doctors in this case said this little girl was murdered."

Medrano-Cambara's attorney, Michael Nelson, disagreed. Nelson said Ashford's decision was right for a simple reason: "My client is innocent."

Further, Nelson said, the medical evidence was far from conclusive.

Ashford cited the testimony of veteran coroner's physician Dr. Blaine Roffman.

Roffman told the judge he had concluded that the child died of blunt-force trauma. However, Roffman told the judge he couldn't determine whether that blunt-force trauma was accidental or intentional.

Roffman had testified that wasn't his role in the investigation. He said his role was simply to give a cause of death and let authorities determine whether it was intentional or accidental.

Ashford rattled off his rationale in a speech in which he referred to a Founding Father as "Jim Madison" and mentioned the All-American basketball status of a deceased county attorney. He seemed to focus on two things that gave him pause:

» The fact that Omaha police never searched the apartment where they alleged the toddler suffered her massive head injuries. Police said they didn't in part because the head injury had no distinctive marks that would have led them to a blunt object that caused the injuries.

» Several diagnoses that doctors gave for the child's injuries. Doctors struggled to figure out what was wrong with the child. Eventually most of the doctors concluded that she died of blunt-force trauma to her head, though she had no skull fractures consistent with such injuries.

Ashford acknowledged that the "greater weight of the evidence" led him to believe that Brianna suffered the head injury while in Medrano-Cambara's care.

However, he said, prosecutors could not answer how, when or where those injuries occurred.

The judge said investigators should have searched the apartment and interviewed neighbors.

"There's unanswered questions in this case," Ashford said. "If this were a civil case (where the burden of proof is lower), the state might very well prevail. But proof here is beyond a reasonable doubt. I cannot find beyond a reasonable doubt that the defendant intentionally and knowingly caused the child abuse that resulted in death."

He concluded with a loud: "She is NOT GUILTY."

At that, Medrano-Cambara's husband burst into tears. Outside court, 30 members of her church gathered in a circle and prayed with Medrano-Cambara's attorneys, Michael Nelson and Michael McClellan.

Kleine said Nelson's choice to try the case before a judge was a "shrewd move."

"I sometimes wish the state had a right to a jury trial," Kleine said.

Nelson said the verdict was extremely satisfying. He said he turned down a judgeship offered to him in November by Gov. Dave Heineman because he knew he "couldn't tell Keny that I would no longer be able to represent her."

"There's no better feeling," Nelson said of the acquittal. "She's been in custody for something she didn't do. Now she can go home to her children."

Adriana Martin doesn't have that luxury.

She recalled Brianna as a beautiful girl who always carried a blanket, slept between her parents and hugged her daddy, Huber Medrano, with every bottle he brought her. "She was very happy. Adventurous. Loving. Sweet."

And she was healthy — contrary to Medrano-Cambara's statements to police, Martin said.

Medrano-Cambara told investigators that Brianna had vomited in the two days leading up to her hospitalization. Another witness testified that Brianna's father had spoken of the vomiting at the hospital.

The defense used that testimony — and fluid in Brianna's lungs — to suggest that Brianna had suffered a head injury a day or two earlier. A defense physician suggested that she had been walking around with a brain injury for days, a point that was disputed by several doctors for the state.

Martin said her daughter hadn't vomited since she was a baby — and the only one who said she had was Medrano-Cambara.

Martin and Huber Medrano, a distant relative of Medrano-Cambara, are no longer together. Martin said the pain, the void, was insurmountable.

"Imagine two people sitting in a room, alone now," Martin said. "We didn't know how to cope with this. It was unbearable.

"Part of both of us died that day. And she walks away."

Her voice trailed to tears.

"It's too much."

Contact the writer: 402-444-1275, todd.cooper@owh.com

http://omaha.com/article/20120310/NEWS97/703109853/-1

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