BRATTLEBORO — Vermont’s deputy chief medical examiner testified Friday that she could not rule the death of an elderly woman at an assisted living facility a homicide because it was outside her area of expertise.
Dr. Elizabeth Bundock said that while she determined that Nita Lowery, 83, of Brattleboro, died of severe low blood sugar, or acute hypoglycemia, which resulted in brain death, she had ruled that the manner of her death was “undetermined.”
“The mechanism was acute hypoglycemia,” she said.
After a three-year investigation, the Vermont attorney general’s office in 2012 brought second-degree murder charge against one of Lowery’s nurse’s aides, Jodi LaClaire, of Bennington, N.H.
LaClaire has pleaded not guilty to the murder charge, a companion charge of elder abuse, and seven counts of financial exploitation of a vulnerable adult. Police alleged LaClaire, a diabetic, injected Lowery with insulin, putting her into an irreversible coma.
Police said LaClaire, 39, then stole Lowery’s credit card, set up a PIN number from her Thompson House room in the hour before she collapsed in a coma, and later withdrew a total of $4,000 over several weeks from Lowery’s card.
Bundock, who performed an autopsy on Lowery’s body April 2, 2009, the day after she died, said she then conducted a two-month investigation into the medical causes behind her death. She had initially put the cause of death as “pending” and later changed it to an “acute hypoglycemia event.”
Bundock said she knew questions had been raised about Lowery’s death by her family, and she had consulted with police investigators who were also looking into Lowery’s death.
Bundock was on the stand for the entire afternoon Friday, explaining her expertise and experience — she was a medical examiner in both Boston and New York City — and that her specialty was neuropathology, or pathology of the brain.
She said it was possible that she had misdiagnosed Lowery’s cause of death because that wasn’t an area of her expertise.
“I guess that might be correct,” she told LaClaire’s attorney, Daniel Sedon of Chelsea. “In the end, I really felt Nita Lowery had a hypoglycemic event. But I’ll put the interpretation of why ... it’s out of my field of experience.”
Bundock said she had done research into medical texts about hypoglycemia, and whether any of Lowery’s underlying medical conditions could have triggered the extremely low blood sugar.
Bundock said that during the autopsy she had discovered a 2-centimeter squamous-cell cancerous tumor in Lowery’s lungs. Lowery had earlier survived both breast and bowel cancer, a serious stroke in 2000, and also had emphysema. She was a longtime smoker. Lowery had a history of tumors, the doctor said.
Sedon asked Bundock if she was aware of an article published in the Japanese Medical Journal concluding that small squamous-cell lung cancer tumors could lead to hypoglycemia.
In the Japanese case study, the subject was extremely thin, as was Lowery, who weighed 102 pounds at the time of her death. Bundock said that Lowery was very small, and bordered on being malnourished.
Under cross-examination by Sedon, the deputy chief medical examiner said that drugs, prescription drugs, alcohol use, and organ failure can all contribute to hypoglycemia.
Assistant Attorney General Matthew Levine repeatedly challenged Sedon’s use of the 1982 Japanese medical article, and tried to get it thrown out as evidence. But after Bundock reviewed the article, and said it was similar to other medical writings she routinely used, and had used in researching Lowery’s condition, Judge David Suntag admitted it as evidence.
Bundock said she had found a small healing scab on Lowery’s right arm, similar to an injection site. But she said under questioning from Sedon that it was typical of intravenous marks left in patients.
In addition to the alleged insulin injection, Lowery was injected with glucose by an emergency medical technician to try and rouse her from her stupor, even before she was transported to Brattleboro Memorial Hospital.
Bundock said she examined Lowery’s brain to try and determine the cause of her fatal collapse, and she admitted under questioning by Sedon that there was “significant overlap” in the effects on the brain from both a stroke and hypoglycemia.
“They can look very similar, they can look indistinguishable,” she said.
Bundock said there was no evidence in Lowery’s autopsy of alcoholism, an issue that Sedon had stressed in court Thursday, based on nurses’ notes from Thompson House that often referred to Lowery’s drinking.
Bundock said the autopsy revealed that Lowery had suffered from high blood pressure, and that her kidneys showed scarring and hardening of the arteries. That problem had gone undiagnosed.
Earlier Friday, Susan Shanoff, senior corporate fraud investigator with People’s United Bank, testified about the problems she encountered getting surveillance images that police claim show LaClaire at an ATM in Keene, N.H.
The bank had said money was withdrawn by ATM from Lowery’s account at 8:48 a.m. on March 31, 2009. The person shown in the surveillance video with that time stamp did not match LaClaire’s description, Shanoff said, but LaClaire did appear at the ATM in within a few minutes of that time.
Shanoff said it was not unusual to have the video surveillance time stamps off by “several minutes” from the transaction time at the ATM.
The trial, which is expected to last a total of three weeks, resumes Monday with testimony from more medical experts.
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