A child’s death divides medical community in high-profile Chico murder trial

11/17/2013 12:00 AM

10/08/2014 11:30 AM

On April 18, 2012, a 2-year-old boy was rushed by ambulance to a Chico emergency room, then whisked by helicopter to Sutter Memorial Hospital in Sacramento.

Benjamin Yhip had been here before. The previous November, the little boy had been hospitalized for four days at the aging East Sacramento facility, where a medical team puzzled over his malnourished, dehydrated figure and failing kidneys.

At the time, one pediatric neurologist thought, it seemed that Benjamin was a “profoundly sick boy” who “did not have long to live,” according to Butte County court documents.

Now the child was back, comatose, hooked to medical machines in Room 683 as his tiny body and swollen brain inexorably failed. At 3:30 p.m. the following day, he was declared clinically brain dead and removed from life support six hours later – half a world away from his native island of Taiwan, where he and his twin brother had been adopted from an orphanage in November 2010.

Benjamin Michael Yhip, three months shy of his 3rd birthday, was now an organ donor.

More than 18 months after the toddler’s death, his adoptive parents in Chico, a doctor and a nurse, are awaiting trial, accused of killing the boy.

Dr. James “Peter” Yhip, a 47-year-old cardiologist, and his wife, Edelyn, 44, a registered nurse, are each charged with murder and felony child endangerment in connection with his death.

While a trial date is set for next April, a Butte County judge will decide on Monday whether to grant a defense motion to dismiss the case.

Already, the People vs. Edelyn and James Peter Yhip is shaping up to be a high-profile legal ordeal that veers into touchy territory. In thousands of pages of court documents filed in Oroville, the county seat, arguments fly about the treatment of prominent murder suspects, the science of child abuse, the tactics of law enforcement, the validity of paid expert testimony, the protectiveness of the medical community and the nature of foreign adoptions.

The defense garnered an ally this year with the entry of the Northern California Innocence Project at Santa Clara University School of Law, which investigates cases where individuals may have been wrongfully accused or convicted of crimes.

Experts on both sides are lined up, ready to offer complex theories about the anatomy of brain injury and the simmering, international controversy over the diagnosis of shaken baby syndrome.

At its heart, though, the murder case in Butte County boils down to a simple question: How did Benjamin die? Was he systematically neglected and abused, as the prosecution contends? Or did he come to the Yhips already a sick and damaged child, whose chronic health problems were not properly diagnosed until it was too late?

“This child was killed,” said Butte County District Attorney Michael Ramsey. “And we’re going to prosecute the people who were responsible for this child's death.”

Officially, Benjamin’s cause of death is listed as brain damage due to “blunt force trauma,” according to the autopsy report.

And that’s where the argument begins.

“There is just no evidence of murder here,” said Paige Kaneb of the Northern California Innocence Project. “That’s why I was willing to jump on.

“There is nothing reliable to say that this child was killed.”

“Man down!”

The 911 call came in at 5:59 p.m. from the exclusive Carriage Estates neighborhood, an unincorporated pocket of homes along Chico’s northern edge.

It was April 18, 2012. A Wednesday.

Edelyn Yhip told the dispatcher her son was unresponsive and she suspected he had aspirated.

“Man down!” the ambulance crew was advised.

A three-person crew arrived in eight minutes at the Yhip home, where a little girl led them to a bedroom.

The EMT would later testify they found Benjamin lying on a bedroom floor in a diaper and T-shirt. Two firefighters were already there, manually ventilating the pale boy while another small boy clung to his mother’s leg nearby. The paramedic noticed what appeared to be vomit on the floor. Edelyn was crying.

The child was loaded into the ambulance and taken Code 3 – lights and sirens – to Enloe Medical Center, eight minutes away.

The recollections of each individual who saw Benjamin Yhip in the next 24 hours have now been dutifully noted and legally dissected. What caused a 33-month-old child to collapse and stop breathing in his own home? What marks, if any, were observed on the boy’s body – and when? Was he jostled about in the medical transport? Could straps or cords have caused bruising or injuries?

At Enloe that night, court records show, emergency room staff conducted a radiological exam and determined that Benjamin had a “right subdural hematoma and bi-lateral retinal hemorrhages” – bleeding inside the skull and behind the eyes. Medical staff also identified a large area of brain swelling.

Chico, a college town of about 87,000, does not have a pediatric hospital, and children needing intensive care are routinely transferred out of Enloe. Benjamin was loaded onto an emergency helicopter for the quick flight to Sacramento, 90 miles to the south.

At Sutter Memorial, known as Sacramento’s “baby hospital,” Dr. Angela Rosas thought Benjamin’s prognosis for survival was “unlikely,” according to court documents.

A pediatrician with Sutter Medical Group, Rosas specializes in child abuse and neglect and frequently is called upon to testify in complex criminal cases throughout Northern California and beyond.

Rosas had examined Benjamin during his previous stay in November 2011, when he had arrived at the hospital malnourished, dehydrated and “severely underweight,” his kidneys beginning to fail, court records show. Rosas ordered full-body X-rays, and a pediatric radiologist identified what he believed to be numerous healing fractures in both shoulders, his left hand and both feet.

At the time, records show, Rosas thought the findings might indicate rickets, a bone disorder that can be triggered by Vitamin D deficiency.

During the November hospitalization, the family told the Sutter medical team that Benjamin had a “chronic feeding problem” dating back to the orphanage in Taiwan, according to court records. Rosas observed that the boy weighed a scant 18 pounds, below the 3rd percentile, and clearly suffered from a “failure to thrive.”

The Sutter medical team directed that Benjamin be fitted with a tube, placed through his nose, to supplement his feedings.

Rosas would later testify that she and several colleagues were “suspicious” about possible child abuse during that four-day stay in November 2011, and they filed a report with child welfare and law enforcement agencies. Even so, Rosas concluded in her typed report that a diagnosis of abuse or neglect was “not apparent thus far.”

By April 19, 2012, the situation appeared dire for the little boy from Chico, lying in the pediatric intensive care unit, tied to a ventilator. His brain was dangerously swollen. In her new exam on the now comatose child, Rosas noted bruising on the boy’s right ear and left neck and chest area, along with scratch marks on his forehead and chin.

Rosas ultimately concluded that the child’s brain swelling and bleeding, along with the retinal hemorrhages, were indicative of “abusive head trauma.” It was her belief that Benjamin had been shaken or “slammed” with considerable force.

That afternoon, Benjamin Yhip was removed from life support and pronounced dead at 9:30 p.m.

Five days later, a medical examiner who contracts his services to Butte and Glenn counties performed an autopsy at a Chico funeral home.

Dr. Thomas Resk found that Benjamin’s brain was severely swollen, with a large amount of blood around his brain and within his spinal cord. He examined the bruises identified by Rosas and located what he described as old fractures in the boy’s upper arms, along with a “healing compression fracture” in the vertebrae.

Resk told a Butte County detective the subdural hematoma most likely had occurred no more than six hours before he was taken to Enloe Medical Center. The cause of death, Resk concluded, was anoxic encephalopathy (brain damage from oxygen deprivation) due to brain injuries, the result of blunt force trauma.

The death was deemed a homicide, pending investigation.

The DA builds a case

Butte County District Attorney Michael Ramsey was appointed the county’s top prosecutor in 1987, winning the next six elections. A fourth-generation Butte County resident, Ramsey posts a mission statement on the DA’s web site: “To do justice, as no one is above the law, nor beneath its protection.”

In this case, Ramsey contends, the evidence is conclusive.

“It’s pretty simple: It’s abusive head trauma,” the district attorney said in an interview with The Sacramento Bee. “It’s become complicated by the rather interesting and... far-fetched legal-medical theories they are advancing.”

According to the prosecution’s narrative, Benjamin was perceived as the problem child, a little boy Edelyn allegedly referred to as “The Little Emperor” because of his many needs and demands.

The relationship was so strained that Edelyn and Benjamin visited a Sacramento psychotherapist on April 5, 2012, one in a series of appointments to address the boy’s alleged inability to bond with his adoptive mom. At that session, Edelyn declared that the couple had decided to “re-adopt” the boy, or give him back to an agency to find a new home, according to court documents.

Exactly two weeks later, Benjamin was dead.

There is little dispute that injuries and ailments seemed to define Benjamin Yhip’s short life.

One defense attorney told a Butte County judge last year that the Yhips made more than 30 visits to physicians, counselors and specialists to deal with the child’s “very unusual medical and behavioral problems,” according to a transcript of the couple’s arraignment.

The defense team says it also has obtained adoption-agency records showing that Benjamin was hospitalized for 33 days while he was a baby in Taiwan, frequently for infection-related causes.

But each side interprets the medical history quite differently.

The prosecution contends that this is a case of “battered child syndrome,” with neglect and abuse escalating against Benjamin until Edelyn delivered a final blow.

“This child was targeted,” said Ramsey.

In court documents, the prosecution lays out its theory that Benjamin was the child who “upset the apple cart” with his many needs. His twin brother and older sister, meanwhile, were “obedient” and thus not targeted, a prosecution document states.

Benjamin and his twin brother were about 16 months old when they arrived in Chico in November 2010, settling into the Yhips’ four-bedroom, ranch-style home. The couple, who were married in December 1996, already had adopted a girl from China, four and half years older than the boys.

Photographs taken early on of the new, blended family depict smiling faces posing at the ocean, or against a scenic mountain backdrop.

The reality was not so idyllic, according to investigators, who combed through medical records and interviewed babysitters and others who had observed the family.

Beginning in at least March 2011, the prosecution contends, Benjamin’s string of medical problems included bruises and black eyes; premature loss of two lower teeth; sores inside his mouth; a skin tear at the base of his penis; a spiral fracture of the upper leg bone; numerous healing fractures in multiple limbs; a compression fracture of his vertebrae; dehydration; significant weight loss; severe malnourishment and renal failure, documents state.

In at least four instances, documents show, the couple blamed injuries on falls in the bathroom. In January 2012, Peter Yhip took the boy to the Enloe emergency room to treat a broken leg after the father said he accidently fell on his son in the shower.

Children’s Services Division, the county’s child welfare agency, received three reports of suspected neglect and abuse involving Benjamin in a six-month period, but none was substantiated, court records show.

At least two babysitters told investigators they saw worrisome signs in the comfortable, 3,170-square-foot suburban home. One babysitter found that Benjamin had been locked into his bedroom, for which she did not have a key, the records state.

The same babysitter reported that the older daughter once told her that Edelyn was “being mean to Benjamin” and had grabbed him and thrown him to the floor, court records show. The little girl reportedly told the babysitter her mom was “scary,” according to one sheriff detective’s report.

Another babysitter told investigators she was ordered to place 2-year-old Benjamin on a liquid diet of water and Ensure, an adult dietary supplement. When she questioned the restrictive diet, the sheriff’s report states, she was told by Edelyn Yhip to “mind her own business.”

Kelly Maloy, the lead prosecutor on the case, described the Yhip home as “highly structured and highly disciplined.” Court documents, along with summaries of the Butte County Sheriff’s investigation, describe Edelyn as a stressed-out, depressed mom who cut back her nursing hours to become the children’s primary caregiver.

Peter Yhip routinely worked 12-hour days, six days a week, while his wife’s life “was absorbed with the multitude of medical problems Benjamin suffered,” one court document states.

Peter’s temperament also came under scrutiny. In documents filed last year by the attorney general, the cardiologist at Enloe Medical Center is described as “bad tempered” and lacking in “judgment, integrity and honesty.”

In one instance, the state claimed, the cardiologist’s “belligerence and verbal abuse” drove one patient to run away from him while wearing only a hospital gown. Another patient, the state alleged, declared that “she would rather die than have a procedure performed by him.”

Six days after Benjamin’s death, Peter was asked by a Butte County detective if he thought his wife shook Benjamin to death, and “he said he agreed,” according to a law enforcement report. When the detective asked the cardiologist if he felt Edelyn was capable of such a thing, he allegedly responded: “Isn’t anybody?”

Maloy, the supervising deputy district attorney, explained that Peter Yhip ultimately was charged because “he always knew what was happening to the child, and he failed to protect.”

Ramsey said he believed Peter Yhip used his position to conceal the abuse.

“No one’s going to believe that a medical provider is going to be abusing their child,” said Ramsey. “No one’s going to believe that a medical provider would be doing things medically inappropriate.”

Defense touts “hard science”

In the J Street law offices of Victor Haltom and John Duree Jr., a “war room” is taking shape.

The experienced criminal lawyers have amassed more than 30,000 pages of documents in thick binders – some written in Chinese – that they say will prove their clients’ innocence.

On their side, they say, is “hard science.”

The defense attorneys maintain that the Yhips, who had no prior criminal histories, are victims of a terrible injustice – that Benjamin was not shaken or beaten at all. Instead, they say, Benjamin died from a “raging infection” in his head, the symptoms of which mimicked some classic signs of child abuse.

The attorneys contend that the couple were wrongly accused after Dr. Rosas at Sutter and Dr. Resk, the Butte County forensic pathologist, misinterpreted the medical findings by relying on outdated science.

Now, they say, a family’s future is on the line.

“The District Attorney’s ‘Statement of Facts’ is anything but,” the defense attorneys write, in documents now before the court.

Piece by piece, one explanation after another, the defense attorneys lay out their own narrative of Benjamin’s short life with his adoptive family.

The injuries, the ailments, the frequent doctors’ visits – these are not evidence of abuse and neglect at all, they maintain. Instead, the defense attorneys say, these are hallmarks of “loving and devoted” parents, struggling to find answers for a chronically sick child.

According to court documents, the Yhips told medical professionals that the little boy was given to fits of head-banging, biting of his tongue and cheeks, vomiting and refusing food.

“This child had an extremely complicated set of medical conditions,” said Duree, who represents Peter Yhip.

According to the defense, the health troubles began in Taiwan, long before the Yhips ever entered the picture. Benjamin came to this country a very sick child, they say, as evidenced by his 33 days of hospitalization while at the orphanage, many times for infections.

In Chico, his medical problems persisted, the attorneys say.

Benjamin’s pediatrician, Dr. Daniella Marcos-Gannon, made “multiple entries” chronicling the child’s feeding problems, court documents show. Rosas, a key prosecution witness, testified last December she had no doubt the boy had a feeding disorder when she first saw him, emaciated and dehydrated, at Sutter Memorial Hospital.

The role infection played in the child's short life – and, allegedly, in his death – also is chronicled in defense documents. Dr. Gannon, for instance, reportedly had five contacts with the child related to infections.

In one serious incident in August 2011, Dr. Gannon saw Benjamin when his cheek swelled drastically and his eye was swollen shut, a condition she initially thought might be related to a recent vaccination, court documents state. The district attorney lists the facial incident as more evidence of the “ongoing history of documented abuse.”

In fact, the defense argues, the facial swelling “was eventually determined to be a Staphylococcus Aureus infection that was ultimately treated with Augmentin, an antibiotic.”

The condition of Benjamin’s bones consumes hundreds of pages of court filings, with defense team experts asserting that the child suffered from a metabolic bone disease. The condition affects bone strength and can result in fractures or deformities.

Defense experts note that, on X-rays, diseased bones can be easily confused with healing fractures, often cited as evidence of abuse. In Benjamin’s case, X-rays taken of the child’s bones in November 2011 and again in April 2012 look virtually identical, except for the leg break that Peter Yhip said occurred in the shower. The otherwise matching images would be unlikely if numerous bones actually had been broken and were in healing stages, the defense contends.

Ultimately, though, the case comes down to the events of April 18, 2011.

Haltom, who represents Edelyn, said his client was home alone with the children when she found Benjamin collapsed and not breathing in his bedroom. He said she tried to resuscitate him while awaiting emergency crews.

The prosecution’s assertion that Benjamin was struck in the head, as suggested by the bruise on his ear, does not square with the evidence, said Haltom. Neither the paramedic nor the EMT – nor the emergency-room treating doctor – said they observed any bruises or external injuries on the boy’s body, according to court documents.

The defense team, relying on three medical experts in California and two other states, points to infection as the so-called “bullet” that killed Benjamin Yhip.

Dr. Janice J. Ophoven, a Minnesota pediatric forensic pathologist,concluded in her review that Benjamin suffered from a severe eye infection that resulted in a fatal “cortical venous thrombosis,” or a clot in the brain. That condition, she wrote, can “mimic the findings of abusive head trauma.”

“The child has a history of multisystem abnormalities that accompanied him from his homeland,” wrote Ophoven. “These abnormalities affected his bones, his nutrition, his ability to fight infections, his growth and his overall ability to engage in basic activities of daily living.”

Ophoven’s findings were backed by a forensic neuropathologist in Chicago, Dr. Jan E. Leestma, who wrote a textbook on forensic neuropathology. Leestma also noted that Benjamin’s bruises were small and “common” in cases where patients are resuscitated, transported to multiple facilities and prodded with catheters and tubes.

“In short the evidence for blunt force head injury is scant,” Leestma concluded.

Kaneb, with the Northern California Innocence Project, said the group made the unusual decision to join a pre-trial matter because of the mounting controversy around shaken baby syndrome. She explained that “evolving science” has led some medical and legal experts to conclude that “hundreds and possibly thousands” of caregivers have been wrongfully convicted of harming children.

Until the last decade or so, pathologists and other medical professionals routinely diagnosed shaken-baby cases based on three core findings: retinal bleeding, brain swelling and brain bleeding.

Those findings in Benjamin helped form the basis of the prosecution’s case.

According to Kaneb, making a shaken-baby diagnosis based solely on those findings, known as “the triad,” is now considered by some experts to be scientifically suspect because other medical conditions – such as infections or genetic disease – can result in the same three findings.

The medical findings in Benjamin’s case add up to a tragic death, the Yhips’ lawyers maintain.

But not murder.

“I don’t know how much the science of child abuse is going to be changed by what happens in Butte County Superior Court,” Duree said, “but we are in the middle of an issue that is very big and very important.”

The case grinds forward

On July 18, 2012, Edelyn Yhip was arrested at home in her bathrobe. Her husband was arrested at work while treating a patient.

Defense attorney Duree complained that the arrests were “ham-fisted” and an “unnecessary show of force,” given what he described as the couple’s cooperation with investigators and willingness to voluntarily surrender.

Since the couple’s arrest, the case has spawned accusations in Butte County of “aggressive” police tactics, improper interventions by Yhip family friends and conflicts of interests on both sides.

“It has divided the medical community here,” said Ramsey.

Supporters of the Yhips have attended their hearings. At least six medical professionals who have worked with Peter Yhip signed declarations of support for their colleague, in which they describe him as a skilled and dedicated doctor.

Last year, the couple, their family members and friends put up eight properties – including four homes in Southern California – to secure Peter’s release on $1 million bail. Edelyn’s bail also was set at $1 million; she posted a cash bond.

A group of spectators broke into courtroom applause last year when Butte County Superior Court Judge Steven J. Howell rejected the state’s efforts to suspend the couple’s professional licenses.

Earlier this year, the district attorney succeeded in having Howell removed from the case amid allegations he was “prejudiced” against the prosecution. Howell had returned the Yhips’ two surviving adopted children to their care a month before he concluded the 13-day hearing in dependency court.

In his ruling favoring the couple, Judge Howell noted that he had considered numerous factors – including “a large body of evidence which suggests that Benjamin died due to extreme illness as opposed to criminal agency.”

It is Howell’s decision in dependency court that forms the basis of the defense team’s latest strategy. On Monday, Judge Barbara L. Roberts will consider a defense motion urging that the criminal case be dismissed, based on a legal doctrine that precludes an issue from being litigated more than once. The defense attorneys contend that Judge Howell effectively ruled on the matter when he returned the surviving children to the couple’s care and found no substantial risk to them of abuse or neglect.

The stakes are high for the Yhips, who are out of jail and back at work. Peter Yhip continues to see patients. Edelyn has resumed her part-time job at Enloe Medical Center, working in chemotherapy education, her attorney said.

If convicted, they face possible life sentences.

“It all comes down to what the science and medicine show,” said defense attorney Haltom. “And we feel we have very solid evidence that Benjamin’s death was the result of a disease process.”

District Attorney Ramsey says he is undeterred.

“They’re going to give their defendant the best defense they can,” he said. “Sometimes that means throwing everything up against the wall and seeing what sticks.”

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