Milwaukee -- The forensic pathologist who autopsied an 8-year-old autistic child hours after he was killed during an exorcism told jurors Wednesday the boy died from asphyxiation due to intense pressure on his chest - not from medication he was taking.
Minister Ray Hemphill, 47, who prayed and sang over Terrance Cottrell's chest as parishioners held him down Aug. 22, 2003, stands trial for felony physical child abuse. If convicted, he faces up to five years in prison.
His defense attorney contends that prescription medication, not Hemphill, ultimately killed the boy.
According to medical records, Terrance, who stood 4-foot-9 and weighed 130 pounds, was diagnosed with autism at age 2.
In the seven months before his death, he had been prescribed the antipsychotic drug ziprasidone, also known as Geodon, initially at a dosage of 20 milligrams a day, which was gradually increased to 200 milligrams.
Toxicology reports showed elevated levels of the drug in his system, along with the presence of two over-the-counter cough suppressant medications.
Although Dr. Jeffrey Jentzen, the medical examiner who performed the autopsy, conceded that Terrance's Geodon prescription was in the "upper limit" of what's normally recommended, he asserted that it was not a toxic level.
"The drugs he was taking did not contribute to his death," Jentzen testified.
Jentzen told jurors that, when Terrance's body was autopsied in the early morning hours after his death, the child was wearing shorts and a sweat-soaked T-shirt.
Jentzen also found severe hemorrhaging at the back of the boy's neck, which he attributed to either "a blow with a blunt object" or "sustained pressure."
Both descriptions are consistent with witness testimony that the boy thrashed about as Hemphill held his head against the floor and that his head may have struck an elevated step near the pulpit.
Terrance, like most autistic children, hated to be touched and had few words to express his needs, according to previous testimony. His mother and two female parishioners helped restrain him as he lay on his back on the floor of the strip-mall based Faith Temple of the Apostolic Faith Church, where Hemphill administered the boy's 12th such "prayer service," as the defense calls it.
Hemphill told investigators he had no formal theological training and had received his calling from God. He also said that his brother, the reverend of the independent church, had ordained him.
To convict Hemphill, prosecutors must prove that his actions were reckless, and Jentzen's strong testimony Wednesday appeared to bolster their case.
Jentzen told jurors he found signs of petechial hemorrhaging in Terrance's right eye, a condition signaled by tiny spots where blood vessels have ruptured. Such marks are typically seen in cases of strangulation, or from compression or increased pressure to the vascular blood supply, Jentzen said.
Outside the jury's presence, Judge Jean DiMotto and lawyers discussed whether an autopsy photo of Terrance's face depicting the condition would be allowed into evidence.
When the boy's mother, Pat Cooper, caught a glimpse of the picture as it was handed to the judge, she covered her face with her hands and rushed out of the courtroom in tears.
DiMotto has allowed Cooper, who has not been charged for her role in her son's death, to seek protection from prosecution under the Fifth Amendment.
Despite defense objections, DiMotto ruled that jurors could view the graphic photo, which depicted a close-up view of the right side of Terrance's face.
The photo showed a hand in a sterile, white glove holding a pair of long metal forceps that were used to pry Terrance's right eye open. Jurors saw four discreet pinpoint hemorrhages on the lateral portion of Terrance's lower lid.
On cross-examination, Harris asked the medical examiner if deprivation of oxygen was the only way petechial hemorrhaging occurs.
"No, I see it in other cases," Jentzen said.
"True or false," Harris returned. "Almost universally, if you're going to have hemorrhaging in one eye, you'll have it in both eyes?"
"Not necessarily," Jentzen responded. "It's common, but not universal."
A detective on the scene after Terrance's death also testified Wednesday about an interview he conducted with Hemphill shortly after midnight.
Detective William Beauchene said the minister demonstrated how he had pinned the boy with his own body "in order to control him from kicking and screaming," during the exorcism.
"He said he did it because Terrance is very strong," Beauchene said.
Prosecutor Williams sat next to Beauchene on the witness stand, and asked the detective to play the role of Hemphill. The pair reenacted for jurors how the minister laid his right arm, shoulder and right half of his chest perpendicular across the boy, applying pressure against his chest for almost two hours.
"At no point did Minister Ray Hemphill tell you that any of his actions on Aug. 22, 2003, were any different than things he'd done at prior prayer services?" Harris asked on cross-examination.
"No, he did not," Beauchene testified.
Another detective read a statement she had taken from Hemphill the following morning.
In it, the minister described his relationship with Terrance's mother as that of "elder and parishioner," and that he had never heard Terrance utter complete words, only noises, and an occasional attempt at saying "Jesus."
During part of the testimony, the victim's father, Terrance Cottrell Sr., fell asleep in the back row of the gallery. A low snore rolled from his mouth as his head lolled off to his right side, his eyes tightly shut. Moments later someone passed behind him, and Cottrell awoke, briefly wiping his mouth and reorienting himself.
Witnesses so far have stated that Cottrell Sr. was not present during the church visits the family made in the last three to four months of the boy's life.
The state rested Wednesday, with the defense set to present their case on Thursday. The trial is being broadcast live on Court TV.