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A doctor who performed an autopsy on a toddler found dead outside a church says the child suffered from serious head trauma.

Dr. Elizabeth Brooks-Lim, Alberta’s chief medical examiner, testified on Tuesday at the trial of Tasha-Lee Doreen Mack.

Mack and the child’s father, Joey Crier, are charged with second-degree murder in the 2017 death of 19-month old Anthony Joseph Raine. A date has not been set for Crier’s trial.

Brooks-Lim said she did the autopsy on Anthony in the days after he was found dead outside the Good Shepherd Anglican Church in Edmonton.

“I determined the cause of death of this child to be head trauma,” she told Court of Queen’s Bench Justice Rob Graesser. “The manner of death was determined as a homicide.”

To make those findings, Brooks-Lim said she reviewed Anthony’s entire medical history, considered that he was found outside and examined his injuries. Those included a major skull fracture, bruising on the entire front of his face, blood in his right ear canal and bruising to his arms and the front of his chest.

“There were multiple impacts to the head of this child because the entirety of his face is bruised,” said Brooks-Lim. “This was not one simple blow to the head.”

She said there was also a blow or multiple blows to the area around his mouth.

Brooks-Lim said there’s no evidence of healing, so many of the injuries would have taken place in the minutes, hours or up to a day before he died.

A rib fracture, she said, was likely to have happened about seven to 10 days prior to his death and could have caused difficulty breathing or eating.

She said Anthony wasn’t starving, but she did see signs of inadequate nutrition or stress.

Crown prosecutor Monica Sabo asked Brooks-Lim whether the lack of medical attention affected Anthony’s death.

She replied that it prevented his survival and that it was possible a doctor could have relieved pressure from the swelling and bleeding around the boy’s brain.

“That didn’t happen,” she said.

All the injuries led Brooks-Lim to conclude that it was a homicide.

“It’s difficult to imagine how they could have happened in an accidental setting,” said Brooks-Lim, who noted that there was too much trauma.

Mack’s lawyer, Ajay Juneja, asked the medical examiner during his cross-examination whether head trauma can be accidental.

She said it is a common cause of accidental death.

Juneja also asked whether Brooks-Lim was certain Anthony would have lived had he received medical attention.

“It would all depend on when the child was taken in,” she said.

It’s possible that he still could have died from his injuries, she added.

Mack’s trial continues Thursday and is expected to take at least one more week.

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