Medical examiner testifies in daycare death
Delaware’s Chief Medical Examiner took the witness stand to give his medical opinion that the death of a 10-month-old boy at a Millsboro daycare was the result of an overdose of diphenhydramine.
Testifying in Delaware Superior Court Nov. 17, Dr. Gary Collins said he made his ruling after an autopsy revealed the boy’s blood contained high levels of diphenhydramine, an antihistamine most commonly found in the over-the-counter drug Benadryl. Diphenhydramine also acts as a sedative and can cause death in extremely large doses.
Collins testified the boy had five to 10 times the amount that would be considered safe for an adult. He said an acceptable dose of diphenhydramine for an adult is 50 to 100 milligrams, or about 66 to 112 nanograms per liter. Collins said the boy had about 500 nanograms per liter in his system at the time of his death in January 2015.
Prosecutors have accused the boy’s daycare provider, Valorie Handy, of intentionally giving the boy diphenhydramine to get him to take his nap. Charged with first-degree murder by abuse of neglect, Handy, 52, faces a possible life sentence if convicted.
Collins, the state’s chief medical examiner since 2012, said he found no evidence of internal or external trauma. He said the boy was well-nourished with a good height and weight for his age and no wounds or marks that would indicate abuse.
“A healthy, chubby, baby boy,” said Collins, describing the boy from the stand. He said the boy was 15 to 16 inches tall and weighed 21 pounds.
Collins said he also examined environmental factors, finding no evidence of infection or sickness and no evidence the boy may have suffocated. He said the boy had no allergies or cold, and he lacked fine motor skills to get into a medicine cabinet.
“There’s no reasonable explanation for him to get levels high enough to kill him,” Collins testified. “There’s no good reason for him to be on it or even an accidental reason.”
Based on that, the boy’s death was ruled a homicide, Collins said.
During Collins’ testimony, Handy, as she had at several points in the trial, wiped away tears but remained composed.
According to police testimony on the first day of the trial and Handy herself in a video re-creation played in court, Handy had put the child down for a nap in a pack-and-play that contained small toys. When Handy went to wake the boy up half an hour later to change his diaper, he was unresponsive. In the video, Handy told police the boy was on his side as he slept. During her opening statement, prosecutor Melanie Withers said police later found Benadryl in Handy’s home, which doubled as her Handy’s Little Helpers daycare.
Collins testified he researched similar deaths and found that fatalities due to diphenhydramine intoxication are not common in children. He said previous cases in which children had high levels of diphenhydramine were in younger children where the child was purposefully poisoned.
Prior to Collins giving his opinion on the cause of death, Judge T. Henley Graves allowed the defense, public defenders Gary Traynor and Daniel Strumpf, to question Collins about his research. Traynor argued that the cases Collins cited in his research did not support that the diphenhydramine levels in the boy were high enough to cause death. Collins said cases of diphenhydramine-related deaths in children are rare in part because it is typically not given to children.
Collins said the boy’s diphenhydramine levels were so high, the boy’s body was still absorbing the drug after he died. Typically, Collins testified, recommended small doses of diphenhydramine are absorbed into the stomach very rapidly. He said the boy consumed the diphenhydramine within an hour or two of his death.
Handy’s defense attorneys have denied she gave the boy diphenhydramine and have been critical of Delaware State Police for not collecting all evidence available at the scene, including cups of milk and food sent to the daycare by the boy’s mother.
The trial will continue Monday, Nov. 21, in Delaware Superior Court in Georgetown.
