The state medical examiner has ruled that the death of 10-year-old Damaud Martin in a state-regulated group home in July was caused by complications from cerebral palsy and past head trauma — severe conditions stemming from abuse the Baltimore boy suffered more than six years ago.
With the medical examiner's autopsy complete, Baltimore police and prosecutors are investigating the disabled foster child's death as a homicide. The findings, which were released this week, will also factor into a probe by Maryland health regulators into the death.
While it is not unusual for a medical examiner to say a recent death was caused by injuries suffered years earlier, most of those cases in Baltimore involve shooting victims. In a similar high-profile case, the death of James Brady in August was ruled a homicide, even though the shooting occurred during the assassination attempt on President Ronald Reagan in Washington in 1981.
Allie Phillips, deputy director for the National Center for Prosecution of Child Abuse, said there is no data on how many cases like Damaud's are investigated and prosecuted as homicides.
"It certainly doesn't happen very often," Phillips said. "It's difficult to match what happened when the child was 3 to what has happened now seven years later."
But "it absolutely can be done" based on good medical testimony, she added.
The Baltimore state's attorney's office, the medical examiner and city police declined to comment because of the ongoing homicide investigation and the probe by health regulators.
Damaud's mother, Tamekia Martin — who was convicted in 2009 of child abuse that led to her son's injuries — continued to maintain her innocence Thursday. "I didn't do it," she said.
Police have made no arrest in the new investigation, and Martin, 34, said authorities have not informed her about the homicide determination. If they do, she said, she'll be ready to name the person who is responsible for the boy's injuries.
"Everybody's coming after me, but I didn't hurt him," she said.
Cerebral palsy is typically a condition children are born with, but it can be triggered by child abuse that causes severe brain damage, as in shaken baby syndrome, medical experts say.
A doctor at Johns Hopkins Hospital who cared for Damaud in 2008 told police and prosecutors then that the boy's "brain injury and the bleeding on his brain were consistent with child abuse [and] shaken baby syndrome," according to a police report. The boy was 3 years old.
In May 2009, Martin agreed to an Alford plea, which means she did not admit guilt but acknowledged there was enough evidence to convict her. Court documents show that she and her daughter, then 7, told police that Martin's friend pushed Damaud down the stairs at their Northeast Baltimore rowhouse near Clifton Park.
Martin, who was jailed for 13 months after being arrested, said she agreed to the plea deal to end her incarceration. Her conviction resulted in a suspended 15-year sentence.
"I didn't know it was going to cost me my life," she said, referring to losing custody of her children.
She and her mother, Rosita Martin, hired an attorney in August and he has notified the state of their intention to take legal action against the government and LifeLine, the state contractor that ran the group home.
At the time of Damaud's death July 2, regulators were in the process of removing 10 disabled foster children from LifeLine's care. Weeks earlier, state inspectors had told LifeLine that they were going to revoke its license because of problems with care. The company's chief executive responded by saying that she was closing the home because state payments were too low.
One of the problems at LifeLine that inspectors found before Damaud's death was inadequate staffing. A Baltimore Sun investigation showed that the state awarded contracts worth millions of dollars to the company despite numerous issues: problems with medical care, a founder imprisoned for arson, unpaid taxes, and police reports of abuse and neglect unknown to regulators.
Dr. Mary Case, chief medical examiner for four counties around St. Louis, has studied the issue of abusive head trauma for most of her four-decade career.
"They're not very common," Case said. "We'll see four or five traumatic head injuries a year."
Most result in death shortly after the injuries, she said.
Case has seen three deaths similar to Damaud's in the past five years. The most recent — and extreme — came last week: She ruled a 21-year-old man's death a homicide stemming from a brain injury he suffered when he was 5 months old.
"It's much less common to have them survive" for years, she said. "There's no time limitation. If the injuring event was done by another person it's considered a homicide."
She said such injured children — who survive with feeding and breathing tubes — are vulnerable to pneumonia, seizures and other conditions. While those conditions might lead to death, she said, the cause still stems from the original injuries.
Martin's comments about her son's injuries have changed over the years. At one point, she said in an interview that he hit his head on a curb after being pushed off a bike and that he also fell down stairs. She later said in court papers that someone who lived with her pushed him down the stairs.
At her 2008 arraignment, she pleaded not guilty. Her public defender wrote in a motion for bail reduction that Martin's daughter, Sandoria, "gave four different versions of what happened to her brother" but that "all were consistent" in blaming another adult in the home for causing the injuries. The motion said Martin lied to police about being the only adult at home because she "was terrified" of the other person.
On Oct. 15, 2008, she sent a handwritten letter to the court stating why her $850,000 bail should be reduced.
"I didn't do any wrong to my son," she wrote. "I didn't hurt him so why do I have to pay for something that I didn't do."
In August 2013, she asked the court to reconsider her conviction, writing that "the attorneys misrepresented my case. I am not guilty."