Summary of the Case……………………………………………………………………………………….3

Section I.

Jordan’s Medical History Prior to His Cardiac Arrest…………………………………………11

Section II.

Jordan’s Cardiac Arrest and Treatment Received…………………………………………….12

II-A. Description of events before and after Bryant
found the baby with cardiac arrest……………………………………………………………..12

II-B Examination of Jordan by the paramedics and treatment given……………………………..13

II-C Examination of Jordan at the Lancaster General Hospital
and treatment given…………………………………………………………………………….15

Section III.

Review of the Medical Examiner’s Autopsy and Pathology Report,
and Interpretation of Results……………………………………………………………………..15

III-A. Spongiosis of the cerebrum, Purkinje cell dropout in cerebellum,
and brain edema……………………………………………………………………………….17

III-B. Jordan's weight loss…………………………………………………………………………21

III-C. Jordan's thymus atrophy……………………………………………………………………21

III-D. Jordan's aspiration pneumonitis……………………………………………………………21

III-E. Causes of the marks observed on Jordan’s
lower chest and upper abdomen……………………………………………………………..23

III-F. Causes of the inflammation and bleedings in Jordan’s liver……………………………….25

III-G. Causes of the inflammation
and necrosis in Jordan’s gallbladder…………………………………………………………..26

III-H. Causes of the bleedings in Jordan’s intestine and mesentery………………………………27

III-I. Likely causes of Jordan’s petechial hemorrhages…………………………………………..28

Section IV.

Problems with the Methodology Dr. Ross Used
in the Investigation of This Case……………………………………………………………………29

Section V.

Analysis of Bryant’s Alleged Confession That He Killed Jordan:
Did Bryant Really Confess?………………………………………………………………………32


Section VI.

Conclusions and Recommendations……………………………………………………………35

References…………………………………………………………………………………………..37

Jordan’s mother left home at about 0005 on September 25, 1994 and left her boyfriend, Bryant Arroyo watching her four-year-old son and her baby, Jordan Anthony Shenk, asleep in his crib upstairs. Jordan was eight-and-a-half months old, and Bryant was 22 years old. Jordan’s mother and her three children had lived with Bryant since June of 1994.

Jordan’s mother returned home about two hours later, at approximately 0200. At about 0240 Bryant went upstairs to check on Jordan and found him unconscious and lifeless in his crib. He was not breathing. Bryant carried the baby downstairs and yelled to the mother to call 911. He put the baby on a chair and performed cardiopulmonary resuscitation (CPR).

The police and paramedics arrived a few minutes after they received the call. They also performed CPR on Jordan to revive him, but they were unsuccessful. The paramedics transported Jordan to Lancaster General Hospital at 0311, where he was pronounced dead at 0340. He was treated with epinephrine, atropine, sodium bicarbonate, and oxygen by the paramedics and in the hospital. He was also given 410 ml of fluid IV by the medical staff.

The paramedics examined Jordan and observed eleven brownish/purplish circular marks on his lower chest and upper abdomen, which were approximately 1/8 of an inch in diameter. Jordan’s mother stated that she observed some bruising on the chest wall resulting from Bryant’s attempts to perform CPR.

The paramedics and the physician at the emergency room also noted an old erythematous mark (1/2 x 5 cm) on the baby’s left cheek. As stated by Jordan’s mother, this was a burn mark caused by an iron about two weeks prior to the baby’s cardiac arrest. The paramedics and the emergency physician did not notice any other mark or injury on Jordan’s body.

Dr. Wayne K. Ross, forensic pathologist of Lancaster County, Pennsylvania, performed the autopsy on Jordan at about 0800 on 25 September 1994 [Autopsy No: A94-347 (LC94-265)]. Prior to autopsy, full body x-rays were performed and showed no evidence of acute or healing trauma. Dr. Boal, pediatric radiologist, also reviewed these x-rays and did not observe any significant abnormalities. In addition, Dr. Ross examined Jordan’s body and observed no evidence of injuries caused by trauma in the scalp, mouth, back, and upper and lower extremities.

Randy Miller, Assistant District Attorney, Officer Roland L. Buch, and Detective Allen W. Leed from the Manheim Township Police Department were present with Dr. Ross and observed the autopsy. Dr. Ross took tissue samples from selected organs and lesions at the time of autopsy and submitted them to Harrisburg Hospital to process them for histological evaluation.

After completing his autopsy on 25 September, Dr. Ross went to Manheim Township Police Department and met with officers and detectives. He informed them that Jordan died from complications of blunt trauma to the chest and abdomen and that the manner of death was homicide. He also provided the same information to Mr. Miller in the district attorney’s office.

Bryant Arroyo was arrested in Lancaster County, Pennsylvania on 26 September, 1994 in connection with Jordan's death. On 10 May 1995, he was convicted of first-degree murder and sentenced to life imprisonment without parole. Dr. Ross testified at Bryant’s preliminary hearing and trial that Jordan was killed by blunt trauma to the chest and abdomen, and that the manner of death was homicide.

Moreover, Detective Larry Mathias and Detective Solt from the Manheim Township Police Department alleged that Bryant confessed to them that he killed Jordan because he had an anger problem, was angry with his cousin at the time, and took it out on the baby. The Commonwealth presented to the jury an eight-page confession typed out by Det. Solt.

Bryant was not allowed to testify in his trial, and his public-defender lawyers did not retain a medical expert to review Dr. Ross’s pathology findings and to testify for the defense. Bryant denied the allegation that he killed Jordan or confessed to the police. In addition, Bryant had nineteen character witnesses—including Jordan’s mother and grandmother—who testified and/or wrote affidavits on his behalf and rejected the police’s clam that Bryant had an anger problem.

Nancy Garcia, President of Families United for Justice in Springfield, MA contacted me and asked me to review the medical evidence in Bryant’s case and to provide an opinion concerning the factual causes that led to Jordan’s death. Nancy is Bryant’s representative. Bryant and his mother also contacted me and asked me to evaluate the case.

I evaluated the medical evidence, trial documents, testimonies of witnesses, police reports, and medical literature pertinent to Jordan’s case. I used differential diagnosis to identify the possible causes that led to the bleedings and death, and the synergistic actions among these causes. I describe my findings in Sections I through V of this report. Section VI contains my conclusions and recommendations.

Jordan was born on 6 January 1994 by caesarian section at 41 weeks of gestation. His birth weight was 5 pounds, 15 ounces. He was taken to his pediatrician several times for regular checkup between 24 January and 12 August 1994. His last visit to his pediatrician was 43-days prior to his cardiac arrest on 25 September.

Jordan’s weight on 12 August was 15 pounds, 10 ounces, which is identical to his weight on 25 September (15 lb and 10 ounces) after he received 410 ml of fluid IV (weighing about one pound) following his cardiac arrest. These data indicate that Jordan lost about one pound during the forty-three days prior to his cardiac arrest. In addition, Jordan's thymus weight at autopsy was 13 g, which is about 52% of normal, indicating thymus atrophy and immune depression. Jordan’s mother and his babysitter reported that he had a cold during the week prior to his cardiac arrest.

As noted, Dr. Ross performed an autopsy on Jordan’s body on 25 September 1994 and concluded that Jordan was killed by blunt trauma to the chest and abdomen and that the manner of the death was homicide. However, the medical evidence described in Section III of this report clearly shows that Jordan died as a result of serious acute and chronic illnesses. He suffered from spongiosis of the brain (cerebral cortex and white matter); focal Purkinje cell dropout in the cerebellum; aspiration pneumonitis; weight loss; thymus atrophy; inflammation of the liver, gallbladder, and mesentery; sepsis; metabolic disease; and internal bleedings.

The presence of these significant pathological abnormalities in the brain, lungs, and other organs explain the sequence of events that led to Jordan’s cardiac arrest on 25 September. The brain lesions caused neurological, gastric, and esophageal reflex problems that led to aspiration pneumonitis. This situation caused sepsis, thrombocytopenia, inflammation in liver and other organs, deficiency of blood clotting factors and internal bleedings, lung bleedings and edema, asphyxia, and cardiac arrest.

The objectives of Dr. Ross’s investigation were to find the factual causes and the manner of death. My investigation revealed that Dr. Ross did not achieve these objectives, because he did not follow standard medical procedures in his investigation. He also rushed to judgment in providing the cause and the manner of death to the Manheim Township Police and the assistant district attorney. In addition, he did not reveal important medical evidence to the court that explains the factual causes of bleedings and death. The following is a list of clinical medical data that support my conclusions.

1) Dr. Ross overlooked the fact that Jordan was suffering from weight loss during the forty-three-day prior to his cardiac arrest. As stated above, the baby lost about one pound. Jordan also suffered from thymus atrophy. These data indicate that the baby suffered from chronic illness.

2) Dr. Ross examined Jordan’s body at about 0800 on 25 September, observing sixteen circular, red and brown minor contusions of various sizes, 1/8-1/2 inch in diameter, on the lower anterior chest wall and upper abdomen. He assumed that these bruises were present when the paramedics picked the baby up at his house, and that these bruises were caused by blunt trauma inflicted intentionally prior to the baby’s death. I find Dr. Ross’s assumptions scientifically invalid based on the following medical facts:

a. The paramedics examined Jordan prior to transporting him to Lancaster General Hospital at 0305 and they found only eleven brownish/purplish circular bruises and marks on his lower chest and upper abdomen. The size of the marks was approximately 1/8 inch in diameter. These data indicate that five bruises or marks of the sixteen bruises and marks reported by Dr. Ross were formed after the baby was transported by the paramedics. In addition, the sizes of these bruises and marks increased by 400% from the time the baby was transported by the paramedics at 0305 until the time of autopsy at 0800.

b. Dr. Ross examined the H & E stained tissue sections from the bruises and marks on Jordan’s lower chest and the upper abdomen. He did not find a significant white blood cell infiltration in these areas. Also, in the abdominal tissue, he saw only congested blood vessels without hemorrhage. These observations contradict Dr. Ross’s conclusions that the bruises in the chest area occurred when the baby was alive and that the baby had bruises on the upper abdomen.

c. Various types of injuries in the chest and abdomen have been reported in patients receiving cardiopulmonary resuscitation (CPR), and Jordan’s mother stated that the bruises on the baby’s chest were caused by CPR.

d. Jordan had spongiosis of the brain, aspiration pneumonitis (leading to sepsis), and inflammation of the liver. Thrombocytopenia has been reported in children who have sepsis and brain spongiosis. Thrombocytopenia and inflammation of liver increase susceptibility to bruising and bleedings.

3) Dr. Ross examined the H and E stained tissue sections of Jordan’s brain microscopically and found serious, chronic brain disease—namely spongiosis of the cerebral cortex and white matter, and focal Purkinje cell dropout in the cerebellum. But Dr. Ross did not consider this an important discovery. Furthermore, he did not reveal these findings to the court when he testified in October of 1994 and May of 1995. These lesions are observed in babies with propionic acidemia (PA) and other metabolic problems associated with branched amino acids. PA is a genetically related (recessive gene) metabolic problem. It also causes aspiration pneumonitis, thymus atrophy, sepsis, bleedings, and weight loss—all observed in Jordan’s case.

4) Dr. Ross stated that Jordan’s thymus weight was 13 grams. He was eight-and-a-half months old at the time of autopsy. The average thymus weight (g) in a white infant male at six to nine months of age is reported to be 25 g., making Jordan’s thymus weight about 52% of normal. These data indicate that Jordan suffered from thymus atrophy. Reportedly, babies who had PA and spongiosis of the brain also had thymus atrophy and serious infections, as observed in this case.

5) Dr. Ross examined the H & E stained lung tissue sections microscopically and found aspiration pneumonitis. However, he did not consider this an important discovery in his evaluation. He also did not reveal this crucial information in court when he testified in October of 1994 and May of 1995.

Aspiration pneumonitis is usually caused by a foreign substance (food and/or secretions) and microorganisms entering the lung causing inflammation. It has occurred in children with poor airway reflexes or gastroesophageal reflux, or both. Jordan had serious neurological problems that caused poor airway and gastroesophageal reflexes, namely spongiosis of the cerebral cortex and white matter, and focal Purkinje cell dropout in the cerebellum.

Inflammation of the lungs due to the aspiration of foreign substance and bacteria can explain the bleedings and edema of the lungs observed by Dr. Ross. In the earliest stage of pneumococcal pneumonia, protein-rich edema fluid containing numerous organisms usually fills the alveoli. Marked congestion of the capillaries is followed by a massive outpouring of polymorphonuclear leukocytes and accompanied by intra-alveolar hemorrhage. On gross examination, the lungs of patients who die of streptococcal pneumonia are heavy and display bloody edema, which is identical to Dr. Ross’s observation in Jordan’s case.

6) Dr. Ross examined the H & E stained tissue sections of Jordan’s liver and found that the liver was totally infiltrated, primarily with polymorphonuclear cells (PMN) but with macrophages as well. The presence of the PMN and macrophages in the liver indicates inflammmation and that the inflammation was about 24 hours old or more. The PMN usually enter the inflammatory site within 6 to 12 hours after initial injury, while macrophages enter later, usually after 24 hours. Bacteria were the likely cause of the liver inflammation. Jordan had aspiration pneumonitis, and bacteria can travel via blood and infect other organs. Dr. Ross did not take a blood sample or abdominal fluid to culture them for bacterial growth in order to exclude bacteria as a cause in this case.

7) Dr. Ross examined Jordan’s gallbladder at autopsy and found early necrosis associated with edema in the gallbladder wall. He also examined the H and E stained tissue sections of the gallbladder and found a blood clot, autolysis of epithelium, and subepithelial hemorrhages with early infiltration of PMN.

It takes three to four hours for necrosis in the gallbladder to become apparent to the naked eye. It takes longer to observe cell autolysis, which is caused by enzymes activated and released from the lysosomes of dead cells. Dead cells evoke an inflammatory reaction that brings leukocytes to the area. The autolysis observed in Jordan's case occurred prior to death, because the wall of the gallbladder was infiltrated by white blood cells. It is not medically possible for all these events to occur in less than two hours. In addition, the inflammation and necrosis in Jordan’s gallbladder were likely caused by microorganisms, because the baby was suffering from aspiration pneumonitis, liver inflammation, thymus atrophy, and immune depression.

8) Dr. Ross examined the H & E stained tissue sections of the mesentery and the intestines, and observed fresh hemorrhage with inflammation in the mesentery. The mesentery was also infiltrated with PMN and macrophages. The presence of the PMN and macrophages in the mesenteric tissue indicates that Jordan’s mesentery was inflamed and that the inflammation was about 24 hours old or more, as explained above. In addition, bacteria were the likely cause of the inflammation of the mesentery, because of the aspiration pneumonitis, inflammation of the liver and other organs, and thymus atrophy as explained above.

9) Dr. Ross examined Jordan’s gastrointestinal tract, liver, and gallbladder grossly and microscopically. He observed fresh bleedings in liver, wall of gallbladder, multiple areas of the mesentery, pericolonic region, serosa of small intestine, and ascending colon. He also collected 200 ml of bloody fluid from the abdominal cavity. The bleedings in these sites arose from the synergistic actions of several factors. These include: a) bacterial infections; b) probable thrombocytopenia due to sepsis and metabolic problems; c) inflammation of the liver, causing deficiency of clotting factors as explained in Section III; d) severe damage of liver, gastrointestinal tract, and other internal organs, possibly caused by cardiopulmonary resuscitation CPR, as has been reported in medical literature.

10) Without taking blood sample and/or sample from the abdominal fluid to do bacterial culture, Dr. Ross assumed that the inflammation in the liver, gallbladder, and mesentery were caused by trauma. Bacterial inflammation of the lung (aspiration pneumonitis) can lead to the inflammation of other organs.

Detectives Mathias and Solt alleged that Bryant Arroyo freely confessed to them after 1600 on 26 September 1994 that he killed Jordan. Mathias and Solt claimed that Bryant confessed to them when they told him that the medical examiner informed them that Jordan’s injuries were intentional and not caused accidentally by somebody performing CPR. The officers told Bryant that they believed he was responsible for causing Jordan’s injuries.

The police alleged that Bryant told them he went upstairs to Jordan’s room after 0030 on 25 September; that he picked the baby up with his left hand under the baby’s arm and started punching the baby; that he then switched the baby over to hold him with his right hand and punched the baby with his left hand; that he then laid the baby down on his older brother’s bed and punched him some more. It was alleged that Bryant punched the baby in the chest and stomach area a few times, and that he then put the baby back in his bed and laid him face down.

Bryant has claimed that he did not confess to the police that he killed Jordan, but that the police altered his statement of 26 September describing Jordan’s cardiac arrest incident and the way he did CPR to rescue the baby. Bryant’s alleged confession is an eight-page typed-document produced by Det. Solt with a computer and a word-processing program. There are no copies of Bryant’s alleged confession handwritten by Bryant or the detectives to compare with the computer-generated document. Det. Solt discarded all interview notes.

I found that Bryant’s alleged confession described above does not dovetail with the medical evidence pertinent to this case, or with the sequence of events that led to the baby’s cardiac arrest and death. Below is a list of medical evidence and facts that raise doubt about the police’s claim that Bryant confessed to them he killed Jordan.

1) Jordan’s weight on 25 September was about 15 lb. The police alleged that Bryant picked Jordan up by one arm with a single hand. Then, using his other hand, Bryant punched the baby with a strong force in the chest and the abdomen. Jordan had serious neurological problems, aspiration pneumonitis, liver inflammation, and sepsis. Reportedly, babies who had these health problems also had thrombocytopenia and bleeding problems. I do not believe it is possible to manhandle a healthy 15 lb baby in the manner described by the police, not to mention a baby with the bleeding problems Jordan had, without leaving bruises and marks.

The paramedics, emergency physician, and the medical examiner examined Jordan on 25 September and did not see any evidence of trauma on his the upper and lower extremities. The medical examiner reported that Jordan’s upper arms, forearms, and hands are symmetrically developed and free of evidence of trauma, edema, and other significant natural diseases. In addition, prior to autopsy, full body x-rays were performed and showed no evidence of acute or healing trauma.

2) It was alleged that Bryant punched Jordan repeatedly with his hands in the upper abdominal region. Punching a baby with bleeding problems repeatedly, with a strong force, as described in Bryant’s alleged confession and by the medical examiner, will certainly causes serious bruises. Dr. Ross examined the H & E stained tissue section from the marks on the skin on the abdominal area and observed only congested blood vessels with no obvious hemorrhage or inflammatory reactions. These findings do not support the allegations that the baby was hit in the abdominal region with strong force (or with any force significant enough to cause injury) as described in Bryant’s alleged confession.

3) The sizes of the bruises on the lower chest area increased by 400% from the time the paramedics picked up the baby from his house at 0305 until the time of autopsy at 0800 (Section III). These data and the evidence described in Section III suggest that these minor bruises (1/8 inch) were caused when people performed CPR on Jordan.

4) Jordan suffered from spongiosis of the cerebrum and Purkinje cell dropout in the cerebellar cortex; aspiration pneumonitis; thymus atrophy; inflammation of the liver, gallbladder and mesentery; and severe weight loss. Babies with these health problems also reportedly suffered from thrombocytopenia and bleedings (Section III). These are the factual causes of Jordan’s cardiac arrest and bleedings, and not blunt trauma as alleged by the medical examiner and the police.

5) The events described in Bryant’s alleged confession dealing with the manner of death in Jordan’s case dovetail only with the medical examiner’s theory that Jordan was killed by repeated blows to the chest and abdomen. The medical examiner’s theory is not supported by the medical facts. In addition, the medical examiner shared his theory with the police on 25 September before any microscopic examinations had been done.

6) Bryant was interviewed three times by the police prior to 1600 on 26 September, and on each occasion he stated that he did not hurt Jordan. He found him unconscious in his crib and performed CPR to revive him. Bryant’s story was consistent on the three occasions, and it dovetails with the medical facts, whereas the allegation by police does not.

7) As noted earlier, the police alleged that Bryant confessed to them that he had an anger problem and that he killed Jordan to let his anger out. They alleged that Bryant was angry with his cousin on 24 September. Bryant had nineteen character witnesses who knew him well—including Jordan’s grandmother, mother (who had lived with Bryant for four months), and Bryant's cousin—who testified and/or wrote affidavits on his behalf stating that he is a very calm person and they never saw him getting angry, and rejecting the police’s clam that Bryant had an anger problem.

The medical evidence and facts described above clearly contradict the statements made by Detectives Mathias and Solt that Bryant confessed to them that he had an anger problem and killed Jordan because of it. These facts also indicate that Bryant did not provide the statements cited in his alleged confession describing the methods and the manner of Jordan’s death. I believe that the State of Pennsylvania and the court need to re-examine the medical data presented in this report and ask Detectives Mathias and Solt to explain their positions.

Furthermore, the medical evidence in this case clearly contradicts Dr. Wayne K. Ross’s claim that Jordan died from blunt trauma to the chest and abdomen and that the manner of death was homicide. The medical evidence clearly shows that Bryant was falsely accused. He was unjustly convicted because the factual causes of illness and death were not revealed to the jury by the medical examiner and police.

I hope that the government and the medical authority of the State of Pennsylvania will evaluate the medical evidence presented in this report and open an investigation to correct the injustice. I believe that Bryant Arroyo should be released from prison immediately and should be compensated for pain and suffering and for the time spent in prison.

In addition, the State of Pennsylvania should inform Jordan’s family about the factual causes of the baby's illness and death. The medical evidence clearly shows that he died from a genetically related metabolic problem, propionic acidemia. The gene involved is recessive. Jordan’s family should be alerted to test their other children and future children for this fatal genetic defect to prevent similar tragedy.

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