A forensic physician who studied medical reports on Jeffery and Rebecca Trebilcocks' adopted children said he believes the oldest boy suffered from rickets and fetal alcohol syndrome.
Dr. Steven Gabaeff of Jackson, Calif., who is also licensed to practice emergency-room medicine and has 30 years' medical experience, said he never examined the children in person. However, he said he reviewed numerous documents, including Dr. Blaine Tolby's report that the abnormally undersized boy suffered from psychosocial dwarfism brought on by a traumatic home situation.
The Trebilcocks are charged with criminal mistreatment of their four adopted children. The defense began presenting its case Tuesday in the trial's second week.
Gabaeff disputed Tolby's diagnosis. He said the boy developed a vitamin D deficiency in 2002 when he entered the Trebilcocks' Longview home as a foster child and began eating a vegan diet, which has no dairy products. The prolonged absence of vitamin D led him to develop rickets, a thinning of the bones, Gabaeff said. He said the boy's stunted growth is a result of rickets, not psychosocial dwarfism.
Gabaeff he said the boy's broken ribs also are caused by rickets, which he said was rampant in the 1930s and 1940s but is much less common today.
Neverthless, he said, "Many misdiagnoses of child abuse are really rickets," he said.
He said when the boy entered Doernbecher Children's Hospital in March 2011, he had a vitamin D level of nine. The normal range is 30 or more.
At Doernbecher, the boy was given large doses of vitamins that "gave him the capacity to grow again," Gabaeff said. "He made a very good recovery."
During cross-examination, Deputy Prosecutor James Smith tried to differentiate between vitamin D deficiency and rickets. Gabaeff insisted they are the same.
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Smith also noted that other experts didn't find rickets.
"The OHSU radiologist didn't find rickets," he said. "He found osteopenia," or poor bone density.
"That's rickets," Gabaeff said.
As for fetal alcohol syndrome, which Tolby said the boy didn't have, Gabaeff said he diagnosed the condition based on telltale facial features, behavior and a social services report that said the boy's birth mother drank 10 to 12 beers a day during pregnancy.
"You had no training to diagnose fetal alcohol syndrome," Smith said.
"I've done 20 years of reading. I've seen hundreds of cases. I know what it is. It's not that difficult to diagnose," Gabaeff said.
He said odd behavior such as eating dog food — alleged in the Trebilcock's case — could be blamed on fetal alcohol syndrome.
Smith showed Gabaeff a psychological exam in which the birth mother said she didn't drink during pregnancy.
"Whatever it says won't change my opinion," Gabaeff said. "(The boy) had fetal alcohol syndrome."