Doctor crusades to exonerate imprisoned mother

TRACY JOHNSON

SEATTLE POST-INTELLIGENCER

A retired Seattle doctor has spent nearly a decade on a daunting mission: to prove that a woman serving 40 years in prison didn't kill her little girl.

Investigators were sure Noreen Erlandson did it, and so was a 1992 Snohomish County jury. The adopted 2-year-old Korean girl was covered with bruises, and her brain bled inside her skull from some kind of swift blow.

One doctor still recalls Kayla Erlandson's tiny body as suffering "one of the most severe beatings I've seen."

But Carl Nugent, a veteran physician in family practice, is certain Kayla suffered from a little-known medical disorder. The rare form of epilepsy strikes young children, leading to injuries that can be severe -- and mistaken for abuse.

An expert in childhood epilepsy agrees that some seizures can leave children seriously hurt, and a circle of Erlandson's fiercely supportive friends and neighbors agree that it would explain what they couldn't: Why Kayla was always falling down. Why she was slow to learn things.

And why her mother, a nurse-practitioner who cradled the girl most of the way home from a foster shelter in South Korea, was blamed for something so unthinkable.

Erlandson, 48, who lives at Gig Harbor inside the razor-wired fence of the state's only prison for women, says she is more convinced each day that Kayla suffered from Lennox-Gastaut Syndrome. She hopes to prove she is innocent.

"The more information I get, the more I believe this is what she had," she said. "There's nothing else I can think of that could have happened."

Tragedy spans a decade

Erlandson picked up Kayla from the baby sitter April 24, 1991, and took her to the family's two-story home in the woodsy outskirts of Bothell. The toddler dozed in the car, her mother said later, picked lethargically at her dinner and began throwing up.

Erlandson said she carried Kayla into the bathroom and stood her next to the toilet when the phone rang. She left Kayla alone for a minute or two to talk to her husband, who was headed home from a business trip.

She said she then heard a "bonk" and found the little girl whimpering on the bathroom floor. She said she thought Kayla slipped and hit her head on the rim of the toilet, but she seemed to be OK.

Later, after she had tucked Kayla into bed, she said she found her struggling to breathe. She was trying to awaken the little girl when her husband came home.

They called the family doctor, then 911.

Medics could tell Kayla had suffered a severe head injury. Seizures racked her small body, her pupils were uneven, and her brain was swelling.

She also had a small tear in her liver, a burn near her elbow and what appeared to be a bite mark on her scalp.

Doctors at Harborview Medical Center tried surgery to relieve the pressure in her skull, a last-resort effort to save her.

She died two days later.

By then, police had arrested her mother.

Always covered with bruises

When Erlandson's world fell apart that spring, Carl Nugent didn't know her. His wife, Alice, had met her through a shared interest in folk dancing.

Curious, Nugent sat through parts of her trial. Testimony about Kayla's injuries made him skeptical, so he began looking into the toddler's death himself.

He stumbled onto something called Lennox-Gastaut Syndrome as he read about seizures caused by head injuries. He'd never heard of the disorder, he said, but its classic symptoms described Kayla perfectly.

Many people recalled the toddler as being inexplicably klutzy, and some noticed that she rarely put her hands out to protect herself when she fell.

The disorder not only slows a child's learning ability, but its different kinds of seizures can prompt unexpected falls.

The seizures can be fleeting, ending in a few seconds. Children often bounce back up so quickly that their parents miss what happened -- and their claims that the bruised child "just suddenly fell" may raise eyebrows, Nugent said.

Kayla took a scary tumble two weeks before she died, leaving her face cut and swollen. Her mother was nowhere near her when it happened.

A baby sitter heard a loud crash and found Kayla on the floor, crying and bleeding amid the broken glass of a heavy water-cooler bottle. Somehow the tiny 2-year-old had hit it hard enough to break it.

Nugent believes only a myoclonic seizure -- when muscles contract suddenly and intensely -- could cause her to fall so forcefully. And he doesn't think it was a fluke.

The little girl was always covered with bruises, once prompting a grocery clerk to call Child Protective Services. But the caseworker didn't find evidence of abuse, Nugent said. She suggested Kayla wear a helmet.

Nugent is convinced a quick, violent seizure also led to Kayla's death. He believes it made her fall hard in the bathroom, striking her head against the porcelain rim of the toilet.

But the key was what he found in Kayla's medical records: Paramedics gave the toddler two 1.2-milligram doses of intravenous Valium.

The drug is often used successfully to calm seizures, a symptom of severe head injuries. But literature about Lennox-Gastaut warns that the drug can worsen or prolong seizures in children who have it.

Before Kayla was given the Valium, according to the testimony of one firefighter, she was "conscious with her eyes open and breathing on her own." Afterward, Nugent said, Kayla's left pupil became much larger than her right, and neither would respond to light.

Medics told the Erlandsons to meet them at Children's Hospital, then abruptly decided to go to the region's top trauma center instead. Nugent suspects it was because Kayla's condition took an alarming dive after she was given the Valium.

"There's such an obvious cause for what happened," Nugent said, emphasizing that medics couldn't have known and weren't to blame.

Textbooks and research papers clutter several rooms of Nugent's Ravenna home, where the feisty 74-year-old works on or thinks about Erlandson's case every day.

He travels to national seminars on child abuse, forensic science and epilepsy, and he has studied every word of a trial transcript nearly 3,000 pages long.

Yet he knows that his quest to exonerate the woman may be impossible.

"The law loves final conclusions," he said.

Evidence points to guilt

There was no mention of seizures or Valium during Erlandson's 1992 trial.

Prosecutors told jurors that Erlandson was frustrated that Kayla wasn't as good as her adopted Korean son, who was 4. She was klutzy, slow to learn and threw tantrums.

The evidence was vast and damning. There were horrifying photographs of Kayla, and testimony that the severity of her head injury was on par with tumbling several stories from a building.

Paramedics testified that Erlandson tried to keep them from cutting off Kayla's pajamas as if she didn't want them to see bruises. They recalled the panicked gibberish she told them, something about a water bottle and a too-hot bath.

A dental expert, though disputed, testified that the bite mark behind Kayla's ear seemed to match Erlandson's teeth.

The mother had written in her journal that Kayla adored one of her playmates, then added that the boy was always biting her. Prosecutors called the added phrase an effort to shift blame.

The jury took two days to find Erlandson guilty of second-degree murder. The verdict hit her Seattle attorney, David Allen, hard.

"This is a woman who has an exemplary background with no suspicion of any wrongdoing in the past," he said at the time. "This is not like one of those cases of ongoing abuse. That didn't happen here."

The typical sentence ranges from 10 to 13 years in prison, but Snohomish County Superior Court Judge Joseph Thibodeau said Kayla was a vulnerable child who had endured "extreme cruelty." He gave Erlandson 40 years.

Holding up a stack of letters from Erlandson's supporters, he said he was struck by how many people refused to see the truth.

Debate over syndrome

Even today, Dr. Abraham Bergman doesn't have any doubt that justice was served. A witness for the prosecution in 1992, he recalls Kayla's injuries as "textbook abuse."

"This was one of the most severe beatings I've seen in my 40 years of pediatrics," said Bergman, chief of that department at Harborview. "Falls from short distances do not cause such trauma."

Another witness for the prosecution, Dr. Ellsworth Alvord, is familiar with Nugent's theory.

"It's not impossible, but each point I think he is stretching to the limit," the University of Washington neuropathology specialist said.

But Dr. Gregory Holmes, director of the Division of Epilepsy and Clinical Neurophysiology at Children's Hospital Boston, has seen seizures cause serious injuries, including a "subdural hematoma" brain injury like the one Kayla had.

Holmes believes a seizure could cause a toddler to fall against a toilet rim with enough force to cause a serious head injury -- and that a mother may have no idea it was a seizure.

"It might be tough, initially, for a parent to tell," said Holmes, who is also a professor of neurology at Harvard Medical School. "They're quick. The parent could be standing right next to the child, and all of a sudden, the child is on the ground."

Holmes thinks it's more likely that the head injury killed Kayla than the Valium, though her other injuries make him more circumspect.

He has seen burns on children who have fallen against something hot, and he speculated that a fall against something angular -- like a coffee table -- could cause a liver laceration.

But he pointed to the obvious. There is no way that Lennox-Gastaut Syndrome can cause a bite mark.

'Proud to be her mother'

Erlandson has maintained her innocence for 10 years, and she still contends that another child must have bitten Kayla. She said the toddler had come home from a baby-sitter co-op once before with teeth marks on her leg.

"I'm not a biter," Erlandson said. "Timeouts were my way of discipline."

In prison, she keeps photographs of her daughter, who liked to sleep with a stuffed bunny and thought every white-bearded man was Santa Claus. The toddler's learning and coordination problems didn't make her love the girl any less, she said.

"I can't even fathom that theory as a parent," she said, shaking her head. "I didn't commit a crime. I was the best mother that I could be."

She said she always tried to let Kayla know that being adopted meant that she had been specially chosen. In the seven months that she had her, she dressed her in pink and tied bows in her hair.

"I was proud to be her mother," she said. "I took a gazillion pictures of her, bruises and all."

She remembers panicking the night Kayla wouldn't wake up. She said she didn't know what was wrong, so she rambled frantically about Kayla's accident with the water bottle.

She said when the medics started cutting off Kayla's pajamas, she reached over to unsnap them because "the mom in 'me felt like, 'Wait, wait. Don't treat her like an object.'"

Facing prison time until 2022, Erlandson has high hopes for Nugent's research. So do her friends, many of whom pitched in thousands of dollars for her legal costs.

"Noreen is innocent," said Paddy Cottrell, a longtime friend who also adopted children from Korea. "Once the steam roller of county prosecution takes after you, all reason is gone."

The last of Erlandson's court appeals, arguing juror misconduct, was rejected in 1997. After standing by her for six years, her husband filed for divorce.

"It still hasn't been proven to me what happened to Kayla," Doug Erlandson said, but "I do believe there was a miscarriage of justice."

Seattle defense attorney David Marshall recently agreed to look over her case for free and found Nugent's theory plausible.

"Some of the literature he's shown me about the syndrome is quite remarkable," Marshall said.

Showing Kayla had it, however, would be a challenge. Ideally, he said, he could convince the state Court of Appeals that today's medical technology would have changed the outcome of Erlandson's trial.

"You have a higher hurdle the second time," Marshall said. "We would have to get quite a case together before we try to persuade the courts."

P-I reporter Tracy Johnson can be reached at 206-467-5942 or tracyjohnson@seattle-pi.com