Shawna L. Gatto enters a Kennebec County courtroom on Monday, the first day of her murder trial. Gatto is accused in the killing of 4-year-old Kendall Chick.

AUGUSTA, Maine — Dr. Mark Flomenbaum, the state’s medical examiner, testified Tuesday that his autopsy indicated 4-year-old Kendall Chick died from blunt force trauma to her head, a “catastrophic” traumatic injury to her abdomen and chronic “child abuse syndrome,” or multiple injuries to many parts of her body over time.

Flomenbaum’s testimony filled much of Tuesday morning, the second day of the murder trial of Shawna Lyn Gatto, 44, at the Capitol Judicial Center.

Gatto is charged with depraved indifference murder. She is accused of killing the child at the Wiscasset home they shared with her fiance, Stephen Hood, on Dec. 8, 2017. Chick had been removed from her mother’s custody by the Maine Department of Health and Human Services and placed with Gatto and Hood.

Gatto pleaded not guilty to the crime. She waived her right to a jury trial, and Superior Court Justice William Stokes will rule in the case.

Flomenbaum told Stokes on Tuesday that Chick died of “blunt force trauma to the abdomen, with laceration to the pancreas” and blood in the abdominal cavity. He also said that the child suffered tears in the membranes supporting the large intestine and colon, with complicating factors including chronic child abuse syndrome.

Assistant Attorney General John Alsop, who with Assistant Attorney General Donald Macomber is prosecuting the case, questioned Flomenbaum about the autopsy and asked him to explain in detail each of 47 graphic photos of Chick’s corpse, both before and during the autopsy, as well as X-rays.

On the photographs taken the night of Chick’s death, Flomenbaum pointed out 15 to 20 distinct injuries to the child’s face, including two bloodied and blackened eyes, a bleeding nose, swollen, misshapen lips, a scraped and purple ear, and multiple cuts and bruises on other parts of her face, including a cut on her chin where “the skin has been split open by blunt force.”

Bruises along her cheek, her neck and in other places on her body are “typically what we see with fingernail impressions,” Flomenbaum said. Injuries to her ear were “typically the type of injuries you get from “tweaking” or “twist and pull,” he said.

He also pointed to a visible dent on her forehead, and said an X-ray of her skull showed “abnormal and unusual” swelling.

Macomber said Monday that police found a “head-sized defect in the drywall of Chick’s bedroom, with transfer of stain of her blood and one of her hairs embedded in the wall.”

Police also found blood stains on the lower bunk bed in which Chick slept, on the bathtub in which Gatto said she left Chick, on paper towels in a bathroom trash can and on a towel in the kitchen, among other places, according to transcripts of interviews with Gatto by investigators, including Lincoln County sheriff’s Deputy Jared Mitkus. They also found evidence of “ subsequent cleanup.”

Flomenbaum on Tuesday pointed to a photo of Chick’s brain, showing a swelling that could have occurred from oxygen deprivation “or could be associated with anything that is going to cause a slow dying process.” He also said the brain was “full of blood” that was “fairly fresh,” indicating a hemorrhage.

The medical examiner testified that bruises on her arms occurred in an area “where tight grasping would cause injury,” as well as bruises on the insides of her elbow, her thighs and other areas.

Other bruises — some “fresh” and some “many days” old — were present on an instep — “a very funny location to get injured if you’re injuring yourself,” he said

“Typical bruising of toddlers from falling or tripping or learning how to walk” more often results in injuries to more “bony” areas, rather than soft tissue, he said later.

Chick’s thymus, observed under a microscope, indicated “this child had been subject to a great deal of stress,” Flomenbaum said.

She had developed peritonitis, he said, and the “noteworthy” swelling in her abdomen, where he determined membranes were perforated and her pancreas injured, “is indicative of being alive for many, many, many minutes.”

Defense attorney Jeremy Pratt, who is defending Gatto, said, “You can’t rule out that any of those injuries were caused by Stephen Hood, can you?” and later, “It could be Ms. Gatto, or it could be Stephen Hood. Or it could be a third person I haven’t identified.”

Tuesday afternoon, Flomenbaum answered questions from Stokes. He said in the hours before Chick collapsed, she would not be active at all, and that either the injury or the results of the injury would have been painful.

Following Flomenbaum’s testimony, Stokes took a defense witness out of order due to scheduling. Jack Daniel, a forensic psychologist, agreed with Flomenbaum that Chick’s pancreas was bleeding, but said that “retroperitoneal hemorrhage” could present in a non-specific way, including delayed symptoms such as abdominal pain, potentially over a period of time.

Daniel also disagreed with Flomenbaum on several other points, saying he believes peritonitis occurred between one and 12 hours following a fatal injury.

Daniel said that, had he been in charge of the investigation, he would have requested an iron stain of the area of injury, particularly the area of the head of the pancreas, which would have shown whether red blood cells were present.

Flomenbaum had testified previously that the state does not have equipment to perform an iron stain, and that he does not typically request them.

Asked by Pratt whether he thought Chick was abused, Daniel said yes, but he acknowledged he had no evidence of who abused her.

He said it would not necessarily be obvious to an observer that Chick was near death, and that she could have been put into another room for a “timeout” or a nap and died without anyone realizing it.

Also Tuesday morning, Maine State Police detective Joshua Birmingham concluded testimony that he started late Monday afternoon. Birmingham explained to Alsop photographs he took of Gatto’s cellphone after he seized it the night of Chick’s death.

Among the photos was one dated Aug. 8, 2017, which showed Chick’s face with bruising around her eye, a swollen nose and cuts to her face.

Birmingham also read from photos of a number of text messages from Gatto’s phone, including one from Sept. 14, 2017, to Hood, saying, “I’m so [expletive] done with this kid. She’s been running around this house in her princess shoes and fell right into the coffee table.”

He also read another text from Gatto to her daughter-in-law, Danielle Coffin. Date-stamped 4:34 p.m. the day of the child’s death, it read: “You need to get home now. I think Kendall is dead.”

Throughout the day, Gatto sat silently and still, eyes averted from the court proceedings and from a computer screen before her displaying evidence photos.

If convicted of murder, Gatto could face 25 years to life in prison. She could also be found guilty of the lesser crime of manslaughter.

If you or someone you know is experiencing domestic violence and would like to talk with an advocate, call 866-834-4357, TRS 800-787-3224. This free, confidential service is available 24/7 and is accessible from anywhere in Maine.