Editor’s note: This story contains graphic testimony and descriptions of injuries to an infant that some readers may find disturbing.

ASHEVILLE, N.C. (828newsNOW) — A forensic pathologist testified Tuesday that 12-week-old Riley Leshae Hannah Stephenson died from a combination of abuse, malnutrition and pneumonia, in the first-degree murder trial of her father.

Nickolas Shane Stephenson, 37, faces first-degree murder and intentional child abuse charges in the June 2022 death of his daughter. The baby’s mother, 32-year-old Diandra Haleigh Fuhr-Farlow, has pleaded guilty to intentional child abuse causing serious bodily injury.

Forensic expert testifies

Prosecutors called Dr. William Thomas Harrison, a forensic pathologist and neuropathologist, to the stand Monday. He returned Tuesday to complete direct examination and face defense questioning.

Harrison, an assistant professor of pathology and neurology at Atrium Health Wake Forest Baptist, told jurors his work involves performing autopsies to determine the cause and manner of death. His neuropathology training focuses on the brain and spinal cord.

“The cause of death is the underlying process that causes someone to die,” Harrison explained. “The manner describes the circumstances — whether natural, accidental, suicide, homicide or undetermined.”

Harrison is board-certified in both specialties and can independently conduct autopsies and certify deaths. He also described North Carolina’s medical examiner system, noting that suspicious deaths from all 100 counties are referred to regional centers, including Wake Forest in Winston-Salem, which covers 34 counties in Western North Carolina, including Buncombe.

The autopsy

Harrison testified that Riley’s autopsy lasted nearly 10 hours because of extensive injuries requiring special procedures and documentation.

He described the infant as “very emaciated” with visible ribs, facial injuries and scalp wounds. A full skeletal survey revealed numerous fractures in various stages of healing. Harrison said he removed and prepared several bones for detailed microscopic examination.

He identified fractures in the ribs, both upper arms, the collarbone, both lower legs and the spine. One rare injury, a severe tear inside the upper lip extending to the bone, indicated a forceful blow to the mouth.

Harrison explained that healing fractures at different stages suggest repeated trauma rather than a single event. He said the rib fractures were “classic” for squeezing injuries in infants and could not have resulted from CPR.

“A broken rib by itself doesn’t tell me anything,” Harrison said. “It’s the location and the constellation of injuries that matter. This pattern is very classic in our field.”

Other injuries included fractures to the vertebra, arms and legs, including breaks at the growth plates consistent with twisting or pulling, and a lateral clavicle fracture that was suspicious because of its location. Harrison said none of the injuries were consistent with birth trauma, noting Riley was delivered by C-section.

Malnutrition and illness

Harrison said Riley was severely malnourished, weighing below the first percentile for her age, and showed signs of pneumonia and acute kidney failure.

“Multiple broken bones require energy to heal,” he said. “In a child who is already malnourished, that takes away reserves needed to fight infection. That made her far more susceptible to pneumonia being severe.”

Toxicology tests were negative for drugs or illicit substances. Harrison said Riley’s injuries could not be explained by natural disease or conditions such as brittle bone disease.

Documenting the injuries

Jurors viewed dozens of autopsy photographs showing bruises, burns, abrasions and contusions on Riley’s face, scalp, ears and limbs. Harrison called bruising behind the ear particularly suspicious and highlighted the deep laceration inside the upper lip.

X-rays and internal examination showed fresh and healing fractures in the ribs, clavicles, arms and legs. Some fractures were surrounded by callus tissue, indicating earlier injuries. Microscopic testing confirmed thermal burns and multiple healing fractures.

Harrison also dissected Riley’s neck and spine, finding hemorrhaging around nerve roots that could indicate trauma or complications from oxygen deprivation.

After reviewing all findings, Harrison certified Riley’s death as a homicide. He said the cause was “complications of multiple injuries, malnutrition and pneumonia,” which he described as interrelated.

Cross-examination

The defense clashed with prosecutors over expert testimony tied to a cell phone video of the infant at the center of the case. The dispute arose after Harrison, who performed the autopsy, testified that violent head movements shown in the video could potentially cause a neck injury.

Court-appointed defense attorney Dustin Randolph Dow argued that prosecutors failed to disclose Harrison’s opinion ahead of trial, calling it a “significant piece of evidence” that should have been turned over during discovery.

Dow accused the state of withholding information, noting Harrison had discussed the video in a pre-trial meeting with Assistant District Attorneys Stormy Ellis and Amy Buchanan two weeks earlier. He asked the judge to strike that portion of Harrison’s testimony and instruct jurors to disregard it.

Ellis countered that Harrison’s statement was not a new expert opinion but rather a general observation about possible risks shown in the footage. Ellis said the defense had long been aware of the video and had even retained its own expert but chose not to present a report.

Superior Court Judge George C. Bell declined to strike the testimony but instructed jurors that Harrison had not concluded the actions in the video caused Riley’s injuries.

During cross-examination, Harrison reiterated that Riley’s fractures were in different stages of healing, indicating multiple incidents rather than a single event. He observed a scalp bruise but no skull fractures or major neck trauma and could not determine whether bruising resulted from alleged acts such as being slammed into a railing or squeezed.

Harrison also confirmed that malnutrition likely weakened Riley’s immune system, leaving her more vulnerable to pneumonia. Asked if medical treatment could have saved her, he said only that she “would have had a better chance” if care had come sooner.

Prior coverage

Pediatrician testifies infant’s death was ‘child torture’

‘She would cry’: Mother recounts abuse before baby’s death

Body cam, crime scene evidence shown in Asheville murder trial

Emergency responders testify in death of 12-week-old

Jury hears opening arguments in Asheville infant death case

Infant’s death at center of Buncombe County murder trial