BELFAST — Marissa Kennedy’s 10-year-old heart simply “gave out” from the constant stress of pain, infections and injuries caused by months of chronic physical abuse, the state medical examiner testified Wednesday.

Dr. Mark Flomenbaum said he recorded between 40 and 50 “distinct blunt-force injuries” on Marissa’s body as well as a lacerated liver, blood on her brain, three semi-healed broken ribs, and deep wounds to her knees and feet from consistent repeated, prolonged kneeling.

Testifying on the fourth day of the murder trial of Marissa’s mother, Sharon Carrillo, Flomenbaum said the girl’s hair was falling out due to chronic stress, she had fluid build-up in her lungs and “dramatic” changes to a gland that helps fight infections. Additionally, cells in Marissa’s heart had begun to die in a way that Flomenbaum said indicated an organ struggling to keep up with enormous amounts of adrenaline released over a long time.

Marissa Kennedy

“The cause of death was the cumulative effect of all of these things I was talking about,” said Flomenbaum, who conducted the autopsy on Marissa a day after her February 2018 death at her family’s Stockton Springs condominium.

“The heart finally gave way – that was the mechanism – because of the constant stresses it had due to the pain, the inability to fight the infection, due to the bleeding on the brain,” Flomenbaum continued. “Each one of them independently could have been survivable. But when we add them together, it fits easily a condition we refer to in our literature as ‘battered child syndrome.'”

Carrillo is charged with depraved indifference murder in the death of Marissa. State prosecutors allege that Carrillo and her husband, Julio Carrillo, essentially beat the 10-year-old to death over a period of months and then tried to stage her death as an accident or as the result of self-inflicted injuries.

Julio Carrillo pleaded guilty to murder in August and was sentenced to 55 years in prison.

Sharon Carrillo’s defense attorneys are expected to argue that she gave false statements to police and never participated in beating her daughter. The defense also has suggested that Carrillo was herself a victim of Julio Carrillo’s domestic violence and that she was very susceptible to being persuaded to falsely incriminate herself because of her low intellect.

In cross-examination of Flomenbaum, defense attorney Christopher MacLean said that despite all of the evidence supporting his conclusions, “none of the medical evidence can tell us who killed the child.”

“That is correct,” Flomenbaum responded.

It was another day of heart-wrenching testimony in a child abuse case that shocked Maine residents and prompted scrutiny of the state’s child welfare programs. Following the death of Marissa and a 4-year-old Wiscasset girl, the state beefed up staffing in child protection programs and is in the process of instituting other reforms aimed at improving communication and collaboration across agencies.

Earlier Wednesday, jurors were shown multiple disturbing cellphone videos offering a glimpse into the chaotic Carrillo household. In separate videos, Sharon Carrillo and Marissa are seen screaming at Julio to stop recording them as they cry, shout and try to get away from him.

“I’m doing nothing wrong, leave me alone!” Sharon Carrillo screams at one point.

Julio Carrillo tells her he won’t stop recording until she calms down, threatening to call the police again and telling her “This is Julio recording for proof.” He also tells Sharon Carrillo – who would later tell police she was sometimes “triggered” into emotional states by recollections of sexual abuse she suffered as a child – that she should lose custody of her children.

In another video Julio Carrillo shot, Marissa is seen screaming, crying and growling as she repeatedly attempts to swat the phone away from her stepfather. Julio Carrillo tells the pajama-clad girl that he is going to email the video to the hospital – likely a reference to Acadia Hospital, a Bangor mental health facility where Marissa spent a month – and is heard instructing Sharon Carrillo to pack a bag with Marissa’s clothes.

Sharon Carrillo’s defense attorneys played the videos for jurors while cross-examining a Maine State Police computer crimes forensic analyst who extracted them from the numerous cellphones recovered at the condo. The videos could come up again as they seek to portray Julio Carrillo as the abusive aggressor and his wife as a victim.

And those were not the only disturbing images that police and analysts found on the phones.

Jurors saw two cellphone pictures showing Marissa – wearing nothing but underwear – kneeling on the tile floor with her arms raised straight above her head. Sharon Carrillo can be seen in the background of one of the photos in the same pose, which she told police is the posture Marissa was forced to maintain during punishments.

Just one day before Marissa died, someone also used a cellphone to take photos of the severely injured child’s body.

During Flomenbaum’s testimony, jurors were shown graphic autopsy photos of Marissa’s bruised, swollen and broken body. While most jurors dutifully watched as the images were displayed on television screens, Sharon Carrillo typically kept her head down or turned away from the screens.

Flomenbaum testified that some of the injuries were “patterned” in ways that are consistent with the marks left by knuckles or toes. A state police forensic analyst later testified that she also had matched several of the “patterned” injuries to the metal buckle of a belt that the parents admitted using on Marissa.

Wednesday’s court session ended with the jury beginning to watch video of a roughly three-hour interview a state police detective conducted with Sharon Carrillo days after her daughter’s death. The jury already had heard or watched three other police interviews with Carrillo in which she sometimes acknowledges participating in beatings of her daughter.

The defense is expected to attempt to convince jurors to disregard confessions from a client they say was living in fear of her abusive husband and was easily manipulated because of her mental disability.

The state could wrap up its side of the case as early as Thursday.