Family wants to know: What killed Isabella?

Isabella Nealy’s relatives say they’re struggling with a question that the state failed to answer: Why did the 4-month-old baby die?

“I think we’d have a cause of death for Izzy if they’d investigated thoroughly and not just swept it under the rug,” said Jennifer Cothern, the baby’s aunt.

Gaston County Police said they suspected that Isabella might have been neglected before her death on May 25.

An autopsy report said Isabella had reportedly been placed facedown in her bassinet – a sleep position experts consider too dangerous for infants. Her mother, apparently intoxicated, had been passed out on a nearby couch, the autopsy states.

Samantha Cothern, Isabella’s mother, had for several days treated the baby’s runny nose with medicine labeled for children at least 4 years old, according to a medical examiner’s report. The U.S. Food and Drug Administration recommends that parents avoid giving over-the-counter cold medications to babies because the products can have life-threatening side effects.

But county prosecutors declined to pursue criminal charges after the medical examiner’s office ruled that it could not determine how the baby died.

Isabella’s death illustrates how North Carolina medical examiners often skip basic steps that experts say are essential to competent infant-death investigations.

The Gaston County medical examiner responsible for investigating the death did not visit the Bessemer City trailer where Isabella died. The examiner’s report also omitted key facts, failing to mention that another of the mother’s babies had died unexpectedly years earlier.

Visited at her current home in Gastonia, Samantha Cothern declined to comment, saying the memories were painful.

Two family members said a thorough initial medical examiner investigation would have noted that Cothern, now 32, had a history of drug abuse and crime, including arrests for robbery, larceny and obtaining controlled substances by misrepresentation.

But the relatives say the medical examiner didn’t talk to them until after she finished her report. It wasn’t until a family friend called with new information, they say, that the medical examiner learned about the previous baby’s death in 2003 – and that state social services officials had removed two other children from Cothern’s custody.

Isabella’s relatives said the medical examiner told them she didn’t know Cothern had other kids.

Failing to discover such red flags would be unacceptable in states with leading medical examiner systems, experts say.

‘Mama, he’s not breathing!’

On the morning of July 13, 2003, Glenis Cothern heard her 3-month-old grandson crying. After awhile, the crying stopped. Baby Brendan was in a bedroom with his mother, Samantha, and Glenis said she figured he was being taken care of.

Minutes later, Samantha ran from the bedroom holding her limp baby. “Mama, he’s not breathing!” Glenis recalls her daughter saying.

Glenis failed to revive her grandson with CPR.

Dr. Bruce Flitt, the medical examiner, did not go to the death scene, and family members said he did not interview them. The state medical examiner’s office concluded that Brendan – who until then, family members say, had been a happy, healthy baby – died from sudden infant death syndrome. Flitt did not return phone calls seeking comment.

Experts say medical examiners are supposed to call deaths SIDS only after a thorough scene investigation, an autopsy and a review of the baby’s medical history have ruled out all other causes.

A 2010 Observer investigation found that hundreds of infant deaths were wrongly attributed to SIDS. About two-thirds of the cases involved circumstances that suggested the babies may have suffocated.

In response, N.C. Chief Medical Examiner Dr. Deborah Radisch changed how the state classifies infant sleep deaths, and the number of cases labeled SIDS has declined markedly.

An Observer series published earlier this year revealed that Flitt turned his position as a medical examiner into a business operation by having nurses perform his duties.

The nurses, who were not formally authorized to conduct death investigations, compiled information and submitted paperwork to Flitt, according to lawsuit depositions from an unrelated case. He signed his name to investigative reports, collected payment from the county or state and split the money with the nurses.

Another tragic morning

Eleven years after Brendan’s death, Samantha Cothern gave birth to Isabella.

Blonde and chubby, the baby giggled when people blew on her belly. She liked to be held facing outward, so she could observe the world.

Isabella and her mother had been evicted from their home and were living with a neighbor in Gaston County when tragedy struck again.

On the morning of May 25, Cothern’s roommate heard her “hollering for help,” the autopsy report states. Isabella was unresponsive.

The medical examiner assigned to the case was Carol Pinkard, one of the nurses whom, according to a deposition, Flitt had hired to handle his cases years earlier. Now 54, Pinkard works independently as a medical examiner.

Why Pinkard didn’t go to the home where Isabella died – or include key details in her report – is unclear. She declined repeated requests for an interview.

State records show Pinkard has visited death scenes in about 25 percent of her cases – significantly more often than most North Carolina medical examiners. But the data also show that she went to the scene in just one infant death of the seven she investigated until mid-2013.

Experts say that falls short of best practices. Visiting death scenes is crucial to thorough investigations because it can yield clues that autopsies can’t uncover. But North Carolina doesn’t require medical examiners to visit scenes.

‘No explanation’

Relatives have questions about Samantha Cothern’s role.

But the medical examiner’s inability to determine a cause of death creates an investigative challenge for police and prosecutors, Gaston County Police Capt. Jay Human said. Human also noted that Cothern had asked two other adults in the house to watch Isabella the night before the baby was found not breathing.

“You can’t find fault” when the cause of death is ruled undetermined, Human said. “You’re looking for asphyxiation or something that points to an act.”

Gaston County District Attorney Locke Bell said that, according to people who were in the house, Cothern had consumed alcohol and taken drugs before Isabella died. But that alone, Bell said, “does not show that she did anything” to cause the baby’s death.

Dr. Thomas Owens, Mecklenburg County chief medical examiner, performed an autopsy on Isabella and wrote in a report that it might be a case of SIDS or possibly viral myocarditis – an inflammation of the heart wall.

But because another baby in the family had died under mysterious circumstances, Owens wrote, the cause of death would remain as undetermined.

The state’s failure to find a cause of death has left the family with “nothing at all,” said Jennifer Cothern, the baby’s aunt.

Said Glenis Cothern, Isabella’s grandmother:

“Our baby (Isabella) was taken from us, and we have no explanation for it,” she said. “My baby needs to have someone stand up for her.”

This story was originally published December 27, 2014 at 5:20 PM.