NEW HAMPTON - Prosecutors continued laying the foundation for their case Thursday in Randy Blanchard's trial for first-degree murder, offering a physician who said only one conclusion makes logical medical sense.

Aliya Blanchard, 12 days old, died in February 2008 because of injuries in her brain, Dr. William Carey testified in Chickasaw County District Court. And those were caused by "nonaccidental trauma," he told Judge Richard Stochl.

"Nothing else makes sense in this case other than nonaccidental," Carey said.

Prosecutors are trying to prove Blanchard shook his daughter and struck the infant's head, causing a skull fracture and internal bleeding in the baby's brain.

Carey is a neonatal physician at the Mayo Clinic in Rochester, Minn., and first treated Aliya after her transfer by helicopter from Covenant Medical Center in Waterloo.

Three CT scans, projected on a screen set up in the courtroom, revealed the fracture and blood, Carey said. The test also showed the infant's brain was swollen.

Carey later noted severe bleeding in the retinal area of Aliya's eyes, which suggested the baby's head and snapped back and forth violently. The action would break veins as the optic nerve stretches and tears, he said.

According to Carey, Blanchard said he might have bumped Aliya's head on an open microwave oven door, suggesting the alleged incident caused the injuries.

"'That's not possible,'" Carey said he responded.

After reaching his diagnosis with the help of colleagues, including a pediatric neurosurgeon, Carey said he told Aliya's parents she suffered "inflicted injury" and would likely die.

Annette Eilderts, the baby's mother, grew more upset after hearing the news and cried, according to the doctor's testimony.

"Mr. Blanchard didn't seem particularly affected by it," Carey added.

Prosecutor Denise Timmins also questioned the doctor about Aliya's neurological condition. Carey testified she was profoundly unresponsive.

"Is it fair to say, but for the equipment she was hooked up to, she would not be living?" Timmins asked.

"Absolutely," Carey said.

On the question of other possible causes for the injuries, Timmins asked about bleeding disorders, a vitamin K deficiency, the herpes virus and an infection. Carey dismissed or diminished each of those possibilities as highly unlikely.

David Staudt, Blanchard's defense attorney, however, pressed Carey on how he ruled out an infection before receiving some test results. Staudt later asked for a definition of a "reasonable medical certainty," suggesting physicians might have individual standards.

Staudt also asked if ingesting an illegal controlled substance might alter a person's response to a situation.

"Possibly," Carey said.

Staudt later wanted clarification on whether the doctor, when he quoted Blanchard, said "strike" or "bump" when talking about the microwave door.

Bump is "not a medical word," Staudt said.

"I'm not adverse to using the word 'bump,'" Carey said.

The doctor's opinions, frequently explaining medical terms in laymen's terms, apparently scored point with at least one person in the audience.

"Well, he really knows his junk, doesn't he?" a woman remarked during a recess.

The trial is scheduled to resume at 9 a.m. Monday.

Contact Dennis Magee at (319) 291-1451 or dennis.magee@wcfcourier.com.