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DES MOINES, Iowa — The state continued presenting its case Tuesday in the trial of a Clive man accused of killing his girlfriend’s 20-month-old daughter.

A diagnostic radiologist and a trauma surgeon testified about the injuries Ruby Alvarez suffered on Nov. 29, 2014.

“When you are reviewing images like you saw with Ruby Alvarez, are you concerned when you start to see these types of fractures in this specific location?” asked the prosecution. “I am. These fractures are considered to be a classic sign of child abuse,” said Dr. Bradley King, a diagnostic radiologist who interprets scans that are done at Methodist Hospital.

“Either through your training, whether it be through medical school, all the way through, as you sit here today, literature that you reviewed in your own career, have you ever come across these types of injuries where they weren’t some type of non-accidental trauma?” asked the prosecution. “No,” King responded.

The prosecution is relying on the expertise of medical professionals to explain why they do not believe the injuries Ruby suffered are consistent with a fall.

The defense is arguing that the child accidentally fell from a high chair, after the defendant, 26-year-old Joe Lopez, left the child unattended.

Defense attorney Thomas Miller focused in on how the rigidity of a surface might impact and influence the likelihood of a fracture. The defense has told the jury that unusually rigid, concrete flooring at the apartment in Clive where Lopez lived with his girlfriend played a role in causing the injuries Ruby suffered.

Dr. Richard Sidwell, a trauma surgeon, also took the stand Tuesday. He was in the emergency room with Ruby the night she was brought to the hospital.

He said that falling from a high chair would not produce the complex injuries Ruby sustained.

“Things don’t add up, and so the injuries that we know in the emergency room — meaning bad skull fracture, bad brain injury and broken ribs — that is not consistent with a history of falling from a high chair,” Sidwell said.

The defense pressed Sidwell on the significance of the kind of floor they say Ruby fell onto. The defense argued that the toddler accidentally fell out of a high chair onto a rigid, concrete floor, which played a role in Ruby’s injuries.

Sidwell said the concrete floor argument doesn’t change his professional opinion that Ruby’s injuries do not occur with a low-level fall of a toddler.

Lopez was staying with his girlfriend, Nissa Alvarez, when her daughter sustained the injuries.

Lopez is charged with first-degree murder and child endangerment resulting in death.

 Monday statements

The prosecution called its first witness Monday, a detective from the Clive police department.

The prosecution showed jurors photos the detective took of Ruby at Blank Children’s Hospital on Dec. 2, the day before she died. He said the purpose of taking the photos was to document the injuries Ruby sustained. The detective appeared to get emotional during his testimony.

The state also showed photos of the basement apartment in Clive, where Joe Lopez lived with Ruby’s mother. The photos show the kitchen area, where Lopez says he brought Ruby on Nov. 29.

Lopez claimed the child had been crying, so he fed her some turkey, placed her in a high chair and then went to the bathroom, leaving the child unattended.

Some photos showed a tape measure at the tray of the high chair, which is 31 inches from the floor. The defense said Ruby was 32-inches-tall, maintaining that the child learned to stand on the high chair and accidentally fell on Nov. 29.

The prosecution argued that there’s no way a ground-level fall could cause a child’s death.

A pediatric radiologist then took the stand Monday, who took a CAT scan of the child’s skull. He said he found bleeding between her brain and skull and a number of skull fractures. The radiologist claimed the CAT scan showed Ruby suffered from “non-accidental trauma,” meaning he did not believe her injuries were caused by an accident.

The defense questioned the doctor’s expertise.

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