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A former Erie County medical examiner on Wednesday explained her decision to change her ruling on the manner of death for Bianca Cartagena from undetermined to homicide, a year after the 8-year-old girl’s body was found in her mother’s East Amherst home.

Dr. Dianne R. Vertes testified that while she listed the cause of death as asphyxiation, she was initially unsure whether it was homicide or accidental, and so she listed it as undetermined in her first report March 10, 2011.

But after conferring with a pathologist hired by the Amherst Police Department to review the autopsy and after studying photos of the victim in her mother’s bed at the death scene, Vertes said she ruled the death a homicide in her revised report Nov. 28, 2011.

The testimony came on the third day of Candace Croff Cartagena’s nonjury murder trial before Erie County Judge Thomas P. Franczyk.

Cartagena, 35, is accused of suffocating her daughter on Nov. 29, 2010, while Bianca was visiting her at her home on Greengage Circle. The child was then living with her maternal grandmother, Kathy Sweeney, and Sweeney’s husband in North Tonawanda because the defendant could not take care of her.

Bianca’s body was found in Cartagena’s bed the evening of Nov. 30, after the Sweeneys became alarmed because she had not returned from her visit with her mother. The family called police after going to Cartagena’s home and finding the body.

Police then found Cartagena on the floor in a shed behind the home. She told them she had taken a lot of pills in an attempt to kill herself because of marital and financial problems.

Prosecutors contend Cartagena killed her daughter during that visit in a jealous rage after Bianca spent Thanksgiving with Cartagena’s estranged husband, Ruben Cartagena, and his girlfriend, who planned to take her to Disney World the following week. She was indicted in May 2013, 2½ years after her daughter’s body was found.

In ruling the death a homicide, Vertes, who retired last year as Erie County medical examiner and is now a pathologist at a hospital in Binghamton, cited the disarray of the bedding and Bianca’s clothing as indications that there had been a physical struggle.

She also cited the victim’s facial pallor, which she said suggested a smothering force had been applied to her face, nose and mouth, forcing the blood out of that area.

She testified that the face’s pallor suggested that an object, possibly a pillow, had been placed over it.

She also said the fact that Bianca was a healthy, active child and gymnast suggested that she would have been able to fight her way out of asphyxiation unless intentional force was being applied. She estimated that the death occurred around 5 p.m. Nov. 29, based on the degree of decomposition that had occurred when she performed an autopsy two days later.

Under cross-examination, Vertes admitted that she hadn’t noticed any facial pallor on Bianca when she performed the autopsy.

But after Albany-area pathologist Dr. Michael Sikirica reviewed the autopsy and issued a report, she said she reviewed photos of Bianca from the death scene and noticed the facial pallor.

She said the pale area around the nose and mouth had not been clearly evident when she performed the autopsy because of decomposition but was more visible in the photos taken shortly after death.

At the judge’s direction, Vertes compared photos of the victim’s face taken Nov. 30 at the death scene with ones taken during the autopsy the next day, pointing out the change in appearance.

In other testimony, Vertes rejected the defense’s contention that Bianca died of natural causes – undiagnosed dilated cardiomyopathy – because she had an enlarged heart.

She testified that while Bianca’s heart was slightly heavier than normal because blood had settled into it, it was not abnormally large.

She said the heart’s chambers were dilated, but she found no other signs of dilated cardiomyopathy, a disease in which the heart is two to four times the normal weight, is globe-shaped rather than pear-shaped, has fluid in the sac around the heart and shows scarring.

She also said Bianca’s medical history showed no symptoms of the disease such as fatigue, shortness of breath, chest pain and palpitations.

In other testimony, Stacia Reeves, a friend and former co-worker of Cartagena, testified that she received a Facebook message from her in February 2011 saying she had tried to kill herself after Bianca died in her sleep, that she had spent two months at Erie County Medical Center and that she was living in Buffalo.

Another witness, Raison Holt, testified that Cartagena met his brother in December 2010 while they were both in the psychiatric ward at ECMC. Holt said she lived with her brother and him in Buffalo for three or four months.

After Cartagena and his brother broke up, Holt said she became upset and complained to him about his brother, then blurted out, ”I didn’t mean to hurt Bianca.”

The next day, he said Cartagena called him and told him she was tired of her ordeal with his brother and was going to a cemetery to take three bottles of sleeping pills to be with Bianca. He said he urged her to come back to the house, and she did.

The trial continues today; the next session is June 30 when a medical expert for the defense will testify about the cause of death.

email: jstaas@buffnews.com