BRATTLEBORO - On March 20, 2009, Nita Lowery saw her personal physician in Brattleboro.
The 83-year-old and Dr. Denise Paasche chatted about her health and about her new gig volunteering at Brattleboro Memorial Hospital. Lowery, a resident of the nearby Thompson House care home, was well-dressed and wore makeup.
"She was in stable condition," Paasche recalled Thursday. "We had a nice conversation, reviewed her chronic health issues, but none of them were active at that time."
Three days later, Lowery was in a coma. Nine days after that, she died. And in a murder trial in Windham Superior Court Criminal Division, prosecutors called Paasche to the stand in an ongoing attempt to prove that Jodi LaClaire - who was responsible for Lowery's care at Thompson House - gave Lowery a fatal dose of insulin and then began stealing her money.
But Paasche's testimony ended up dominating the trial's second day as defense attorney Dan Sedon explored Lowery's medical history and pushed hard to establish that she had been a heavy drinker.
"Could one suspect that alcohol is the common denominator?" Sedon asked.
"I don't suspect that," the doctor replied.
LaClaire, 39, of Bennington, N.H., faces nine charges including one count of second-degree murder, one count of abuse of a vulnerable adult and seven counts of financial exploitation of a vulnerable adult.
She was the lone nursing assistant working Lowery's floor at Thompson House the night before Lowery was found unconscious in her wheelchair.
Though LaClaire is a diabetic who uses injectable insulin, Lowery was not a diagnosed diabetic. Nonetheless, medics called to Thompson House just after 7 a.m. on March 23, 2009, found an unresponsive patient suffering from severe hypoglycemia, or low blood sugar.
Two quick checks showed her glucose level to be 16 and 13, according to testimony from Louis Yelle, a Rescue Inc. paramedic who responded that day. Normal blood-sugar levels, Yelle said, range from 60 to 100.
"She appeared, at first glance, to be sleeping," Yelle said. "When we approached her, we tried to elicit a response by saying her name."
Lowery did not respond to voices or to touch. She was given dextrose (sugar) in an attempt to revive her.
"My expectation is that her level of consciousness would have improved," Yelle said. "It did not."
At Brattleboro Memorial Hospital, doctors found that Lowery had suffered "serious brain damage," Paasche testified. Her mouth and face moved, but they were "automatic movements," she added.
"We reached the opinion that it was very unlikely that her condition would improve significantly," Paasche said.
Family members decided, in light of Lowery's condition and her previously stated desire to not undergo "invasive, aggressive care," to withdraw life support. She died at Thompson House on April 1, 2009.
Paasche noted, however, that Lowery's blood-sugar levels never crashed again after the initially low levels noted at Thompson House.
"They were stable," she testified. "If she had a condition in her body that was lowering her blood sugar, we would have expected to see those levels drop again."
That goes to the heart of the case, as prosecutors contend that only an outside source of insulin -- such as an injection -- could have caused Lowery's blood sugar to dip so low so quickly.
But Sedon made clear from the outset that he would explore other potential medical reasons for Lowery's sudden illness.
There is no doubt that Lowery had a variety of ailments: Paasche listed severe headaches, sleep issues, periods of low oxygen, macular degeneration, heartburn, a painful leg rash, chronic obstructive pulmonary disease (COPD), chronic nausea and gastric reflux.
Lowery had persistent feelings of "being out of balance and somewhat dizzy" due to a stroke suffered in 2000, Paasche said. She also had a history of breast cancer and colon cancer, though both had been resolved through surgery.
Paasche said she considered Lowery's ailments fairly common in a person of her age. But she also described her former patient as a "frail elderly person."
Sedon questioned the nature of that frailty, asking whether it was possible that Lowery had suffered a stroke rather than acute hypoglycemia given her medical history, her age and the fact that she was a longtime smoker.
"No," Paasche replied, citing scans performed at the hospital. "I was certain she was in a coma."
Sedon also took pains to portray Lowery as a woman who may have abused alcohol, even while she was under supervision at Thompson House.
He produced multiple reports from Thompson House staff and from others saying Lowery had been drinking and then fell or was heard cursing. One such report from 2006 said Lowery "was extremely intoxicated tonight, very loud and using foul language in the halls."
Other reports said it was suspected that Lowery had been drinking before noon and that she may have been "minimizing" her alcohol consumption in consultation with a psychologist.
Paasche said she was not aware of most of those reports and did not suspect, based on her interactions, that Lowery abused alcohol.
"At the time I was working with her, I did not think there was an ongoing problem," she said, speculating that Lowery's medical conditions may have led some to misconstrue occasional mishaps.
"Remember that she had very bad balance, so if she tried to get up, falls would happen and people might have interpreted that (as drunken behavior)," Paasche said.
Sedon also produced two Thompson House reports saying Lowery had stuck her fingers down her throat to induce vomiting. But Paasche later said she never had a concern that Lowery -- who was notably thin -- suffered from an eating disorder.
Sedon's back-and-forth with Paasche dragged on for most of the day, with the doctor at one point saying, "I don't know what else you want from me."
The only other witness called Thursday was Dr. Benjamin Suratt, a physician at Fletcher Allen Hospital in Burlington and an associate professor of medicine at the University of Vermont.
Suratt said he was asked by the state to determine whether there were any pulmonary illnesses that may have caused or contributed to Lowery's death. He testified that he considered and ruled out COPD, pulmonary embolism (a lung clot), a severe episode of sleep apnea and aspiration of gastric contents into Lowery's lungs.
Asked by Sedon about the possibility of a stroke, Suratt said there was no evidence of that in the records he had seen.
"The autopsy would have undoubtedly shown something if it had been significant enough," Suratt said.
Suratt was the prosecution's seventh witness. LaClaire's trial is scheduled to run through Sept. 27.
Mike Faher can be reached at firstname.lastname@example.org or 802-254-2311, ext. 275.