BRATTLEBORO -- In a half-darkened courtroom Monday morning, with a highly magnified image of Nita Lowery's brain projected onto a white screen, Dr. Roland Auer invoked the image of a burn patient.
The cortex of the 83-year-old Brattleboro woman, who died in 2009, had "scars everywhere," Auer said.
On the ninth day of the Jodi LaClaire murder trial in Windham Superior Court Criminal Division, Auer, a Montreal-based neuropathologist, told jurors that he had come to two conclusions after seeing those scars in Lowery's brain.
First, he believes they were caused by severe hypoglycemia, or low blood sugar. And Auer said the hypoglycemia - which in Lowery had happened so dramatically that Auer compared it to "falling over a cliff" - did not occur as part of some natural process or disease.
"This was an unnatural, exogenous source of insulin," Auer said.
Prosecutors claim that source was a shot delivered by LaClaire on March 23, 2009. At the time, LaClaire was a licensed nursing assistant at the Thompson House care home on Maple Street in Brattleboro.
Minutes after LaClaire's shift ended that morning, Lowery was found unresponsive in her second-floor room with what a medic has testified were critically low blood-sugar levels. She never awoke and died nine days later.
LaClaire, 39, of Bennington, N.H., is charged with second-degree murder and abuse of a vulnerable adult. She also is charged with seven counts of financial exploitation of a vulnerable adult stemming from allegations that she used Lowery's USAA credit card to withdraw more than $3,000.
Lowery was not a diabetic. LaClaire is and uses insulin, though there is dispute about whether or not she was a diagnosed diabetic at the time of Lowery's death.
Auer is well-acquainted with the effect diabetes can have on the brain: The employee of Sainte-Justine University Hospital Center and the University of Montreal specializes in hypoglycemic brain damage.
Dan Sedon, LaClaire's lead defense attorney, has sought to poke holes in the prosecution's case by asserting that brain damage from low blood sugar can be difficult or nearly impossible to distinguish from brain damage associated with stroke.
But Auer claims he discovered the key to making that distinction while conducting research on rats in the 1980s.
"We found, strikingly and surprisingly, that hypoglycemia was different from ischemia, or low blood flow (from stroke), and also different from epilepsy," Auer said.
That statement came Friday morning, the first time Auer was called to testify at the LaClaire trial. He did not return to the stand for that afternoon's session after prosecutors from the Vermont Attorney General's office realized that they could not clearly show how evidence in the Lowery case had been transported across the border to Auer.
The prosecution thinks enough of Auer's opinion that three witnesses -- including the state's deputy chief medical examiner -- were called Monday morning simply to establish the chain of custody for the Lowery samples.
When Auer again took the stand later in the morning, he used a laser pointer to show jurors brain-damage patterns that, he claims, are not found in incidents like stroke or heart attack.
"That is the fingerprint of hypoglycemic brain damage," Auer said.
Auer said he had no doubt that the cause of Lowery's coma was low blood sugar.
He also testified about the scope of Lowery's brain damage. Had she survived, "she would be in what we call a persistent vegetative state," Auer said.
He referred to his experiments with rats: The longer the rodents remained in the coma, Auer said, the more difficult they were to awaken.
"A clock starts running," he said. "The more minutes you are in a hypoglycemic coma, the more nerve cells you will lose."
In Lowery's case, Auer said, "that kind of scarring and loss of brain cells would require at least an hour of coma."
In asserting that the introduction of insulin into Lowery's body had been "unnatural," Auer said he had ruled out other causes for her hypoglycemia including certain tumors that can lower blood sugar.
Such tumors were not found in the victim's autopsy and, at any rate, would have produced symptoms prior to March 23, 2009, Auer maintained.
"They don't announce themselves by the glucose falling over a cliff," he said.
Prosecutors took pains to establish Auer's credentials, including the fact that one of his articles has been cited 300 times.
But during a sometimes-contentious cross-examination that included debate about the differences between stupor and coma, Sedon questioned whether Auer's conclusions were "accepted science." Results consistent with his theories had been found in just one-third of human subjects so far, Sedon pointed out.
Auer said that, in some respects, his research "hasn't been recognized by other pathologists" -- because, he believes, they have not looked at the proper evidence.
He also admitted that, when initially examining the Lowery case, he could not come to a conclusion.
"I needed additional slides to give an intelligent opinion on this," Auer said under later questioning.
But Auer stood by the integrity of his research and his conclusions in this case, even after Sedon prompted him to acknowledge that, in more than three decades as a neuropathologist, he never had seen insulin poisoning introduced from outside the body.
"We always say that the evidence speaks to us, no matter what we think," Auer said.
With the jury having exited the courtroom, the remainder of the day consisted mostly of arguments over bank-surveillance photos that may or may not show LaClaire withdrawing Lowery's money at ATMs in Brattleboro and Keene, N.H.
The alleged transactions began the day Lowery was found unresponsive and ended the day she died.
Defense attorney Rick Ammons told Judge David Suntag that jurors should not see those photos. He questioned the accuracy of the images' time stamps, the reliability of the system recording them and the possibility -- though he did not level any specific accusation -- that the digital pictures had been modified.
"There are a lot of questions about what they're offering, and they haven't answered any of them," Ammons said. "They haven't even tried."
Assistant Attorney General Ultan Doyle, however, said the state had offered plenty of evidence and had called to the stand several bank investigators who testified that the photos in the courtroom matched the photos they had culled from surveillance video.
"The foundation in this case was laid about a mile thick," Doyle said.
Suntag ruled that all of the prosecution's photos would be admitted into evidence because the state had met its legal burden -- at least, at this point in the trial.
"The court does not determine the credibility of the witnesses who testified," Suntag said. "That is not the court's role. That's the jury's role."
And it now appears that those jurors may have to spend longer than they had expected listening to evidence in the LaClaire case.
The trial has been proceeding slowly, and the prosecution has not yet rested its case after calling 22 witnesses. Suntag on Monday said there is a "distinct possibility" that the trial will not end on Friday as scheduled.
Prosecutors now hope to wrap up their case on Wednesday, meaning the defense cannot begin presenting its case until Thursday.
The delay will impact jurors, and it is raising blood pressure at LaClaire's table: Sedon said the extended schedule "raises all kinds of problems" for the defense's witness list.
Mike Faher can be reached at firstname.lastname@example.org or 802-254-2311, ext. 275.