An autopsy didn't show the N.C. medical examiner's office exactly how 10-year-old Zahra Baker died.
But evidence from the whole investigation convinced doctors that the child was killed and her death should be called a homicide, said N.C. chief medical examiner Deborah Radisch.
Last month, Radisch's office ruled that Zahra died as a result of "undetermined homicidal violence," a finding that's rarely called for in North Carolina and other states. She talked about the ruling for the first time in an interview this week, though Radisch would not discuss details of the Hickory girl's death or the investigation.
"Undetermined homicidal violence" is used in cases in which the physical autopsy can't determine a cause of death, Radisch said, "yet the circumstances surrounding the case and the finding of the body and the condition of the body would indicate the manner of death is a homicide."
The ruling can pose problems for prosecutors, because the exact cause of death isn't known. But last summer, the Wake County district attorney's office successfully prosecuted Sherita McNeil in the first-degree murder of her 19-month-old son, even though the state medical examiner's office found the same cause of death in that case.
"It's obviously very difficult, because we can't prove exactly what killed the child. I assume they're struggling with that in Hickory as well," said Wake County assistant district attorney Melanie Shekita. "One of the things the prosecutor has to show is that the defendant was the proximate cause of the death of the child. So that's the biggest obstacle to overcome."
Elisa Baker, 42, is charged with second-degree murder in connection with her stepdaughter Zahra's death, which investigators believe took place in September. Zahra's story - she was a cancer survivor from Australia with an engaging smile - has generated international attention.
There were multiple reports of child abuse at the Baker house, according to social services officials. Investigators say Zahra was dismembered after she was killed and her body parts were scattered. They didn't find and identify those remains until November. Elisa Baker has told investigators that the girl died of an illness and that the child's father dismembered and hid the body.
The dismemberment was among the evidence that pointed to homicide in Zahra's case, Radisch said. The autopsy, which was performed by Dr. Jonathan Privette and supervised by Radisch, talks about "cut/tool mark injuries" to areas that included vertebra, a collarbone and a thigh bone.
The doctors also considered medical records and investigative findings in settling on homicide as the manner of death, Radisch said.
Her office's doctors and investigators "never are limited to just our autopsy findings. You've got to know about the circumstances of the case."
She cited the example of a person who dies from a gunshot to the head. "If you know nothing about the scene, you wouldn't know if it was a homicide or suicide. We don't know who pulled the trigger. We look at the circumstances, the scene, if there's a note," she said.
A finding of "undetermined homicidal violence" can pose obstacles for prosecutors, but they're not insurmountable, said Wake County's Shekita, who prosecuted the McNeil case. She said her side relied on circumstantial evidence. In the death of McNeil's son, DeVarion Gross, the autopsy showed "healing broken bones. We could say there was abuse to the child."
Evidence also included statements from McNeil saying she "hated that child, she wished he would die," Shekita said. The toddler's body, like Zahra's, was hidden for several weeks. Wake prosecutors argued that cover-up pointed to homicide.
It's the same kind of evidence Radisch says her staff looks at in determining not just a person's cause of death, but also the manner. The cause of death is usually a specific injury or disease, unless it is undetermined. The manner is usually a natural death, accident, homicide, suicide or undetermined.
Because Radisch is charged with determining a manner of death, her office routinely talks to police investigators, county medical examiners, family and others to learn more beyond the autopsy. Occasionally, they visit a scene after the death: "You can't look at the body in a vacuum," she said.
The undetermined homicidal violence designation has been used in several cases across the country recently in deaths in which a body has been dismembered or badly damaged. It was the ruling in the death of 2-year-old Caylee Anthony in Florida. Her remains were discovered six months after she disappeared. Her mother, Casey Anthony, is charged with first-degree murder. N.C. medical examiners made the same ruling in a Greensboro case last year, after Retha Crook Simpson's dismembered body was found in bags, chopped and bound.
Staff writer Franco Ordoñez contributed.