A Children's Hospital emergency room physician testified Thursday that 18-month-old Sierra Carpenter was a victim of "excessive child abuse." Doctor Thomas Bruns said he was "very alarmed" after seeing the child when she was brought in by LifeForce helicopter on April 25, 2006. Sierra died two days later without regaining consciousness.

And Medical Examiner Dr. Frank King said the child had multiple "inflicted" injuries over her body, including fresh and older ones.

Brian Rutherford, 28, is standing trial for felony murder and aggravated child abuse in the courtroom of Judge Don Poole. Traci Carpenter, 21, the mother of the child, is charged with child abuse, but is not currently on trial.

Dr. Bruns said Sierra had suffered a severe brain injury and was comatose. He said she still had a heartbeat, but it was necessary to breathe for her.

"There were many different bruises over her body," he said. He said they were varying in color, indicating some were older than others.

He said there was a large bruise on the forehead, one on the left arm, and several on the inner thighs. He said both ears had significant bruises, which he said were strong indicators of child abuse. He said it appeared a finger had been poked into the ears.

Dr. Bruns said some of the injuries indicated the child had been shaken.

He said the child's mother was "very angry" after he gave the dire report. He said, "Usually in these situations, they are very tearful. There were no tears with her - just much anger. It was not the normal mood or reaction of a mother."

He said Ms. Carpenter, who was 18 at the time, told him that Sierra had been "absolutely fine" earlier that morning. She said she was in the shower when Rutherford began pounding on the door and told her that Sierra was not breathing.

Dr. Bruns said he was told that Mr. Rutherford, boyfriend of Ms. Carpenter, had driven off from the hospital in a gray volvo. He said Rutherford "did not stay around to find out" the report on the child.

Dr. Greg Talbott, medical director at the Children's Pediatric Care Unit, said Sierra was suffering from abusive head trauma and had a severe brain injury.

He said her injuries indicated she had been shaken. He said, "If you shake a crying baby, it will probably stop crying."

Dr. Talbott said, "This was a severe force imparted to a child far more than a rational adult would do."

He said Sierra's condition continued to decline until she was pronounced dead at 1:30 p.m. on April 27, 2006 from "severe abusive head trauma."

Dr. Carolyn Brannen said she was the pediatrician for Sierra, first seeing her when she was a couple of days old and then the last time in March of 2006. She said she was underweight at first, but was later "a healthy, happy child."

She said she never saw any signs of child abuse.

Dr. King said Sierra died due to "multiple blunt force trauma" to the head, though there were many injuries.

He said there was swelling of the brain as well as blood on the brain, and some portions of the brain had died before she was pronounced dead.

He said there was evidence both that she had been severely shaken and also struck with an object numerous times.

Dr. King said some of the injuries were a few days old and others may have been two weeks old.

He said the injuries were to her head, face, back, eyes, left arm, buttock, thighs and leg.

The medical examiner said the autopsy showed "an abusive pattern by some person or persons against this child."

He said the type injuries she had would not have been caused by falling down.

Shannon Shaver, an older sister of Traci Carpenter, acknowledged she told a detective that Traci had been a neglectful mother.

She said she believes her sister "did not lay a hand" on Sierra," but she said she blames her "for allowing Sierra to be with the person she did."

Ms. Shaver said, "Traci is capable of a lot of things, but harming Sierra is not one of those things."

She said she and Traci "took different paths." She said Traci married early and had a child and was a widow before she was 18. She said she herself had children later and is devoted to them.

She said not long before the child was taken to the hospital she noticed, while Sierra was playing with her son, Houston, that she had a bruise on her forehead. She said she was told that Rutherford's young daughter had hit her. She said Houston "still talks constantly" about Sierra.

Ms. Shaver said she only met Rutherford once - when Traci brought him over and introduced him. She said, "I thought he looked better than some of the others she had brought over."

She said the death of Sierra "has changed everything about our lives. It's a world no one should have to live in."