During the trial against Heather Barron and Kareem Leiva, who face charges in connection with the murder of 10-year-old Anthony Avalos, a pediatrician took the stand to confirm Avalos’ condition upon his arrival at UCLA Mattel Children’s Hospital in Los Angeles.

Dr. Andranik Madikians described Avalos as “skin and bones” and said Avalos’ organs were failing.

Children accuse Heather Barron and Kareem Leiva of extreme abuse

Barron and Leiva are standing trial following a series of disturbing reports detailing an abusive household of two parents and seven children. The two parents are facing accusations of extreme child abuse. Two of the seven children testified last week that Leiva forced them to kneel on rice until their knees bled.

Additionally, Leiva allegedly made the children fight each other in gladiator-style battles and forced them to eat tortillas filled with peanut butter with a strict time limit. If the children did not finish their meals in the allotted time, Leiva would force them to drink hot sauce.

In Avalos’ case, the parents brutally beat him for years. However, the abuse led to his death after he told them he had an interest in boys and girls, prompting investigators to consider homophobia as a motive behind the murder. The children accused Leiva of dropping Avalos on his head up to 20 times and brutally beating him to death.

A pediatrician at Mattel Children’s Hospital confirms Avalos’ condition

The children’s testimony says Barron and Leiva left Avalos’ dying body on the floor for at least a day before taking him to a nearby hospital. The pediatrician who took the stand further testified to Avalos’ condition. The 10-year-old boy arrived at the hospital exhibiting symptoms of extreme malnutrition.

Dr. Madikians confirmed Avalos’ organs were failing upon his arrival. Initially, Avalos went to Antelope Valley Medical Center before Mattel Children’s Hospital. Helen Withers, a forensics service nurse at that facility, testified, “His bones were protruding. You could count his ribs and they didn’t have a lot of fat.”

An ER doctor at Antelope Valley Medical Center named Michael Gertz testified that Avalos had no pulse or cardiac activity of any kind. His pupils did not respond to stimulation, and he was completely motionless.

Avalos’ injuries were severe

Following his transfer to Mattel Children’s Hospital, a CT scan revealed brain swelling and bleeding akin to “shaken baby syndrome.” Priscilla Cabunoc, a nurse at Mattel Children’s, said Barron was not present at the time of Avalos’ death. Cabunoc said she’s seen hundreds of children die in her line of work.

Only a handful of parents were not present at the time of death, including Barron. Of those who were not there to see their children die, all of them besides Barron were simply unable to reach the hospital in time.

Barron, on the other hand, was only in the room for about 10 minutes before she left. “To me it looked like she was forcing herself to have some type of emotions,” said Cabunoc. Avalos was alone when he died. However, one of his aunts did come into the room shortly after his death. Barron did not return to the room for more than an hour.

During the trial, prosecutors displayed graphic images of Avalos’ autopsy. Barron and Leiva reportedly looked at the images with no emotion on their faces. Barron previously claimed that Avalos suffered his injuries after playing basketball and slipping on a rug inside the home.

LA County Board of Supervisors approves a $32 million settlement

Following their recent testimony, the Los Angeles County Board of Supervisors approved a $32 million settlement for Avalos’ family. The boy’s aunt and uncle confirmed they’d reached out to the Department of Child and Family Services multiple times to report Barron and Leiva.

Avalos’ death is sparking new conversations around other high-profile deaths in recent years. Specifically, 4-year-old Noah Cuatro and 8-year-old Gabriel Fernandez. DCFS was supervising both children in the months leading up to their death. Avalos’ family accuses DCFS of continued, systemic failure in their inability to protect abused children.