For prosecutors to sustain a charge of murder, they would have to conclusively establish the cause of death. Although Lisa was brought into St. Vincent’s Hospital on the morning of November 2, 1987, in a fatal coma, she did not die “officially” until November 5 when she was removed from life support. “After it was turned off,” a doctor later said, “there were a few minutes her heart continued to beat.” How she came to be in that coma was essential to establish criminal liability.

Dr. Aglae Charlot, the medical examiner who performed Lisa’s autopsy wrote in her initial reports that the victim’s injuries were “suggestive but not conclusive of trauma.” During her testimony during the week of November 12, 1988, though, she stated that Lisa may have died from blunt trauma as the result of a homicide. Dr. Charlot was not the only doctor to come to that conclusion.

Dr. Mary Lell, the hospital’s chief of pediatric neurology, testified that Lisa’s head injuries were consistent with a forceful blow and that the blow could have been a fist. She also ruled out the prospect of choking or poisoning as a cause of death. When the possibility of a fall was suggested, Dr. Lel was emphatic. “I’ve seen a number of children who have sustained that type of injury…the injury that would be sustained in that situation is completely different from the injury sustained by Lisa Steinberg.”

But it was Dr. Douglas C. Miller of the New York University Medical Center who made the strongest impression on the jury. He said that Lisa’s brain damage was “blunt head trauma, and nothing else.” He made the comparison with the head blows suffered by professional boxers and who sometimes die from them. “They never have their skulls fractured either,” he said. The fatal blow would have to be one of sufficient force, a fact that worked against Steinberg because it was alleged that Hedda Nussbaum was in such a debilitated condition on the night of November 1, 1987, she simply did not have the energy to strike that hard. “They (the blows) would have to have been…a tremendous force,” Miller said. In short, Lisa’s brain had been smashed into the walls of her skull.