Medical finding
alters abuse case

A Maui tot's rare genetic
disorder, the first found in Hawaii,
casts doubt on charges
against her father

By Gary Kubota
Star-Bulletin

WAILUKU -- Maui Prosecutor Richard Bissen is reassessing an alleged child-abuse case against a Maui man in light of medical testimony that most, if not all, injuries to the man's child came from a rare genetic disorder.

The disorder occurs in one in 60,000 children, and the child is the first medical case of this type in Hawaii, according to an expert.

"This is a dramatic change," Bissen said. "The case has to be re-evaluated."

Pedro Cabaccang faced from six years, eight months to 20 years in prison, and was scheduled to be sentenced yesterday for attempted manslaughter. He was arrested in January on an assault charge involving his then 14-month-old daughter.

Instead, Maui Circuit Judge Artemio Baxa granted a request by Cabaccang to withdraw his no-contest plea to attempted manslaughter.

Baxa scheduled a trial for March 22.

The child, who has some brain damage, remains in a hospital and under the protection of Family Court.

During a hearing yesterday, Dr. Berkley Powell, a specialist in genetics, testified that the girl suffered from ornithine trans-carbamoylase deficiency, or an inability to digest protein.

Powell, a pediatrician at Kapiolani Medical Center for Women and Children, said the deficiency causes an increase in ammonia in the child.

He said the ammonia damages the brain cell lining and allows other chemicals to enter and kill the brain cells.

Powell said the increase in ammonia also led to liver damage.

The ammonia in the girl's system at one point was more than three times the normal amount, he said.

Under cross-examination, Powell said he could not rule out that the child may have been deprived of oxygen through asphyxiation. But he said a substantial amount of the injuries, if not all, stemmed from the genetic deficiency.

Powell said physicians initially were surprised when the child's liver condition did not slowly improve.

He said the deficiency was found during a September examination and the girl was put on a low-protein diet and given medication.

"She became brighter, less irritable," Powell said. "Her liver disease basically vanished in a few weeks."

Powell said that the disorder usually affects boys more severely than girls because of their different genetic compositions, and that most boys do not survive.

He said records showed the girl initially had a slightly above-normal amount of ammonia in her system, and a later test showed a normal level.

Powell said under these circumstances, he would not have asked for more tests. He said he was asked to look at the girl's condition after her liver condition did not improve.

Deputy Public Defender Reinette Cooper said two days after she learned about the genetic deficiency, she filed a motion to withdraw the no-contest plea to attempted manslaughter.

During an earlier hearing, Bissen said the charge filed against Cabaccang was based not only on the condition of the child, but also on a confession by Cabaccang that he held the child down on a pillow. He has been free after posting $25,000 bail.