EPHRATA — A Spokane County deputy medical examiner concluded 2-year-old Rafael "Raffy" Gomez's death was a homicide, finding the boy died as a result of repeated physical abuse.

Raffy's mother, 32-year-old Maribel Gomez of Ephrata, is on trial in Grant County Superior Court, charged with homicide by abuse and first-degree manslaughter for Raffy's September 2003 death.

Dr. Marco Ross, who conducted Raffy's autopsy, testified Wednesday Raffy died as a result of blunt-force trauma to the head. The blunt-force injury caused Raffy's brain to swell, shutting down his heart and lung functions.

Ross told Grant County Superior Court Judge John Antosz, who's hearing the non-jury trial, the head injuries Raffy suffered could not be the result of an accident or self-inflicted.

Raffy did not die because he threw himself backwards, during a tantrum, and hit his head on the floor. And Raffy did not die because he fell from a bed, Ross said.

The accidents Gomez described to medical providers at the time of Raffy's injuries would not generate enough force to explain the boy's serious injuries, he said.

During his short life, Raffy sustained four skull fractures, two broken legs and a multitude of burns, abrasions and deep bruises. His shoulders were both repeatedly and seriously damaged, most likely from twisting, pulling and shaking.

Ross said the numerous injuries, taken together, add up to a pattern of abuse.

The person inflicting those injuries, especially to the shoulders, would know they were causing Raffy significant harm, Ross told Antosz.

Gomez's defense lawyer, Bobby Moser, told the court his key witness, Dr. Janice Ophoven of Minnesota, completed a report she was required by the court to submit. Wednesday was the deadline for the report, which describes her opinion about Raffy's death and injuries. Ophoven is scheduled to testify Feb. 28.