Fort Bragg physicians and child protective services officials missed opportunities to save the life of a 5-month-old girl, according to testimony Wednesday in the trial of Wilson "Josh" Lee Tubbs III, 39, who is charged with killing the foster child last year.

Five weeks before her death in December 2012, child development evaluators at the county Office of Education's Early Start program noted dramatic changes in the the behavior of the infant, Emerald Herriot.

The child went from happy, healthy and cooing on Oct. 23, 2012 to being non-responsive, fussy and irritable. She was moaning and drooling during the Nov. 13 exam, according to the report. The report said she had reverted to the behavior of a day-old infant.

The child also had been vomiting and holding her tiny fists to her eyes, the report noted.

On Wednesday, Dr. Rachel Gilgoff, a pediatrician who specializes in child abuse at Children's Hospital in Oakland, said the report was "one of the saddest" she'd ever read because the symptoms reported were indicators of physical abuse and the report potentially could have saved the life of Emerald Herriot.

"She was clearly, clearly neurologically impaired," Gilgoff said.

The two-person developmental evaluation team was alarmed by the child's condition on Nov. 13. They told the child's new foster parents, Tubbs and his wife, Marte, to immediately take the child to a neurologist. They also forwarded their report to Child Protective Services and the pediatrician to whom CPS ultimately referred the child.

A worried Marte Tubbs lobbied CPS to authorize an evaluation with a neurologist at the University of California, San Francisco but the child was sent to a local pediatrician, said Public Defender Linda Thompson, who is representing Josh Tubbs against a charge of child abuse resulting in death. The charge carries a potential life sentence.

The Fort Bragg pediatrician who examined the baby, Dr. Vicki Soloniuk, apparently did not suspect abuse. She treated the child for the flu and referred her to an optometrist who treated the child for scratches on the corneas of her eyes, she testified on Tuesday. The optometrist reportedly did not find signs of bleeding in the child's retinas, which would have been a sign of head trauma.

Soloniuk also was not alarmed by the unusual increase — about four inches -- in the size of the child's head in one month's time, a likely indicator there was bleeding and swelling in her brain, Gilgoff said.

Gilgoff said it's a sad fact that many child abuse cases go undiagnosed until it's too late.

"Thirty percent of children with abusive head trauma were seen by a pediatrician for vomiting" and misdiagnosed before the true cause of their ailments were uncovered, she said. The No. 1 erroneous diagnosis is stomach flu, the diagnosis given for Emerald Herriot, she said.

Neither Soloniuk nor the optometrist immediately returned phone calls on Wednesday.

The Child Protective Services worker involved in the case referred questions to his supervisor, who could not be reached Wednesday.

CPS had authorized an extensive neurological exam on the baby when she was just over a week old because of potential harm caused when her birth mother allowed her head to swing freely during an argument. That exam found no problems. The child was taken from her mother and placed in a temporary foster home at that point. She was placed in the care of Josh and Marte Tubbs, on Oct. 31, less than two weeks before Early Start evaluators noted her dramatic decline. Marte Tubbs is a relative of the child's biological father.

Josh Tubbs took the child, unresponsive and not breathing, to Mendocino Coast Hospital's emergency room on Dec. 2. She was pronounced brain dead and taken off life support at Children's Hospital a few days later. Tubbs initially told police the child had fallen from a 21-inch high bench the day before. He said she was fine then, but the next day he could see something was very wrong while she was in a swing. He said he yanked her from the swing, accidentally hitting her head on a post, then placed her on the hard floor to administer CPR, possibly hitting her head again.

He later told investigators from the District Attorney's Office that he had slapped and shaken the child because she would not stop crying.

Gilgoff said the injuries the child suffered were the result of something much more violent. They were inconsistent with either a short fall or shaking alone. The injuries included two skull fractures, "massive" bleeding around the brain and more than 49 bruises on the child's face and head. There also was bruising on her chest and one arm.

Gilgoff said it also appears that some of the bleeding in the brain was from an injury inflicted prior to the injuries that caused her death. An older injury is consistent with the symptoms the child displayed during her exams in November, Gilgoff said.

"It's consistent with old and repeated trauma," she said. "I'm convinced something had happened to her around Nov. 2."

The trial is expected to last until the middle of next week.

You can reach Staff Writer Glenda Anderson at 462-6473 or glenda.anderson@pressdemocrat.com