Brendan Creato, 3, was found dead in a creek near the home of his dad, who is charged with his killing.
CAMDEN -- David "D.J." Creato Jr., 23, is accused of murdering his 3-year-old son, but three medical examiners testified in his trial that he cannot say how, where or when the boy was killed.
All three testified that though they found some signs of asphyxia, and they eventually came to the same conclusion about his cause of death: that some kind of "homicidal violence," possibly including suffocation or drowning, killed Brendan Creato.
The boy was found dead in a creek in Cooper River Park in Haddon Township Oct. 13, 2015, about three hours after his father reported him missing from his apartment. The prosecutor's office alleges he killed the boy because the toddler was causing problems in his relationship with his teenage girlfriend.
State Medical Examiner Andrew Falzon testified Tuesday that he only came to the "homicidal violence" determination -- reversing his earlier decision to list the cause of death as "undetermined" -- after reading the prosecutor's case file against Creato.
"The autopsy did not provide any conclusive finding," Falzon said Tuesday.
Echoing the prosecution's theory, Falzon said the main indicator that foul play was involved was that Brendan was found about three-quarters of a mile from his home, shoeless and wearing clean socks. If he didn't walk there, someone must have carried him, Falzon said.
"I think the most crucial piece of evidence was the socks -- that there was not any staining on the socks," he said.
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Falzon was asked by Camden County Medical Examiner Gerald "Buck" Feigin to perform a third autopsy after Feigin and his associate, Charles Seibert, could not find a specific cause of death in their examinations.
While Feigin is the one who put the cause of death down for the death certificate, Falzon testified that he sent a letter to Assistant Prosecutor Christine Shah after the autopsy indicating that there was no conclusive evidence so he would consider the cause of death to be undetermined.
But a year and a half later, he said, the prosecutor's office asked him to review police reports and other evidence in the case file. He then issued the decision concurring with Feigin's and Seibert's findings.
Under cross-examination, Creato's attorney, Richard J. Fuschino Jr., questioned him multiple times about what caused him to change his decision, since he was aware of Brendan's clean socks when he made his first finding after the autopsy.
Falzon said that after reviewing the case file, he knew that investigators never found any shoes belonging to Brendan in the creek or the area, so the clean socks became more significant of a sign of foul play.
"The lack of footwear at the scene is conclusive evidence to me," he said. He confirmed that if any footwear had been found, or if Brendan had been found dead at home, he would probably list the cause of death as undetermined.
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Fuschino pointed out that bodies can be moved and asked Falzon whether Brendan might have died elsewhere, perhaps in an accidental asphyxiation, and his body had been moved. Falzon said he could not determine if the body had been moved.
"I don't have a reasonable explanation for how the body ended up at the creek. I don't have a reasonable explanation for how Brendan died," he said. But, he said, that lack of a clear explanation for how the boy got there with clean socks "makes it a suspicious death."
Also during his testimony, Falzon said that he found two things that the other medical examiners did not note in their autopsy reports: a fairly recent, likely self-inflicted, bite mark inside of Brendan's mouth and some scattered petechia -- tiny broken blood vessels in the eyes.
The latter can be an indicator of asphyxiation, Falzon testified, but typical cases of asphyxiation will result in more widespread, significant petechia than Brendan had.
The trial is continuing Tuesday afternoon with two staff members from the prosecutor's office reading from thousands of text messages Creato exchanged his with girlfriend at the time of Brendan's death, Julia Stensky.
Rebecca Everett may be reached at reverett@njadvancemedia.com. Follow her on Twitter @rebeccajeverett. Find NJ.com on Facebook.