The first thing Jeffrey Mayer noticed when he began investigating the death of 15-month-old Ava Worthington was a large discolored growth, "approximately the size of a baseball," on the right side of her neck.

The child also appeared to be malnourished, with her ribs protruding, said Mayer, Clackamas County deputy medical examiner.Mayer was the first witness in the trial of the girl's parents, Raylene and Carl Brent Worthington. The couple, members of an Oregon City church that practices faith healing, are charged with second-degree manslaughter and criminal neglect for failing to provide adequate medical care to the child.

Prosecutors displayed a photo for jurors that showed a swollen area from the girl's ear to her collar bone.

"I had never seen anything like that," said Mayer, who has investigated more than 1,000 deaths.

Prosecutors claim the growth interfered with Ava's ability to breathe. She died of bronchial pneumonia and a blood infection. Defense attorneys said the growth was unsightly but had nothing to do with the death. The say she died of the blood infection without showing symptoms of a fatal illness.

Mayer was the first investigator at the Worthington home on March 2, 2008, the night Ava died. He spoke with the Worthingtons a few hours after their daughter died, and prosecutors on Tuesday played tapes of the interviews for jurors.

Raylene Worthington, at times barely audible, said her daughter had developed a cough a few days before she died. The cough got worse and as Ava's condition changed, church members were called to pray for the child, who died on a Sunday evening.

Brent Worthington said the girl's breathing got worse Saturday night and that she slept fitfully. Both parents noted that the swelling on Ava's neck started increasing in size about 36 hours before she died about 7 p.m. Sunday.

There were as many as 200 members of the Followers of Christ church at the home when he arrived. "It was standing room only," Mayer said.

Mayer, who has investigated other deaths of church members, said it's not uncommon for large numbers to be present when one of the congregation is seriously ill or dies.

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