The case of a nurse convicted of killing an 11-year-old boy concluded in Lancaster County Tuesday when a judge issued a ruling rejecting her appeal.

Joy O'Shea Woomer, who has maintained her innocence in the death of Brent Weaver, will likely take her appeal to the next judicial level — the Pennsylvania Superior Court.

In her initial appeal, Woomer raised a number of issues, complaining about her trial, her conviction and her subsequent sentence of 7 to 20 years in state prison.

Judge David Ashworth, in a 109-page opinion handed down Tuesday, addressed and rejected every point she raised.

A jury in January convicted Woomer, 50, of third-degree murder and drug charges for the boy's death in September 2002.

The verdict was controversial, especially among the family and friends who knew Woomer from her nursing career and church work and supported her claims of innocence.

Woomer, a licensed practical nurse, is incarcerated at the State Correctional Institution at Muncy.

Her lead defense attorney, Christopher Patterson, said Tuesday he had not read the judge's opinion but expected the case will be appealed to the Pennsylvania Superior Court.

Ashworth's opinion is posted in its entirety on the Lancaster County website, www.co.lancaster.pa.us, under the Court of Common Pleas section.

The opinion refutes five points raised by Woomer:

• That there was insufficient evidence to establish her guilt of third-degree murder and two drug delivery charges.

• That Ashworth was wrong in telling the jury they could find that Woomer had "sole and exclusive custody" of the boy the night he died.

• That the judge was wrong in allowing Woomer's ex-husband to testify about medications and syringes he saw in the nurse's home.

• That the judge was wrong in denying defense attorneys' request for the mental health treatment records of the boy's mother, Carol Weaver.

• That the prison sentence was excessive.

Woomer had been hired as a private duty nurse to care for the child, a cerebral palsy patient, through the night in his East Hempfield Township home while his parents slept.

Her first night in the home was Sept. 26, 2002. The next morning, Brent was dead from a lethal dose of morphine.

Six years later, in October 2008, Woomer was arrested and charged with criminal homicide for the child's death.

• In his response to the claim that there was insufficient evidence to convict Woomer, Ashworth reviewed facts and testimony from the trial — focusing on the events at the Weaver home the day Brent died, as well as the medical tests that followed.

Specifically, as to third-degree murder, Ashworth wrote, prosecutors do not have to prove "she acted with the specific intent to kill," but merely that she acted with malice or with recklessness and extreme indifference to the value of human life.

Malice, in the legal sense, means that someone showed extreme indifference to human life, disregarding an "extremely high risk" that the action "might cause death or serious bodily harm."

• As to the drug charges, there was no morphine in the Weaver home, Brent had not been prescribed morphine and he was not given any by emergency personnel, Ashworth wrote.

"The inescapable conclusion is that the lethal dose of morphine was carried into the Weaver home the night of Sept. 26-27, 2002, and administered there," he wrote.

Woomer testified during the trial that she had cared for two terminally ill children earlier that same summer and given them morphine.

Also during her testimony, Woomer said she "might have" placed vials in her pockets while caring for patients, but denied taking morphine home with her.

"Given defendant's strikingly inconsistent and ever evolving testimony, it was certainly within the province of the jury to find her denial that she pilfered morphine less than credible.

"While defendant denied taking morphine or any syringes into the Weaver residence the night of Brent's death, the circumstantial evidence was sufficient to allow for a finding by the jury that (Woomer) had ready access to morphine and, in fact, possessed morphine the night Brent Weaver died of a morphine overdose."

Since the child was never prescribed morphine, except during hospitalizations, the judge wrote, giving "this narcotic to this child was unauthorized" and clearly against the law.

Medical experts during the trial testified that there was four to six times the common dose of morphine in Brent's blood.

"If (Woomer's) intention had simply been to ease Brent's discomfort and restlessness through the night and he died, by mistake, her 'extreme indifference' to his well-being, by failing to properly monitor him, was otherwise documented throughout this case."

• Under Pennsylvania law, if an adult has sole and exclusive care of a child for a period of time, during which the child sustains injuries which aren't self-inflicted or accidental, it can be inferred that the adult inflicted those injuries.

All those points, Ashworth noted, were met in this case.

Woomer "herself testified that she was the exclusive caregiver to Brent during the night and the only person to enter his bedroom in the seven hours before his death."

The boy's parents said they never came downstairs, and three medical experts agreed the morphine was administered after 3 a.m.

Woomer's efforts to argue that she didn't have exclusive care, Ashworth noted, "bordered on the ridiculous at trial," as the nurse's "testimony continuously evolved in an attempt to put Brent's death at an hour closer to the time that his mother, Carol Weaver, administered his evening medications."

Ashworth noted that Woomer testified that Brent was "potentially" dead at 2 a.m. or 2:45 a.m. when she repositioned his legs.

"It defies logic for this nursing professional to suggest that the child she was handling was dead but she did not know it," Ashworth wrote.

Furthermore, her testimony is completely at odds with emergency personnel who said when they arrived at 6:20 a.m., the boy's torso was still warm.

• During the trial, Woomer's ex-husband, Ronald, testified that he had observed syringes and medications in her home.

Ashworth instructed the jury that they could not convict Woomer just because her ex-husband said "she simply possessed syringes, needles and vials of unknown medication."

His testimony, the judge noted, was based on his observations and not any confidential communication between husband and wife.

According to the opinion, the judge and attorneys had discussed in private the fact that Ronald Woomer collected 13 of the items and turned them over to police. Some of those items contained prescription drugs, Ashworth noted, none of which were morphine.

• The issue of Carol Weaver's mental health records from counseling sessions after her son's death, was resolved a short time after the trial.

Although protected information, Carol Weaver waived her rights so that attorneys on both sides of the case could review the information and quickly resolve the matter.

"The issue was ultimately rendered moot by Mrs. Weaver permitting access to her records," Ashworth noted.

• As to the sentence, Ashworth wrote that he considered statements from both the victim's family and friends as well as those from the attorneys and the defendant.

Ashworth said he also considered Woomer's statements, age, family history, education, lack of a prior criminal record and work history.

It was his decision to merge the drug charges with the third-degree murder sentence, which, Ashworth noted, fell within the state's guidelines.

Ashworth concluded by informing Woomer that she has 30 days to appeal her case to the state's Superior Court.

jkelley@lnpnews.com