"You can almost count every rib individually," testified Associate Medical Examiner Andrew Rosen, who performed Nathalyz's autopsy and ruled her death a homicide by starvation.
"The paucity of nutrition and medical care was glaring in this case," Rosen told the judge during the preliminary hearing.
After hearing testimony from another doctor, two homicide detectives and a city social worker, DeLeon held the couple for trial on all counts.
The lead charge on Rivera, 30, is first-degree murder, which carries a mandatory sentence of life in prison without parole.
The lead charge on Ramirez, 27, is third-degree murder, which carries a maximum sentence of 20 to 40 years in prison. The couple is being held without bail and will be tried together.
Ramirez is also charged with three counts of theft for allegedly misusing $2,130 in Social Security disability payments she received monthly for three of her five children, including Nathalyz, who was born with a genetic disorder that made her partially blind and unable to walk, talk or hold objects.
In support of the theft counts, Assistant District Attorney Gwenn Cujdik showed the judge a series of photographs and video footage taken at the family's West Oak Lane rowhouse of horrors.
Every floor was covered in knee-high debris, trash and broken furniture, while the kitchen appliances were soiled with dirt and appeared to be broken. Holes in the living room floor went straight to the basement.
Nathalyz and her surviving four siblings - who are now between ages 10 and 4 - were covered in bedbug bites and had lice, according to testimony.
After Nathalyz died on a mattress on the floor, Ramirez wrapped her in a roach-infested blanket and took her to Albert Einstein Medical Center, Cujdik said.
"You can't tell me that $2,100 was put toward those children any month," she said.
DeLeon agreed. He estimated that Ramirez had been collecting about $26,000 annually in all sources of government assistance for her children.
"We didn't see any of that $26,000 in those pictures," he said before rejecting requests from defense attorneys Bobby Hoof, for Rivera, and Earl Kauffman, for Ramirez, to drop or reduce charges.
Ramirez, who had moved out to live with a boyfriend at the time of her daughter's death, spent the money on clubbing and casinos, Cujdik said.
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