Former Chief Medical Examiner testifies: "Child would have survived if not for medical misadventure"
20 Apr, 2016, 10:34 ET
LETHBRIDGE, AB, April 20, 2016 /CNW/ - Dr. Anny Sauvageau, the former Chief Medical Examiner of Alberta, and the Chief M.E. at the time of Ezekiel Stephan's death in March 2012, testified today of startling evidence that will likely change the official cause of Ezekiel's brain death, and call into question Dr. Adeagbo's, the first medical examiner, report and motives.
The parents are on trial for failing to provide the necessaries of life. The cause of death has been reported as bacterial meningitis and right pleural empyema – an infection of the lung. A jury is charged with weighing the facts, and will likely find today's evidence significant. The entire trial over these last eight weeks has been based on what is now a highly questionable medical examiner's report.
Dr. Sauvageau led the court through her findings, but not until the Crown Prosecutors did all they could to limit the extent of her testimony. Dr. Adeagbo's report has been the foundation of their case. Dr. Sauvageau was questioned on bias and relevance, and to the reasons for her no longer being the Chief M.E.. The court heard of her refusal to be influenced by unethical and perhaps illegal influences. "My soul is not for sale," she said emotionally, and is the reason why she chose to expose the corruption rather than "keep it secret". This eventually cost her her position as Chief.
Dr. Sauvageau reviewed the history of how Ezekiel had been in and out of a suspected case of croup or respiratory infection, as well, a mild flu over a two-week period leading up to his parents, David and Collet, calling 911 when Ezekiel stopped breathing. He started breathing again, after coughing up some mucus, shortly after the first emergency call. His parents can be heard deciding to rush him to the hospital instead of waiting for an ambulance. The call also records the sound of Ezekiel's breathing as dad put the phone near his son's mouth to convince the operator that he was in fact breathing. Dr. Sauvageau, a leading forensic pathologist and expert in the areas of asphyxia and hypoxic and anoxic injury, listened to the breathing sounds on the recording to help her piece together the likely cause of Ezekiel's breathing constriction.
En route to the hospital, Ezekiel stopped breathing again, and 911 was called a second time. The family met the ambulance on the highway approximately 10 minutes from the Cardston Hospital. Mom performed CPR up to the time the paramedics took over. The ambulance was not equipped to establish an airway in a child Ezekiel's age, because the Alberta Government had recently taken over the ambulance service across the province. This equipment had been destocked against the will of the paramedics, and as a result, the child was without air for over eight minutes. This failed paramedic intervention is characterized by Dr. Sauvageau as a "medical misadventure". It is, in her expert opinion, the cause of Ezekiel's brain death.
The most likely infectious agent in her examination of the entire medical examiner's file is enterovirus. This virus was found in a swab and wash of the nose, throat and bronchial, along with rhinovirus. These are the likely cause of the respiratory infection that caused Ezekiel to suddenly stop breathing. Enterovirus is also capable of an aggressive spread to the brain, and is almost always the cause of viral meningitis.
Dr. Sauvageau concludes the meningitis found at autopsy is likely viral meningitis, and supported her assertion with science. The samples taken of the infected meninges of the brain (pus) revealed an abundance of lymphocytes and other white blood cells associated with viral infections. The usual white blood cell associated with bacterial infections is neutrophils. There wasn't an abundance of neutrophils as Dr. Adeagbo had reported. There were no bacteria identified to conclude Bacterial Meningitis.
Also, when Ezekiel was first admitted to the hospital, his condition prevented a lumbar puncture to sample the cerebral spinal fluid (CSF); this is the only way to diagnose for bacteria meningitis. Because this test wasn't done, and because high doses of antibiotics were administered, Dr. Adeagbo employed a test reserved only for researchers to search for bacteria in the CSF. The research microbiologist cautioned Dr. Adeagbo not to rely on any findings from this test in his report, which he did. Dr. Sauvageau explained the limitations of using the microbiologist's testing tool for 16SrRNA as too sensitive, and could amplify even one bacteria cell as a positive finding. Additionally, the test cannot identify viruses. Therefore, no scientific evidence has supported a finding of Haemophilus influenzae.
Dr. Adeagbo overlooked the failed ambulance intervention as a possible cause of brain death because of something called: Eosinophilic Neurons. When neurons are sampled and dyed with a blue or red stain, they will react according to their condition. When a neuron is starved of oxygen they will stain pink. Dr. Adeagbo reported no such pink findings. However, the asphyxia of the brain cells respond to the dye for only 6 – 24 hours after the injury. Because Ezekiel was on life support for five days after the hypoxic anoxic injury, his white blood cells would have cleaned up the damaged cells and left ghost cells in their place. The pink color would not be expected so long after injury, and hypoxic and anoxic injury could not be ruled out.
Dr. Sauvageau examined the samples of the brain and found overwhelming evidence of brain cell loss and the presence of ghost cells. As an asphyxia expert, she identified the clear evidence of hypoxic and anoxic injury in the brain. Again, the medical misadventure of over eight minutes of oxygen starvation to the brain is, in her expert opinion, the cause of the brain death.
Another posit of Dr. Adeagbo is that the brain swelling from bacteria meningitis was sufficient to cause the brain stem to be compressed, stopping Ezekiel's heart and breathing. "Wrong", said Dr. Sauvageau. Adeagbo's own autopsy report shows no brain herniation. The CT Scan and its report show no tonsillar herniation compressing the brain stem. Also, Ezekiel's anterior fontanelle is still open and any brain swelling would have created a bulging fontanelle. This was not noted in any of the medical reports before and after the autopsy. Dr. Sauvageau examined the autopsy pictures and saw no herniation.
The pleural empyema described by Dr. Adeagbo "is not", Dr. Sauvageau says, "a cause of death". Adeagbo's report stated that the empyema was preventing Ezekiel from breathing sufficiently, thus contributing as a cause of death. Dr. Sauvageau explained in great detail the biology, anatomy and function of the lungs. When she reviewed the medical examiner's tissue slides in the Calgary office, she found an x-ray that had not been disclosed to the Defense counsel. It was taken of Ezekiel's lungs on March 13, 2012, the night he was brought by ambulance into the Cardston Hospital. It shows no pneumonia or pleural empyema.
Dr. Sauvageau questioned why it had not been disclosed or mentioned in Adeagbo's report. Another x-ray was taken over two hours after the first, after he had been intubated. It shows early clouding of portions of his lungs consistent with aspiration pneumonia. Another x-ray was taken some time after this that revealed an even greater sign of a developing lung infection (pneumonia and empyema).
Dr. Sauvageau explained that it is quite common when emergency intubation occurs, stomach contents aspirate into the lungs, causing infection. This infection is what caused the empyema on the outside of the right lower lobe. She also viewed the slides of the tissue samples of the lungs and found giant white blood cells which had been consuming the food contents of the lungs. While the empyema did exist, it did not develop until after Ezekiel was intubated in the care of the physicians. He did not stop breathing because of empyema, as Adeagbo reported, because he had no empyema before intubation. Dr. Sauvageau testified that empyema is rarely fatal, and only after months and years of encrusted buildup.
Ezekiel's expected outcome on the balance of probability of the respiratory infection and viral meningitis according to Dr. Sauvageau is 100%. "In the absence of the medical misadventure during the paramedic intervention, it is most likely that the child would have survived."
SOURCE Ian Stewart
For further information: Ian Stewart, 403-795-0964
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