Alberta toddler's final days before meningitis death detailed in physician's report at parents' trial
Court exhibit released to CBC News paints a picture of child's final days
Read the latest news from the trial here: Mother of toddler who died of meningitis weeps at trial, recounting fear that her other children would be taken away
In his final days of suffering from bacterial meningitis, 19-month-old Ezekiel Stephan had to be given fluids through an eyedropper and his body was stiff to the point of his back being arched, according to a physician's report newly released by an Alberta court to CBC News.
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The toddler was declared brain dead in March 2012 after an emergency trip to hospital to see a physician for the first time in his life, according to the document, which is included as an exhibit as the trial of his parents continues in Lethbridge.
David and Collet Stephan stand accused of failing to provide the necessaries of life to their son.
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The document represents an account of the events leading up to Ezekiel's death by Dr. Jenn D'Mello, who prepared the report following an assessment of Ezekiel at the pediatric intensive-care unit of the Alberta Children's Hospital in Calgary on March 15, 2012.
- The full physician's report is embedded as a PDF at the end of this story
The information in the document comes from Ezekiel's medical chart and an interview with his mother at the time.
First signs of trouble
According to the report, Ezekiel's mother told the doctor the last time he appeared "completely well" was more than two weeks earlier, on Feb. 26, at the family's acreage in Cardston county, south of Lethbridge.
On Feb. 27, Ezekiel "developed a fever and was whining a lot," the report reads.
The parents told the physician they initially thought he was simply teething but then, later that day, they noticed he had developed laboured and "whistly/wheezy" breathing.
The couple phoned a family friend whom they described to the physician as a registered nurse and Ezekiel's birth attendant. Listening to the child's breathing over the phone, the friend suggested it sounded like he had croup.
"Collet subsequently looked croup up on the internet and saw that it was a viral infection and that the only medical treatment typically offered was a dose of steroids if it was severe," the physician's report reads.
"As per the internet suggestions, they treated Ezekiel's breathing difficulty with cool air and a humidifier. They also started Ezekiel on some herbal/naturopathic remedies which they believe help fight off viral infections and have given Ezekiel in the past when he has a cold."
Those remedies included olive leaf extract, garlic and methylsulfonylmethane, in addition to the "daily herbal/naturopathic supplements" that the parents had been giving Ezekiel, according to the physician's report.
That daily regime included Omega 3-6-9, whey protein, FermPlus, an unnamed digestive enzyme, and Empowerplus — a controversial supplement sold by a company founded by Ezekiel's grandfather, Anthony Stephan.
The company, Truehope Nutritional Support, had been locked in a years-long battle with Health Canada over the supplement, which the federal department warned in 2003 did not have enough scientific backing to be considered safe and was being sold without a drug identification number.
Truehope, based in Raymond, Alta., eventually won in a legal decision that allowed for Empowerplus to continue being sold in Canada.
David Stephan told the court he is vice president of the company.
The physician's report stated Collet took Empowerplus daily during her pregnancy and Ezekiel's parents started giving him daily doses of Empowerplus mixed into a smoothie "since approximately 10 or 11 months of age."
Meanwhile, the child's symptoms, which his parents believed to be croup, continued for another week, although the physician noted "he never really had a cough."
The boy had minimal appetite and little interest in drinking so Collet and David "used an eye dropper to make sure he was getting enough fluids," the report states.
Aside from his first day of illness, Ezekiel's fever never returned, and his temperature never measured above 37.8 degrees, according to the report.
He continued to be lethargic and have occasional bouts of difficult breathing, particularly at night, "but the parents felt he was gradually improving and responding to the cool air, humidifier, and extra herbal remedies."
By March 5 Ezekiel appeared "much improved" and "well enough to go to a pre-school type program he attends," so Collet stopped the olive leaf extract, garlic and methylsulfonylmethane treatment, "as he seemed to have recovered from his 'croup.'"
Unusual 'neurological symptom'
On March 6, however, Ezekiel was "unusually lethargic — more so than he had been during any of the days in the week prior."
"He laid in bed the entire day and his only response would be to moan unhappily when Collet left the room," the physician's report reads.
He again would not eat or drink and was restarted on his extra herbal remedies.
"Collet also described noticing an unusual 'neurological symptom' that day where Ezekiel had repetitive movements of his right arm where he would pull at his diaper or rub his cheek and these movements seemed unusual and involuntary to Collet."
He seemed "a bit better" the following day and the abnormal movements ceased, but his lethargy continued.
From March 8-10, Ezekiel seemed to "gradually improve" but on March 11, the symptoms worsened again and his parents "noticed his body to be very stiff."
Body stiffness worsens
By March 12, the stiffness was so severe that Ezekiel's "back was arched" and his parents called their family friend again, who came over to examine the boy with a stethoscope.
"According to Collet, their friend concluded that Ezekiel's symptoms could be from meningitis," the physician's report reads.
"Collet then looked up meningitis on the internet; specifically she mentioned looking at the WebMD website. She came across the Kernig and Brudzinski's test for meningismus and tried them on Ezekiel. She reports the tests were obviously positive, further indicating to her that Ezekiel was suffering from meningitis."
Ezekiel's parents then resumed the treatment with olive leaf extract, garlic and methylsulfonylmethane and used the eye-dropper method to ensure he received enough fluids, as "he would not drink on his own," the report reads. They also started giving him Total Reload, an electrolyte and amino-acid supplement.
Within two hours, "they felt he'd had some improvement and was less lethargic."
"They called their naturopath in Lethbridge to ask for recommendations for treating viral meningitis and were advised to start him on something called BLAST," the report states.
Trip to Lethbridge for 'BLAST'
The next day, March 13, the family drove to Lethbridge to run some errands which included picking up the BLAST from their naturopath.
"Ezekiel seemed a bit more alert that morning but he was too stiff to be successfully placed in his car seat so his crib mattress was put in the back of the car and he laid on that for the drive," the report reads.
"They picked up the BLAST and started Ezekiel on that and then drove back home."
After a nap at home and more fluids, Ezekiel seemed more alert but still lethargic.
Abnormal breathing and 911 call
After another nap, Ezekiel woke up about 8:30 p.m., when Collet noticed he had "abnormal breathing where he seemed to be gasping and struggling" to draw breath, followed by pauses in his breathing that lasted for a few seconds.
"Collet patted him on the back when his breathing paused and then he resumed breathing but paused again shortly after," the physician's report states.
"At that point the parents called 911 and Collet gave Ezekiel some rescue breaths. He coughed up a bit of mucous and again his breathing resumed. In discussion with 911 they decided to drive him to the hospital at that point rather than await an ambulance as his breathing had resumed.
"They again placed him on the mattress in the back of the car and Collet stayed with him while David drove. Within minutes of departing, Ezekiel stopped breathing again. Collet again gave rescue breaths but this time Ezekiel did not resume breathing."
Collett then gave him about five chest compressions, according to the physician's report, and his breathing resumed briefly but the frequent pauses continued.
The couple called 911 again and stayed on speaker phone with the operator until an ambulance met their vehicle.
"While on the phone with 911, the parents gave full CPR for about 10 minutes until EMS arrived," the report states.
"Ezekiel had no spontaneous return of breathing and Collet reports he was blue by the time EMS arrived."
Emergency transport and brain death
The ambulance took Ezekiel to the emergency room at the hospital in Cardston where he was intubated and received about 30 minutes of CPR, multiple doses of epinephrine and atropine, and regained circulation.
He was then transported to the ER in the Lethbridge along with the Cardston physician, where they were met by a pediatric intensive-care transport team, who took Ezekiel to Calgary via helicopter.
After arriving at the Alberta Children's Hospital, Ezekiel required "significant cardiopulmonary support," according to the physician's report, and "broad spectrum antibiotics."
The working diagnosis was bacterial meningitis, although that was not confirmed by a lumbar-puncture test, as Ezekiel was "too unstable to undergo this procedure."
He did not regain consciousness in hospital and, following a CT scan and a neurological assessment on the morning of March 15, 2012 the physician reported that Ezekiel was "completely unresponsive" and had "met criteria for brain death."
The trial began March 7. The prosecution rested its case just over two weeks ago. David Stephan started testifying on Monday and the Crown was continuing to cross-examine him Wednesday in Lethbridge.
Mobile app users, click here to view the entire physician's report.
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