Ethan Patrick Williams died of massive bacterial poisoning from a severe infection of the bones and muscles in his right leg and hip, the doctor who performed his autopsy said Thursday.
Williams, 4, died Aug. 25 at Cardinal Glennon Children's Hospital in St. Louis. His mother, Emily A. Altom, and stepfather, Michael D. Altom, each face voluntary manslaughter charges under a warrant alleging negligent care. They also are each charged with three counts of felony child endangerment because of the way they cared for Ethan, his older brother Holton Williams and their son Dorian Altom.
They will make their first court appearance Tuesday in Perryville, Mo.
The autopsy report on Ethan will be ready soon, said Dr. Jane Turner of the St. Louis city medical examiner's office. The cause of death, however, is not in doubt, she said.
"It was clear he died from complications of the osteomyelitis and fasciitis that he was diagnosed with on admission to the hospital," Turner said.
Osteomyelitis is a bacterial infection of the bone and bone marrow. Fasciitis is a bacterial infection of the tissue between muscles.
The bacteria pumped their waste into Ethan's system, Turner said. That toxic material in his blood caused his heart and kidneys to fail, she said. Ethan also suffered from pneumonia.
Doctors at Cardinal Glennon sought to control the infection by operating on Ethan's leg and pumping antibiotics directly on the infection, Turner said.
A complete autopsy report will be ready after a complete review of medical files, Turner said. That review was underway Thursday, she said.
Family members have said Ethan was diagnosed with a severe staph infection. Turner said she has not found the documentation of the exact bacteria involved but expects to during her review.
Ethan was taken to Perry County Memorial Hospital on the evening of Aug. 1. Perry County doctors transferred him to Cardinal Glennon by helicopter.
Ethan's great-uncle, Chuck Carron of Farmington, questioned whether Perry County doctors were prepared for such an illness and whether they acted fast enough to send Ethan on to St. Louis.
"They waited for 12 hours to evacuate him to Cardinal Glennon," Carron said. "They kept him there knowing they were not equipped to handle it."
He also questioned whether Ethan picked up the infection at Perry County Memorial. Staph infections can be present in hospitals.
There is no chance Ethan was infected at Perry County Memorial, Turner said. "He was severely ill when he was admitted to Perry County. His right leg was swelling and he couldn't put any weight on it. His illness was quite advanced."
The care given at Perry County Memorial was the best the hospital could provide, said vice president Patrick Carron, no relation to Chuck Carron. The hospital's policy for septic patients, he said, is to stabilize them and transfer them to the appropriate hospital as soon as possible.
"That is appropriate care for a rural hospital," Patrick Carron said. "They are started on antibiotics and they are cultured immediately by our physicians, working under the direction of an infectious disease doctor from a pediatric medical center."
The time to transfer a patient depends on how long it takes to stabilize their condition, Patrick Carron said. "You would want any patient to be stabilized before transit if their condition is one that can be stabilized. Sometimes that happens rather quickly, but other times it could last 10 or 12 hours."
Ethan's grandfather, Lyn Murray defended Emily and Michael Altom on Thursday. "They were good parents. They are good parents."
Murray said he and his wife, Emily Altom's mother Terri Murray, are seeking custody of Holton Willams and Dorian Altom. They are waiting for word from the Children's Division of the state Department of Social Services, he said.