Doctors fought to save Perry County boy

Sunday, October 2, 2005

Editor's note: Ethan Patrick Williams, 4, died Aug. 25 from an antibiotic-resistant bacterial infection. Since his death his mother, Emily Altom, and stepfather, Michael Altom, have been charged with manslaughter and child endangerment. The Southeast Missourian obtained Ethan's case file, including medical records, from the Department of Social Services under the Sunshine Law. Unless otherwise attributed, the information presented in this story is from that file.

Ethan Patrick Williams grunted in pain from a swollen, infected leg and wheezed in a fight to draw breath late in the evening of Aug. 1.

Perry County Memorial Hospital doctors sought to ease his distress and arranged for transfer to Cardinal Glennon Children's Hospital in St. Louis. A helicopter carrying Ethan arrived at Cardinal Glennon about 3:30 a.m. on Aug. 2.

He was restless, with pale skin and a fever of 104 degrees. In notes written at 5 p.m. Aug. 2, Dr. Jeremy Garrett stated Ethan "has critically ill, rapidly worsening condition." His right leg was visibly swollen, about 20 percent larger than his left. In an operating room late in the afternoon of Aug. 2, surgeons opened his right leg from the hip to the knee as they sought to combat a severe infection.

Lab reports later showed an antibiotic-resistant strain of staphylococcus in his lungs and blood as well as in his right leg, hip bones and muscles.

The next day showed a slight improvement. Ethan was "clinically making progress despite prominent systemic infection on presentation!"

On Aug. 4, as doctors were trying to relieve pressure on Ethan's laboring lungs, he went into cardiac arrest. They restarted his heart with compressions and drugs.

Thus began a 24-day struggle to save Ethan, age 4 and barely 45 pounds. It was a battle doctors would ultimately lose.

During the three weeks at Cardinal Glennon, doctors had successfully used various antibiotics to free Ethan's blood and leg of the infection. He was overwhelmed, however, by stubborn way the germ held onto his lungs.

At one point, a new strain showed up in cultures of germs from his lung, indicating a possible increase in the germ's ability to resist antibiotics, experts interviewed for this story said. Antibiotics were changed, but that did not stem Ethan's decline.

The final crisis came just before 4 a.m. on Aug. 25.

The concentration of oxygen in Ethan's blood, which had been dropping for days, plummeted. At the same time, the blood became increasingly acidic, a common side effect of sepsis, or blood poisoning.

"When the body is living, it constantly makes acids," said Dr. Gordon Christensen, an infectious disease expert at the University of Missouri.

Much of the acid is released through the lungs, he said. Ethan's pneumonia prevented that.

As oxygen levels decline, acids build up and blood pressure drops, Christensen said. Starved of oxygen, acids build up and break down internal organs, he said.

Doctors were giving Ethan drugs to keep his blood pressure up and his kidneys functioning as well as fluids to stabilize his electrolytes. "Various critical organs die because they are not getting enough blood. Things are being made that impair the ability of the heart to work," he said. "Fluids are leaking out of the blood vessels."

Taking custody

State caseworkers took custody of Ethan and two other children after visiting Emily and Michael Altom's home with Perry County sheriff's deputies Aug. 3. Emily and Michael Altom are both 25; the other two boys are Holton Williams, 6, and Dorian Altom, 2.

The case file exposes, in minute detail, a family living in a home strewn with filth, which became the basis of the child endangerment charges. The manslaughter charges filed by prosecutor Tom Hoeh state that the parents "knowingly caused the death of E.P.W. by failing to obtain necessary medical care for E.P.W. after the need for such care was obvious."

Emily Altom sat at her son's bedside throughout most of his ordeal. She watched as doctors and nurses at Cardinal Glennon Children's Hospital inserted tubes to help him breathe and took samples for the lab to determine the effect of treatments.

A concern that the devoted attention came too late underlies the criminal charges against the Altoms. Ethan fell while riding his bicycle July 28. He attended a birthday party at his grandmother's nearby home on July 30, and family members described him as apparently healthy and playful until that evening, when he began complaining of pain in his leg and hip.

On July 31, a Sunday, Ethan spent the day on the couch at home and began running a fever. Emily Altom gave him Tylenol. He soiled himself while lying on the couch and Emily said he turned "a modeling clay gray color," according to a sworn statement filed with the criminal charges. Emily Altom took Ethan outside and washed him off with a garden hose.

Michael Altom sought medical treatment for himself for an infected finger early the next day, according to the sworn statement.

Around 4:30 p.m. on Aug. 1, Ethan was taken to the Perry County Memorial emergency room, where doctors diagnosed him with "very early middle lobe pneumonia with dehydration." He was given fluid and seemed to improve.

At 9 p.m., Ethan was admitted to a ward at the hospital. Around midnight, his breathing became labored, prompting a diagnosis of acute respiratory distress or perhaps fluid overload. With no lab reports at Perry County Memorial -- those would not be complete until Aug. 3 -- Dr. Bhargav Kanani, Ethan's regular physician -- nevertheless realized Ethan needed more intensive care than Perry County Memorial could provide.

"I think he actually had a bronchopneumonia which was not being appreciated because he was dehydrated prior to getting fluids and I think it is a bronchopneumonia setting in and with his clinical grunting that would support the diagnosis," Kanani said in his dictated notes.

Transfer was arranged to Cardinal Glennon.

Family members and Allen Moss, the Altoms' Cape Girardeau attorney, have questioned whether appropriate care was given at Perry County Memorial.

After hearing a description from Kanani's notes dictated at 1:52 a.m. Aug 2, Christensen said he sees nothing wrong with the way Ethan was handled at Perry County Memorial. "It sounds like he was handling the case very well," Christensen said.

Moss, who has already been critical of how the Perry County sheriff's office handled the investigation, questioned the release of the medical records.

"I don't think they have the authority from Cardinal Glennon to release this child's medical records," Moss said. "I'd like to see that in writing."

Under Missouri law, all reports and records generated in child abuse and neglect investigations are closed records unless the case concerns a child's death or near-fatal injury. In those cases, the director of the Department of Social Services has discretionary power to make the records public if there is little likelihood of harm to other children in the family.

"The director is to consider the release based on the impact on siblings, whether the children's safety would be jeopardized by the release of the records," said Deborah Scott, spokeswoman for the department. Since Ethan's brother and half brother are in protective custody, she said, the records are being released.

The Altoms could not be reached for comment. They have moved from the home they occupied on Perry County Road 328, and cellular telephone numbers listed in the case file have been disconnected.

"I have instructed them not to make any comments about the facts of the case," Moss said.

rkeller@semissourian.com

335-6611, extension 126

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