A year after Ethan's death

A year has passed since Ethan Patrick Williams lost a monthlong struggle with a bacterial infection resistant to modern antibiotics.

The 4-year-old Perry County boy died Aug. 25, 2005, at Cardinal Glennon Children's Hospital in St. Louis. His fight for life was ultimately undermined by the pneumonia caused by the staph infection that had lodged in his lungs.

As Ethan lay in the hospital, investigators from the Missouri Children's Division and the Perry County Sheriff's Department visited the aging mobile home where he lived with his two brothers, his mother and stepfather. They found appalling filth, a home strewn with garbage and reeking of animal waste.

The two other boys were taken from the home. Both were treated for staph infections as well, but the disease was far less advanced. After Ethan's death, mother Emily and stepfather Michael Altom were charged with medical neglect resulting in death.

Nearly nine months after Associate Circuit Judge Michael Buellerdieck found sufficient evidence to send the case to trial, the Altoms haven't had their day in court. The case will be tried in Rolla, Mo., on a change of venue, but lawyers on both sides agree that any court action is many months away.

The Altoms each face a single count of voluntary manslaughter and three counts of felony child endangerment. If convicted, they face up to 36 years each in prison. The child endangerment charges are based on the poor sanitation and living conditions endured by all three children in the home.

Defense attorney Allen Moss Jr. said the Altoms are frustrated by the delays, caused by the need to do extensive work to prepare for the medically complex case.

A big part of the delay, Moss and Perry County Prosecuting Attorney Tom Hoeh said, is the result of the need to take sworn depositions from potential witnesses. The pretrial questioning is a necessary part of preparation -- so the defense can be ready to challenge medical conclusions and so the prosecution can craft questions in the courtroom that keep witnesses focused on the issues of the case.

The Altoms "really are eager to have this behind them," Moss said. "They would like to get a trial setting as soon as possible, but they realize that there is a lot to get done."

Moss said the Altoms did not wish to be interviewed for this story.

The voluntary manslaughter case hinges on whether Hoeh can show that the Altoms failed to respond in a timely manner to Ethan's mounting symptoms.

In a preliminary hearing Dec. 2, Hoeh presented testimony, pictures and other evidence over almost three hours. In some of the most riveting testimony, Dr. Ann DiMaio-Ricci of Cardinal Glennon said she was almost certain the Ethan's medical cause was hopeless from the moment he arrived.

Ethan was first taken to Perry County Memorial Hospital for treatment on Monday, Aug. 1, 2005. The emergency room visit followed at least 48 hours of deterioration at home, according to testimony at the hearing, sworn affidavits and case files from the Department of Social Services.

Ethan began complaining of pain in his leg and hip on July 30. By the afternoon of July 31, he was running a fever and had turned a "modeling clay gray color," according to a sworn statement by Perry County Sheriff's Cpl. Jason Kelly.

Kelly's affidavit also reported that Emily Altom told him she had taken Ethan outside and used a garden hose to clean him after he soiled himself and the couch used as his sickbed.

Doctors at Perry County Memorial, unaware of the dangerous infection, treated Ethan's symptoms, which included severe dehydration and a fever of 104. They stabilized the boy, but around midnight his breathing became labored and he was taken by air ambulance to St. Louis.

During testimony in December, Dr. Elizabeth Engel, a pediatric orthopedic surgeon, said Ethan had a severely infected femur and the infection had spread to his blood, muscle tissues and lungs.

The offending bacteria, known in medical circles as methicillin-resistant Staphylococcus aureus, cannot be killed with antibiotics such as penicillin. Fighting the bacteria requires a laboratory diagnosis to determine which newer antibiotics have a chance of controlling it.

The infection was so severe, Engel testified in December, that she believed Ethan had been infected for up to two weeks prior to treatment.

While the leg infection responded to treatment, the pneumonia did not. His lungs filled with fluid, choking off his oxygen supply and increasing the sepsis, or poisoning, of his blood.

Ethan died at about 4 a.m. Aug. 25.

The case is moving slowly, Hoeh said, because of the need for detailed deposition testimony from numerous witnesses. Most depositions of prosecution witnesses, except those from St. Louis, have been completed, he said.

"I think we will be ready to obtain a trial date before the end of the year," Hoeh said. That trial, he added, will probably take place early in 2007.

Hoeh refused to comment further on the case.

The case is one of the most complex he has handled, Moss said. "I have had to become schooled in all the medical issues and certainly have become well-schooled in methicillin-resistant staph infections. You have to have that knowledge if you are going to effectively cross-examine a physician."

To keep the Altoms out of prison, Moss will need to convince jurors that they acted as reasonable parents. Without giving details, Moss said he thinks he can do so.

"I am pleased with the way things have gone in discovery up to this time," he said.

rkeller@semissourian.com

335-6611, extension 126