Altoms to face trial

PERRYVILLE, Mo. -- When Dr. Ann DiMaio-Ricci looked at 4-year-old Ethan Patrick Williams soon after his arrival at Cardinal Glennon Children's Hospital in St. Louis, she had a single thought:

This child was going to die.

"Clearly, here was a child in septic shock," DiMaio-Ricci testified Friday in the preliminary hearing on felony neglect charges against Ethan's mother and stepfather.

Emily Altom and Michael Altom were bound over for trial on charges of voluntary manslaughter and three counts each of felony child endangerment. The Altoms, represented by attorney Allen Moss of Cape Girardeau, did not testify during the hearing, which lasted two hours and 45 minutes.

Associate Circuit Judge Michael Bullerdieck ordered the Altoms to appear in court again Dec. 16 for a formal reading of the charges. They will ask for a change of venue at that time, Moss said.

Ethan died Aug. 25, more than three weeks after his parents took him to the emergency room at Perry County Memorial Hospital. When he arrived there, he had a fever of 104 degrees with signs of pneumonia and severe dehydration.

Eleven hours later, when Ethan became noticeably sicker after first seeming to rally, he was transferred to Cardinal Glennon.

The manslaughter charges against the Altoms allege they neglected their son's medical needs, leading to his death. The endangerment charges allege that the living conditions at their mobile home in south-central Perry County were unsanitary and dangerous to Ethan, his older brother, Holton Williams, and younger brother Dorian Altom.

Prosecutor Thomas Hoeh used 17 photographs of the Altoms' home, and testimony from child abuse investigator Donna Kuntze Bullard and Perry County sheriff's Cpl. Jason Kelly, to establish that the home had living conditions one witness described as "squalor."

Under questioning, however, Kelly had difficulty remembering which parent had told him things he wrote in a sworn affidavit that accompanied their criminal charges.

And he admitted to Moss that an item he got wrong -- the time of day that the Altoms took Ethan to the hospital -- had never been corrected by an amended statement.

Moss also drew testimony out of doctors appearing at the hearing that there is no certainty of a connection between the living conditions at the trailer and Ethan's illness.

The manslaughter charge carries a penalty of five to 15 years or life in prison. The other three counts could add 21 years to the sentences for each parent.

Friday's hearing was not intended to decide the Altoms' guilt or innocence. Instead, a preliminary hearing decides whether there is sufficient evidence to take a case to a jury.

Ethan died of complications from a bacterial infection. He had a severely infected femur in his right leg where an antibiotic resistant strain of staphyloccocus had caused osteomyelitis, Dr. Elizabeth Engel of Cardinal Glennon testified.

Engel is a pediatric orthopedic surgeon who operated on Ethan's leg on Aug. 2.

The bone was infected by bacteria that had been circulating in his blood, Engel said. That infection spread to his lungs, causing the pneumonia that eventually killed him.

Both Engel and DiMaio-Ricci testified that they had never seen a case of osteomyelitis go untreated so long that it caused pneumonia and death.

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

During his cross-examination of witnesses, Moss sought to raise doubts about whether any action, or failure to act, by the Altoms caused Ethan's death. Hoeh, meanwhile, elicited testimony that Ethan's infection had likely been festering for up to two weeks before his hospitalization.

Hoeh began presenting his case by calling Donna Adams, a receptionist at Perry Kids Pediatric Clinic. Adams testified that Emily Altom called her about 4 p.m. on Monday, Aug. 1, seeking an appointment for Ethan for the next day.

One of Ethan's brothers was scheduled for a physical the next afternoon, Adams said. Emily Altom told her Ethan was running a fever, Adams said, testifying that she suggested to Emily Altom that she bring Ethan in for treatment right away.

"I asked her to please come in right now," Adams said. "That means, don't wait to clean themselves up or change their clothes. We want parents to put them in the car and come in right now."

Emily Altom declined, Adams said. Ethan's grandmother, Terri Murray, however, called about 15 minutes later and said they were taking Ethan to the emergency room at Perry County Memorial Hospital.

Ethan was treated for his symptoms at Perry County Memorial, testified Dr. Paul Salmon, an emergency room physician. But lab work on Ethan's blood, which showed the dangerous antibiotic-resistant bacteria, was not completed until two days later, after Ethan had been transferred to Cardinal Glennon.

Under questioning from Moss, Salmon said he did not put into his treatment notes, and apparently did not observe, any tenderness in Ethan's legs. Salmon also said he did not see a "modeling clay gray color" that Emily and Michael Altom allegedly told police they had noticed the day before he was taken to the hospital.

The doctors from Cardinal Glennon were adamant in their testimony that a reasonable parent without specialized medical knowledge would have taken Ethan for treatment much sooner. The symptoms reported by the parents to the doctors, including Ethan feeling ill off and on for up to five days and getting dramatically worse in the 48 hours before treatment, should not have been allowed to linger, they said.

The child abuse and neglect investigation of the Altoms began the day after Ethan was hospitalized. Bullard went with three law enforcement officers and Perry County juvenile officer Kevin Gruenwald to the Altoms' home.

The home had an "overwhelming smell of trash or a dead animal or something" that could be detected down the road, she said.

The Altoms had agreed to meet her and the officers at 4 p.m. Aug. 3, Bullard said. She arrived around 1 p.m., with the Altoms and law enforcement officers arriving shortly afterward.

"Emily jumped out of the car perspiring and visibly shaking, with two boxes of trash bags," Bullard testified. "She said, 'I know the house is dirty and if you go in you are going to remove the kids.'"

Inside the home, Bullard said, she found foul, dirty conditions that included trash-covered floors and animal feces on the floors of the kitchen and children's bedrooms.

She wasn't allowed to testify much about it, but it was the second time Missouri Children's Division workers had investigated the Altoms for neglect. In 2004, similar conditions were found and the children were removed from the home for six days.

rkeller@semissourian.com

335-6611, extension 126