Today In Court – Wednesday March 16, 2016

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“No Crystal Ball”

Those were the words of Dr. Barbara Ross, the Pediatric Intensivist first called by the Crown yesterday, as she responded to Defense questions under cross-examination today. But before we report on her answers from today, lets explore what she likely meant by not having a crystal ball. According to Webster’s, a crystal ball is: a sphere, especially of quartz crystal, traditionally used by fortune-tellers as a means or method of predicting future events. With all of Dr. Ross’s impressive qualifications, she herself is not a crystal-lomancist: one who discerns through crystal balls. This is not to be silly. It is part of the court transcript, and its good to remind us of the implication. What the doctor is saying, is technical advances in modern diagnostic tools today still can’t prove with certainty what a symptom observed indicates, or what it will progress into tomorrow. Well doctor, neither can parents, and neither could David & Colette as they attentively responded to Ezekiel’s needs. Its fine to work backwards from an autopsy, hindsight is 20-20 as they say, but “it’s harder to go forward” in recognizing and assessing symptoms. “Symptoms vary”, said the doctor. There is no way of knowing with certainty which of Ezekiel’s symptoms before the 911 calls meant he was gravely ill with bacterial menigitis.

And this is the sum of Dr. Ross’s evidence. Bacteria Meningitis presents differently depending on the type or strain of bacteria. It also differs between patients. The symptoms can come and go. In fact, the symptoms resemble so many other possible infections such as colds and flu’s. This is why doctors frequently will see a child and send them home with a general diagnosis, offering the parent the option of coming in later if symptoms worsen. Dr. Ross acknowledged that sometimes children in her intensive care unit had been seen by a prior physician with no general alarms. Doctors get it wrong too. Or, as the doctor also advanced, maybe the highly aggressive and opportunistic bacteria associated with meningitis move in and take over where a minor viral or bacterial infection has been active. She said Meningitis often starts from a blood stream infection. First, a lung, sinus or throat infection sets in (usually viral), then bacterial infection establishes, which moves into the blood stream and cerebral fluid, and then the meninges. The doctor went as far to say: “meningitis could not have been diagnosed with certainty prior to the Medical Examiner Report (autopsy); it would only have been on her differential list”, even after viewing the CT Scan of Ezekiel’s brain.

Dr. Ross also helped the court understand a few points with regard to the process of resuscitation. When trying to establish Ezekiel’s airway it was important to get sufficient air into his lungs to raise his chest. The exhaling of carbon dioxide, or ventilation, takes place when the elastic nature of the lung cavity returns to the pre-inhalation state. “If it’s not rising, it’s not working” as it relates to the chest is a good rule she agreed. The attempts to resuscitate using various types and sizes of masks or tubes by EMT’s suggested to the doctor that a good airway had not been successful before EMS got Ezekiel to the Cardston Hospital. The doctor also confirmed that Ezekiel was resuscitated back to spontaneous heart beating and spontaneous breathing, which brain signals come from the brain stem. This means his brain stem was not dead when the Rescue Team from Calgary prepped him for flight.

The court also heard from Dr. Tracey Tannis today, the Lethbridge Naturopathic Doctor that has been part of the RCMP’s investigation into this case. When Colette called her office 4 years ago to inquire about something natural to boost Ezekiel’s immune system she spoke with Dr. Tannis’ assistant. The assistant inquired with Dr. Tannis and was told a product called Blast would be advisable. Colette did pick up the Blast and used it according to Dr. Tannis’ dosing instructions. Then when a criminal investigation involved her clinic, Dr. Tannis and her assistant were asked specific questions that even in today’s examination seem contrived and are inconsistent with previous statements, and with each other. Their compounded tale always concludes with some form of assertion that nothing other than “get your child to the ER” was ever offered. Since the news of Ezekiel’s death and this trial the Tannis clinic has come under heavy criticism and even death threats. Dr. Tannis likely wanted to help Colette with Ezekiel 4 years ago. However, today it appears the doctor and her staff seek only to help themselves.

Last to be heard today was Dr. Frederick Cunningham, a Family Medicine/Emergency Doctor with expertise in anesthesia and airway management. He was called in by Dr. Clark, the Emergency Room Doctor on duty the night Ezekiel was brought in after the 911 calls. Dr. Cunningham immediately switched out the size 3 breathing tube to a 4 necessary to establish a better airway. Two I.V.’s were put into Ezekiel’s legs to enable hydration and drugs used to recover his heartbeat. There was no pulse at the time he first sees Ezekiel, and chest compressions were continuing. By the time he was transported to Lethbridge via ambulance, Ezekiel had spontaneous heartbeat, but they continued to bag breath for him because they didn’t think it appropriate to check if he had any spontaneous respiratory effort. Dr. Cunningham travelled to Lethbridge Regional Hospital with Ezekiel to direct his care until the STARS team took over. The STARS team reported Ezekiel was breathing on his own.