Ezekiel Stephan: Justice denied, quackery triumphant

It’s been over a year since I last wrote about the tragic death of Ezekiel Stephan, who died of bacterial meningitis, thanks to medical neglect. Unfortunately, this time around, I’m writing about this case because this week there’s been a massive miscarriage of justice. In a retrial, Ezekiel’s parents, David and Collet Stephan, were acquitted and will face no responsibility for the death of Ezekiel:

An Alberta couple who treated their son’s illness with natural remedies rather than take him to a doctor have been found not guilty in the toddler’s death after a retrial.

David and Collet Stephan were tried on charges of failing to provide the necessaries of life to 19-month-old Ezekiel, who died in 2012.

Supporters in the courtroom cheered and Collet Stephan cried as she hugged her husband.

Court of Queen’s Bench Justice Terry Clackson spoke to the court in Lethbridge, Alta., for only four minutes on Thursday before releasing his written decision in the judge-alone trial.

Yes, these quacks who killed their child through medical neglect, and they’re going free. Even worse, they’ll now be heroes to the alternative medicine crowd in Canada (and, let’s face it, the world), for having been “falsely accused” of child neglect, being “persecuted” by the system, and finally having beaten the charges and found to be innocent. Yes, they’ll be heroes. Even worse still, David Stephan can go back to do ing what he does best: Grifting in the service of his company’s Truehope supplements and making money by appearing at “natural health” expos, the latter being a revenue stream that his conviction had cut into severely, as expo organizers, facing very negative publicity, dropped him like the proverbial hot potato.

David and Collet Stephan

Ezekiel, you might recall, was the 19-month-old son of David and Collet Stephan. He lived in Alberta with his parents until his death from bacterial meningitis seven years ago. He was a child who very likely would have lived had it not been for the fact that his parents were (and still are) heavily into alternative medicine. His parents tried to treat him with “natural remedies,” at one point took him to a naturopath, until, by the time they sought conventional medical care, Ezekiel was in extremis. Basically, Ezekiel had been ill for a couple of weeks and getting sicker and sicker, but the parents didn’t seek conventional medical care until he stopped breathing, which led them finally to call an ambulance. But it was too late. Ezekiel died.

As a result, David and Collet Stephan were tried and convicted in 2016 under Section 215 of the Criminal Code which deals with “failing to provide the necessaries of life.” At the time, I was actually somewhat surprised, as courts in the US and Canada appear to give parents wide—too wide—latitude for making decisions about what is best for their children, and great deference is generally granted to parental authority and parental “rights.” It is this deference that can cause a problem in protecting children from their parents’ belief in quackery when they become seriously ill. Before the verdict was announced, I had half expected that to happen in this case, the more so because David Stephan is a prominent member of his community, belonging to a family that runs a nutritional supplements company, Truehope Nutritional Support. Of course, Stephan’s entire business and worldview were (and still are) inextricably linked to what happened, with his belief in “natural healing” having lead to Ezekiel’s unnecessary death. Indeed, reports from the trial indicated that Stephan tried to use Truehope supplements to treat his son. As far as David Stephan’s business goes, Health Canada launched an unsuccessful court case in 2004 to stop the distribution of the company’s product Empowerplus, a product that the company claimed to be able to manage mental illnesses. The case ended in 2006 when the company was found not guilty of distributing the supplement without a drug identification number. Not surprisingly, the Stephans are antivaccine, too.

David Stephan was sentenced to four months in jail, and his wife was ordered to spend three months under house arrest. Meanwhile the Stephans’ appeals wended their way through the courts. In November 2017, the Alberta Court of Appeals upheld the conviction, but because the decision was not unanimous, the case could automatically be heard by the Supreme Court. The Supreme Court’s decision was disappointing, puzzling, and even infuriating. Basically, the Court ordered a new trial, using this rationale:

Karen Molle, lawyer for the Stephans, told the high court the original trial judge didn’t instruct the jury properly to determine whether the Stephans acted differently than other reasonable parents.

“This jury charge gave this jury little choice but to convict,” Molle said.

Julie Morgan, representing the Crown, said the trial judge’s language was generalized, but it was enough for the jury to understand the case.

“The jury would have understood what their job was,” she told the court. “They found that the appellants did not meet the community standard, when they failed to take their child to a doctor when he had meningitis, and that endangered his life.”

Justice Michael Moldaver, speaking for the high court, stated that the trial judge did not properly instruct jurors “in a way that the jury could understand.”

As I said at the time, I don’t know Canadian law and am not a lawyer anyway. At the time, I was worried about just the result that’s happened, that David and Collet Stephan would be acquitted, and unfortunately my worries were justified.

You’ll never believe the Court’s rationale for acquitting the Stephans:

The judge ultimately sided with the defence’s medical experts in finding the boy had viral not bacterial meningitis and ultimately died of a lack of oxygen.

Speaking with the media after the decision was handed down, David Stephan called the last seven years an “emotional roller-coaster.”

“We didn’t know what to expect coming into today, and it’s the right decision, and it’s shocking because it’s been seven years of our life fighting this so it’s become part of our identity,” he said.

“It’s a beautiful thought that we can move on with our lives.”

Stephan said his case “helps protect parental rights” so that parents won’t be held criminally liable if they choose alternative treatments for their sick children.

Here’s David Stephan, speaking to the media after the verdict:

Ah, yes, “parental rights,” the all-purpose justification that quackery-loving parents everywhere use to justify medical neglect of their children, be it treating diabetes with prayer instead of insulin, refusing chemotherapy for their children with cancer, refusing to vaccinate their children against potentially deadly diseases, and many other ways that parents abuse and neglect their children by subjecting them to treatments not supported by science. I always note when I come across people like the Stephans invoking “parental rights” that these parents always make it about them and their rights and somehow never seem to bother to consider their children as a separate, autonomous being with rights of his own, which encompass the right to good medical care and not to be subjected to medical neglect. Children are not extensions of the parents’ bodies. The parents do not own their children. They are supposed to be the guardians of the children, and in that role society gives them very wide latitude in deciding how to raise the children (too much, if you ask me). When parents medically neglect their children, then the state has to step in to protect the child’s rights.

Senator Rand Paul once said about school vaccine mandates, “The state doesn’t own the children. Parents own the children, and it is an issue of freedom.” This is the attitude of far too many parents about their children, that they own them. Sadly, it’s not just in the US where there is a widespread view that parental rights are absolute or near absolute and people react with outrage against the state and sympathy for the parents whenever the state tries to intervene. I see this in every single case of medical neglect that I write about on this blog; public opinion is almost always on the side of the parents. Sadly, prosecutors and child protective services know this too, which can’t help but restrain them. As a result, in some places, even parents who justify not treating their children with anything resembling science-based medicine using their religious beliefs have pretty much carte blanche to do whatever they want, to subject their children to whatever treatment or lack of treatment they want. The result? Lots of dead children.

If you want to see just how bad things are in the US, at least, I will briefly recount a case that I’ve discussed several times before, that of Kent Schaible, whose parents Herbert and Catherine Schaible chose prayer instead of antibiotics to treat Kent’s bacterial pneumonia. Their son, two years old at time, had been suffering from a respiratory illness for two weeks. It worsened and developed into pneumonia, as his parents prayed. The parents were convicted of involuntary manslaughter and child endangerment, were sentenced to ten years of probation, and had to promise to take their children to a doctor when they were ill (i.e., “pretty please, promise not to do it again””). That was 2009. Guess what happened in 2013? They did it again! Their 7-month-old son Brandon Scott died of bacterial pneumonia and dehydration, and once again Herbert and Catherine Schaible did nothing but pray as their child’s condition deteriorated until he finally died. It is not exaggerating in the least to say that it took two dead children, both of whom died under similar circumstances, before the state finally acted to protect the Schaible’s other children by taking their children away and sentencing the Schaibles to several years behind for third degree murder. It was nowhere near enough.

But what about the Court’s decision to believe the Stephans’ medical expert, who claimed that Ezekiel did not die of bacterial meningitis, but of viral meningitis? The “reasoning,” such as it is, is truly cringeworthy:

Back then, the official cause of death was bacterial meningitis.

However, in his written decision, Clackson wrote that he accepted the opinion of Alberta’s former chief medical officer, Dr. Anny Sauvageau, who told court she does not believe Ezekiel actually died from bacterial meningitis.

“In this case, we know there is no specific treatment that is effective for viral meningitis,” Clackson wrote.

“It follows that the Crown did not prove medical attention would have saved [Ezekiel’s] life or that if he had viral meningitis and it was life-threatening [which is not established in the evidence], medical attention even could have saved his life.”

My response? WTF does it matter? Yes, bacterial meningitis is easier to treat because it can respond to antibiotics, and viral meningitis has to run its course, but, damn! Seriously? That’s the Court’s “reasoning”? They do realize, I hope, that supportive care, such as being placed in a pediatric intensive care unit on a ventilator, would have maximized Ezekiel’s chances to ride out the meningitis, even if it had been viral. The Court ruled that the child died of “lack of oxygen.” Even if he did have viral meningitis lack of oxygen could have been prevented by placing Ezekiel on a ventilator and supporting him until it became clear whether he could survive.

How on earth did the Court accept the defendants’ bullshit argument? And, make no mistake, the argument was purest concentrated bullshit. As Alheli Picazo notes:

The child did NOT have viral meningitis.

The bacterial meningitis was at such an advanced state by the time Ezekiel finally reached hospital, he was clinically brain dead and sepsis was coursing through his bloodstream; the post-mortem revealed pus on his brain, in his spinal fluid, and on his right lung.

These facts are 100% knowable, and known, and irrefutable. People lie, autopsies and medical reports do not.

I don’t know what Dr. Anny Sauvageau was smoking, but she really should lay off or at least share. It’s not as though the diagnosis of bacterial meningitis was subtle, as explained above, and viral meningitis looks very different at autopsy than bacterial meningitis. It also looks very different from brain death due to hypoxia.

Here’s Picazo again:

Brain death from oxygen is markedly different from brain death from meningitis, and both the CT scan in hospital and autopsy conformed there were NO signs of brain damage or death from oxygen deprivation.

The child died from “a cardiac arrest secondary to what was likely a hypoxic event because of his overwhelming bacterial meningitis.”

Here’s my good buddy Dr. Clay Jones, a pediatrician who knows a thing or two about meningitis, writing for Science-Based Medicine:

Dr. Adeagbo concluded that Ezekiel died from both bacterial meningitis as well as pneumonia with an accompanying empyema. Empyema is typically diagnosed in the setting of a bacterial pneumonia when pus collects within the lining of the lung.

So what does this mean? It certainly makes sense from a clinical perspective. Ezekiel likely developed bacterial pneumonia caused by infection by either S. pneumo or HiB, which went untreated and developed into an empyema. At this point surgical drainage is usually necessary for recovery in addition to appropriate antibiotic treatment. His bloodstream was repeatedly showered with the pathogenic bacteria, which eventually made its way to the child’s brain.

This new information adds to my suspicion that Ezekiel was much more ill-appearing than described by his parents and the nurse who visited the family’s home. Although there may have been some degree of waxing and waning of his symptoms, particularly with the fever he almost certainly developed during the course of his illness, I am very skeptical of claims that he had any significant recovery just prior to his arrest. This also makes it more likely that he suffered a great deal prior to his death.

And back to Picazo, who lets us know that Dr. Anny Sauvageau is not only not licensed in Alberta but unqualified in forensic pathology:

Here’s what you need to know about Dr. Anny Sauvageau:

Her qualifications and credentials have come under scrutiny before. She is not board-certified or trained in forensic pathology, nor does she have license to practice medicine in Alberta.

She did not, at any point, examine the child and her nonsensical testimony and blatant misreading of the autopsy would have medical professionals calling for her to be stripped of her medical license — but she doesn’t have one.

It turns out that Dr. Sauvageau also has a history of being a hired gun for child killers (excuse me, “expert witness”) and that the Stephans aren’t the only homicidally neglectful parents for whom she’s come up with, let’s say, “creative” alternate explanations for the death of the neglected child. For instance, there was the case of John Clark in Calgary, a child who had been born at home, had never been vaccinated, was not fed properly and had never seen a doctor until the day before he died. Her defense in the case brought against John’s parents Jeromie and Jennifer Clark was only somewhat less ridiculous. John was brought to the hospital malnourished with a clinical picture most consistent with sepsis, and Dr. Sauvageau claimed that it was an overly aggressive correction of the child’s hyponatremia (low sodium) that killed him, not the malnutrition and sepsis. While this story is marginally more plausible (overly aggressive correction of hyponatremia can indeed cause seizures), when taken in context with the whole picture, I have a hard time taking her testimony in this case seriously, either. For instance, Dr. Sauvageau also claimed that John wasn’t septic because there were no positive blood cultures. (Hint: You can be septic and still have negative blood cultures. Indeed, the definition of sepsis does not require a blood culture positive for bacteria; positive blood cultures are no longer even part of the diagnostic criteria for sepsis.) She also claimed that John’s small size was due to a hormonal condition, not malnutrition, based on his “body proportions.”

In the case of Ezekiel Stephan, Dr. Sauvageau’s testimony reached incredible levels of absurdity, surpassing those of her testimony for the defense in the death of John Clark:

Sauvageau’s analysis of Ezekiel’s condition comes from reading Adeagbo’s report and listening to the 911 call made by Ezekiel’s parents after the boy had stopped breathing.

During the call Ezekiel started breathing again and David put the phone to the toddler’s mouth.

“I can hear the breathing of the baby that is not a normal breathing … as an expert on asphyxia. .. [it was] an obstructed phenomenon,” said Sauvageau.

This is patently ridiculous. Dr. Sauvageau relied only on reading the autopsy report and listening to a recording of a 911 call to make such ridiculous speculations, and the Court actually took her seriously—more seriously than a trained forensic pathologist who actually did the autopsy and found puss on the brain and in the lungs?

There is only one reaction to testimony like this and the Justice actually giving credence to it:

Godzilla facepalm

Or maybe:

Or maybe:

And that’s before knowing that Dr. Sauvageau is suing Alberta Justice for wrongful dismissal, claiming that her position was not renewed after she stood up to political pressure to change a contract for transporting bodies for the Office of the Chief Medical Examiner of Alberta.

The Alberta Crown Prosecution Service is considering appealing:

In a written statement, the Alberta Crown Prosecution Service said it has not yet decided whether to appeal Clackson’s decision.

“We respect the decision of the Court,” reads the statement. “This has been a challenging case for everyone involved. The Alberta Crown Prosecution Service will review the decision to determine next steps.”

I know the prosecutor has to say he “respects the Court’s decision,” but I don’t. I do not respect the Court’s decision. Not at all. The Court’s decision is so at odds with easily demonstrable reality that it is the duty of the prosecutors to appeal it, and I hope they do. Seriously, David Stephan claimed in his closing argument (he apparently was representing himself) that that it was paramedics who caused Ezekiel’s death by improperly intubating him and that Ezekiel might have lived had the first ambulance that arrived been better equipped to treat a child his age with breathing difficulties. He also claimed that he and his wife didn’t know Ezekiel had meningitis, even though there was copious evidence presented that they they at least suspected that he did and had been urged to take Ezekiel to the hospital as he deteriorated. In light of the case against the Stephans, this ruling is truly incomprehensible.

Don’t believe me? Get a load of this quote from Justice Clackson:

Clackson said that Ezekiel was indeed sick, but the law does not impose a duty to seek medical attention for every sick child.

“The child had been sick, had improved, then regressed and was waxing and waning. They were watching him closely for signs of meningitis, just in case, even though he did not appear to have any of the symptoms,” Clackson wrote.

“I have concluded that the Stephans knew what meningitis was, knew that bacterial meningitis could be very serious, knew what symptoms to look for.”

During the trial, the Stephans testified that they initially thought Ezekiel had croup, an upper airway infection. They treated him at their home with natural remedies, including a smoothie made with garlic, onion and horseradish.

The parents said the boy appeared to be recovering at times and they saw no reason to take him to hospital, despite his having a fever and lacking energy.

They did call an ambulance when the child stopped breathing. He was put on life support in hospital and died a few days later.

But Clackson said meningitis wasn’t the cause of the child’s death in March 2012.

“As I have concluded that Ezekiel did not die of meningitis, it follows that the Crown has failed to prove its case.”

The law does not impose a duty to seek medical attention for every sick child? Perhaps not—but only if the illness is obviously minor to a reasonable layperson. That was clearly not the case here. Ezekiel was, as we say in the biz, sick as snot and circling the drain. Not to take him for medical evaluation and to opt for treating him with witchcraft was child abuse at its most naked. As for the claim that Ezekiel died of oxygen deprivation because the first ambulance didn’t have the right equipment, it was pretty clear from the medical evidence that it almost certainly wouldn’t have mattered if it had. By the time the parents called EMS, Ezekiel was almost certainly too far gone to be saved. Even if he could have been saved, what about the suffering and long-term sequelae he would have suffered from bacterial meningitis treated too late?

The bottom line is that Justice Terry Clackson has screwed up royally, issuing an utterly nonsensical judgment so divorced from science, medicine, and reality that I would laugh at it if the consequences weren’t so horrific. He believed the testimony of an unqualified doctor who never actually did the autopsy on Ezekiel and used only the autopsy report and the audio recordings of the 911 call and the EMS response over that of a forensic pathologist to acquit David and Collet Stephan. His ruling will both allow David Stephan to continue his grift peddling his useless supplements, which are promoted to treat real diseases and whose use are likely to lead to preventable deaths, and, worse, will likely demoralize child protective service officials and prosecutors, who are likely to think twice prosecuting medical neglect. There will be blood on Justice Clackson’s hands.