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Justice Terry Clackson accused of racism over his ruling acquitting the parents of Ezekiel Stephan for his death from medical negligence

Alberta Justice Terry Clackson has come under fire for racist language in his ruling acquitting David and Collet Stephan in the death of their child. Is the criticism deserved? Yes. His ruling was horrible on other grounds, but he added racism to the mix.

With a grant deadline and other tasks fast approaching, I didn’t have time to construct my usual 2,000+ word magnum opus for today. However, last night I became aware of a new development in the case of Ezekiel Stephan, who in my opinion died of medical neglect and whose parents were tried for tha neglect but acquitted in a head-scratchingly bad and cringeworthy decision that I just had to comment on briefly. As you recall, I discussed the case a week ago, specifically the horrible ruling that is so wrong on both the evidence and science. Well, the ruling is out now, and it’s even worse than I had described based on the news accounts. Because I don’t have time to delve in detail into the horribly bizarre reasoning by Justice Terry Clackson’s decision. I reserve that for (probably) my not-so-super-secret other blog on Monday. In the meantime, let’s take a look at Clackson’s characterization of the Crown’s expert witness, Dr. Bamidele Adeagbo, a former medical examiner in Calgary who testified that Ezekiel’s autopsy showed Ezekiel had died from bacterial meningitis. It was so bad that there was a complaint of racism:

A group of professors has sent a six-page letter to the body that oversees federally appointed judges, saying language used in a recent ruling that acquitted two parents in the death of their toddler could be perceived as racist.

“We believe that Justice (Terry) Clackson’s choice of words is inappropriate, shocks the conscience, and speaking for ourselves, undermines our confidence in the administration of justice,” says the letter to the Canadian Judicial Council and signed by 42 professors of medicine and law from across Canada.

Yes, Dr. Adeagbo is African, Nigerian specifically:

In his ruling, Clackson devotes an entire section to complaining about the way Adeagbo spoke. He says that he is, in part, summarizing the concerns the defence had about Adeagbo’s expertise as a witness but also that he had concerns with the doctor’s garbled enunciation, dropping his Hs and mispronouncing vowels, and his failure to use the appropriate definite and indefinite articles and correct endings for plurals and past tenses.

“Justice Clackson harshly mocked Dr. Adeagbo’s manner of speech and accented English, and thereby inappropriately implicated his national or ethnic origin as a person of African roots,” say the professors in their complaint. “It is hard to imagine that if Dr. Adeagbo, who is of African origin, had spoken in a typically American, Australian, British, or other more familiar accent, Justice Clackson would have been so scathing…”

While Clackson concludes, in the end, the way Adeagbo spoke had no real effect on his credibility as a witness, the letter’s signatories say the judge “formed an inappropriate view that one’s spoken expression, as rooted in one’s national or ethnic origin, is relevant to the weight of one’s testimony.”

If Dr. Adeagbo’s accent as a non-native speaker of English was “irrelevant” to how Justice Clackson viewed his credibility as a witness, then why did Clackson spend so much verbiage basically snarking on his accent? Let’s go to the ruling itself:

Dr. Adeagbo’s evidence was replete with technical medical jargon. His vocabulary was extensive. His ability to articulate his thoughts in an understandable fashion was severely compromised by: his garbled enunciation; his failure to use appropriate endings for plurals and past tenses; his failure to use the appropriate definite and indefinite articles; his repeated emphasis of the wrong syllables; his dropping his Hs; mispronouncing his vowels; and the speed of his responses. Inaddition, his answers were not always responsive and he would on occasion embark upon a mission to educate the parties and the Court. As a result, there were many instances when it was necessary to have Dr. Adeagbo: repeat his answers; slow down his delivery; focus on the question asked; and accept that, despite our ignorance, the question asked need to be answered. The Transcripts of his testimony are replete with many examples of the foregoing. All of this was exacerbated by the use of a video link as an accommodation to Dr. Adeagbo. However, even when present in person, as he was the final two days of his testimony, the problems I have identified, continued. Nevertheless, the profound difficulty all the participants experienced in comprehending Dr. Adeagbo’s evidence, does not form a basis for a realistic concern that he was biased or partial. In my view, all of those problems are best considered in the Cost-Benefit Analysis and, if his testimony is admitted, in the weight to be given to his evidence.

How nice of Clackson to conclude that his difficulty with English doesn’t mean that Dr. Adeagbo was biased. In any event, does anyone think that Justice Clackson would have written a paragraph like the one above if Dr. Adeagbo were white and had trouble with English because he came from a European country and English was his second language?

Dr. Clackson doesn’t stop there, though:

[21] Dr. Adeagbo demonstrated all of the following behaviours and attitudes over the six days of his testimony. He was calm, rationale, reasonable, arrogant, petulant, exasperated, combative, argumentative and angry.

[22] Those attitudes were demonstrated not just verbally but also in Dr. Adeagbo’s movements, body language and physical antics. Again, these behaviours were more prevalent during the video-link presentation. Unfortunately, the Transcript does not adequately capture some of the behaviours I have described. Suffice to say that they were not the behaviours usually associated with a rational professional imparting opinion evidence for the benefit of the Court.

Look, I get it. Dr. Adeagbo might not have been the best witness on the stand. I also feel for him. I’m sure being cross-examined by David and Collet Stephan’s lawyers was painful, given how they’ve tried to twist the science and evidence into pretzels of pseudoscience and conspiracy theories. I’m also puzzled. Dr. Adeagbo was a medical examiner. Surely he must have testified in dozens or even hundreds of cases. That’s part of the job of a medical examiner, to be the Crown’s expert witness on the cause of death. Has any other justice ever complained about him like this before? In any case, I can totally understand why he might have gotten frustrated, but obviously wish he hadn’t. Even so, I have a hard time not strongly suspecting that Justice Clackson is racist, given how much verbiage he expended snarking on Dr. Adeagbo’s difficulty with English and his “uppity” manner and how he believed the risibly ridiculous testimony of the defense’s primary expert witness, Dr. Anny Savageau, instead. Not coincidentally, she is white.

Once I get a chance to go through the whole ruling, I’ll post a more detailed analysis of it next week, either here or on my not-so-super-secret other blog. Justice Clackson’s “reasoning” (if you can call it that) is even worse than I described last week. It’s so bad that I really have to wonder if Justice Clackson was biased either for the Stephans or against Dr. Adeagbo in some way.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

75 replies on “Justice Terry Clackson accused of racism over his ruling acquitting the parents of Ezekiel Stephan for his death from medical negligence”

My opinion, as a not-a-lawyer, is that the best grounds for appeal is the verdict appears to have been made on a matter not before the court – death as a result of negligence, not failure to provide the necessaries of life as actually charged.

I wonder if Clackson’s conduct is sufficient to have him removed from the bench.

It wasn’t the Alberta government that refused to hand over the money – the Court of Queen’s Bench denied the request. Neither did Stephan sue, as such. That option is still open. (see the rulings of the case management judge, Associate Chief Justice Rooke at canlii.org).

David moaned loudly about Rooke being prejudiced against self-represented litigants. Again, see Rooke’s reply. SRLs can be something of a problem, since the judge is expected to do what is reasonable to help the litigant. I think the situation is both better (judges can “un-hear” things) and worse when the trial is before a judge alone.

I was just so hopping mad as an Alberta taxpayer that the Stephans had the audacity to request the money. He has never showed an shred of remorse instead blaming the ambulance and ER doctors. This decision needs to be appealed by the crown.

Because the retrial was ordered by the Supreme Court of Canada due to an error on the part of the judge in the original trial, I would not be opposed to the Stephans being reimbursed for at least some of their expenses for the original trial – if and only if that is standard practice (and it is not, as far as I know). However, they were also asking for a very large packet of money for the new trial, including for investigative work, and my response to that would be a flat “No!”

If you haven’t read it yet, I highly recommend Rooke A.C.J.’s ruling on the Stephans’ pre-retrial motions:
http://canlii.ca/t/j1vgf

My impression of Rooke is that he is very sharp, very well versed in law and scrupulously fair. He deals with a lot of matters that cause grief for the courts, such as vexatious litigant rulings. I say he gets “all the fun stuff” but I don’t envy him. I do intend to try to attend some sessions in his court.

You’re right, Justice Rooke is worth reading. From Memorandum of Reasons for Decision of the Associate Chief Justice J.D. Rooke “Worse, the Stephans’ allegations are not merely vague statements made without any supporting evidence, but their allegations are wrong in fact. They do not relate to how I have discharged my professional CMJ function, but instead are personal, and, additionally, many – indeed, most – are absurd, spurious, malicious, insulting, sensational, scandalous, inflammatory, scurrilous, defamatory and offensive beyond permissible bounds. To avoid different adjectives, I will collectively refer to the Stephans’ claims about me as “scandalous”.”

from Rooke at http://canlii.ca/t/j1vgf

[115] The complexity of this trial is created by the Accused. Notwithstanding that the death of a child is not an element of the offence that the Crown must prove to get a conviction (see R v Stephan, 2017 ABCA 380 (CanLII) at para 171, 61 Alta LR (6th) 26), the Stephans are not focusing on the real elements of the alleged criminality. As argued by the Crown, they are rather bent on trying to prove that someone else (the medical personnel) was/were responsible for their child’s death (TR 65/32-40). Indeed, there need not be a death to constitute a failure to provide necessaries (as the Crown submits at TR 66/6-67/39), and the Crown takes the position that the failure to provide necessities arose before anyone else intervened.

As a South African, I’m automatically uncomfortable with the charge of racism. Here, it is all too frequently used as an ad hominem attack to deflect criticism. Having said that, it is clear that Justice Clackson’s verdict is astonishingly bad and should not be allowed to stand.

In this case I think the charge of racism is warranted. In also uncomfortable with people who clem that charges of racism is frequently used as a strategy to shut down criticism. Such claims are nearly always exaggerated, in my experience.

If it were the medical examiner were out there saying “You can’t criticize my testimony, that’s racist” it might be relevant to note that people sometimes cry racism under a view that “the best defense is a good offense” but this is other people pointing to the judge’s comments going “that’s racist.” So personally, I’m uncomfortable that you devoted 2/3s of your comment to a scenerio that isn’t even occuring here. why bring it up when it’s very clear to bystanders that the judge brought in issues that are irrelevant to the examiner’s testimony?

Yep. The judge could have said that the medical examiner’s testimony was full of jargon and hard to understand without bringing up the accent in such detail. I mean, hell, he wrote a whole paragraph about it!

I work for a global company and I work closely with a department in India. I once asked one of them “So, is our accent hard to understand sometimes?” Hemming and hawing before they admitted, yes, American accents are tough to understand if you’re not used to them, because we emphasize different syllables, pronounce certain sounds a little differently. I thought about that when the judge complained about “dropped” H’s and “mispronounced” vowels.

Judges must be able to cope with all manner of accents and modes of speech, and should have developed the skills long before being appointed to the bench. I have more sympathy for jury members. It is the court reporter who really has the tough job, since she/he must make a shorthand record on the fly (though shorthand is fundamentally phonetic). In Alberta Queen’s Bench, audio recordings of proceedings are also made, but it is my understanding that the recordings are normally just for archival purposes unless there is some contention with regard to written transcripts (my understanding is very limited, based on a brief conversation with the court reporter in a case similar to the Stephans’).

I have great difficulty understanding small children and I once encountered a Newfie whom I found nearly completely unintelligible.

yes, American accents are tough to understand if you’re not used to them

Try having an Australian accent.

Julian, in this case you would have done well to follow your own advice. The only way your comment about crying racism to deflect criticism applies in this case is if you think the judge was correct to dismiss the medical examiner’s testimony for 1) having an accent, 2) having emotions, and 3) using technical jargon.

Terrie, learn the difference between “May have” and “must have”. I was unaware of the rest of the evidence of racism that the other commenters provided, until they provided it. I made my comment in good faith.

“As a South African, I’m automatically uncomfortable with the charge of racism. Here, it is all too frequently used as an ad hominem attack to deflect criticism.”

I sincerely doubt that statement is any more true in South Africa than it is in the US – and here, it’s total bullshit. Our entire culture is steeped in racism and it’s safe to assume that if an action seems rooted in subconscious racial bias, than it probably is. Given what I know about South African history, I’d expect the situation is as bad or even worse over there.

You’re uncomfortable with the assertion of racism, even when it’s blaringly obvious, because racism SHOULD make you uncomfortable, not because the assertion is wrong.

“As a South African, I’m automatically uncomfortable with the charge of racism. Here, it is all too frequently used as an ad hominem attack to deflect criticism.”

I sincerely doubt that statement is any more true in South Africa than it is in the US

ORLY?
Google “Bell Pottinger” and the “White Monopoly Capital” campaign, instigated by Jacob Zuma to deflect from his massive corruption. Google Julius Malema and some of the noxious things he’s said about white people.

Thabo Mbeki was notorious for shouting “racism” to deflect from criticism, especially w.r.t. his AIDS denialism.
One exmple here:
https://www.theguardian.com/world/2007/nov/06/southafrica.aids

Another example was his vicious attack on rape survivor and advocate Charlene Smith.
http://news.bbc.co.uk/2/hi/africa/3716004.stm

Don’t pontificate on something you know NOTHING about.

Justice Clackson should learn to use commas correctly before criticizing somebody else’s English.

“However, even when present in person, as he was the final two days of his testimony, the problems I have identified, continued. Nevertheless, the profound difficulty all the participants experienced in comprehending Dr. Adeagbo’s evidence, does not form a basis for a realistic concern that he was biased or partial.”

I did my best to transcribe verbatim. The PDF is a scanned copy of the ruling. Why the hell can’t courts produce regular PDFs, instead of the archaic use of paper for everything that had to be scanned. If they meed the judge’s signature, they can always scan just that page and add it to the PDF.

To use the terminology of the courts, I regard Clackson’s comments as scandalous.

I do not recall seeing or hearing a single word of criticism of Dr. Adeagbo’s speech or professional conduct in the original trial. The only related matter raised at appeal was that the Stephanss were claiming the Crown had too many expert witnesses. My belief is that Clackson decided he didn’t want to accept Adeagbo’s testimony, preferring that of Savageau instead, quite possibly because her testimony wasn’t technically beyond his ability to comprehend, or at least he thought it wasn’t. His outrageous remarks about Adeagbo I think are there as “cover” for his own lacking and prejudices.

And once again – the fact that Ezekiel died and the proximal cause of his death are not specifically material to the charge against the Stephans.

IIANAL, but it seems to me they are material. As Rooke wrote, “The Crown takes the position that the failure to provide necessities (sic) arose before anyone else intervened.” The necessaries, in this case, amount to a sick child needing to get medical care, yes? But the Stephans contend that Ezsekiel did not appear to be that sick, that it was reasonable for them to think he had a relatively minor self-limiting condition. So exactly how sick Ezekiel was, and how sick he appeared to be, are matters of contested fact, and what happened to him is evidence in that contention. Specifically, if the the autopsy correctly established the cause of death as bacterial meningitis, then Ezekiel had to be far more ill – and fairly obviously so – than the Stephans claimed. So, if you substitute Savageau’s opinion for Adeagbo’s, then the Crown’s position that the necessaries were not in fact provided becomes more difficult to prove…

Of course, there were other facts not in dispute, like the fact that the Stephans admitted Ezekiel was too stiff to fit into his car seat among other things supporting the Crown’s position, so the death and it’s cause may not have been necessary, but they’re not immaterial.

Did Savageau have any explanation of Ezekiels symptoms befiore David called the EMTs, an argument for her clailm the boy only had a viral infection, and a credible rebuttal of the specific findings of fact in the autopsy that supported Adeagbo’s opinion? I have the impression this “dueling experts” thing at the retrial was little more than farce, that Clackson was determined to deliver an acquital no matter what, and just needed some this excuse to hang it on.

It is shocking that a judge would spend so much effort criticizing–even mocking–the verbal expression of a medical professional–how very Trumpian of him. It is simply irrelevant to his testimony. The judge should be disciplined, at the very least, by whatever agency oversees judges. (Does any body actually oversee judges?)

The language comments certainly seem (to me) to be rooted in racism.

This

Suffice to say that they were not the behaviours usually associated with a rational professional imparting opinion evidence for the benefit of the Court.

makes me believe the judge allowed his personal perception of Adeagbo’s presentation and speech convince him that Adeagbo was not knowledgeable.

“Dr. Adeagbo’s evidence was replete with technical medical jargon.”

An expert medical witness used medical terms? How shameful (?).

It’s certainly possible to be a more effective witness if an M.E. can simplify his/her language. In this instance, I wonder if Justice Clackson was trying to dredge up an additional reason to justify favoring the defense expert over Adeagbo.

He complained about the jargon, and then he ALSO complained about the witness attempting to “educate the court”, in other words explain his jargon.

The only nice thing about this case is that it reminds me that the US does not have the ENTIRE market cornered on racist assholes.

I find it remarkable that a government official would complain about the accent of another government official in a country that has two primary languages. Would the justice have been so rude about a French-speaking ME’s accent in English?
And then to complain that the expert witness tried to “educate the court”!

so rude about a French-speaking ME’s accent in English

Oh, it’s not impossible, some English-speaking Canadians do resent the French-speaking ones (and vice-versa, I would say). I know I met a few.
Full disclosure, my French accent in English is really awful, so some level of annoyance from my auditoire is warranted. I lost a few job interviews because of it.
(I can also sympathize with the physician putting his esses in the wrong places. I do it all the time, even after almost two decades of writing a few English sentences every day, here and in a few elsewheres)

That being said, a Chinese-Canadian colleague who witnessed an anglophone Canadian unload on me his displeasure of French-accented foreigners summarized the encounter thusly: “that this guy told you, that was almost racist!”
(bonus point: this encounter happened in Montreal)

tl;dr: for all I know, this judge would also have had a few mocking and dismissive words with a French-accented or a Russian-accented medic, for example.
And that would still have been racist.

I had two French-speaking Canadian coworkers (not Quebecois, accidentally mentioning that nearly got my head bit off) and I never had any issue with either of their accents. Except the one guy who had a weird and unique pronunciation of “metabolism” (different from the other guy’s pronunciation) which I would never have noticed except that he was studying cellular metabolism so he said “metabolism” about 50 times in any given presentation and oy, it was jarring.

But there was never any question of being able to understand him.

Isn’t educating the court the reason to hire an expert witness? If I have to make a decision about something I’m no expert in, I hire an expert to teach me, so I can make a better decision.

It is a complete farce. Clackson has shown himself unfit for the office he holds. Holding racially prejudiced views as a judge is completely wrong.

Dr. Adeagbo demonstrated all of the following behaviours and attitudes […]. He was calm, rationale, reasonable, arrogant, petulant, exasperated, combative, argumentative and angry.

In other words, he was human and getting worn down (I wonder by who? Just the defendant, or by the judge as well?)
I have met a Leonard Nimoy impersonator at Toronto’s FanExpo, some years ago. Maybe he is available, next time the judge wants a Vulcan scientist. He claimed to speak six languages (in persona or IRL, I don’t know), so the judge would even have a choice of accents.

FYI:

I did some cursory browsing around Dre Anny Sauvageau and she was indeed registered as Anatomo-Pathologist here in the Quebec Province from god know when until 2011 with the Licence number 02299 (link http://cmq.org/bottin/details.aspx?id=6854C37A286FBDB71C7FCBDC2628C333&lang=fr&a=1) (see one of Doug’s comment for her status to practice medicine in Alberta but suffice it to say it met the same fate here, no licence to practice)

I did check how many court cases she was involved and still is involved and the count is 18 according to this search:

https://www.canlii.org/en/#search/text=Exact(Sauvageau)%20AND%20Exact(Anny) which include one irrelevant case. Some still going on in both the Quebec province as well as Alberta.

Alain

I can speak with a bit of authority here. I taught the Medical Services of the Nigerian Navy about 15 years ago; albeit very briefly.
Everyone, both male and female, from the Admiral to the Senior Rates, Lab Techs and what you lot would call Corpsmen spoke eloquently and fluently (they only struggled with my British and rather bizarre sense of humour).
Lagos was quite a rough place and we were not allowed to wander from our hotel. So I spent a lot of time reading the local newspapers and it was a joy. The syntax and grammar was glorious,
My best comparison would be with the Times of London mid 18th century.
So this strikes me as bullshit.

I had two history professors at VCU who were black foreigners. One was Nigerian and one was from the Caribbean (I think Barbados). Both were perfectly understandable despite having strong accents.

Nigerian medical professionals’ command of English is undoubtedly a lot better than that of the scammers who send out e-mails promising massive wealth from abandoned bank accounts, if you only send them your bank information.

I just got a letter (snail mail) from “Mr Nicholas Ryder”, “Director of Investments at Weatherbys Private Bank, UK”. Mr. Ryder informs me that someone with the same last name as me has an account of over 17 million pounds which is lying fallow because the owner got killed in an accident on the A358 motorway in Somerset eight years ago. Mr. Ryder is offering to split the dough with me 50-50, saying, “In the banking circle (sic), this happens every time.

Ryder urges me to ”keep the content of this letter confidential”. Oops, sorry about that Nick.

Nigerian medical professionals’ command of English is undoubtedly a lot better than that of the scammers who send out e-mails promising massive wealth from abandoned bank accounts, if you only send them your bank information.

There’s a (now seemingly inactive) site dedicated to scamming the scammers, after a fashion. This has a fair chance of being offensive to some — read the disclaimers at the top if you choose to visit.

As a student I trained in an ER where there was a Ghanaian doctor. He spoke English beautifully, with precise diction and an extremely “U” accent.
Undoubtedly, he must have had significant socioeconomic factors working for him, but nationally doesn’t necessarily dictate the way someone speaks a given language.
Except for Hungarians. They seem to retain their original accent no matter what other language they speak in and no matter how long they have spoken it.

It’s worth noting that English is an offical language of Nigeria. This is common in many countries that were previously colonies and where there are a large number of native languages. There are three major native languages in Nigeria, not counting the I don’t know how many smaller native languages, plus the many different dialects of each language. So it’s not surprising that many from that country speak English just fine, though with an accent unfamiliar to North American ears.

Except for Hungarians.

I’ve only known one Hungarian — he must have been a freshman and I a sophomore. He wound up being placed in the same lab space that I previously had to myself, which was no big deal, but I distinctly remember that he introduced himself with some bestiality joke that I couldn’t follow. It ended with his making some sort of loud braying noise.

There are three major native languages in Nigeria, not counting the I don’t know how many smaller native languages

Approximately 72,000 at a rough guess.
I possibly exaggerate, ,but those branches of the Niger-Congo language phylum are insanely fissiparous. It is like there is a village all speaking the same language one day, and they get bored, and decide that they’re going to speak two languages, and everyone on this side of the village is going to keep the same grammar but change every second word.

Totally OT but I thought that supporters of SBM/ srgeons might like it:

Whenever you hear a woo-meister tell you about how they have superior solutions to all human health problems, compare:
this dude had been highly active his whole life and had mild arthritis, THEN 2 years ago, he fell off a curb getting off a bus in SoHo and developed various problems ( pain, difficulties walking/ doing things) which he treated himself until they got worse. A GP tried steroids and PT but sent him to an Orthopedist who tried PT, a spinal injection and other steroid shots, sending him to a YOUNG doc who does special surgery hip replacement- using an anterior approach, minimal incision, robotic arm ( ?) assisted surgery using ceramic replacements, gluing the incision.
Within a few hours, the guy was up and around with a PT’s help and left the hospital very soon afterwards. He could walk and do most activities he needed to IMMEDIATELY, using a cane outdoors, not inside and didn’t take any of the pain meds they gave him. He is all right; he’ll drive soon and go back to work.
I knew that surgery had advanced but I had no idea how much ( I realise that maybe his case was an outlier)

Alties tell us that SBM is ONLY useful for emergencies. BUT we all know that its basis is human health holistically determined and what doctors/ nurses learn applies to all situations- it’s all interrelated. Emergency is not a special case. Chronic conditions like arthritis , heart disease are healed through surgery and meds not taking supplements accompanied by wishful thinking and chakra balancing .Alties HAVE to grant that emergency medicine is superior because followers will believe their eyes and ears.- they can’t dismiss SBM entirely.

Denice, you don’t need a question mark after “robotic arm”. It’s like laparoscopy done with a remotely operated suite of tools using fiber optic video; it’s sometimes called Da Vinci surgery. Technically/pedantically, it has nothing to do with robots. Engineers would call it a waldo,for the title character in a Robert A. Heinlein novelette who invents a system of remote manipulators.
My experience with it was not so benign. I had a robotic assisted radical prostatectomy done by a large teaching hospital system’s robotic system instructor. They handed me off to him because of my aortic/mitral valve replacement. He was the department’s “high-risk” surgeon. I was supposed to go home in two days. Instead, he left a bleeder in my abdomen that put me in SICU for a week under heavy sedation and possible low grade coma after multiple transfusions, failed interventional radiology, and an emergency laparotomy. I was kept for a week in the worst, least mentally stimulating, room in a hospital that had undergone major renovations costing millions in every part except that one. I was obtunded for months after, which is why I failed to sue. Instead of having the Foley out in a week, I had the same one in place for almost a month. It was taken out in the ER at 3 AM after it painfully kinked in my bladder. Pure luck that I didn’t end up with a UTI. “High-risk surgeon” for sure.
But what can you expect when you’re Captain Murphy’s Godson? Like the old joke,the operation was a success but the patient (nearly) died.
Give him this much credit: it’s ten years out and my PSA is still undetectable. What was a Gleason score 7, “Stage 1.5” prostate cancer right up to the capsule had been carefully peeled away from the rectal wall, which gave me problems for months. He managed to preserve one of the two nerves. The death of the other nerve was not pleasant. For reasons I won’t go into, I miss having a prostate, too.
(Oh, and Orac, symptoms were so minimal that I only identified them in retrospect, and had no finding on digital rectal exam. It was found by a random PSA of 7 done at my internist’s office, followed by a protein-bound PSA of 86%. I was only 56, so it was probably pretty aggressive.If they had waited for a suspect finding it’s anybody’s guess how much worse things could have been. I will defend routine PSA screening and I don’t care what the statistics show. It was one hundred percent of me at risk. It outweighs any cost-benefit analysis.I would have been paying the cost without getting the benefit.)

@ ORD:

I put a ? because I’m not entirely sure if the doctor used the robotic arm on this particular patient although it was in the description of that type of surgery on his information page but it’s definitely small incisionS (2), anterior and glued together.
Glad to hear that they fixed your problem despite the initial situation.

@ Denice–those new small-incision, minimal muscle resection anterior hip replacements are pretty amazing to see the recoveries from….

But remember, there’s a rather well-known anti-vaxxer online (initials SS) who August of 2108 diagnosed with cancer (based on a gofundme page for his surgery and treatment) who as of last month was still online, still very anti-vax with his postings who clearly hasn’t the capacity to learn a damn thing.

I’ve plowed through part of Clackson’s ruling. A few things are apparent to me.

First and foremost, he was trying the case as criminal negligence causing death. That was not the charge before the court – failure to provide the necessaries of life.

He developed a strong disliking for Adeagbo during the strange combination of hearing his testimony and a voir dire to determine his eligibility as an expert witness.

He would not dare to refuse to certify Adeagbo as an expert witness. If he did, things would crash down upon him from a great height.

He came up with as many dubious reasons as he thought he could get away with to discredit Adeagbo as much as possible. The after-the-fact babble about cost-benefit analysis is absurd, in my opinion. I see that as an analysis that would be made prior to hearing any evidence from the witness in court, and then when the finder of fact would be a jury, not a judge alone.

Adeagbo appears to have dropped the ball on some details.

Clackson preferred Sauvageau’s testimony primarily because he didn’t dislike her.
Given his recent tribulations with the Supreme Court of Canada (and likely chastisement from higher up in Alberta Justice) I can’t help but wonder if the sided with her because she is also at war with Alberta Justice (most recent thing I can find is the fifth amendment to her claim, raising the amount she is seeking to $7.5 – that was just over 2 years ago).

There may have been dubious evidence for some of Adeagbo’s findings, but Sauvageau’s opinions seem to have been based almost entirely on probability and most-common-cause notions.

In my mind, the case for failure to provide is made at the point where Ezekiel had become too stiff to put into his car seat and he was not promptly taken to a physician. An ordinary prudent person without specialist knowledge would have sought medical attention at that point, regardless of what they thought the cause might be. They would do that even if they had no notion that failure might lead to death.

Question for docs and pathologists:

Can anything be said about the probability that meningitis would be viral when there is empyema at or about the same time?

If you have empyema and you’re too stiff to put in your car seat, you have meningitis until proven otherwise. Of course, if you have empyema, you should have already been in the hospital and not dying a wretched painful death at the hands of your unbelievable cruel, neglectful parents.

The commenter Moose pointed that out on the previous thread on this topic

If a medical student in a pathology course exam attributed an empyema (pus between the lung and chest wall) to a viral illness the instructor would (correctly) fail them. It demonstrates an ignorance of a common principle: pus = bacteria.

Curious, I went to check the Wikipedia article on pleural empyema.
I don’t know about toddlers, but a reference was quoted by Wikipedia to support this sentence:

Mortality in children is generally reported to be less than 3%

IOW, it is highly likely that Ezekiel could have been saved, if he have been sent to an hospital from the start.

I should have been more specific.
“Empyema” usually, it seems, implies pleural infection, but it can apply to other cavities.
My question is if there is pleural empyema, would one expect meningitis to be bacterial or viral? I would have thought that bacterial meningitis resulting from spread of the pleural infection would be vastly more likely than an “independent” case of viral meningitis. I would see viral is highly unlikely, though certainly not improbable.

In either case and regardless of legal culpability, it is certainly damning of all of the treatments given to Ezekiel by his parents, since he clearly had a serious lung infection and meningitis at the time he quit breathing.

You still don’t believe we are obligate frugivore-herbivores?
It seems, the simple rise in hemoglobin and hematocrit, prove it.
No rise in the vegetarian but a rise in the omnivore.

“Protein intake from only haem animal origin was associated with increased haemoglobin and haematocrit levels whereas protein intakes from plants were not associated”
“low-grade chronic inflammation”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905638/

They have now recommended the lowering of red blood cells will save the health care systems of the world BILLIONS of dollars, billions.

“Regular blood donation is associated with pronounced decreases of BP in hypertensives. This beneficial effect of blood donation may open a new door regarding community health care and cost reduction in the treatment of hypertension ”

https://www.ncbi.nlm.nih.gov/pubmed/26643612

“Our findings highlight the considerable economic burden of hypertension in Australia and that effective strategies aimed at the prevention and adequate control of hypertension are likely to pay significant economic dividends for individuals, employers, and governments in the longer term.”

https://www.ncbi.nlm.nih.gov/pubmed/30798659

“Our findings suggest that an increased Hb level is a predictor of elevated serum ALT in adolescent girls with dyslipidaemia. Our study also highlights the importance of further research to establish cut-off points for Hb and its utility in diagnosing and preventing the onset of dyslipidaemia in adolescents. ”

https://www.ncbi.nlm.nih.gov/pubmed/26328752

And how was the Middle Ages/ Renaissance? Did you enjoy the bleeding and purging?

Did you notice the next suggested article on your “donations reduce blood pressure”, that said, “actually it doesn’t, it’s just regression to the mean”.
Here: https://www.ncbi.nlm.nih.gov/pubmed/28083954

Also, you know there isn’t an herbivorous source of B12, an essential nutrient, right?

My extremely knowledgeable vegan daughter gets her B12 from yeast. She salsa dances in competition, and practices acro-yoga.
A vitamin deficiency is one thing she clearly does not have.

ORD, I stand respectfully corrected.
I (lazily) maintain an omnivirous diet, so what I know about B12 comes from reading essays (and watching YouTube videos) by vegans. The science-based vegans are pretty adamant about “you need to be sure you’re getting enough of these specific vitamins and minerals and amino acids and you should take whatever cheap supplement is vegan” (as opposed to people selling supplements), so I had assumed that it was very hard to find in dietary sources.
Good to know!

(Is yeast herbivirous? Hmmm…)

Err…
“Human are herbivore” is not on-topic for this thread. Did you take a wrong turn at Albuquerque? Anyway, since you are here:

No rise in the vegetarian but a rise in the omnivore.

So what? It may also well be that the vegetarian is lacking in iron, thus has less hemoglobin. That’s not a good thing.

Regular blood donation is associated with pronounced decreases of BP in hypertensives

Well, yes. If you donate blood, you have less of it to pump around. And I do expect people with a higher hematocrit to have also a higher blood tension
However, while donating blood is a nice way to treat symptoms, it doesn’t prove that too many RBCs is the cause, or rather the main cause for hypertension.

hypertension in Australia

This paper says nothing about red blood cells, or hemoglobin. Irrelevant to your topic.

Our findings suggest that an increased Hb level is a predictor of elevated serum ALT in adolescent girls with dyslipidaemia

“in adolescent girls with dyslipidaemia.”
A condition which could be genetic.
It seems to me the main health issue of these young girls is not an excess of red blood cells.
And while (disclaimer – I’m not a physician) they may want to look at ways to lower their RBC number,
1 – it’s not a certainty, again, that a high hematocrit/hemoglobin level is a cause, rather than a symptom, of their health issue. For all I know, a lower RBC count is going to be detrimental to these women.
2 – these observations cannot be transposed to the population at large, which doesn’t suffer from an abnormal level of lipids in blood

One grain of truth in your assertions – a diet with a high intake of meat is not good for you.
But the same can be said about sugar intake. And our sugar intake is mostly coming from fruits, grains and tubers, and products thereof. Not from meat.

What kind of dressing is recommended for word salads?

“Obligate carnivore” means any animal who requires nutrients only found in meat. So an “obligate herbivore” would be an animal that requires nutrients only found in plant matter. So, what you’re saying is that humans can’t survive only on animal products. Which… duh.

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