CT scan of toddler’s brain one of the “most devastating” PICU Dr. had ever seen

During Ezekiel’s transport, a three-person team was deployed including a pediatric doctor who was training to become an emergency pediatrician, and a respiratory therapist, to make sure multiple organ failure could potentially be managed.

Burkholder told the court the toddler was in shock and that he became more unstable during the flight.

Arrival in Calgary

Ezekiel was brought in for assessment at 2:45 a.m. March 13 and was seen immediately. What was most concerning to the doctor, was his lack of neurological response, including fixed and dilated pupils, no response to talking, to painful stimuli, and no gag or cough reflex. There were also signs of intracranial pressure in the back of the eyes, meaning the brain was swollen, and his kidneys were also not functioning properly.

The child was not breathing on his own and was also in asystole – a condition she said only 5 per cent of children usually survive.

A CT scan was then ordered to rule out a tumor or brain bleeding. The results, the doctor told the court, were among the worst she had ever seen.

It was at this point during the voire dire that David Stephan made an objection, citing Burkholder’s qualifications and/or ability to accurately read a CT scan. She told the court she acknowledged she was not a specialist however she was required to read CT scans at least once a week and had basic training to read them.

The scan revealed severe swelling of brain tissues, a lack of the grey and white colors seen on normal scans and fluid filled spaces that, combined with the swelling, put an immense amount of pressure on the brain tissues, blood entering the brain, and the brain stem – which regulates basic things like breathing and heart function.

Diagnosis

Co-Crown prosecutor Britta Kristensen then asked Burkholder how she arrived at her diagnosis. The doctor testified that the CT scan and blood tests in combination with her physical exam and speaking with the Stephans led her to believe Ezekiel would likely be suffering from bacterial meningitis.

While speaking with both David and Collet Stephan, the doctor testified she was told Ezekiel had no previous medical issues, but also that he was not immunized and had been treated for what they thought may have been croup – with herbal medications and supplements. She was told that the toddler got better for a short period of time, then worse, and became stiff; with an arching back and lethargy. He had not been able to eat but was given fluids through a syringe.

Asked by the Crown why a lumbar puncture – or spinal tap – was not performed on the child, Burkholder told justice Terry Clackson that it was contraindicated, or should not be done because of the increase in intracranial pressure, decreased consciousness, instability of basic functions like heart rate and breathing and the abnormal CT scan results. Performing the test to remove spinal fluid could result in a fatality.

That said, Burkholder also testified that while she believed bacterial meningitis was the cause of the toddler’s illness and she treated him subsequently with antibiotics intravenously, she also treated him for viral meningitis using an anti-viral medication. The purpose was to prevent any further potential brain injury.

If a patient is treated with even one dose of antibiotics when suffering from bacterial meningitis, it kills that bacteria within hours, she told the court. However, a course of antibiotics is recommended to continue for several weeks to treat the inflammation and underlying infections.

Burkholder also testified that the probability a child suffering from bacterial meningitis survives if treatment is started early, is about 95 per cent, however, depending on the length of the illness, age, and several other factors, anywhere from 10 to 30 per cent of survivors will suffer neurological damage that can range from hearing loss to cerebral palsy and developmental delays.

Ezekiel’s neurological function did not improve at all during his time at the hospital, however his heart rate improved, and there may have been some spontaneous breaths taken at one point.

A chest X-ray also showed a mild to moderate mass of fluid outside of the right lung, and the child’s urine output escalated to the point where a larger catheter had to be inserted into him to keep up with the urine output.

Two brain death exams were also performed on the child, as is legally required. The first was completed March 15 and the second on March 16. Both exams were performed by other doctors.

The Crown wrapped up its questioning of Dr. Burkholder Thursday afternoon, as David Stephan began his cross examination. Lethbridge News Now will be at Court of Queen’s Bench Friday for the continued cross examination.

Testimony Wednesday

During testimony Wednesday, June 12, RCMP tapes were played for the court, during which both David and Collet spoke with RCMP Cpl. Ryan Bulford.

Back when the couple’s case management hearing occurred in early March, 2019, the Stephans both applied to have the tapes ruled inadmissible during their second trial, citing oppressive conditions, trickery, that they were both not of “operating mind,” and the fact that no one told them they didn’t have to speak with police or the child abuse consultant.

Justice J.D. Rooke denied the application saying that while a person does have the right to remain silent, that doesn’t mean they don’t have a right to be spoken to by a person in authority.

He told the court the RCMP officer also made no threats to the couple, including whether to potentially take their son Ezra away. In fact, the officer had no authority to do so.

On the atmosphere of oppression, Justice Rooke told the court that no oppressive conditions existed, and that if the mere presence of police constituted that, there would never be voluntary statements given to them.

On the subject of operating mind, both David and Collet earlier told the court they were extremely stressed out, sleep and food deprived. David’s father, Anthony also testified that David “wasn’t there.” Justice Rooke agreed that the two were under an enormous amount of stress, but that he accepted the Crown’s argument that the elder Stephan was not present during the police interviews and therefore could not assess executive function. There was also no evidence of drug or alcohol intoxication, mental illness or physical illness with either David or Collet.

And on the issue of trickery, the judge found that no one dealing with the Stephans was an undercover officer or agent, and that no one represented themselves as other than what they were.

The argument that Dr. Jennifer D’Mello misrepresented herself to Collet was also rejected by the judge.

by Lara Fominoff

CT scan of toddler’s brain one of the “most devastating” PICU Dr. had ever seen

What's Happening