Friday, January 22, 2010

A Reasonable Parent Would Have Sought Medical Care for Neil Begley, doctor says


By Nicole Dungca, The Oregonian
January 22, 2010, 11:14AMView full sizeRANDY RASMUSSEN/THE OREGONIANWayne Mackeson, Jeffrey Beagley's defense attorney, addresses the jury during the trial of Beagley and his wife, Marci.


The Beagley trial
Benjamin Brink /The OregonianMarci and Jeff Beagley


ARCHIVE: Previous stories about faith healing in Oregon.Jeffrey and Marci Beagley, members of the Followers of Christ church, are charged with criminally negligent homicide for allegedly failing to provide adequate medical care for their 16-year-old son, Neil, who died in June 2008 of complications from a urinary tract blockage. The trial began on Tuesday.

The main characters in the courtroom today, including the Beagleys, are:
» Judge Steven Maurer
» Prosecutor Greg Horner
» Prosecutor Steven Mygrant
» Defense attorney Wayne Mackeson represents Jeff Beagley
» Defense attorney Steve Lindsey represents Marci Beagley
» Doctor Edward Guillery, a pediatric nephrologist


11:11 a.m. Both defense lawyers had no questions for Guillery and the state had no further witnesses.

Because defense was not expecting to start calling witnesses until Monday morning, the court will adjourn for the day.

11:09 a.m. Would Neil have survived if they had sought treatment the week before he died?

“Yes,” Guillery said. Even if they had sought treatment the day before he died, that would be the case, he continued.

Horner took up that In that day before his death, with an effort to seek medical care, would he be alive?

“Absolutely,” Guillery said. Though his condition would have been worse, medical personnel in the city have been trained to deal with that situation.

“Could Neil have survived even the day of his death had he received medical care?”

“Yes,” Guillery said.


11:04 a.m. Horner asked more about what long-term care Neil would have gotten. Guillery said he would likely be stabilized in the intensive care unit before staying in the hospital for several days. They would likely seek the treatment of dialysis, and eventually a kidney transplant.

He explained dialysis, particularly peritoneal dialysis, which is often used by pediatricians, and also said a kidney transplant “would be the best thing for (Neil).”



11:01 a.m. Horner asked more about what kind of treatment Neil would have likely gotten if he had gotten medical treatment in the week before his death.

Guillery said he would get an exam, and after several steps, he would likely be referred to a local nephrologist like himself, he said. He would have also be referred to an intensive care unit.

They would have administered dialysis immediately, Guillery said. This referral to a type of dialysis matches the opinion of yesterday’s medical expert, a local pediatric urologist.


10:48 a.m. Horner asked if a reasonable parent would have sought medical care for Neil in those last two weeks.

“Certainly” in those two weeks, and the days before his death, Guillery said.

The longevity of the symptoms and his decline were factors for that opinion, he said.

The testimony followed a lengthy back and forth between Maurer and Mackeson over the defense’s objection about Guillery’s use of statements from family members taken from the police. The jury had been ordered out of the room for the discussion.

10:31 a.m. Guillery also relied on statements from family members concerning Neil’s conditions in the last few months, and days, of his death. They showed a child with a “pattern of inexorable decline” in the last week of his death, Guillery said.

Were the symptoms presented in a way that would have raised concerns about the possibility of death?

“Yes, I think a parent would have that concern,” Guillery said. “If they had been recording the diet this way and seeing these symptoms, a reasonable parent would have that concern.”

10:24 a.m. Jurors were brought back in, and Horner came back to the food journal.

"What was in that journal that caught your attention that you think is important?"

"The fact that there was one is what really caught my attention. Parents bring in food journals .. for much younger children, and they usually reflect a significant concern that something is wrong," Guillery said.

The journal suggests that "something has been going on for a while," he said.

The contents were also striking to Guillery.

"He was getting a peculiar diet that suggests to me that there was really a problem," Guillery said. Sixteen-year-olds should be eating entire bags of groceries, he said.

The vomiting without fever or diarrhea or other flu-like symptoms was quite unusual, he said.

10:15 a.m. Maurer ultimately ruled that Guillery’s opinion on what a reasonable parent would do will be allowed in questioning.

Maurer had responded to Mackeson by saying Guillery’s opinion on that issue would help show a “community standard” that is integral to the judgment of the case.

Mackeson continued to argue that the question would not be helpful, since the jury is the one who must decide what is or is not reasonable on standards that stem from a community, not necessarily an expert looking at the facts of the case who presents a “professional standard” for the parents.

Maurer and Mackeson went back and forth with several arguments, comparing the Beagley case to medical malpractice trials and a trial involving an automobile accident.

10:02 a.m. Mackeson objected to a question from Horner that concerned the actions of a reasonable parent in the Beagleys' position. The jury was led out of the courtroom because of the objection.

The question is a doctor’s comment on the state of mind of the defendant, Mackeson said. Mackeson called it a “legal question” and unhelpful for the jury.

Horner argued that the trial is about a “reasonable person’s” judgment. What Guillery would ultimately comment on, Horner said, is whether they were doing something appropriate or reasonable. Guillery, as a medical expert who deals with many parents, would be a good source for what a “reasonable parent” would do, Horner said.

9:59 a.m. Guillery referenced the food journal again, agreeing with a question from Horner that asked if the Beagleys’ attempt to feed Neil glucerna, a formula for adults who have diabetes, was “inappropriate.”

9:58 a.m. Guillery was “disturbed” by the food intake journal that recorded how much Neil ate: “Most striking to me is the diary of the food intake, which as a doctor who is also in general pediatrics, is a disturbing thing to see,” he said.

He was also struck by the reports showing comments from family members prior to the death, as well as the printouts detectives found in the room where Neil died. They concerned internet searches about peptic ulcer disease and treating heartburn.

They were a sign of an awareness of a “significant medical problem,” Guillery said.

9:51 a.m. “Are you aware of any children dying from this condition?” prosecutor Greg Horner said.

“No, I’m not,” Guillery responded, before further explaining: “I’ve never encountered a child who has died from this beyond that early newborn period.”

“Have you ever heard of any situation that you’re aware of, of any child dying from this condition that was completely untreated?” Horner asked.

Guillery said he had never seen that situation, or heard a report of that.

Horner zeroed in on Neil’s case: why did Neil die, as opposed to these other children with this condition?

“Because he received no medical care during his life,” Guillery said.


9:44 a.m. Guillery testified that he has seen many children with Neil’s condition of posterior urethral valves. He is one of four pediatric nephrologists in Oregon, he said.

“We know that when boys have this condition, it very commonly leads to an inexorable decline of their kidney function,” Guillery said.

A minority of those children are identified after birth, and he sees those children for an extended period of time, he said.

The children who have this condition diagnosed later in life have often been brought to a pediatrician because of problems with bed-wetting or urinary accidents during the day, he said.

9:42 a.m. Guillery agreed with the medical examiner’s cause of death, which was involved complications with urinary tract outlet obstruction.

“It’s entirely obvious,” Guillery said. “There can be no doubt, based on my impressions.”

9:30 a.m. Doctor Edward Guillery, a pediatric nephrologist, was the first witness to be called to the stand today. He follows yesterday’s testimony from a pediatric urologist and the medical examiner who conducted Neil Beagley’s autopsy. Both medical experts said Neil Beagley’s condition had been beyond anything they had seen before.

Guillery's specialty, nephrology, is the field of medicine that studies kidney disease."

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