1 Nov 2010

Doctor in "faith healing" case says infant's death was caused by long- and short-term child abuse through neglect

The Oregon City News - July 6, 2009

Grandmother says Ava Worthingon ‘never was weak’

UPDATE • Defense in Oregon City faith-healing trial counters that 15-month-old was healthy and well treated

By Matthew Graham

Defense attorneys began chipping away Monday afternoon at prosecutors’ arguments that 15-month-old Ava Worthington died as a result of neglect and abuse when her parents relied on faith healing instead of medical help for a blood infection and pneumonia.

Their first witness, Ava Worthington’s grandmother, said the child she saw during February and early March 2008 was healthy, strong, well-fed and “nicely round.” In fact, Julie Worthington, Carl Brent Worthington’s mother, told the jury that Ava only seemed to be teething and had a runny nose and some slight chest congestion, right up until the hours before she died.

“I remember her being very strong,” Julie Worthington said during about two hours on the witness stand in Clackamas County Circuit Court. “She never was weak.”

Ava died March 2, 2008, after weeks of what medical examiners said was failing health because of a blood disease and pneumonia. Her parents, Carl Brent Worthington and Raylene Marie Worthingon, are on trial for failing to provide medical care for their daughter.

The Worthingtons are members of the Followers of Christ Church in Oregon City, which believes in faith healing and avoids medical doctors.

Julie Worthington’s sometimes tearful testimony helped defense attorneys Mark Cogan and John Neidig set the scene for jurors during the last weeks of Ava Worthington’s life. She said that in mid- to late February 2008, Ava seemed like a normal child, playing with her cousins and eating all sorts of food — bananas, Cheerios, fruit and scrambled eggs — without difficulty swallowing. She also defended her son and daughter-in-law, saying they were “a very good mother and dad” to Ava.

To bolster their case, defense attorneys showed the jury a videotaped statement by Raylene Worthington saying her daughter seemed to be fine until just before she died. Attorneys also showed the jury photos taken by Julie Worthington of what appeared to be a healthy, hefty Ava more than a week before she died.

Introduction of the photos and the video touched off a minor legal skirmish with prosecutors, who objected, saying the defense team had improperly introduced them into evidence. Judge Steven L. Maurer agreed and forcefully admonished defense attorneys (after the jury had left the courtroom) on proper evidence procedure and sternly took them to task for the missteps.
Prosecution ends it case

After prosecutors rested their case Monday morning, defense attorneys asked Judge Maurer to dismiss the charges against the Worthingtons because state law that was changed in 1999 to remove the “spiritual treatment” defense in manslaughter cases violated the family’s constitutional right to free exercise of religion. Maurer rejected the request.

Julie Worthington’s testimony came after the prosecution’s final witness, who told the jury that Ava’s death was caused by long- and short-term child abuse through neglect.

Dr. Dan Leonhardt, a pediatrician and child abuse specialist with Child Abuse Response and Evaluation Services and Legacy Emmanuel Hospital, told the jury that medical neglect, a form of child abuse, occurs when caregivers fail to follow medical advice once it’s given or fail to seek medical help in the face of obvious and serious medical conditions.

Leonhardt corroborated what other doctors told the court last week, that the cystic hygroma on tiny Ava Worthington’s neck constricted her breathing. He and other prosecution witnesses said that labored breathing required more effort, and the child couldn’t eat enough to make up for that extra effort exerted.

Other prosecution witnesses testified last week that when Ava died her height and weight more typical of a four- to six-month-old child. Her growth pattern was “catastrophic,” Leonhardt said.

“When I reviewed Ava I had concerns that she had been medically neglected and that this was going on for a long time, and that there was acute neglect as well,” Leonhardt told the court Monday morning. “She is severely malnourished at the time of her death.

“Her respiration was labored, she was struggling, she was fighting to breathe. That continued on the day of her death and there was never any indication that at any point in time – at three to four months (when the growth was first noticed), December (when it got larger), the day before her death, the hours before her death – was any medical care sought … There was clearly long-standing medical neglect.”

He said that based on her growth chart – she was in the 95th percentile for height and weight when she was born and below one percent when she died – he would have hospitalized her immediately had he been informed of her situation three months before her death, when the cystic mass got noticeably larger, according to the parents.
Child stops breathing

On the last two days of Ava’s life, however, Julie Worthington said her son and daughter-in-law became concerned about Ava’s condition and asked the family and church members to pray and “lay on of hands” as part of a faith-healing effort.

Church members and family went to Brent and Raylene Worthington’s home to pray and lay hands on the child three times March 1 and 2 — once in the afternoon, another time at about 4:30 a.m. March 2 and again at about 6 p.m. that same day. Each time, Julie Worthington testified, the prayers seemed to help and Ava showed signs of improvement.

“After the laying on of hands, Ava asked for her bottle,” she told the jury while fighting back tears. “I could hear her saying, ‘Baba, baba.’ I thought that was very good.”

In fact, Julie Worthington told the jury that Ava’s death was a shock to everyone who had gathered at the home that night to fast and pray for her recovery. Breaking down with emotion, she recounted how Ava played for several minutes on her parents’ bed before lying on her side next to her mother.

“She was showing very good signs,” Julie Worthington said.

Then, at about 7:15 p.m., Raylene Worthington grabbed the child and shouted that she had stopped breathing. Family members rushed to her side, but Ava had died.

“We felt like she had just went to sleep and she was going to have a good night,” Julie Worthington said. “She was doing so good.”
Turning to ‘Turner Syndrome’

In previous cross-examinations of prosecution witnesses, defense attorneys brought up Turner Syndrome, indicating something they may explore as a defense.

Turner Syndrome occurs in females when one X chromosome is not present or damaged. People with the syndrome typically grow abnormally, usually being very short in stature though their weight grows normally; exhibit lymph build-ups in parts of their bodies; and have no ovaries or non-functioning ovaries. They can also have heart deformations, malformed kidneys, skeletal deformities and webbed necks.

But the prosecution addressed that, asking Leonhardt if Turner Syndrome could have caused Ava’s medical problems.

“I don’t see anything that could’ve supported that diagnosis,” Leonhardt said. “She had none of the features I just mentioned – her heart was formed normally … her growth chart doesn’t show Turner Syndrome … I don’t see anything that would support the diagnosis of Turner Syndrome.”

More defense witnesses will testify this week, including medical experts, family members and law enforcement officers who were at the Worthington home the night Ava died.
Case background

Brent, 29, and Raylene Worthington, 26, face second-degree manslaughter and second-degree criminal mistreatment charges because they didn’t take Ava to a doctor as her condition worsened.

Prosecutors said the Worthingtons were negligent in their daughter’s death and were charged with the crimes because Oregon law requires parents to seek medical attention for their ailing children. Their case is the first to be brought under the 1999 state law that is seen at odds with religious freedom.

Their trial began June 29 before Judge Steven L. Maurer in Clackamas County Circuit Court. A 12-person jury is hearing the case.

Deputy District Attorneys Greg Horner and Steven Mygrant are prosecuting the case. Portland attorney Mark Cogan represents Brent Worthington. Portland Attorney John Neidig represents Raylene Worthington.

Reporter Kevin Harden contributed to this news story.

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