MACHIAS, Maine — The retired medical examiner who performed the autopsy on a 12-year-old boy who died at the Lubec home he shared with his father and two younger sisters 2½ years ago testified Tuesday that Aloric Smith’s diabetes was “not well controlled” in the two to three months before his death.
Dr. Margaret Greenwald took the stand on the second day of the jury-waived trial of the boy’s father, Edward Smith, 44, in Washington County Superior Court.
Smith, formerly of Lubec, is charged with manslaughter, aggravated furnishing of a scheduled drug and endangering the welfare of a child, because he allegedly gave Aloric Smith drugs not prescribed for him.
Greenwald told Superior Court Justice Robert Murray that Smith died of diabetic ketoacidosis. Acute gastritis was a contributing factor in the boy’s death, she said.
Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated, according to the website emedicinehealth.com. The condition results in the body consuming its own muscle, fat and liver cells for fuel. Common causes for the condition are infections that include diarrhea and vomiting.
Greenwald said Tuesday that Smith’s hemoglobin A1c, used to measure how an individual’s diabetes is managed over time, was measured at 15.7. A1c refers to a component of hemoglobin to which glucose is bound. The doctor said that a level should be under six.
The boy’s glucose level was estimated to be 407 at the time of his death, the medical examiner testified. A normal level for a juvenile with diabetes would be under 150, she said.
Greenwald also said that the portion of a Valium pill Edward Smith allegedly gave his son to help him sleep did not contribute to the boy’s death.
In her opening statement Monday, Assistant Attorney General Leanne Robbin described Smith as a negligent parent who failed to get his son medical attention when his flu symptoms grew worse.
Defense attorney Jeffrey Davidson of Machias said that Smith was a loving and caring father who misjudged how a stomach bug going around town in 2012 would affect his 12-year-old boy’s diabetes, but he was not criminally negligent.
On Tuesday, Davidson referred to the boy’s medical records that showed on Jan. 4, 2012, Aloric Smith’s A1c level was above 14, but his glucose level average was 170, according to information recorded by his glucose meter.
Under cross-examination, Greenwald declined to comment on that inconsistency because she is not an expert on diabetes.
Janine Gramlich, who worked for Families United at the time of the boy’s death, testified that the Department of Health and Human Services had referred the Smith family to her agency for assistance. She worked with the family from November 2011 until Smith’s death. Families United is a private nonprofit with four Maine locations that helps children and parents resolve conflicts and problems.
Goals set by DHHS were to improve Edward Smith’s parenting skills so that the children consistently got to school on time, he was meeting their medical needs and getting them to doctors’ appointments. He also was to attend counseling, she testified.
Gramlich did not say why the defendant was required to attend counseling.
After Aloric Smith’s death, DHHS became involved directly with the Smith family, Kelly Barnes, a supervisor in the Machias office testified. She said that after the boy’s death, Edward Smith’s daughters went to live with their mother, Monica Reardon, and maternal grandmother in Brockton, Massachusetts.
Barnes said that she attended an “emotional” family meeting with Smith and the children’s mother. A few days after that meeting, Barnes said that she told Smith that if his daughters, then in first grade and kindergarten, were to move back in with him, DHHS would take legal steps to take custody of them.
Barnes testified that on April 23, 2012, Smith called her and said, “I’m a parent who made a mistake, and I will blame myself for the rest of my life.”
The trial is expected to continue through Thursday.
Robbin said Tuesday after the trial recessed for the day at 3 p.m. that she expects to rest her case Wednesday after Aloric Smith’s caregivers at the Diabetes, Endocrine and Nutrition Center at Eastern Maine Medical Center in Bangor testify. Maine State Police Detective Elmer Farren also is scheduled to take the stand Wednesday.
Edward Smith is scheduled to testify in his own defense on Thursday.
Murray is expected to take the case under advisement after closing arguments. There is no timetable under which he must issue his decision.
Smith has been held since his arrest in October 2013 in Rogersville, Missouri, at the Washington County Jail, unable to post $5,000 cash or a $50,000 surety bail.
He moved to the Midwest several months after the boy’s death with Donna Smith, 34, of Springfield, Missouri, whom he married a year before his arrest. She testified Monday that she and her children spent the night of April 3 to April 4, 2012, at the home the defendant shared with his children.
She testified that she gave the boy a drink of water about 2:30 a.m. and helped him to the bathroom. Donna Smith told the judge that Edward Smith found the boy had died about 6:30 a.m. and called 911. She testified that he had planned to take the boy to see a doctor that morning.
If convicted of manslaughter, Smith faces up to 30 years in prison and a fine of up to $50,000. He faces up to five years in prison and a fine of $5,000 if convicted on the drug charge and a year in prison and a fine of up to $2,000 on the endangering charge.
BDN writer Tim Cox contributed to this report.