MACHIAS, Maine — The doctor who treated Aloric Smith testified Wednesday that the boy’s father was told repeatedly to call the Diabetes, Endocrine and Nutrition Center at Eastern Maine Medical Center in Bangor if the boy became ill and could not keep down food.
Members of the team of medical professionals, who work at the center, testified on the third day of the jury-waived manslaughter trial of Edward Smith, the father of 12-year-old Aloric Smith, who died April 4, 2012, at home. The father is accused of not seeking medical attention for the boy after Smith was vomiting for at least two days and growing gradually weaker until he could not feed himself or get to the bathroom on his own.
“We tell parents [of children with juvenile diabetes] that if their child is sick, you call us,” Dr. Anne Boniface, the pediatric endocrinologist at EMMC, told Superior Court Justice Robert Murray on Wednesday. “Someone is available 24/7.”
The doctor testified that if she had spoken to Edward Smith in the two days leading up to his son’s death, she would have told him to take the child to his pediatrician’s office or a hospital emergency room.
Smith did neither, according to Assistant Attorney General Leanne Robbin, who is prosecuting the case.
The 44-year-old former Lubec man is charged with manslaughter, aggravated furnishing of a scheduled drug and endangering the welfare of a child, because he allegedly gave his son drugs not prescribed for him.
Defense attorney Jeffrey Davidson of Machias said in his opening statement Monday that Smith was a loving father who misjudged how ill his son was. The boy had an appointment to see his pediatrician the day before he died, but his father cancelled it because the boy seemed to be getting better.
Aloric Smith died of diabetic ketoacidosis, Dr. Margaret Greenwald, the retired medical examiner who performed the autopsy, testified Tuesday. 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.
Smith was diagnosed in October 2009 with juvenile diabetes, Boniface said Wednesday. Referring to medical records, she said that the boy and his parents, Edward Smith and Monica Reardon, were at the first appointment. The boy and the parents were shown how to test Aloric Smith’s glucose levels using test strips and a meter and how to measure and inject insulin. The boy also was given a glucose meter.
Diet and how parents should deal with an illness were discussed, Boniface testified. She said that what the center calls “Rules for Sick Days” were gone over at the first appointment and at subsequent appointments, according to the center’s records.
A problem arose in January 2012 when Smith’s glucose meter showed his recent glucose levels in the normal range, but a glucose level taken in the office that day on the meter and his A1c level, which measures how his diabetes is being managed over time, was higher than normal, the doctor testified.
It had been a year since his last appointment, Boniface said. She said that the center recommends quarterly visits.
Testimony earlier this week from a social worker who worked with the family revealed that Reardon had left the family sometime in 2011, and Edward Smith did not own a reliable vehicle to make the trip to Bangor.
The boy was given a new meter in March 2012 because of concerns that the other meter was defective, Corey Webb, a physician’s assistant at the clinic who treated Aloric Smith, testified. An A1c test was not taken at the appointment because it was too soon after the test in January for the data to be valid and because MaineCare would not pay for it, he said.
Even though Smith and his parents were instructed to check his blood sugar four or five times per day, evidence was introduced Tuesday that showed the boy’s glucose level was checked just once in the 60 hours before he died.
Davidson has maintained that there were at least five glucose meters in the home because Edward Smith is diabetic. The defense attorney has said that a different meter could have been used to test the boy’s glucose level during that time.
No evidence of glucose readings from meters other than the two Boniface and Webb have said came from the center has been introduced.
“We could have successfully treated him if he had been brought to a hospital [in the hours before his death],” Boniface said Wednesday.
Donna Shaw Smith, 34, of Springfield, Missouri, 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. Shaw Smith, who is married to the defendant, told the judge 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.
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.
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.