Police wanted an autopsy and called at least three times to make their case. They were given "a dismissive 'no,'" Monroe police spokeswoman Debbie Willis said Tuesday.
State officials confirmed that a social worker witnessed at least one of those conversations, and the detective mentioned Child Protective Services' past involvement with the boy's family.
Still, the medical examiner's office ruled the boy's death "low suspicion." His body was released and cremated without an autopsy. Two weeks later, toxicology tests ordered by the medical examiner came back showing the boy died with lethal amounts of what appears to be over-the-counter painkillers in his system.
Police are investigating the death as a potential manslaughter. The case is complicated by a lack of evidence from a body, little cooperation from the boy's parents and possible missteps in how his death investigation was handled. National experts say there aren't clear-cut policies for when a child death investigation requires an autopsy.
The boy, identified in court papers only as "A.J." of Monroe, was pronounced dead Jan. 30. His father brought the boy into the hospital emergency room unresponsive, nearly 40 minutes after he said he found the boy "ash white," the documents showed.
In the days after the boy's death, a detective called the medical examiner's office at least twice to request an autopsy, Willis said. A sergeant called, as well.
The detective attempted to explain that he'd investigated the boy's parents in a reckless endangerment case two years before, she said.
"It was a dismissive 'no,' they were not going to do an autopsy," she said. "They asked if we had documentation of any physical abuse, and we said no."
The medical examiner representative reportedly told the detective that if police wanted to send documents, they'd be reviewed, Willis said. They asked for no additional information.
"The detective felt at that point that we'd had three dismissive phone calls, they're not listening, and we have an investigation to continue here, and did not send any reports to them," Willis said.
The Snohomish County Executive's Office, which oversees the medical examiner, has declined to discuss any specifics of the case, citing the ongoing police investigation.
Police look into deaths that may involve crimes, but the medical examiner's office determines how someone died and whether the death was natural, an accident or the result of someone else's actions.
A determination on the boy's manner of death is pending, meaning there's not enough information.
State toxicologists reported finding lethal amounts of salicylates in the boy's blood. Salicylates are common in aspirin and other over-the-counter drugs.
The tests determine the presence and amount of the drug in the blood, not how it was ingested.
An autopsy would have answered important questions, such as whether there were pills in the boy's stomach. Even without that evidence, authorities still should be able to investigate, said Janice Ophoven, a Minnesota-based pediatric forensic pathologist who has consulted on cases nationally and abroad.
"In this particular case, we have a cause of death -- that's not going to be in dispute," Ophoven said. "Then the question becomes how did that stuff get in there, and is there a reasonable explanation for that?"
Salicylate poisoning generally causes noticeable symptoms that last hours before death, she said. Those include breathing problems, nausea and vomiting.
"Assuming that the numbers are reported accurately and this is a fatal dose, somebody is going to have to answer the question of what the family thought when they saw signs of salicylate poisoning," Ophoven said.
The case ultimately will come down to "good police work in the days and weeks to come," she said.
Job defies policy
There are no policies to tell forensic pathologists in Snohomish County, or anywhere else, exactly when to perform autopsies. Instead, death investigators must rely on their training and experience to make the right call.
"The almost infinite varieties in ways that people die makes it impossible to write a policy to deal with every kind of death," said Dr. Andrew Baker, spokesman for the National Association of Medical Examiners and medical examiner for Hennepin County, Minn.
Baker added: "Whether one is done is only a piece of the much larger puzzle. Whether you do one or not depends on what historical information is available to you."
A former associate pathologist for Snohomish County said the information from Child Protective Services should have made a decision on the Monroe boy's case an easy call.
"To me, it's obligatory to do an autopsy in this case if the medical examiner knew of the CPS reports," said Dr. Carl Wigren, who left Snohomish County in 2009 and now consults with coroners, attorneys and families.
The child's father pleaded guilty in 2010 to reckless endangerment after police discovered his children living in deplorable conditions. The children, then 10 and 5, were removed from the home for three months. Before then, state social workers investigated numerous allegations of mistreatment involving the couple's two sons, including a report that the older boy, now 12, had been given a double dose of anti-seizure medication on at least two occasions.
Both boys were severely developmentally delayed, but doctors haven't found genetic or neurological reasons. The older boy has been removed from the home.
Timeline still unclear
What also remains unclear is the timeline of events between the younger boy having medical trouble and the hospital declaring him dead, police said.
His father said the boy was breathing and alive when they left the home, but the emergency room doctor said when they arrived, the boy appeared to be in the early stages of rigor mortis, which happens hours after death.
Child Protective Services received notice from the hospital about the younger boy's death, said Sherry Hill, spokeswoman for the state Department of Social and Health Services
A social worker was investigating the case by 10 a.m. that morning. That included contacting Monroe police to ask if they would be assigning a detective.
Generally, hospitals contact CPS or law enforcement when the child's death is unexpected.
The social worker was in frequent contact with the detective. The social worker noted that she was there when the detective called the medical examiner's office. During that conversation, the detective conveyed the family's history with CPS. CPS officials never received a request from the medical examiner to see those reports, Hill said.
"We felt assured that the M.E. was aware of the history of this family," Hill said.
The social worker noted that the medical examiner expected to determine a cause of death that day. The social worker noted that the medical examiner planned to complete a toxicology screen and a full body scan to determine if there were any signs of abuse or neglect, Hill said.
Once the medical examiner concluded that the death wasn't suspicious, the social worker talked with the family about the possibility of doing an autopsy. She advised the family that an autopsy could be helpful to determine what caused the boy's seizures, which could be helpful to their care of their older son. The social worker made it clear that the family would need to request a full autopsy.
The social worker reported that the parents said they would consult with their own doctors and "take care of it."
Officials with the Children's Administration plan to convene a child fatality review. The law calls for a review when a child dies of suspected neglect or abuse and has received services from the state in the past year.
Shortly after A.J.'s death, leaders at his school broke the news to students and families.
A.J. was in a first-grade class.
"He faced many health challenges in his short life and we will miss him," Fryelands Elementary School Principal Jeff Presley wrote at the time. "A.J. was a wonderful member of our school family and our thoughts are with his parents and brother."
Reporter Eric Stevick contributed to this story.
Rikki King: 425-339-3449;firstname.lastname@example.org
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