The child was brought into a Monroe emergency room in the early stages of rigor mortis. Toxicology tests later concluded that the boy -- identified in court papers as "A.J." -- died from a lethal amount of what appeared to be an over-the-counter painkiller in his system.
A CPS investigation into the boy's Jan. 30 death concluded there is reason to suspect negligent treatment or maltreatment involving the boy's parents, the records said.
"It is more likely than not that (the parents') acts or omissions are related to the cause of Alexander's death," according to records.
Detectives were told that level of salicylates found in the boy's blood was the highest seen in anyone in the state in two years, according to Child Protective Services records recently obtained by The Herald.
A doctor and child abuse expert consulted by state case workers concluded the high level of salicylates would have caused the boy to have seizures and would have resulted in his death.
"He would have had to gotten into it or been fed a lot of it," said Dr. Kenneth Feldman, the medical director of the Seattle Children's Protection Program.
How the boy ended up with so much of the drug in his system is unknown. His remains were cremated without the Snohomish County Medical Examiner conducting a full autopsy.
Monroe detectives continue to investigate the child's death. They hope to wrap up the criminal investigation within the next month or two, police spokeswoman Debbie Willis said.
There is a lot of information to include in the final case report, including the family's history with Monroe police and CPS, she said.
"We want to make sure it's all captured, and the prosecutor's office has as a complete a case as we can do," she said. "There's still a child who died, and we have to come up with the best answers we can of what happened for that child's sake, for the family, and there's another child in the family, and we want to make sure he is protected also."
The police investigation has been hampered by the lack of an autopsy. Officials with the Medical Examiner's Office refused to do a complete autopsy even after Monroe police advised them that the father was investigated in 2010 for neglecting and mistreating his young sons, both with severe development delays.
An autopsy could have provided answers to what specific form of salicylate poisoned the boy and may have indicated whether the overdose was accidental or a crime.
The medical examiner "was unwilling to hear the ER doctor's or Monroe PD detective's concerns or perform a full autopsy," the social worker wrote.
There are no state policies to tell forensic pathologists exactly when to perform autopsies. Death investigators must rely on their training and experience to make the right call.
The medical examiner, Dr. Norman Thiersch, is the county's highest-paid public employee. He reports to Executive Aaron Reardon.
Reardon's office has suggested that police and social workers did not adequately convey their concerns about the boy's death.
County records show that the boy's body was released to a funeral home just three hours after Monroe police began investigating the suspicious death. The child's remains were cremated a day before Monroe police learned that results of the routine toxicology tests.
Since that information surfaced, state social workers have been investigating allegations of negligent treatment or maltreatment, according to CPS records. They removed the boy's older brother from the home. He remains in foster care, state Department of Social and Health Services spokeswoman Chris Case said Wednesday.
As part of their investigation, social workers consulted with Feldman. The doctor noted that the child's anti-seizure medication was slightly below a therapeutic level, but there is no evidence that the medication would have failed to control the boy's seizures.
The boy's primary doctor also called the death "bothersome" because there were no physical explanations for why the boy would die of a seizure disorder.
The boy's father told investigators that he awoke about 3:30 a.m. on Jan. 30 and felt like he needed to check on his son. He told the detective his son was ash white. He said he thought the boy may have had a seizure, so he decided to take him to the Valley General Hospital emergency room in Monroe, court papers said.
The father allegedly reported that the boy was breathing and alive when they left their home for the hospital, about two miles away, but the emergency room doctor said when they arrived, the boy appeared to be in the early stages of rigor mortis. He also had vomit on him, which is a symptom of poisoning, the CPS report said.
The emergency room doctor reported concerns that "something didn't seem right," according to CPS records.
The father reportedly asked the doctor if they'd be able to tell what happened at home. A social worker noted that at the hospital the boy's mother "acted incongruently, drinking coffee and chatting with staff, who did not even realize she was the mother based on her presentation," according to the state records.
The parents allowed the social worker and detective to see their home on Feb. 3. There were no overt health or safety concerns, though it appeared that the home had been staged for the visit, according to the records. The social worker encouraged the parents to request a full autopsy.
The boy's remains were cremated on Feb. 9. The boy's parents stopped cooperating with police early into the investigation, Willis said. They have not talked to police since.
A state fatality review is scheduled for July 28. A review is conducted when a child dies unexpectedly while under state care or while receiving state services.
Diana Hefley: 425-339-3463; firstname.lastname@example.org.
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