If the wife of a former Waltham man accused of poisoning her with antifreeze had been brought to Newton-Wellesley Hospital hours earlier during a follow-up appointment and tested when she arrived, medical experts said yesterday in court she could still be alive.
In the third day of testimony at Middlesex Superior Court, three doctors specializing in kidney disease and related illnesses all said James Keown's wife should have come to the emergency room hours earlier.
Doctors also offered differing opinions on their analysis of medical records and drug interactions, which defense attorney Matthew Feinberg suggested might have caused Julie Keown to become confused and depressed during the last days of her life.
After her second admission to the hospital in nearly two weeks, Julie Keown slipped into a coma and died on Sept. 8, 2004.
Authorities say her husband, a former Missouri radio host, poisoned her with antifreeze at least twice, successfully killing her the second time. Keown killed his wife to cash in on her $250,000 life insurance policy, authorities allege.
During her first ER visit on Aug. 20, 2004, Julie Keown had difficulty walking and speaking. She was also nauseous and dizzy, medical records say.
Brought to Newton-Wellesley Hospital by her husband, Julie Keown was released nearly four days after doctors failed to determine what was wrong with her despite a blood test that showed slightly higher levels of acid in her blood.
Dr. Hasan Bazari, who previously testified, told jurors that once ingested, antifreeze will throw off the body's acidic balance. Within the first few hours of poisoning, the acidity change can be found with a simple test, he said.
As time elapses, the acidity will slowly return to normal while the ethylene glycol metabolizes and crystals begin forming in the kidney, leading to major organ failure, said Bazari.
On her first visit to Newton-Wellesley's ER, Julie Keown was seen by Dr. Julia Neuringer, an attending physician specializing in kidney diseases.
Neuringer said after an examination, she suspected Julie Keown's kidneys were not functioning to their full capabilities and had Keown come back for a follow-up visit a few days later.
During that follow-up, Neuringer said she reviewed a CT-scan of Keown's kidneys and both she and Julie Keown were "shocked" at their condition. Neuringer said she told Keown she had a chronic kidney disease that would eventually require dialysis and a possible transplant.
Despite her chronic condition, Neuringer said she determined "some acute component that we still hadn't explained" had triggered a sharp decline in Julie Keown's kidneys within the past month.
Neuringer testified yesterday that she agonized over Julie Keown's condition, unable to come up with a concrete answer about the "acute component" before she was released.
"I personally did not feel as though the (acidity level) was due to ethylene glycol," said Neuringer, who has treated extreme forms of antifreeze intoxication before. "Nothing really fit. ... I could not explain the first set of labs."
In retrospect, Neuringer said Julie Keown must have swallowed a small dose of antifreeze the first time or the acidity tests were taken at the tail-end of ingestion.
"What you're telling us is that you were wrong?" Feinberg asked during cross examination.
"I don't think I was wrong then. What I'm telling you is if I had the correct (medical) history, I would have made the correct diagnosis," said Neuringer.
Neuringer said Julie Keown was previously prescribed Prilosec, a drug that decreases acid in the stomach. Thinking the decline in her kidney function was due to an allergic reaction to Prilosec, Neuringer prescribed an anti-inflammatory steroid.
However, the defense's medical expert, Dr. Richard Hellman, who testified at length over the course of two days, said the steroid can cause side effects such as lack of muscle control, fatigue, moodiness and psychosis.
Hellman, who is on staff at Indiana University School of Medicine, said it is unclear if Julie Keown was experiencing ethylene glycol poisoning during her first hospital visit on Aug. 20, 2004.
The symptoms and test results Julie Keown presented during her first admission could be attributed to other factors, including a combination of her reported diarrhea and the pre-existing kidney condition, he said.
Hellman did not dispute that Julie Keown died from ethylene glycol poisoning just weeks later.
On Sept. 4, 2004, James Keown attempted to call Neuringer at approximately 10 a.m. because his wife was suffering from similar, but more severe, symptoms. Keown was referred to Dr. Grazyna Galicka-Piskorska, an on-call kidney doctor covering for others Labor Day weekend.
Galicka-Piskorska said she told Keown to bring his wife in immediately to the hospital and she would meet them for a consult.
The Keowns arrived at the hospital nearly 12 hours later, around 9:15 p.m., Galicka-Piskorska said.
The following day, said Galicka-Piskorska, she met with the couple in Julie Keown's hospital room.
After reviewing tests done throughout the night on Julie Keown, Galicka-Piskorska told James Keown his wife's symptoms could indicate ethylene glycol poisoning and asked him if they had any products with that as an ingredient in their home.
Galicka-Piskorska said James Keown told her that nothing containing ethylene glycol was in in their home.
She also said he told her his wife was not suicidal.
As to their delay in getting to the hospital, "He said that his wife didn't want to, that she wanted to rest and that she refused to go to the hospital," Galicka-Piskorska said.
Kerri Roche can be reached at kroche@cnc.com or 781-398-8009.
