Two medical experts yesterday offered varying opinions in court about why the wife of a former Waltham man charged with her murder died after ingesting antifreeze.
In the second day of testimony in Middlesex Superior Court, two doctors specializing in the treatment and care of people with kidney disease told jurors what happened to James Keown's wife in her final days.
Authorities say Keown, an ex-Missouri radio host, plotted to poison his wife with ethylene glycol, commonly found in antifreeze. After her second admission in nearly two weeks to Newton-Wellesley Hospital with slurred speech, dizziness and nausea, Julie Keown slipped into a coma and died on Sept. 8, 2004.
Prosecutors say Keown killed his wife to escape financial trouble by cashing in her $250,000 life insurance policy.
Prosecution witness Dr. Hasan Bazari, on staff at Massachusetts General Hospital and Harvard Medical, who specializes in kidney disease, said ingesting just four ounces of antifreeze is deadly.
Bazari did not examine Julie Keown in person but reviewed her medical records and other evidence.
Also, scar tissue found on Julie Keown's kidney after her death appeared to be a couple of weeks old, leading him to believe she was mildly poisoned just weeks prior to her death.
After a four-day stay beginning on Aug. 20, 2004, doctors were still not certain what was wrong with Julie Keown when she was released, Dr. Kevin Rankins told jurors Monday.
When she returned in September, her symptoms were nearly identical but had significantly intensified, eventually causing her heart to stop working, said Bazari.
Between three and eight hours after it is consumed, antifreeze throws off the body's acidic balance, Bazari said. During that time, someone who has ingested antifreeze, like many other alcoholic compounds, will display signs of drunkenness, including slurred speech and difficulty walking, he said.
As the ethylene glycol makes its way through a person's system, it metabolizes and forms crystals in the kidneys, causing toxins to build and eventually leading to death if untreated, said Bazari.
Assistant District Attorney Nat Yeager told jurors Monday that Julie Keown had a pre-existing disease causing her kidneys to function at half of their capabilities.
But, said Bazari, "It's likely she had an underlying kidney disorder that had nothing to do with what happened to her."
Her condition could have been monitored and corrected, said Bazari. However, in time it could have led to dialysis or the need for a kidney transplant, he said.
Julie Keown's mother, Nancy Oldag, told jurors yesterday that her son-in-law phoned in the morning of Sept. 4, 2004, to let her know her daughter was sick again. Oldag told jurors Keown said his wife did not want to return to the hospital.
Julie Keown was eventually admitted at Newton-Wellesley Hospital around 9:15 p.m.
Around 3 a.m. a toxicology screen was sent out for testing. Bazari said, had he been treating her, he would have ordered the test much earlier. Three hours later, according to medical records, the staff administered an antidote commonly prescribed for ethylene glycol.
"They were able to eliminate all the ethylene glycol from her body, but by the time that was done, she had met brain death," said Bazari. "There's no doubt in my mind that she would have had an opportunity to be treated and allowed to live on if she had (been brought in) earlier."
Keown's attorney, Matthew Feinberg, grilled Bazari on his certainty that Julie Keown's kidney condition did not exacerbate the poison's effect.
"So someone with an underlying kidney condition like Julie Keown ... it would take a long time (for the crystals to dissipate)?" said Feinberg.
"The crystals would have built up to a higher level," said Bazari.
Feinberg previously told jurors that authorities have never produced any direct evidence linking his client to the ethylene glycol his wife ingested.
For the second time in court, Feinberg suggested the possibility that Julie Keown committed suicide. He asked Bazari about a 27-year-old man he once treated for antifreeze poisoning. This man, who eventually recovered under Bazari's care, guzzled antifreeze in an attempt to take his own life, said Feinberg.
The defense's medical expert, who was called out of order to accommodate the witnesses, began telling jurors about his experience with ethylene glycol poisoning.
Dr. Richard Hellman, a kidney specialist who works in Ohio, told jurors that according to medical files, Julie Keown had also complained of diarrhea during her first hospital visit.
Hellman also did not examine Julie Keown in person but reviewed her medical records and other evidence.
Diarrhea can cause hypoglycemic acid to form, which would also throw off the body's acidic balance, said Hellman.
"So maybe that was a factor. I don't know, but it's a question. I have questions about that particular situation," said Hellman.
Hellman will continue his testimony today.
Kerri Roche can be reached at kroche@cnc.com or 781-398-8009.
