This is the first post in Himmelfarb’s new series “Disorder in the Court,” which will examine true crime stories with medical connections. Know of a great story to feature? Email Rachel Brill at rgbrill@gwu.edu.
Warning: This post contains discussion of a child’s death.
In July 1989, Patricia Stallings took her 3-month-old son Ryan to a children’s hospital. He was presenting with lethargy, emesis, and tachypnea (rapid breathing). A gas chromatography test revealed an elevated level of ethylene glycol in Ryan’s blood (Shoemaker et al., 1992). This is a compound found in antifreeze. Authorities believed that Stallings had intentionally poisoned her son with antifreeze.
After medical treatment, Ryan was placed in protective custody. The next month, Stallings was granted a short visit with her son. Only a few days after that visit, Ryan’s medical issues resurfaced. He received treatment for ethylene glycol poisoning, but sadly, he died.
Stallings was charged with first-degree murder. In 1991, she was convicted of Ryan’s murder and sentenced to life in prison. But only a few months later, Stallings was acquitted. Medical evidence proved that she had not killed her son.
While awaiting trial, Stallings had given birth to another son, D.J. He was placed in foster care. At only one month old, D.J. began displaying symptoms similar to the ones Ryan had. Doctors diagnosed D.J. with a genetic disorder called methylmalonic acidemia (MMA), a type of organic acidemia (DynaMed). This disorder disrupts normal amino acid metabolism, resulting in the inability to digest certain fats and proteins. This causes an often-fatal buildup of methylmalonic acid in the blood. MMA is rare, occurring in about 1 of 50,000 births (Baumgartner et al., 2014). One fact critical to this story is that methylmalonic acidemia causes the production of propionic acid, which is almost indistinguishable from ethylene glycol.
D.J. was treated for MMA and recovered. At first, Stallings and her lawyer were unable to prove that Ryan also had had MMA. Without strong evidence, the judge dismissed the theory. But after Stallings’ conviction, her case was featured on Unsolved Mysteries. Dr. William Sly and Dr. James Shoemaker of St. Louis University saw the episode and offered to test a blood sample from Ryan. Shoemaker knew that in order to identify propionic acid correctly, a gas chromatography - mass spectrometry test is required, rather than gas chromatography alone (Shoemaker et al., 1992). This test determined that Ryan had in fact died from MMA.
Stallings was released from prison in July 1991 pending a new trial, and the case against her was dropped entirely in September 1991. She later reached an out-of-court settlement with the hospitals and laboratories involved in the case.
References
Baumgartner MR, Hörster F, Dionisi-Vici C, Haliloglu G, Karall D, Chapman KA, Huemer M, Hochuli M, Assoun M, Ballhausen D, Burlina A, Fowler B, Grünert SC, Grünewald S, Honzik T, Merinero B, Pérez-Cerdá C, Scholl-Bürgi S, Skovby F, Wijburg F, MacDonald A, Martinelli D, Sass JO, Valayannopoulos V, Chakrapani A. Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia. Orphanet Journal of Rare Diseases. 2014;9:130. doi: 10.1186/s13023-014-0130-8. https://wrlc-gwahlth.primo.exlibrisgroup.com/permalink/01WRLC_GWAHLTH/gr7gmc/cdi_gale_incontextgauss_ISR_A540650471
DynaMed. Organic Acidemias. EBSCO Information Services. Accessed April 27, 2022. https://www.dynamed.com/condition/organic-acidemias-23
Shoemaker JD, Lynch RE, Hoffmann JW, Sly WS. Misidentification of propionic acid as ethylene glycol in a patient with methylmalonic acidemia. The Journal of Pediatrics. 1992;120(3):417-21. doi: 10.1016/s0022-3476(05)80909-6. https://wrlc-gwahlth.primo.exlibrisgroup.com/permalink/01WRLC_GWAHLTH/gr7gmc/cdi_webofscience_primary_A1992HG94000013CitationCount
