FARMINGTON --- Scalding, aspiration pneumonia and too much medication caused the death of 4-year-old Ethan Stacy and the manner of death was homicide, the deputy chief medical examiner testified Friday morning.
Dr. Edward Leis was the state's second witness in the preliminary hearing for Nathanael Sloop, 34, of Layton, charged with murdering his wife's son. The fourth and last day of the preliminary hearing is set for 8 a.m. April 19.
Also testifying Friday was Dr. David Andrenyak, a toxicologist with the University of Utah. He said the concentration of Xanax and Benadryl found in Ethan's body were at adult levels, but they were not the sole cause of the boy's death.
"It's a whole picture in considering how Ethan might have died," he said.
Leis testified earlier in the day about injuries Ethan sustained, which included second- and third-degree burns on his legs and feet consistent with being scalded in hot water.
"What is interesting is the areas above and below the knees were spared," Leis said.
That is consistent with the knees drawn up outside of the water in a flex position with his feet flat in a bathtub, he said.
Ethan also had bruises on his head and legs caused by being struck before he died. His body also showed signs of chemical burns that occurred after he died, Leis said.
During cross-examination, Leis confirmed it is difficult to tell when the bruising on the legs occurred or what caused it. He concurred the leg bruises could be consistent with a child who gets injured while playing, but were not significant in causing the boy's death.
The boy's disfigured body was found near Powder Mountain on May 11, 2010, wrapped in eight garbage bags. He died May 8, 2010, officials said.
Tests showed that Ethan had inhaled particles of feces or vomit into his lungs, which infected the respiratory system and caused the aspiration pneumonia.
Leis said the fractures to the boy's skull and face that occurred after he died were caused by a hammer. The boy's head was struck multiple times through garbage bags that his body was wrapped in. Bruises on his face and head that happened before he died were slight, Leis said.
Lab reports showed some of the drugs in Ethan's system were prescriptions for Sloop, according to a toxicology report.
On cross-examination, defense attorney Scott Williams asked Leis if he had any idea how Xanax got into Ethan's system.
Leis said he did not know.
Over-the-counter children's cold medication and children's Tylenol also could have contributed to the boy's dehydration, Leis said.
Leis and Andrenyak both said they were unaware that children's Benadryl, which was given to Ethan, had been recalled shortly after he died because the recommended dosage was incorrect.
Andrenyak said the product numbers of children's Benadryl that was recalled were not the same as the one that Stephanie Sloop bought and that was found in the Sloops' apartment.
The burns on the boy's legs also would have caused Ethan to be dehydrated because of their severity, Leis said.
During cross-examination, defense attorney Richard Mauro asked Andrenyak for his opinion on why a doctor would prescribe the number of medications Sloop was taking.
"The person builds up a tolerance and they have to take more of it to get the relief from (the pain)," Andrenyak said. "They are used to it and tolerate, but there are so many pills here you almost to the point you wonder how a person can function."
Mauro has said that Sloop was under a doctor's care and had presented medical records indicating Sloop had taken more than 4,100 doses of prescription medication in the 11 months preceding Ethan's death.
The medications included Valium, Lortab and other central nervous system depressants, he said.
The preliminary hearing will determine if there is sufficient evidence to hold Sloop for trial on the charges he faces.
The criminal case against Ethan's mother, Stephanie Sloop, 30, is separate from that against Nathanael Sloop. A roll call hearing is set in her case for April 15.
Both Sloops are charged with aggravated murder, second-degree felony child abuse, second-degree felony obstruction of justice and third-degree felony abuse or desecration of a body.