Despite the best efforts of the emergency medical technicians, AJ was pronounced dead on arrival at the hospital. The stunned parents were barely able to process this news when they got a call from the neighbor telling them that the other twin, JJ, had gone into respiratory arrest and 911 had been called. That twin was taken to a different hospital, where he too died.

Initially, there was concern that Mrs J might have inadvertently given the children too much of the acetaminophen/codeine. The coroners (there were 2, as 2 hospitals in 2 separate counties were involved) initially believed the twins died from acetaminophen/codeine toxicity. The boys had elevated levels of it in their blood streams. To investigate, the Sheriff seized the bottle of medication, but after testing, the bottle was shown to contain the correct concentration of medication as made by the pharmacy, and the proper amount was still left in the bottle.  

One of the coroners suspected that the twins might have a genetic defect affecting their ability to metabolize medication. He sent samples of the blood to be tested and the twins were found to have a genetic mutation of an enzyme that is responsible for metabolizing drugs, including opiates. It was determined that the boys were “impaired” metabolizers, accounting for elevated levels of codeine in their blood. The conclusion was reached that their deaths were a result of the genetic mutation which caused a codeine overdose.

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When the parents were able to function again, they sought the counsel of a plaintiff’s attorney. He, in turn, had all the medical records reviewed by his experts, and they believed that the genetic mutation was not responsible for the children’s deaths.

The attorney took the case and sued Dr L. The physician consulted with his own attorney who was satisfied with the coroner’s conclusion and felt that the deaths were due to the genetic mutation and not a result of medical malpractice.

The case went to trial. For obvious reasons the parents made extremely sympathetic witnesses and some of the jurors were in tears as Mrs J. told the tragic story.