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Death by prayer
When Madeline Neumann needed medical attention, her parents refused. Will state law protect their decision?
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It was 3:45 in the afternoon on Easter Sunday when Marathon County Medical Examiner John Larson was called to the St. Clare's Hospital emergency room in Weston, just outside Wausau, to investigate the death of a child.

At the hospital Larson examined the dehydrated, emaciated body of 11-year-old Madeline Kara Neumann. Lines snaked into the lifeless girl's body.

Larson stepped away so the young girl's parents, Dale and Leilani Neumann, could be alone with her and their grief. Then he took them aside, asking what funeral home they preferred.

"We won't need one," he was told. "She will be alive tomorrow."

Larson pressed further. He explained that the body would be taken to Madison for an autopsy. Again the couple waved away the facts lying before them in the hospital bed. "You won't need to do that," they assured him. "She will be alive by then."

Madeline Kara Neumann - "Kara," as she was called - didn't come back to life. Instead, her parents have been charged with second-degree reckless homicide in her death.

In the days, perhaps weeks, before their daughter died of diabetic ketoacidosis - an illness authorities contend could have been readily treated - Dale and Leilani Neumann refused to seek medical care. They did so despite the girl's worsening condition and despite the urging of family members and friends. Instead, they insisted her body was a battleground in a spiritual war between Jesus Christ and the forces of Hell. Only by resisting worldly medicine, they believed, could she be saved.

Marathon County District Attorney Jill Falstad and other lawyers in the case are under a court gag order and won't comment. But Falstad's decision to file criminal charges over the actions and inactions of Madeline's parents represents an unusual and even bold legal step.

Wisconsin law, like that of as many as 40 other states, carries an explicit exemption from prosecution for child abuse or neglect for parents who forgo medical treatment for their children on religious grounds and instead seek "treatment...through prayer."

That exemption probably helped Dale and Leilani Neumann, who have three other minor children, escape a specific charge of abuse or neglect, says Shawn Peters, a scholar at the UW-Madison and author of the recently published book, When Prayer Fails: Faith Healing, Children, and the Law. The homicide statute under which they were charged carries no such exemption.

Yet the state's law could undermine the prosecution. Even if ultimately convicted, the couple could win an appeal because of the faith-healing exemption.

"The fact that you have an exemption in one part of the criminal code, and then another part of the criminal code is interpreted as not protecting that same conduct, raises an issue of due process of law," says Peters. "This exact set of circumstances has come up several times in other states. Defendants have had their convictions overturned or criminal cases against them have not been allowed to proceed."

Unless a plea bargain settles the case quickly, Peters believes the fate of the Neumanns could hang in the balance for years, at least until the Wisconsin Supreme Court weighs in on the issue.

Beyond that, the Neumann case pulls a veil from the often-shrouded practice of faith healing across the country. "It shows the persistence of these healing practices and the law's inadequacy to remedy this particular issue," says Peters. "I do think there are more cases we don't know about."

True believers

With its modern brick architecture, brightly colored décor and free Wi-Fi connection, Monkey Mo Coffee Shop in a Weston strip mall has the look of a chain like Starbucks. But this is a mom-and-pop operation, opened in early 2007 by Dale and Leilani Neumann.

(In April, shortly after their daughter's death, the couple told the Wausau Daily Herald they were transferring ownership to a longtime friend from California. But in late July, the shop's newly renewed Marathon County Health Department license continued to list the Neumanns as the business' registered agents.)

The family's history is sketchy. The Neumanns - Dale is 46, Leilani 40 - did not respond to a note left for them at Monkey Mo in mid-July. Over the last two decades, say police reports, the family has moved about, living at various times in Green Bay, California and Wausau.

Beyond its mission of delivering caffeine, Monkey Mo also was the home base for the Neumanns' ministry: a strain of Pentecostal Christianity emphasizing belief in faith healing and the doctrine that the Apocalypse is looming.

The Neumanns were readers of and occasional contributors to a website called Unleavened Bread Ministries (www.unleavenedbreadministries.org). The banner across its top proclaims, "Warning: These are America's Last Days."

Unleavened Bread Ministries is operated by David Eells, a self-appointed preacher in Pensacola, Fla. It's filled with predictions of impending apocalypse and assertions that people can be healed of illness through faith and prayer. One page features 63 separate testimonials to miraculous cures ranging from cancer and birth defects to hay fever and "uneven tire wear" on a car.

In February, Leilani Neumann posted an essay on the site that offers a glimpse into her views. It relates her vision of laying hands on others to impart the Holy Spirit. She says she did just that in real life the same day.

"Many times The Lord has told me things that are going to happen many years down the road, but this was the first time I had experienced this kind of preparation for that very day," she wrote. "I feel God saying it is time for believers to step forward in obedience and faith and signs will follow."

Spiritual attack

At 2:33 p.m. on Easter Sunday, March 23, two officers from the Everest Metro Police Department, which covers the city of Schofield and both the town and village of Weston, were dispatched to the Neumann home. Ariel Neff, a family relative in California, had reported that the couple's 11-year-old daughter was ill, in a coma, and her family would not have her hospitalized for "religious reasons."

The officers found Dale Neumann in the dining room, attempting to administer CPR to his unconscious daughter, pushing down on her chest. "Both the mother and the father were praying to God," officer Scott Marten wrote in his incident report. Madeline Neumann's eyes were open and her body warm, but she was thin and looked malnourished. Emergency medical personnel took her to St. Clare's Hospital, where doctors tried to revive her for 45 minutes before pronouncing her dead.

Initially, the Neumanns were closemouthed. While still at the hospital, they told officer Marten that their daughter "has not been sick at all over the last couple of days," according to his report. He added: "It was extremely hard to get any information from the mother and the father about any medical problems Madeline was experiencing."

But later Sunday evening, the parents submitted to separate police interviews. Both reported their daughter had been weak and tired for about two weeks before her death; her father attributed the change to the onset of puberty. More recently, Leilani Neumann said, the girl was drinking huge amounts of water and urinating frequently.

In his interview with Capt. Scott Sleeter, Dale Neumann downplayed his daughter's symptoms. He said she appeared "a little more tired" on the Friday before her death. She drank a lot of water Saturday, but Neumann noticed nothing alarming. And he rejected Sleeter's description that Madeline was unconscious on Sunday morning. "Neumann preferred to say that she was 'in sleep mode,'" Sleeter wrote in his report.

The day before Madeline's death, her mother told police, she lay on a couch, listless. "We stayed by her side nonstop and we prayed," Leilani Neumann said. "I asked Kara if she loved Jesus and she shook her head yes." The girl's breathing was deep and labored.

That evening, the girl collapsed while using the toilet. The family brought her downstairs to sleep on the couch. Sunday morning, her mother said, Madeline appeared to be breathing more easily. She tried feeding her chicken broth from a syringe; soon afterward, the girl stopped breathing.

Det. Sgt. Dennis Halkoski asked if the family ever thought about taking their daughter to the doctor. "No," Leilani replied. "We just thought it was a spiritual attack and we prayed for her." When her husband suggested getting medical care, "I said, the Lord's going to heal her, and we continued to pray."

A search of the Neumann home that evening showed the couple had sought emergency help - just not from a doctor. The day before the girl died, Dale Neumann had emailed David Eells' website seeking the preacher's direct number: "We need agreement in prayer over our youngest daughter, who is very weak and pale at the moment with hardly any strength," the message pleaded.

The reply, though not from Eells, was in the form of a prayer, which read in part: "We thank You Father for giving Dale and Leilani the faith to hold fast to the confession of their hope that it waver not, for it is Your will Father that Kara was already healed, I Peter 2:24. We add faith to Dale's and Leilani's and command Kara to be healed. We command that spirit of infirmity to loose Kara now, leave her body, leave her home, and go back from where it came and stay there...."

A test of faith

On Sunday afternoon, as their daughter's condition worsened, the Neumanns asked their friends Randall and Althea Wormgoor to come over and pray.

The Wormgoors - whom the Neumanns met in California and persuaded to move to Wausau, possibly so Randall could open a second Monkey Mo coffee shop - did just that. But when they saw how ill Madeline was, they urged the couple to summon medical help.

Dale Neumann reportedly said the girl's illness "was a test of faith for the Neumann family and asked the Wormgoors to join them in praying for Kara to get well," Halkoski wrote after interviewing the Wormgoors. While the Wormgoors were there, the girl lost consciousness, and Randall Wormgoor called 911.

Althea Wormgoor told police that Leilani Neumann told her Madeline's symptoms had been going on for about three weeks - far longer than either parent admitted in their own police interviews.

Ariel Neff, the aunt whose call from California had sent police to the Neumann home, told police she'd heard from Dale Neumann's mother, also in California, that Madeline had been unable to walk or talk for some three or four days. Neff said she spoke directly to Leilani Neumann some days before and urged her to give the girl Pedialyte for nutrition. Leilani allegedly refused, telling Neff that doing so would take away glory from God.

Evalani Gordon, the girl's grandmother, told police that, according to Leilani, Madeline had been tired, weak and listless for as long as a week and a half before her death. When Leilani related on Saturday night that Madeline wasn't walking or talking, Evalani urged her to call a doctor. "No, she'll be fine," Leilani reportedly replied. "God will heal her."

Dr. Ivan Zador, a pediatric endocrinologist at the Marshfield Clinic, mapped out a typical progression of untreated diabetes for police.

Blood-sugar levels skyrocket. The kidneys draw sugar into the urine and pull copious amounts of water from the body. The diabetic urinates frequently and experiences intense thirst. The blood thickens, becoming syrupy; its ability to feed the brain deteriorates. The person gets tired, sleepy and stops drinking, becoming dehydrated.

In place of sugar it can't break down, the body burns fat for energy, making the blood increasingly acidic: ketoacidosis. The heart slows, blood pressure falls, and shock sets in. Eventually, the person falls into a coma.

Madeline Neumann's rapid, deep breathing the day before her death, Zador said, likely signaled ketoacidosis, as the body tries to expel the buildup of acid. Her less-labored breathing on Sunday morning, which her parents took as a sign that she was getting better, was probably just the opposite: her body was giving up a battle it could not win without help of the sort that was not provided.

It's the law

Rita Swan once tried faith-healing on her own child, with disastrous results. The death of her son in 1977 transformed Swan from a Christian Scientist who followed church teachings about curing illness through prayer into an anti-faith-healing crusader. She now runs Children's Healthcare Is a Legal Duty (CHILD) from Sioux City, Iowa.

"We believe that all parents should have a duty to get necessary medical care for their children regardless of their religious beliefs," says Swan.

In 1998, Swan and University of California-San Diego pediatrician Seth Asser published an article in the medical journal Pediatrics based on their review of 172 deaths of children between 1975 and 1995 whose parents had withheld medical care on religious grounds. They concluded that 140 of those children - 80% - would have had a 90% chance of survival had they received conventional medical care; another 18 would have had a 50% survival rate.

"They died of very simple things," says Swan. "Lots of diabetes deaths. Lots of infectious diseases that are readily treated with antibiotics."

And in virtually every state, prosecutors were prevented from bringing neglect charges, because the parents had relied on spiritual healing. Swan traces those laws to a mid-1970s federal mandate, which she says was lobbied for by the Christian Science Church and Christian Scientists.

But a Wisconsin spokesman for the church frames it differently. Even before the federal guidelines were passed, "almost half the states permitted spiritual care in some form for the healthcare of children," says Joe Farkas. "This means religious accommodations did not originate with the federal government. The federal government simply responded to what state governments were already doing."

The feds quietly removed the mandate in 1983, but only a handful of states have repealed or narrowed the exemptions. Wisconsin has not. State statute 948.03(6) still says a person is not guilty of failing to protect children from harm "solely because he or she provides a child with treatment by spiritual means through prayer alone for healing in accordance with the religious method for healing...in lieu of medical or surgical treatment."

This statute drew some attention in 2003, when a 4-year-old autistic child, Terrence Cottrell, was crushed to death in Milwaukee during an attempted exorcism by a self-taught preacher. The man was convicted of felony child abuse. But afterward, Milwaukee County District Attorney E. Michael McCann urged state lawmakers to repeal the "treatment through prayer" exemption. (McCann, now an adjunct professor at Marquette University, ignored repeated requests for comment.)

The UW's Peters, who recounts the Cottrell case in his book, says that as long as the law is in effect, it could plausibly offer the Neumanns an eventual reprieve. Former Dane County District Attorney Hal Harlowe agrees, citing the longstanding legal principle of "the rule of lenity."

"If there is some ambiguity in the law regarding the way it's to be construed, or if there are two offenses that fully describe the conduct involved, then the defendant is entitled to get the benefit of the more lenient application of the law," says Harlowe, now a Madison defense attorney. "At some point, you may see that being argued here."

The Neumanns remain free on signature bonds totaling about $450,000. A judge has found Dale Neumann indigent and qualified him for a court-appointed attorney; a second attorney represents Leilani Neumann. In June, the Neumanns waived their right to a preliminary hearing; their routine request for dismissal of the charges was denied.

The couple's formal arraignment is slated for Aug. 19. Last week a judge ordered that a new protection plan be put in place to ensure that the couple's three remaining children, ages 13 to 17, are not deprived of medical attention should the need arise.

Time for change?

The Neumann case is sparking fresh calls to end Wisconsin's "treatment through prayer" exemption.

"It is time for that law to be repealed," says Annie Laurie Gaylor, co-president of the Madison-based Freedom From Religion Foundation. "The law is a green light for parents to think they don't have any responsibility to society [regarding how] they treat their children. The state should be stepping in here to do everything it can to discourage faith healing in place of medical care."

Any such attempt, however, will face opposition from the Christian Science Church, which is among the most established religious groups that promote the use of prayer to treat physical ailments.

"We deplore the abuse and neglect of children under any circumstances," says Farkas, the church's Wisconsin lobbyist. He says Christian Scientists "don't claim that all cases of religious objections to medical care should be free from legal limitations." And it would be "willing to work with legislators" on any efforts to redraft the law.

But the church would not want the law changed in a way that would expose its members to prosecution for practicing spiritual healing.

"The Christian Science Church has documented 125 years of healings that have occurred through prayer" since it was founded in 1879, says Farkas. "Spiritual healing through prayer definitely has a place in society."

Indeed, the state of Massachusetts, which repealed its own exemption law, is now considering reinstating a narrower form. Boston lawyer Stephen Lyons, who helped defend Christian Scientists convicted - and later acquitted - of homicide in the death of their child 13 years ago, says the new bill would let parents charged in such cases cite belief in spiritual healing as a defense.

Lyons equates families who act on their beliefs about spiritual healing with a long line of pioneers seeking religious liberty. He contends that cases like the one he handled and the one involving the Neumanns are often distorted in a swirl of publicity and prejudice.

"Ketoacidosis is something that kills children in hospitals every day," he says. "But we never second-guess the doctors because we assume that they do their best. But the parents of children who died of these illnesses never get the benefit of the same assumption. What gets lost is what they were seeing, what they were experiencing. No one seems to want to find out about the reasonableness of their conduct."

Shawn Peters takes a different view, born of his review of the history of faith-healing: "The law is supposed to reflect public consensus. Most people do not want this kind of behavior exempted from prosecution."

But even when parents are convicted, they often get light sentences. The feeling is that they were sincere if misguided, and have suffered enough. "What everyone wants to have happen is that children will be protected, that children will be safer, and that children won't suffer," says Peters. "I don't think that prosecuting parents after the child has died really solves that."

Imposing heavy penalties in such cases will not deter people who believe they are implementing the will of God. Peters sees it as a lose-lose situation.

"No one who is involved in these cases likes them," he says. "No one walks away from them feeling satisfied. No amount of prosecuting the parents is going to bring the child back to life."

God is in the medicine

The vast majority of Christians who read the same Bible that led Dale and Leilani Neumann to withhold medical care for their daughter come to sharply different conclusions.

God "is a healing God - we believe that," says Marc Maillefer, senior pastor at Door Creek Church in Madison, part of the conservative Evangelical Free Church denomination. "We pray for healing in our church," and if congregants request it, "we anoint people for healing. I've seen people get healed, and I've seen people who haven't healed."

Miraculous cures are certainly within God's power, he says. But God, he believes, is just as present in medical treatment: "God is the creator of the doctor who has skill and those who make medicine to heal."

Alex Thornburg, senior pastor of the Westminster Presbyterian Church in Madison, offers a similar interpretation. While he takes biblical accounts of healing seriously and believes that medically inexplicable healings are real, the spiritual side of healing "is as much about wholeness as about a disease being cured." A sick person may become whole in spirit even if they do not physically recover.

And Thornburg believes that to rely only on prayer misinterprets the Bible. "God gave us brains to think up the medicines to cure these diseases," he says. "Is that not also part of healing? So to disassociate religion from science and to not use science because you don't think that's religious or spiritual is a misunderstanding, I think."

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