Carl and Raylene Worthington appear in Clackamas County Court on March 31, 2008 in Oregon City, Ore. The couple pleaded not guilty to charges of manslaughter and criminal mistreatment in the death of their daughter, Ava. Religion News Service file photo by Doug Beghtel/The Oregonian.

OREGON CITY, Ore. — Prosecution and defense attorneys differed sharply Monday (June 29) on what led to the death of 15-month-old Ava Worthington.

Ava, malnourished and in obvious distress, “died a needless death” because her parents, Raylene and Carl Worthington, failed to provide adequate medical care, said Greg Horner, chief deputy district attorney.

Yet John Neidig, the attorney representing Raylene Worthington, described Ava as alert, playful and having a good appetite in the days and hours before her death on March 2, 2008. “This child had a cold, and it didn’t appear to be anything of great concern,” Neidig said.

The Worthingtons, members of an Oregon City church that believes in spiritual healing, are charged with criminal neglect and second-degree manslaughter.

Their daughter died at home of pneumonia and a blood infection. Prosecutors say antibiotics could have saved her life.

Defense attorneys said the girl’s illness didn’t seem to be anything out of the ordinary; many people were sick that winter, and a child with congestion and a runny nose didn’t seem alarming.

But Horner said the evidence will show a different picture. The child’s condition got progressively worse over the last few days of her life. A large benign cyst on the right side of her neck grew swollen and discolored, making it more difficult to breathe. The growth first appeared when the girl was a few months old.

Horner said that when detectives asked Carl Worthington whether he was concerned the night before Ava died that she might not survive, he replied “yes.” Instead of seeking medical care, the couple relied solely on prayers and faith healing, the father told detectives.

Horner described the girl as malnourished. He said Ava went from being far above normal height and weight when she was born to far below normal when she died. The first doctor she saw was the one who performed her autopsy, he said.

The Worthingtons never denied medical care to Ava, said attorney Mark Cogan, who represents Carl Worthington. “They never felt it was needed.”

Cogan described the Worthingtons as loving and law-abiding parents. The couple held hands throughout Monday’s court proceedings, which were moved to a larger courtroom to accommodate large numbers of supporters from the Worthingtons’ church.

Ava was the victim of an unforeseeable but “deadly collision” of a blood infection and the onset of pneumonia, Neidig said. The combination hit quickly, and Ava would not have survived even if she had been in a hospital, he said.

Defense attorneys said that the Worthingtons and their family and friends reported nothing out of the ordinary. “They thought she was getting better,” Neidig said.

He downplayed the significance of the cyst. Several women in the Worthington family had such growths, which would enlarge and subside but did not cause discomfort or give reason for concern.

The trial will center on the testimony of medical experts who are expected to offer radically different readings of the evidence.

The Worthington case will be the first time anyone in Oregon has been prosecuted under a 1999 law passed in response to an extraordinary number of child deaths involving their church, the Followers of Christ. The law eliminated religion as a defense in most cases of medical neglect.

The case has attracted the interest of advocates for religious freedom, parental rights and child safety as well as national media outlets.

(Steve Mayes writes for The Oregonian in Portland, Ore.)