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David Stephan and his wife, Collet, arrive at court on March 10, 2016, in Lethbridge, Alta.David Rossiter/The Canadian Press

The naturopath who treated Ezekiel Stephan, an Alberta boy who died of bacterial meningitis in 2012, "did not meet the standard of care" and should be held accountable for her actions, according to a critical letter sent to the College of Naturopathic Doctors of Alberta by nearly four dozen physicians across Canada.

The situation raises broader questions about the growing trend toward the regulation of naturopaths in Canada and whether the colleges are doing proper oversight, said Michelle Cohen, a family physician in Brighton, Ont., who wrote the letter.

The college has opened an investigation based on the letter and did not respond to an interview request.

David and Collet Stephan were found guilty in a Lethbridge court on Tuesday of failing to provide the necessaries of life for their son Ezekiel, who was 19 months old.

The Stephans went to a naturopath, Tracey Tannis, because they suspected that the boy had meningitis. The naturopath testified that she did not physically examine Ezekiel and that she had advised the Stephans to take him to a hospital. But she gave Ms. Stephan an echinacea treatment for the child. Others testified that Dr. Tannis discussed Ezekiel's case with his mother.

Naturopaths are governed by a self-regulatory college in Alberta, in a manner similar to doctors and nurses. Dr. Tannis is still listed as a member in good standing of the College of Naturopathic Doctors of Alberta and there are no notes attached to her registration to suggest that there have been any concerns about her actions.

The physicians' letter criticizes the naturopath for recommending a treatment for a sick child without having examined him and for failing to provide vital information about the grave risks of meningitis and the urgent need for a lumbar puncture and treatment to prevent death or permanent brain damage.

"Albertans should expect that any regulated health-care professional meeting the standard of care for treating children would have basic knowledge about meningitis," the letter says. "Albertans should also expect that any regulated health professional using the designation 'Dr.' would not recommend a treatment for a child without first physically examining them to arrive at a diagnosis."

Dr. Tannis did not respond to an interview request on Wednesday.

Dr. Cohen said she was prompted to write the letter because the case has focused solely on the actions of the parents, not those of the naturopath. Although it's unclear how involved the naturopath was in Ezekiel's care, the college should have already been investigating her conduct and making a public statement about its commitment to oversight and ensuring that regulated naturopaths are providing safe care, she said.

More provinces are moving to regulate naturopaths. But this case suggests that some naturopaths are using the privileges of the regulatory status without following the rules, Dr. Cohen said.

"If they're going to call themselves doctors, which they do, and say that they have done the same kind of training that we do, … then they need to be held responsible when there is such a severely negative outcome," she said.

The letter also highlights the fact that Dr. Tannis, like many other naturopaths, sells treatments directly from her clinic, which could put her in a conflict of interest. "A medical doctor selling medication directly to the public in this way would be expected to bear responsibility for a poor patient outcome, and the expectation should not be any different for a naturopath," it says.

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