At 48 pounds, Joshua Mendoza had lost the will to thrive, Dorchester County Coroner Chris Nisbet said.
That's a description commonly used for 80- or 90-year-old people, but Nisbet used it to describe the 13-year-old who died Feb. 10.
Joshua's death was caused by malnourishment and neglect, and not his lifelong disease tuberous sclerosis, which left him in a wheelchair and prone to seizures, according to the coroner. Relatives have been talking to media outlets in the Lowcountry, countering the coroner's finding.
In the wake of Joshua's death, Kimberly Love and Jason Buckley were arrested and charged with murder.
The boy's grandmother Kathleen Nicholson told The Post and Courier that "the arrests resulted from investigators' failure to understand the genetic disorder that withered his body."
So how did Nisbet determine death due to neglect?
Bone density is one of the measures. A forensic anthropologist has determined the bone density shows malnourishment, Nisbet said. That anthropologist is also continuing to study the case. A forensic pathologist is also on the case.
Nisbet said if the child was near death and the parents wanted him to die at home, proper steps could have been taken to avoid murder charges. One of those is enrolling him in hospice care.
"In my professional opinion, mom and dad didn't do the right thing," Nisbet said. He added the boy's condition likely caused the atrophy in his legs, but "anybody can look at the child and to see he wasn't taken care of properly."
Tuesday, the Coroner's Office released a statement that said:
After a thorough investigation by the Coroner's office, it was learned that the child's last known medical visit was in 2006 after which a DSS investigation was initiated for the parent's failure to follow up on his treatment. The forensic pathologist responsible for the autopsy determined the extent of the abuse to be ongoing and extensive.
According to The Post and Courier, Joshua was formerly enrolled at Fort Dorchester Elementary, but was pulled from school when his condition worsened.
"His condition was not a life-threatening condition," he said. "This child was neglected for years."
According to the U.S. National Library of Medicine, tuberous sclerosis is a genetic condition with no known treatment. The site explains that medication can control seizures. According to Tuberous Sclerosis Alliance, an advocacy group for those afflicted, most patients diagnosed with the disease have a normal lifespan.
There can be complications in some organs such as the kidneys and brain that can lead to severe difficulties and even death if left untreated. To reduce these dangers, people with TSC should be monitored throughout their life by their physician for potential complications.
Nisbet said his investigators are still working the case to gather as much evidence as possible.
"There's a lot of unanswered questions," he said.
Updated 6:56 p.m. Feb. 21 to add information from the Coroner's Office statement.