Connor Carter is gone. But Superman's spirit lives on.

That's what's sustaining an East Hempfield Township couple who have endured a harrowing 15 months since losing their son.

That and their belief that they did not, after all, inadvertently cause his death.

Dr. William and Barbara Carter's 14-year-old boy, known affectionately by family and friends as "Superman" for his humor, energy and thoughtfulness, died December 18, 2008.

Connor was a strapping, 195-pound football player at Hempfield High School. A few days before he died, he'd undergone knee surgery to repair a right anterior cruciate ligament torn in gym class, and he'd returned home in severe pain.

After the boy had lain on the couch a couple of days, his general-practitioner dad affixed to his back a pain-killing patch, fentanyl, that he'd previously prescribed for someone else.

The Carters found Connor unresponsive the next morning, and he was pronounced dead at Lancaster General Hospital.

On March 11, Carter, 59, a general practitioner who also does cosmetic procedures, pleaded guilty to recklessly endangering another person in connection with Connor's death.

Under the Lancaster County Court plea agreement, Carter may earn dismissal of the misdemeanor charge by successfully completing 100 hours of community service, including talking to other medical professionals about the legal guidelines of administering prescription drugs.

He says he hopes to soon regain his license to practice medicine, although he agreed to surrender his license to handle narcotics.

That's the story that has come out publicly so far, and the Carters don't dispute it. But they say it's not the whole story.

Tragic case
One facet the Carters say was obscured by the publicity surrounding the tragic and unusual case is their son's life. The other things are the context and manner of his death.

The Carters say they agreed to the court plea because they were worn out by their battle in the legal system.

"A trial would have been emotionally and financially more than we could endure," Barbara Carter said.

However, she contended last week, that ultimately, "the evidence doesn't support the reckless endangerment" charge or the classification of the death by the county coroner's office as a homicide.

The cause of death was ruled to be "multiple drug toxicity," according to Lancaster County District Attorney Craig Stedman, and that stands.

But the Carters say their understanding of the painkillers' impact changed substantially in January after their defense attorney, Heidi Eakin, questioned the meaning of the toxicology figures reported by an independent lab.

"For 13 months," Barbara Carter said, "the only information we had [from attorneys] was Connor's levels were off-the-chart high."

"Up until two weeks ago," her husband added, "the plea I was faced with made me a felon."

The Carters have said they have a previous relationship with Lancaster County Coroner Dr. Stephen Diamantoni that might have had a bearing on the case.

Diamantoni said Saturday that he recused himself from the case because Dr. Carter worked for him about 20 years ago; the coroner handed off the investigation to Eric Bieber, chief deputy coroner.

Diamantoni, who is also a family practice physician, noted that he recuses himself as a matter of policy from all cases in which there could be a conflict of interest or perceived conflict of interest.

In February, a request by a Lancaster Newspapers reporter for a complete copy of Connor Carter's autopsy report was turned down by Assistant District Attorney Susan Moyer, who handles Pennsylvania Right to Know law matters for the county.

Eakin said there might have been a misunderstanding over the units of measurement in the toxicity report. When she analyzed the document, she said, "it looked like everything was in therapeutic limits."

An independent expert contacted by the Carters confirmed her assessment.

Connor had fentanyl in his system as well as oxycodone and an anti-nausea drug prescribed by another physician, said Dr. Gerald O'Malley, a Philadelphia toxicologist with the national Doctor's Advocate group.

However, O'Malley said, the cited levels of the drugs "were lower than in any other [similar fatality] case ever reported. We're talking 100 times lower."

Could the drugs still have been a contributing factor in the death?

Connor's organs were donated and his remains were cremated, so no further medical investigation is possible.

No one will ever know, O'Malley said. "The law expects black or white answers. People want absolute certainty. Unfortunately... you're often left with more questions than answers."

Stedman said in an e-mail that the strength of the fentanyl patch may not have correlated directly to the drug level evident in Connor's bloodstream.

"There was no real precedent" in the case, he said, "and it was abundantly clear that Dr. Carter has suffered a great loss and a far greater sentence than any court can impose.

"To help us decide the proper path," the district attorney added, "I personally spoke to a number of leading doctors in the area. I also sought the advice of other experienced prosecutors" and East Hempfield Township police.

"The charge we ultimately proceeded on did not include the specific allegation that [Carter] actually killed his son," Stedman said. Thus, "the actual levels [Connor] was able to metabolize prior to death were not relevant in court. Instead, what everyone agreed was that it was criminally reckless to give this particular patch, with its particular strength, to his son under these particular circumstances."

Eakin, a former first assistant district attorney under Stedman, said that "the district attorney's office did everything right in this case."

Barbara Carter said she is grateful that the misdemeanor charge will give her and her husband a chance to rebuild their lives.

However, she said, she was horrified by the seemingly endless legal wranglings and apparent discrepancy in the toxicology report that she says publicly branded her husband and caused him to question his own clinical judgment.

Transferring a prescribed narcotic medication such as fentanyl from one patient to another is technically a felony, Eakin said.

However, contend Eakin, the Carters and others, many medical professionals don't know that.

"He was being a dad and a doctor at the same time," Eakin said of Carter.

The physician said the patch he put on Connor was the third-strongest available and had been returned to him, with its original seal intact, by a patient.

On the day Connor died, according to the police affidavit, Carter told firefighters and medics that the boy had suffered an "accidental narcotic overdose."

But in retrospect, the doctor said, that snap conclusion, made when he was distraught and in shock, was not supported by the evidence.

Last week, Carter and his wife recounted how he had considered the warnings on the fentanyl box, monitored Connor's reaction to the oxycodone prescribed by his surgeon, Dr. Michael Gish, and factored in the teen's large size before administering the patch.

"He's used these safely in his practice for years," Barbara Carter said. "This was his child. He thought through it very carefully."

Connor was in a lot of pain, and his parents were concerned that he had been immobile for more than 30 hours and hadn't been able to put weight on his injured leg, Barbara Carter said.

"We were both worried about a pulmonary embolism," she said, referring to a blood clot on the lung, caused by inactivity.

The night before Connor died, "we watched a movie together," recalled Dr. Carter, who said he suffered the same injury 30 years ago in a game of pickup football in his native Wisconsin.

Barbara Carter went downstairs to check on Connor at 12:30 or 12:45 a.m., she said, and he woke up immediately. "He was talking to me. He was texting a friend" about feeling like an old man and not being able to move around.

In the hours after that, Dr. Carter said, "Something catastrophic happened, and we don't know what it was."